Health Care-Related Determinants of First-Time Long-Term Care Need in Older Adults in Germany: Retrospective Cohort...

In recent years, German long-term care (LTC) insurance has experienced an unprecedented increase in the number of beneficiaries. This raises the question of the role of health care in preventing or delaying the need for LTC. At present, related findings are limited. Addressing this research gap could promote longevity and improve quality of life while reducing the financial strain on the social security system.

This study aimed to investigate the associations between the utilization of health care services and first-time LTC need.

This retrospective cohort study examined nationwide linked claims data from the German statutory health and LTC insurance fund, AOK. The dataset included all individuals aged ≥60 years. Using multiple logistic regression, we investigated the association between health care utilization during the 5-year exposure period from 2016 to 2020 and the occurrence of first-time LTC need during the first quarter of 2021. Physician care, pharmaceutical care, physiotherapy, and medical aids were analyzed while adjusting for age, sex, regional variables, and comorbidities. Metrically scaled variables were categorized using the Fisher-Jenks algorithm to explore possible nonlinearities. Individuals who needed LTC prior to 2021 were excluded.

The study population comprised 5.3 million individuals. A total of 54.3% (n=2.9 million) were women, and the mean age was 71.3 (SD 8.16) years. Receiving more than 2 of the 5 recommended screenings and vaccinations examined, compared with receiving none, was associated with a strong reduction in the odds of first-time LTC need (odds ratio [OR] 0.62, 95% CI 0.60-0.64; P<.001). Odds of first-time LTC need were also significantly lower with high numbers of specialist groups and low numbers of specialist days (more than 7 specialist groups consulted and fewer than 48 billing days) compared with no specialist utilization (any specialist utilization: OR 0.82, 95% CI 0.79-0.85; P<.001; more than 7 instead of fewer than 5 specialist groups: OR 0.94, 95% CI 0.92-0.96; P<.001). Likewise, a physiotherapy prescription in between 5 and 10 quarters of the 5-year period instead of none was related to lower odds of first-time LTC need (OR 0.81, 95% CI 0.79-0.83; P<.001). Generalist care, hospitalizations, polypharmacy, and potentially inadequate medication were concomitant with first-time LTC need. Among the disease management programs and medical aids examined, there were both positive and negative relationships with first-time LTC need.

Utilization of recommended screenings, vaccinations, specialist physician care, and physiotherapy is substantially and significantly associated with the nonoccurrence of first-time LTC need in the older German population. Our study provides a foundation for future research on orienting health care toward preventing functional decline.