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  • MEDICAL-CARE  (1)
  • MEDICALLY ILL  (1)
  • 1
    Keywords: RISK ; RELIABILITY ; PREVALENCE ; depression ; OLDER-ADULTS ; MULTIMORBIDITY ; Generalized anxiety disorder ; RANDOMIZED-CONTROLLED-TRIAL ; INTEGRATED CARE ; MEDICALLY ILL
    Abstract: Objective: To improve health care for the elderly, a consideration of biopsychosocial health care needs may be of particular importance-especially because of the prevalence of multiple conditions, mental disorders, and social challenges facing elderly people. The aim of the study was to investigate significance and costs of biopsychosocial health care needs in elderly people. Methods: Data were derived from the 8-year follow-up of the ESTHER study-a German epidemiological study in the elderly population. A total of 3124 participants aged 57 to 84 years were visited at home by trained medical doctors. Biopsychosocial health care needs were assessed using the INTERMED for the Elderly (IM-E) interview. Health-related quality of life (HRQOL) was measured by the 12-Item Short-Form Health Survey, and psychosomatic burden was measured by the Patient Health Questionnaire. Results: The IM-E correlated with decreased mental (mental component score: r = -0.38, p 〈 .0001) and physical HRQOL (physical component score: r = -0.45, p 〈 .0001), increased depression severity (r = 0.53, p 〈 .0001), and costs (R = 0.41, p 〈 .0001). The proportion of the participants who had an IM-E score of at least 21 was 8.2%; according to previous studies, they were classified as complex patients (having complex biopsychosocial health care needs). Complex patients showed a highly reduced HRQOL compared with participants without complex health care needs (mental component score: 37.0 [10.8] versus 48.7 [8.8]; physical component score: 33.0 [9.1] versus 41.6 [9.5]). Mean health care costs per 3 months of complex patients were strongly increased (1651.1 (sic) [3192.2] versus 764.5 (sic) [1868.4]). Conclusions: Complex biopsychosocial health care needs are strongly associated with adverse health outcomes in elderly people. It should be evaluated if interdisciplinary treatment plans would improve the health outcomes for complex patients.
    Type of Publication: Journal article published
    PubMed ID: 25121639
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  • 2
    Keywords: POPULATION ; COMORBIDITY ; ACCESS ; MENTAL-HEALTH ; MULTIPLE CHRONIC CONDITIONS ; FULLY CONDITIONAL SPECIFICATION ; ILLNESS RATING-SCALE ; SOCIAL-FACTORS ; MEDICAL-CARE ; MULTIMORBIDITY
    Abstract: Background: To analyze the association of health care costs with predisposing, enabling, and need factors, as defined by Andersen's behavioral model of health care utilization, in the German elderly population. Methods: Using a cross-sectional design, cost data of 3,124 participants aged 57-84 years in the 8 year follow up of the ESTHER cohort study were analyzed. Health care utilization in a 3-month period was assessed retrospectively through an interview conducted by trained study physicians at respondents' homes. Unit costs were applied to calculate health care costs from the societal perspective. Socio-demographic and health-related variables were categorized as predisposing, enabling, or need factors as defined by the Andersen model. Multimorbidity was measured by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Mental health status was measured by the SF-12 mental component summary (MCS) score. Sector-specific costs were analyzed by means of multiple Tobit regression models. Results: Mean total costs per respondent were 889 [sic] for the 3-month period. The CIRS-G score and the SF-12 MCS score representing the need factor in the Andersen model were consistently associated with total, inpatient, outpatient and nursing costs. Among the predisposing factors, age was positively associated with outpatient costs, nursing costs, and total costs, and the BMI was associated with outpatient costs. Conclusions: Multimorbidity and mental health status, both reflecting the need factor in the Andersen model, were the dominant predictors of health care costs. Predisposing and enabling factors had comparatively little impact on health care costs, possibly due to the characteristics of the German social health insurance system. Overall, the variables used in the Andersen model explained only little of the total variance in health care costs.
    Type of Publication: Journal article published
    PubMed ID: 24524754
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