title: Multimorbidity and long-term care dependency--a five-year follow-up.
abstract: BACKGROUND
  Not only single, but also multiple, chronic conditions are becoming the normal situation rather than the exception in the older generation. While many studies show a correlation between multimorbidity and various health outcomes, the long-term effect on care dependency remains unclear. The objective of this study is to follow up a cohort of older adults for 5 years to estimate the impact of multimorbidity on long-term care dependency.
  
  
  METHODS
  This study is based on claims data from a German health insurance company. We included 115,203 people (mean age: 71.5 years, 41.4% females). To identify chronic diseases and multimorbidity, we used a defined list of 46 chronic conditions based on ICD-10 codes. Multimorbidity was defined as three or more chronic conditions from this list. The main outcome was "time until long-term care dependency". The follow-up started on January 1st, 2005 and lasted for 5 years until December 31st, 2009. To evaluate differences between those with multimorbidity and those without, we calculated Kaplan-Meier curves and then modeled four distinct Cox proportional hazard regressions including multimorbidity, age and sex, the single chronic conditions, and disease clusters.
  
  
  RESULTS
  Mean follow-up was 4.5 years. People with multimorbidity had a higher risk of becoming care dependent (HR: 1.85, CI 1.78-1.92). The conditions with the highest risks for long-term care dependency are Parkinson's disease (HR: 6.40 vs. 2.68) and dementia (HR: 5.70 vs. 2.27). Patients with the multimorbidity pattern "Neuropsychiatric disorders" have a 79% higher risk of care dependency.
  
  
  CONCLUSIONS
  The results should form the basis for future health policy decisions on the treatment of patients with multiple chronic diseases and also show the need to introduce new ways of providing long-term care to this population. A health policy focus on chronic care management as well as the development of guidelines for multimorbidity is crucial to secure health services delivery for the older population.
authors.affiliation: Centre for Social Policy Research, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany. dkoller@zes.uni-bremen.de.
authors.forename: Daniela
authors.initials: D
authors.lastname: Koller
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schön
authors.forename: Ingmar
authors.initials: I
authors.lastname: Schäfer
authors.forename: Gerd
authors.initials: G
authors.lastname: Glaeske
authors.forename: Hendrik
authors.initials: H
authors.lastname: van den Bussche
authors.forename: Heike
authors.initials: H
authors.lastname: Hansen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D038801:International Classification of Diseases / Q000191:economics / Q000639:trends*; D008134:Long-Term Care / Q000191:economics / Q000379:methods / Q000639:trends; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D010300:Parkinson Disease / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D005791:Patient Care / Q000191:economics / Q000379:methods / Q000639:trends*