title: Significance and costs of complex biopsychosocial health care needs in elderly people: results of a population-based study.
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 &OV0556; [3192.2] versus 764.5 &OV0556; [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.
authors.affiliation: From the Department of General Internal Medicine and Psychosomatics (B.W., I.M., D.N., W.H.), Medical University Hospital, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research (K.-U.S., H.B.), German Cancer Research Center, Heidelberg, Germany; Departments of Internal Medicine and Geriatrics (J.S.), University Hospital, Groningen, the Netherlands; Department of Psychosomatics and Psychotherapy (W.S.), General Hospital, Nürnberg, Germany; and Department of Health Economics and Health Services Research (D.H., H.-H.K.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Beate
authors.initials: B
authors.lastname: Wild
authors.forename: Dirk
authors.initials: D
authors.lastname: Heider
authors.forename: Imad
authors.initials: I
authors.lastname: Maatouk
authors.forename: Joris
authors.initials: J
authors.lastname: Slaets
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
authors.forename: Dorothea
authors.initials: D
authors.lastname: Niehoff
authors.forename: Kai-Uwe
authors.initials: KU
authors.lastname: Saum
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Söllner
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herzog
mesh_terms: D000368:Aged / Q000706:statistics & numerical data*; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000191:economics / Q000453:epidemiology; D017281:Cost of Illness; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs; D006301:Health Services Needs and Demand / Q000191:economics*; D006304:Health Status; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000453:epidemiology; D008875:Middle Aged; D011584:Psychology; D011788:Quality of Life; D011795:Surveys and Questionnaires