Cohort Study on Predictors of Need for Nursing Care in Alzheimer's Disease: An Analysis of Healthcare Data.
The individual and societal burden of Alzheimer's disease (AD) is substantial. Identifying relevant factors deteriorating AD and inducing need for nursing care would be of high relevance for healthcare planning.



The main objective of this study was the identification of predictors of first assignment of a level of long-term care in AD, used as an approximation for disease progression.



In a retrospective cohort study using data from a large German statutory health and long-term care insurance (SHI) company, co-morbidities and drug exposure were evaluated with respect to their predictive value for disease progression (first day the amount of daily nursing care exceeded 1.5 hours). Time to disease progression was modeled using COX-proportional hazard regression with stepwise selection of predictor variables.



The risk of nursing care need increased substantially with increasing age. Number of hospitalizations and number of different drugs used were significant indicators for progression, whereas outpatient visits were associated with a reduced need for care. Gender did not indicate significant influence on progression. Malignant neoplasms of ill-defined, secondary, and unspecified sites, malnutrition, renal failure, and injuries increased the risk of need for nursing care most significantly. Among prescribed drugs, significant increased risks were associated with drugs used in diabetes, preparations for treatment of wounds and ulcers, antiseptics and disinfectants, and analgesics.



Physical comorbidities are relevant contributors to an increase in need for nursing care. Some medical predicting conditions may be linked to cognition, while others may be directly linked to demand for care. AD patients with these comorbidities should be monitored with special attention, as they may be under an increased risk of care dependency.
Institute for Social Medicine, Epidemiology and Health Economics at Charité University Medical Center, Berlin, Germany.|Boston Healthcare Associates International GmbH, Berlin, Germany.
Bernd
B
Brüggenjürgen
Institute for Social Medicine, Epidemiology and Health Economics at Charité University Medical Center, Berlin, Germany.|Frank Andersohn Consulting & Research Services, Berlin, Germany.
Frank
F
Andersohn
Boston Healthcare Associates International GmbH, Berlin, Germany.
Jörg
J
Burkowitz
Boston Healthcare Associates International GmbH, Berlin, Germany.
Nadja
N
Ezzat
Janssen Alzheimer Immunotherapy, Dublin, Ireland.
Maren
M
Gaudig
Institute for Social Medicine, Epidemiology and Health Economics at Charité University Medical Center, Berlin, Germany.
Stefan N
SN
Willich
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009732:Nursing Care / Q000379:methods / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012189:Retrospective Studies
Alzheimer’s disease; comorbidities; deterioration; predictors; retrospective cohort study