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Correlates of hospitalization among the oldest old: results of the AgeCoDe–AgeQualiDe prospective cohort study

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Abstract

Background

Hospitalization is a key driver of health care costs. Thus far, there are only a few longitudinal studies investigating whether changes in explanatory variables lead to hospitalization. Moreover, these longitudinal studies did not focus on individuals in highest age.

Aim

The purpose of the current study was to examine the correlates of hospitalization among the oldest old in Germany longitudinally.

Methods

A multicenter prospective cohort study [“Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)”, AgeQualiDe]. Primary care patients ≥ 85 years took part [n = 861 at follow-up (FU) 7, average age of 89.0 years; 85–100 years]. Two waves were used. Hospitalization in the last 6 months was used as outcome measure. Well-established scales were used to quantify the independent variables such as Instrumental Activities of Daily Living Scale, Global Deterioration Scale or Geriatric Depression Scale.

Results

Logistic random effects regressions showed that the probability of hospitalization in the preceding 6 months significantly increased with increases in the social network, more depressive symptoms, functional decline, and increase in chronic conditions, whereas it was not significantly associated with age, sex, marital status, education, and cognitive impairment. Social networks moderate the relationship between functional decline and hospitalization.

Discussion

The results of the present longitudinal study emphasize the association of depressive symptoms, functional decline, more social networks, and chronic conditions with hospitalization among the oldest old.

Conclusions

Treatments with the aim to reduce or postpone these factors might also help to reduce hospitalization.

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Acknowledgements

Contributors: We want to thank, both, all participating patients and their general practitioners for their good collaboration. Members of the AgeCoDe and AgeQualiDe study group: Wolfgang Maier (principal investigator), Martin Scherer (principal investigator), Steffi G. Riedel-Heller (principal investigator), Heinz-Harald Abholz, Christian Brettschneider, Cadja Bachmann, Horst Bickel, Wolfgang Blank, Sandra Eifflaender-Gorfer, Marion Eisele, Annette Ernst, Angela Fuchs, André Hajek, Kathrin Heser, Frank Jessen, Hanna Kaduszkiewicz, Teresa Kaufeler, Mirjam Köhler, Hans-Helmut König, Alexander Koppara, Diana Lubisch, Tobias Luck, Dagmar Lühmann, Melanie Luppa, Tina Mallon, Manfred Mayer, Edelgard Mösch, Michael Pentzek, Jana Prokein, Alfredo Ramirez, Susanne Röhr, Anna Schumacher, Janine Stein, Susanne Steinmann, Franziska Tebarth, Hendrik van den Bussche (principal investigator 2002–2011), Carolin van der Leeden, Michael Wagner, Klaus Weckbecker, Dagmar Weeg, Jochen Werle, Siegfried Weyerer, Birgitt Wiese, Steffen Wolfsgruber, Thomas Zimmermann.

Funding

This publication is part of the German Research Network on Dementia (KND), the German Research Network on Degenerative Dementia (KNDD; German Study on Ageing, Cognition and Dementia in Primary Care Patients; AgeCoDe), and the Health Service Research Initiative (Study on needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85 + ; AgeQualiDe)) and was funded by the German Federal Ministry of Education and Research (Grants KND: 01GI0102, 01GI0420, 01GI0422, 01GI0423, 01GI0429, 01GI0431, 01GI0433, 01GI0434; Grants KNDD: 01GI0710, 01GI0711, 01GI0712, 01GI0713, 01GI0714, 01GI0715, 01GI0716; Grants Health Service Research Initiative: 01GY1322A, 01GY1322B, 01GY1322C, 01GY1322D, 01GY1322E, 01GY1322F, 01GY1322G). The publication was also supported by the study “Healthy Aging: Gender specific trajectories into latest life” (AgeDifferent.De) that was funded by the German Federal Ministry of Education and Research (Grants 01GL1714A, 01GL1714B, 01GL1714C, 01GL1714D).

Author information

Author notes

  1. Steffi G. Riedel-Heller and Hans-Helmut König are equal contributors.

Authors and Affiliations

  1. Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center, Hamburg-Eppendorf, Germany

    André Hajek, Christian Brettschneider & Hans-Helmut König

  2. Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Germany

    Marion Eisele & Martin Scherer

  3. Medical Faculty, Institute of General Practice, Kiel University, Kiel, Germany

    Hanna Kaduszkiewicz

  4. Institute of General Practice, Hannover Medical School, Hannover, Germany

    Silke Mamone & Birgitt Wiese

  5. Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany

    Siegfried Weyerer & Jochen Werle

  6. Medical Faculty, Institute of General Practice, Heinrich-Heine-University, Düsseldorf, Germany

    Angela Fuchs & Michael Pentzek

  7. Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany

    Janine Stein, Tobias Luck & Steffi G. Riedel-Heller

  8. Department of Economic and Social Sciences, University of Applied Sciences Nordhausen, Nordhausen, Germany

    Tobias Luck

  9. Department of Psychiatry, Technical University of Munich, Munich, Germany

    Dagmar Weeg & Edelgard Mösch

  10. Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany

    Kathrin Heser, Michael Wagner & Wolfgang Maier

  11. DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany

    Michael Wagner & Wolfgang Maier

Authors
  1. André Hajek
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  2. Christian Brettschneider
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  8. Jochen Werle
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  11. Janine Stein
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  12. Tobias Luck
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  16. Michael Wagner
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Consortia

for the AgeCoDe and AgeQualiDe Study Group

  • Wolfgang Maier
  • , Martin Scherer
  • , Steffi G. Riedel-Heller
  • , Heinz-Harald Abholz
  • , Christian Brettschneider
  • , Cadja Bachmann
  • , Horst Bickel
  • , Wolfgang Blank
  • , Sandra Eifflaender-Gorfer
  • , Marion Eisele
  • , Annette Ernst
  • , Angela Fuchs
  • , André Hajek
  • , Kathrin Heser
  • , Frank Jessen
  • , Hanna Kaduszkiewicz
  • , Teresa Kaufeler
  • , Mirjam Köhler
  • , Hans-Helmut König
  • , Alexander Koppara
  • , Diana Lubisch
  • , Tobias Luck
  • , Dagmar Lühmann
  • , Melanie Luppa
  • , Tina Mallon
  • , Manfred Mayer
  • , Edelgard Mösch
  • , Michael Pentzek
  • , Jana Prokein
  • , Alfredo Ramirez
  • , Susanne Röhr
  • , Anna Schumacher
  • , Janine Stein
  • , Susanne Steinmann
  • , Franziska Tebarth
  • , Hendrik van den Bussche
  • , Carolin van der Leeden
  • , Michael Wagner
  • , Klaus Weckbecker
  • , Dagmar Weeg
  • , Jochen Werle
  • , Siegfried Weyerer
  • , Birgitt Wiese
  • , Steffen Wolfsgruber
  •  & Thomas Zimmermann

Contributions

Study concept and design: AH, CB, ME, HK, SM, BW, SW, JW, AF, MP, JS, TL, DW, EM, KH, MW, MS, WM, SRH, HHK.Acquisition of data: JW, AF, MP, DW. Analysis and interpretation of data: AH, HHK, SRH. Preparation of manuscript: AH, HHK, SRH. All authors critically revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to André Hajek.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of all research centers involved (approval numbers: Hamburg: OB/08/02, 2817/2007, MC-390/13; Bonn: 050/02; 174/02, 258/07, 369/13; Mannheim: 0226.4/2002, 2007-253E-MA, 2013-662 N-MA; Leipzig: 143/2002, 309/2007, 333-1318112013; Düsseldorf: 2079/2002, 2999/2008, 2999; München: 713/02, 713/02 E) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent/statement of human rights

Informed consent was obtained from all individual participants included in the study.

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The members of the AgeCoDe and AgeQualiDe Study Group mentioned in “Acknowledgements” section.

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Hajek, A., Brettschneider, C., Eisele, M. et al. Correlates of hospitalization among the oldest old: results of the AgeCoDe–AgeQualiDe prospective cohort study. Aging Clin Exp Res 32, 1295–1301 (2020). https://doi.org/10.1007/s40520-019-01315-2

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  • DOI: https://doi.org/10.1007/s40520-019-01315-2

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