Seger W, Sittaro N-A, Lohse R, Rabba J
Medizinischer Dienst der Krankenversicherung Niedersachsen (MDKN), Hildesheimer Str. 202-206, 30519, Hannover, Deutschland,
Z Gerontol Geriatr. 2013 Dec;46(8):756-68. doi: 10.1007/s00391-013-0521-9.
Empirical data, representative of the total population, are necessary for medico-actuarial risk calculations. Our study compares mortalities of long-term care (LTC) patients who are covered by statutory health insurance with regard to age and distribution of care levels when in home or institutional care with a special focus on whether rehabilitative care was performed.
The data of 88,575 LTC patients were analyzed longitudinally for 10 years, using routine data analyses on the files of the German Federal Health Insurance fund (average observation period 2.5 years, a total of 221,625 observation years). The numbers of LTC patients and their care levels while in home or institutional care were calculated, as were any changes to another care level or discontinuation of LTC benefits (as a result of the need for care falling below the eligibility criteria for care leveI or to death) during 1-10 years after the onset of LTC, always with respect to whether rehabilitative care had taken place or not. For the evaluation of care factors an indicator was developed.
Total mortality was found to decline and reactivation to increase considerably for LTC patients after rehabilitation, basically irrespective of their age or care level and in home or institutional care settings as well. Ten years after the onset of care, 30.7 % of the patients with rehabilitation were still in nursing care, 9.8 % were reactivated and 59.5 % deceased. In contrast, only 9.2 % were still in nursing care, 3.7 % reactivated and 87.1 % deceased without rehabilitation. These results are irrespective of age distribution, care level, and residence in home or institutional care settings. The care status of patients, measured by the percentage in reactivation, care level I-III, and death, substantially depends on age at onset and care level and in addition on rehabilitative procedures. Hypotheses for further research are outlined.
Rehabilitation has a clear-cut potential for life extension as well as reducing or detaining long-term care if applied to (LTC) patients. The group of rehabilitated LTC patients has a comparatively higher degree of reducing or resolving LTC up to a complete reactivation or prolonging of life in spite of care needed. A successful rehabilitative effect occurs over all age groups and all care levels during home care considerably as well as during institutional care to a lower extent. Differentiation between the age at onset of LTC, care level, and first year and follow-up mortalities is recommended as well as between rehabilitated and nonrehabilitated care patients when undertaking medico-actuarial calculations.
医学精算风险计算需要能代表总人口的经验数据。我们的研究比较了法定健康保险覆盖的长期护理（LTC）患者在居家或机构护理时的死亡率，涉及年龄和护理级别分布，特别关注是否进行了康复护理。
对88575名LTC患者的数据进行了为期10年的纵向分析，采用德国联邦健康保险基金档案中的常规数据分析（平均观察期2.5年，总计221625个观察年）。计算了LTC患者在居家或机构护理时的数量及其护理级别，以及LTC开始后1至10年内护理级别是否有变化或LTC福利是否终止（由于护理需求低于护理级别资格标准或死亡），始终考虑是否进行了康复护理。为评估护理因素制定了一个指标。
发现康复后的LTC患者总死亡率下降，重新激活率显著增加，基本不受其年龄、护理级别以及居家或机构护理环境的影响。护理开始10年后，接受康复治疗的患者中有30.7%仍在接受护理，9.8%被重新激活，59.5%死亡。相比之下，未接受康复治疗的患者中只有9.2%仍在接受护理，3.7%被重新激活，87.1%死亡。这些结果与年龄分布、护理级别以及居家或机构护理环境无关。通过重新激活率、护理级别I - III和死亡率的百分比来衡量的患者护理状况，很大程度上取决于开始护理时的年龄和护理级别，此外还取决于康复程序。概述了进一步研究的假设。
康复对于长期护理（LTC）患者具有明显的延长生命以及减少或延缓长期护理的潜力。接受康复治疗的LTC患者群体在减少或解决长期护理方面具有相对较高的程度，直至完全重新激活或尽管需要护理但延长生命。成功的康复效果在所有年龄组和居家护理期间的所有护理级别中都有显著体现，在机构护理期间程度较低。在进行医学精算计算时，建议区分LTC开始时的年龄、护理级别以及第一年和后续死亡率，以及接受康复治疗和未接受康复治疗的护理患者。
