Healthcare

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Abstract

Background

Rising life expectancy in western societies is accompanied by a rising incidence of dependence on assistance and care among elderly people. The purpose of this study was 1) to examine the effect of social determinants on care dependency onset and progression, and 2) to analyse the effect of social determinants on various levels of care dependency.

Methods

We used data from the Berlin Initiative Study (BIS), a prospective, longitudinal, population-based cohort study including 2069 older participants (≥70 years of age) with visits in 2009, 2011 and 2013. Care dependency was assessed if participants require substantial assistance in at least two activities of daily living for 90 minutes daily (level 1) or three hours+ daily (level 2). Multi-state time to event regression modeling which simultaneously model several competing events were used to estimate the effects of social determinants (partnership status, education, income and gender) and morbidity (stroke, myocardial infarction, cancer, diabetes, kidney disease).

Results

During the study period, 556 participants (27.5%) changed their status of care dependency. Having no partner compared to having a partner was associated with a higher risk of transition from no care dependency to level 1 (HR: 1.25, 95% CI: 0.97-1.64). Both women and men without a partner had a higher risk for onset of care dependency. However, in our multistate models, these effects were not significant. The significant association between care dependency and income and between care dependency and education ceased in the multistate models.

Conclusions

Results indicate that older people without a partner tend to be on a higher risk of care dependency onset but not on a higher risk of care dependency progression. Inequality between education and income groups can be explained in terms of morbidity. Further research should focus on partnership status to get more knowledge about their possible role regarding the delay or prevention of care dependency.