scholarly journals Costs for Statutorily Insured Dental Services in Older Germans 2012–2017

2021 ◽  
Vol 18 (12) ◽  
pp. 6669
Author(s):  
Aleksander Krasowski ◽  
Joachim Krois ◽  
Sebastian Paris ◽  
Adelheid Kuhlmey ◽  
Hendrik Meyer-Lueckel ◽  
...  
Keyword(s):  
General Health ◽  
Preventive Services ◽  
The Elderly ◽  
Disease Classification ◽  
Health Conditions ◽  
Dental Services ◽  
Policy Makers ◽  
Very Old ◽  
Outreach Services ◽  
Icd 10

Objectives: We assessed the costs of dental services in statutorily insured, very old (geriatric) Germans. Methods: A comprehensive sample of very old (≥75 years) people insured at a large Northeastern statutory insurer was followed over 6 years (2012–2017). We assessed dental services costs for: (1) examination, assessments and advice, (2) operative, (3) surgical, (4) prosthetic, (5) periodontal, (6) preventive and (7) outreach services. Association of utilization with: (1) sex, (2) age, (3) region, (4) social hardship status, (5) International Disease Classification (ICD-10) diagnoses and (6) Diagnoses Related Groups (DRGs) was explored. Results: 404,610 individuals with a mean (standard deviation, SD) age 81.9 (5.4 years) were followed, 173,733 did not survive follow-up. Total mean costs were 129.61 (310.97) euro per capita; the highest costs were for prosthetic (54.40, SD 242.89 euro) and operative services (28.40, SD 68.38 euro), examination/advice (21.15, SD 28.77 euro), prevention (13.31, SD 49.79 euro), surgery (5.91, SD 23.91 euro), outreach (4.81, SD 28.56 euro) and periodontal services (1.64, SD 7.39 euro). The introduction of new fee items for outreach and preventive services between 2012 and 2017 was reflected in costs. Total costs decreased with increasing age, and this was also found for all service blocks except outreach and preventive services. Costs were higher in those with social hardship status, and in Berlin than Brandenburg and Mecklenburg-Western Pomerania. Certain general health conditions were associated with increased or decreased costs. Conclusions: Costs were associated with sex, social hardship status, place of living and general health conditions. Clinical significance: Dental services costs for the elderly in Germany are unequally distributed and, up to a certain age or health status, generated by invasive interventions mainly. Policy makers should incentivize preventive services earlier on and aim to distribute expenses more equally.

scholarly journals Dental service utilization in the very old: an insurance database analysis from northeast Germany

2020 ◽  
Author(s):  
Falk Schwendicke ◽  
Aleksander Krasowski ◽  
Jesus Gomez Rossi ◽  
Sebastian Paris ◽  
Adelheid Kuhlmey ◽  
...  
Keyword(s):  
Service Utilization ◽  
Care Service ◽  
Dental Service ◽  
Federal State ◽  
Dental Services ◽  
Long Term Conditions ◽  
Very Old ◽  
Federal States ◽  
Icd 10 ◽  
Utilization Of Dental Services

Abstract Objectives We assessed dental service utilization in very old Germans. Methods A comprehensive sample of 404,610 very old (≥ 75 years), insured at a large statutory insurer (Allgemeine Ortskrankenkasse Nordost, active in the federal states Berlin, Brandenburg, Mecklenburg-Western Pomerania), was followed over 6 years (2012–2017). Our outcome was the utilization of dental services, in total (any utilization) and in five subgroups: (1) examinations and associated assessment or advice, (2) restorations, (3) surgery, (4) prevention, (5) outreach care. Association of utilization with (1) sex, (2) age, (3) region, (4) social hardship status, (5) ICD-10 diagnoses, and (6) German modified diagnosis-related groups (GM-DRGs) was explored. Results The mean (SD) age of the sample was 81.9 (5.4) years. The utilization of any dental service was 73%; utilization was highest for examinations (68%), followed by prevention (44%), surgery (33%), restorations (32%), and outreach care (13%). Utilization decreased with age for nearly all services except outreach care. Service utilization was significantly higher in Berlin and most cities compared with rural municipalities, and in individuals with common, less severe, and short-term conditions compared with life-threatening and long-term conditions. In multi-variable analysis, social hardship status (OR: 1.14; 95% CI: 1.12-1.16), federal state (Brandenburg 0.85; 0.84–0.87; Mecklenburg-Western Pomerania: 0.80; 0.78–0.82), and age significantly affected utilization (0.95; 0.95–0.95/year), together with a range of co-morbidities according to ICD-10 and DRG. Conclusions Social, demographic, regional, and general health aspects were associated with the utilization of dental services in very old Germans. Policies to maintain access to services up to high age are needed. Clinical significance The utilization of dental services in the very old in northeast Germany showed significant disparities within populations. Policies to allow service utilization for sick, economically disadvantaged, rural and very old populations are required. These may include incentives for outreach servicing, treatment-fee increases for specific populations, or referral schemes between general medical practitioners and dentists.

scholarly journals Fortified Nudges? Protecting the Vulnerable in a Post-COVID Society

2021 ◽  
pp. 169-173
Author(s):  
Robin Pierce
Keyword(s):  
Social Norms ◽  
The Elderly ◽  
Health Conditions ◽  
Policy Makers ◽  
Slow Evolution ◽  
Voluntary Cooperation ◽  
The Way

AbstractThe eagerly awaited transition back into a functioning and vibrant society presents numerous challenges, not the least of which is how to protect the vulnerable. As society emerges from the “crisis” phase and the lockdown is lifted, it remains unclear to what extent it should be left to the vulnerable to protect themselves.The elderly, the infirm, and those with existing health conditions are particularly susceptible to tragic outcomes from the coronavirus. To be vulnerable to a severe impact of COVID-19 turns the disease into a pervasively lurking death threat. Yet, to suggest that the vulnerable spend their lives in retreat in order to significantly minimize the risk is problematic in multiple ways. As policy-makers craft the way forward, the question must be asked whether an appeal to the goodwill and voluntary cooperation of people, along with the slow evolution of social norms, is an adequate approach to protecting the vulnerable.

scholarly journals Mortality caused by accidental falls among the elderly: a time series analysis

2015 ◽  
Vol 18 (4) ◽  
pp. 769-778 ◽  
Author(s):  
Danielle Ledur Antes ◽  
Ione Jayce Ceola Schneider ◽  
Eleonora d'Orsi
Keyword(s):  
Time Series ◽  
Accidental Falls ◽  
Elderly Population ◽  
The Elderly ◽  
Disease Classification ◽  
Joinpoint Regression ◽  
Time Series Study ◽  
Icd 10 ◽  
The City ◽  
Series Study

Introduction : The worldwide increase in the elderly population has highlighted the importance of accidental falls and their consequences.Objective: To perform time-trend analysis of the mortality rate from accidental falls in (1) the city of Florianópolis (2) the state of Santa Catarina and (3) Brazil. Method : A time-series study of data from the Sistema de Informação sobre Mortalidade ("the Mortality Information System") was performed. The variation in mortality caused by accidental falls was estimated using the joinpoint regression method, based on the International Disease Classification (ICD-10), chapter XX, codes W00 to W15 and W17 to W19, from 1997 to 2010. Results : It was observed that in the most recent periods (2005/2008; 2002/2008; 2003/2008), there was a significant increase in mortality rates related to accidental falls in all three regions, and that these rates increased with advancing age. Conclusion : Strategies to prevent accidental falls among the elderly should be aimed, mainly, at those who are 80 and over, the age in which accidental falls result in higher death rates.

scholarly journals Dental Expenditure by Household Income in Korea over the Period 2008–2017: A Review of the National Dental Insurance Reform

2021 ◽  
Vol 18 (8) ◽  
pp. 3859
Author(s):  
Hosung Shin ◽  
Han-A Cho ◽  
Bo-Ra Kim
Keyword(s):  
Health Insurance ◽  
Concentration Index ◽  
Dental Health ◽  
Age Groups ◽  
The Elderly ◽  
Dental Service ◽  
Delta Method ◽  
Dental Services ◽  
Insurance Reform ◽  
Health Insurance Reform

Since 2009, the National Health Insurance in Korea (NHI) has been implementing a series of policies to expand the scope of dental benefits. This study reviewed the changes in co-payments and dental use patterns before (2008 to 2012) and after (2013 to 2017) the NHI’s dental health insurance reform. The study used Korea Health Panel data of 7681 households (16,493 household members) from a 10-year period (2008–2017). Dental expenditures and equivalent income using square root of household size were analyzed. Dental services were categorized into 13 types and a concentration index and 95% confidence interval using the delta method was calculated to identify income-related inequalities by a dental service. Dental expenditures and the number of dental services used increased significantly, while the proportion of out-of-pocket spending by the elderly decreased. The expenditure ratio for implant services to total dental expenditures increased substantially in all age groups, but the ratio of expenditures for dentures and fixed bridges decreased relatively. The concentration index of implant services was basically in favor of the rich, but there was no longer a significant bias favoring the better-off after the reforms. The dental health insurance reform in Korea appears to contribute not only to lowering the ratio of out-of-pocket to total dental expenses per episode in the elderly but also to improving the inequality of dental expenses.

scholarly journals Combined instruments for the screening of dementia in older people with low Education

2009 ◽  
Vol 67 (2a) ◽  
pp. 185-190 ◽  
Author(s):  
Cássio M.C. Bottino ◽  
Sonia E. Zevallos-Bustamante ◽  
Marcos A. Lopes ◽  
Dionisio Azevedo ◽  
Sérgio R. Hototian ◽  
...  
Keyword(s):  
Older People ◽  
The Elderly ◽  
Cognitive Tests ◽  
Weighted Sum ◽  
Dementia Screening ◽  
Moderate Dementia ◽  
Icd 10 ◽  
Roc Area ◽  
Low Educated ◽  
State Examination

OBJECTIVE: To determine which combination of cognitive tests and informant reports can improve the diagnostic accuracy of dementia screening in low educated older people. METHOD: Patients with mild to moderate dementia (n=34) according to ICD-10 and DSM-III-R criteria and 59 older controls were assessed with the Mini-Mental State Examination (MMSE) and the Fuld Object Memory Evaluation (FOME). Informants were assessed using the Informant Questionnaire on Cognitive Decline in the Elderly and the Bayer-Activities of Daily Living Scale. RESULTS: The 4 instruments combined with the mixed rule correctly classified 100% and the logistic regression (weighted sum) classified 95.7% of subjects. The weighted sum had a significantly larger ROC area compared to MMSE (p=0.008) and FOME (p=0.023). The specificity of the tested combinations was superior to the MMSE alone (p=0.002). CONCLUSIONS: Cognitive tests combined with informant reports can improve the screening of mild to moderate dementia in low educated older people.

Socio economic and psychological dimensions of migration-induced exclusion of the elderly in Kerala, India: an empirical analysis

2016 ◽  
Vol 12 (1) ◽  
pp. 51-65
Author(s):  
Damodaran Rajasenan ◽  
M. S. Jayakumar ◽  
Bijith George Abraham
Keyword(s):  
The Elderly ◽  
Policy Framework ◽  
Policy Makers ◽  
Content Type ◽  
Left Behind ◽  
Emerging Culture ◽  
Principal Factors ◽  
Working Groups ◽  
The Government ◽  
Role Of The Government

Purpose – The purpose of this paper is to link the multifarious problems of the elderly in a socio-economic and psychological framework. Design/methodology/approach – The universe of the sample is elderly left behind in emigrant households in Kerala. In total, 600 samples were mustered using multistage stratified random sampling method. The paper, with the aid of factor analysis, χ2 and correspondence analysis, blemish the principal factors responsible for the migration-induced exclusion of the elderly. Findings – The empirical result derived from the study shows that migration-induced exclusion is all pervasive in Kerala. The elderly left behind yearn for the presence of their children rather than the emigration and concomitant remittances. Research limitations/implications – The findings of the study are helpful to the policy makers to understand the issues faced by the elderly and include all stakeholders concerned to find a solution to tackle these problems faced by the elderly due to emigration of their children. Practical implications – The study is practically relevant in developing appropriate policy framework in Kerala as it illumines the role of the government to overcome the exclusionary trend and other manifold problems of the elderly. Social implications – The study sheds light to a new social problem developing in the state in the form of elderly exclusion owing to emigration of the young working groups in regional dimensions, demographic levels, community angles and the emerging culture of old age home in the Kerala economy and society. Originality/value – The study is a unique one and tries to situate the principal factors responsible for the emigration-induced exclusion of the elderly in Kerala with empirical evidence.

The prevalence of pre-existing mental health, drug and alcohol conditions in major trauma patients

2017 ◽  
Vol 41 (3) ◽  
pp. 283 ◽  
Author(s):  
Tu Q. Nguyen ◽  
Pamela M. Simpson ◽  
Belinda J. Gabbe
Keyword(s):  
Mental Health ◽  
Medical Record ◽  
Major Trauma ◽  
Health Conditions ◽  
Trauma Patients ◽  
Discharge Data ◽  
Mental Health Conditions ◽  
Icd 10 ◽  
Record Review ◽  
Drug And Alcohol

Objective Capturing information about mental health, drug and alcohol conditions in injury datasets is important for improving understanding of injury risk and outcome. This study describes the prevalence of pre-existing mental health, drug and alcohol conditions in major trauma patients based on routine discharge data coding. Methods Data were extracted from the population-based Victorian State Trauma Registry (July 2005 to June 2013, n = 16 096). Results Seventeen percent of major trauma patients had at least one mental health condition compared with the Australian population prevalence of 21%. The prevalence of mental health conditions was similar to the Australian population prevalence in men (19% v. 18%), but lower in women (14% v. 25%) and across all age groups. Mental health conditions were more prevalent in intentional self-harm cases (56.3%) compared with unintentional (13.8%) or other intentional (31.2%) cases. Substance use disorders were more prevalent in major trauma patients than the general population (15% v. 5%), higher in men than women (17% v. 10%) and was highest in young people aged 25–34 years (24%). Conclusions Under-reporting of mental health conditions in hospital discharge data appears likely, reducing the capacity to characterise the injury population. Further validation is needed. What is known about the topic? Medical record review, routine hospital discharge data and self-report have been used by studies previously to characterise mental health, drug and alcohol conditions in injured populations, with medical record review considered the most accurate and reliance on self-report measures being considered at risk of recall bias. The use of routinely collected data sources provides an efficient and standardised method of characterising pre-existing conditions, but may underestimate the true prevalence of conditions. What does this paper add? No study to date has explored the prevalence of Abbreviated Injury Scale and International Classification of Diseases and Health Related Problems, Tenth Revision, Australian Modification (ICD-10-a.m)-coded mental health, alcohol and drug conditions in seriously injured populations. The results of this study show the incidence of mental health conditions appeared to be under-reported in major trauma patients, suggesting limitations in the use of ICD-10-a.m. to measure mental health comorbidities. What are the implications for practitioners? In order to achieve improvements in measuring mental health, drug and alcohol comorbidities, we suggest the use of a series of different diagnostic systems to be used in conjunction with ICD-10-a.m., such as medical record review and self-reporting as well as linkage to other datasets. When applied simultaneously, diagnosis and outcomes of mental health may be compared and validated across diagnostic systems and deviations in diagnoses could be more readily accounted for.

The course of depression in the elderly: a longitudinal community-based study in Australia

1997 ◽  
Vol 27 (1) ◽  
pp. 119-129 ◽  
Author(s):  
A. S. HENDERSON ◽  
A. E. KORTEN ◽  
P. A. JACOMB ◽  
A. J. MACKINNON ◽  
A. F. JORM ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Cognitive Decline ◽  
Service Use ◽  
Community Sample ◽  
The Elderly ◽  
Activity Levels ◽  
Sample Attrition ◽  
Poor Social Support ◽  
Icd 10 ◽  
Depressive States

Background. We report the outcome of depressive states after 3-4 years in a community sample of the elderly.Methods. A sample of 1045 persons aged 70+ years in 1990–1 was re-interviewed after 3·6 years.Results. Mortality (21·7%) and refusal or non-availability (10·4%) were higher in those who initially had had a diagnosis or symptoms of depression. Of those with an ICD-10 depressive episode in 1990–1, 13% retained that diagnosis. Of those who were not depressed initially only 2·5% had become cases. Depression was unrelated to age or apolipoprotein E genotype. The best predictors of the number of depressive symptoms at follow-up was the number at Wave 1, followed by deterioration in health and in activities of daily living, high neuroticism, poor current health, poor social support, low current activity levels and high service use. Depressive symptoms at Wave 1 did not predict subsequent cognitive decline or dementia.Conclusions. Non-random sample attrition is unavoidable. ICD-10 criteria yield more cases than other systems, while continuous measures of symptoms confer analytical advantages. Risk factors for depressive states in the elderly have been further identified. The prognosis for these states is favourable. At the community level, depressive symptoms do not seem to predict cognitive decline, as they do in referred series.

Individual Use of Smartwatches with Self-Monitoring EKG Functionality for Diagnosing Arrhythmias: A Scoping Review (Preprint)

2021 ◽  
Author(s):  
Mohammed Ali
Keyword(s):  
Heart Rate ◽  
Cardiac Arrhythmias ◽  
Healthcare Systems ◽  
Wearable Devices ◽  
Health Conditions ◽  
Self Monitoring ◽  
Policy Makers ◽  
Wearable Systems ◽  
The World ◽  
Individual Use

BACKGROUND cardiovascular diseases (CVDs) have become prevalent in the world. They cause millions of deaths globally with the World Health Organization putting the figure at 17.9 million people every year. These statistics indicate the need for healthcare systems to leverage contemporary advanced technology to detect and diagnose CVDs and provide appropriate and timely care to reduce mortality rates. OBJECTIVE To conduct a scoping review exploring individual use of smartwatches with self-monitoring ECG functionality for diagnosing arrhythmias. METHODS Source were selected from six credible bibliographic databases: PubMed, Medline, EMBASE, PsycInfo, CINAHL, and Google Scholar. Intervention-related terms were used to identify relevant sources. Additionally, a forward search strategy was used to search the databases and identify appropriate peer-reviewed journals. RESULTS The research returned 230 sources, out of which 40 met the inclusion criterion. The studies revealed that increased research, development, and adoption of smartwatches and other wearable devices have intensified in the past two decades. The studies showed that using smartwatches can detect cardiac arrhythmias although this depends on the algorithms and biometric sensors utilized in the smartwatches. Watches with advanced algorithms, PPG, and EKG functionalities exhibit high accuracy, sensitivity, and specificity, detecting AFib and other arrhythmias with high efficacy. Therefore, the best way for technology companies to improve their watches’ accuracy is to design and use advanced algorithms and combine PPG, EKG, activity, and biochemical sensors. Conclusion: The contemporary healthcare space is replete with wearable and non-wearable ¬systems and devices central to detecting health conditions and informing the relevant stakeholders to take corrective actions. Smartwatches are wearable devices used chiefly by patients, health, and fitness enthusiasts to detect and monitor a series of conditions, such as heart rate. Their use has fostered timely detection of cardiac arrhythmias, and therefore, caregivers and policy-makers should emphasize their use. CONCLUSIONS Technological systems have proliferated many human spaces in the last three decades, including education, healthcare, and entertainment. Their use has improved operational efficiency, reduced costs, saved lives, and increased organizations’ bottom lines. Healthcare systems use technological devices and appliances to diagnose patients, perform surgeries, improve pharmacy operations, and reduce medical errors. That way, most healthcare facilities provide quality care, attaining positive clinical outcomes. The contemporary healthcare space is replete with wearable and non-wearable ¬systems and devices central to detecting health conditions and informing the relevant stakeholders – caregivers, patients, and family members – to take corrective actions. Smartwatches are wearable devices used chiefly by patients, health, and fitness enthusiasts to detect and monitor a series of conditions, such as heart rate. They are highly effective in detecting cardiac arrhythmias, and therefore, caregivers and policy-makers should emphasize their use.

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