Healthcare situation before long-term care - A cohort study of AOK-insured individuals aged 60 years and older in Germany.

Background: The number of people in Germany in need of long-term care has increased more sharply in recent years than previously projected. The question of what role healthcare utilization plays in the lead-up to potential long-term care dependency has rarely been addressed to date. The aim of the present study was to describe healthcare utilization over a five-year period preceding the onset of care dependency. Method: This cohort study analyzed routine data from AOK-insured individuals for the period 2016-2021. The data basis consisted of linked routine data from all AOK health and long-term care insurance funds. The sample included AOK insured persons aged 60 and over who received a care degree classification for the first time in 2021. Inpatient hospital stays, general practitioner services, and prescriptions for therapeutic appliances and assistive aids were analyzed for the 20 quarters prior to the onset of care dependency and stratified by age (<80 /≥80 years) and gender. Results: In 2021, 345,945 AOK-insured individuals (58.9% women, mean age 79.7 years) were newly classified with a care degree. In the last quarter before the onset of care dependency, the proportion of people with hospital stays increased significantly, especially for men aged 60-79. The use of general practitioner services remained consistently high - over 90% per quarter - for the cohort aged 80+, while a continuous but lower-level increase was observed among the younger male cohort. The utilization of assistive aids increased over the observation period (14-33%). Conclusions: The results suggest that there is prevention potential particularly among the cohort aged 60-79, which should be more intensively utilized. To this end, more detailed insights into diseases and events that lead to a spike in hospitalizations shortly before the onset of care dependency are needed. Furthermore, research is required into the protective effects of specific therapeutic and assistive aids, and whether they are currently being used appropriately. Finally, the findings point to possible access barriers in health care, which should ideally be explored through a linkage of routine and survey data.