P3‐362: Dementia and Long‐term Care: An Analysis Based on German Health Insurance Data

The aim of this study is to investigate the pathway of incident dementia subjects to long-term care (LTC) defined as receiving benefits or services from the German statutory long-term care insurance scheme, and to determine whether these transitions differ depending on the type of the mainly treating physician. We hypothesize a reduced risk of LTC if patients are mainly treated by a neurologist/psychiatrist (NP) compared to patients mainly treated by other types of physicians (non-NP). Further, we assume that patients receiving any antidementia drug will have a delayed transition to LTC compared to patients undergoing no antidementia drug treatments. We analyzed longitudinal claims data of the largest German public sickness fund of 9,969 incident dementia cases aged 60 years and above regarding the risk of LTC whereas we differentiated between three levels of care dependence. We used a Cox proportional hazard model for the analysis of the risk of LTC after the diagnosis of dementia incidence based on the treating physician and the antidementia drug treatment prescribed adjusted for age, sex, cardiovascular comorbidities and the level of care dependence before the onset of dementia. NP patients have a significantly reduced risk of LTC as compared to patients mainly treated b y non-NPs (care level 1: HR=0.66, p=0.000, care level 2: HR=0.79, p=0.001, care level 3: HR=0.68, p=0.002). Antidementia drug treatment increases the risk of LTC (care level 1: HR=1.69, p=0.000, care level 2: HR=1.50, p=0.000, care level 3: HR=1.48, p=0.000). This is the first study analyzing the risk of LTC of incident dementia subjects. Patients treated by an NP have certain advantages relative to patients diagnosed by other types of physician. Our results imply that a higher rate of involvement of specialists in the treatment of dementia patients would not only be meaningful for the patients, who would benefit from earlier and more accurate diagnoses and treatments; but also for society, as the need for costly LTC is postponed.