Vortragssitzung

Ageing and Health

Talks

Associations between Low-and High-value Care treatments and patient-centered outcomes of People with Dementia: A cross-sectional analysis.
Moritz Platen, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Standort Rostock/ Greifswald

Abstract

This study aims to determine the associations between low-(LvC) and high-value care (HvC) and patient-centered outcomes of people living with dementia (PwD).

Method

The analysis was based on the baseline data of the DelpHi-trial and included 516 PwD. The association of LvC and HvC treatments with health-related quality of life (HRQol) and hospitalization were assessed using multiple regression models.

Results

PwD who received LvC treatments had a lower quality of life (b=-0.08; CI95% 0.14 – 0.02) and were more likely to be hospitalized (OR=2.08; CI95% 1.29 – 3.36). Different HvC treatments were associated with both positive and negative HRQol.

Conclusion

LvC treatments caused negative patient-centered outcomes and should therefore be identified as early as possible and tried to be replaced. Research is needed about innovative models of care, disease management programs, and treatment pathways supporting the identification and replacement of LvC.


Authors
Moritz Platen, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Standort Rostock/ Greifswald
Steffen Fleßa, Lehrstuhl für Allgemeine Betriebswirtschaftslehre und Gesundheitsmanagement, Universität Greifswald
Anika Rädke, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Standort Rostock/ Greifswald
Diana Wucherer, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Standort Rostock/ Greifswald
Jochen René Thyrian, Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE); Institut für Community Medicine, Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin Greifswald
Wiebke Mohr, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Standort Rostock/ Greifswald
Annelie Scharf, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Standort Rostock/ Greifswald
Franka Mühlichen, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Standort Rostock/ Greifswald
Wolfgang Hoffmann, Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE); Institut für Community Medicine, Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin Greifswald
Bernhard Michalowsky, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Standort Rostock/ Greifswald
Forced Displacement, Social Norms, And Contraceptive Utilization in Host Communities
Arndt Rüdiger Reichert, Leibniz Universität Hannover

Abstract

Nigeria has one of the largest number of people who are internally displaced in the world. The main cause of displacement is the ongoing conflict between the Boko Haram jihadist group and the Nigerian government. In this paper, we analyze the impact of displacement on social norms in host communities with a special focus on women empowerment, contraceptive utilization, and violence againt female household members. While classic assimilation theory suggests that minority and majority groups become more similar over time in norms, values, behaviors, and characteristics, this process is likely to cause stress and dispute within villages and homes.

Method

We regress variables describing the prevailing social norm in host communities on violent attacks carried out by Boko Haram in potential sending areas. We then extensively examine the role of internal displacement as mediating variable and its importance relative to other possible channels for the effect of these attacks on social norms. We combine data from three different sources. All databases are geo-referenced. Displacement data. We use data on the number of displaced people from the Inter national Organization for Migration Displacement Tracking Matrix project. The data collection is conducted quarterly at all locations known to host IDPs in the six North Eastern states. Our data comprises 3,444 unique locations. Conflict data. We use data from the Armed Conflict Location and Event Data Project. We restrict the data to attacks that occurred from 2009 to 2018 and where at least one of the actors involved was Boko Haram or the Islamic State. Individual data. We use data from the Nigeria Demographic and Health Survey of 2013 and 2018. The surveys are conducted on a nationally representative sample of households and collects information on maternal and child health and nutrition, health seeking be havior, awareness of best health practices and their application. We have 6,630 (year 2013) and 7,639 (year 2018) households in the six North Eastern states. We set up the following model: Yicst = α + βAct + θ0Xi + δ0Cc + σs + γt + ist (1) where Yicst, indicates the outcome variable of woman i, from the DHS household cluster c, in state s, and time s. For the outcome variables we focus on measures of female em powerment. The variable A counts violent attacks by Boko Haram.

Results

We find positive and significant coefficients when looking at (modern) contraceptive use. Findings also indicate an increase in the probability that women experienced violence and/or sexual violence by their partner. Indeed, we find that the probability that men justify beating their wives increases as well as the probability to have negative views over female contraceptive use.

Conclusion


Authors
Arndt Reichert, Leibniz Universität Hannover
Understanding cognitive decline in older ages: the role of health shocks
Valentin Schiele, Paderborn University

Abstract

Age-related cognitive decline is among the key reasons for the transition of healthy individuals into care dependent ones. Apart from that, cognitive performance is important for labor productivity and for wellbeing. While economists have devoted a great deal of effort to understand the process of human capital accumulation, not so much is known about its depreciation. It is our goal to contribute here. We seek to understand how a specific adverse life event, a health shock, affects cognitive decline among older individuals and whether potential policy measures, namely education and labor force participation, can moderate effects of these shocks.

Method

We use data from the Survey of Health, Ageing, and Retirement (SHARE), the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA). Measures of cognitive abilities are based on test scores while health shocks are experimentally and/or objectively measured by strong reductions in handgrip strength and onset of severe conditions such as heart attack, stroke, or hip fracture. We carry out event study estimations to see whether health shocks are anticipated and to learn about the longer run effects up to eight years after the shock. In the moderation analysis we use reduced form regressions and early retirement ages as set by the governments as well as compulsory schooling regulations to circumvent problems of potential endogeneity of retirement and education.

Results

We find evidence for a considerable effect of health shocks on cognitive abilities. Comparing the effect size to the general age-related decline in cognitive functioning, a health shock, on average, induces a similar cognitive decline as growing 5 years older. The effect, however, does not seem to be mitigated by retirement behavior or education. The effect sizes also do not vary much between regions with different institutional settings including different health insurance systems.

Conclusion

Individual cognitive functioning declines over time. We seek to understand how adverse physical health shocks in older ages contribute to this development. By use of event-study methods and data from the USA, England and several countries in Continental Europe we find evidence that health shocks lead to an immediate and persistent decline in cognitive functioning. This robust finding holds in all regions representing different health insurance systems and seems to be independent of underlying individual characteristics. We also ask whether variables that are susceptible to policy action can reduce the negative consequences of a health shock. Our results suggest that neither compulsory education nor retirement regulations moderate the effects, thus emphasizing the importance of maintaining good physical health in old age for cognitive functioning.


Authors
Valentin Schiele, Paderborn University
Hendrik Schmitz, Paderborn University; RWI & LSCR
Early versus later-life stimulation: How education-induced retirement decisions influence the decline in cognitive abilities
Hendrik Schmitz, Universität Paderborn

Abstract

Age-related cognitive decline is among the key reasons for the transition of healthy individuals into care dependent ones. As an example, its most drastic form, dementia, is responsible for around 50% of all nursing home stays in Germany. Yet, also milder forms of cognitive impairment are among the risk factors of becoming care dependent. Cognitive ability is usually considered to be a modifiable factor which can be increased by mental stimulation both early and throughout the life course. In this project, we are interested in the effects of mental stimulation at different points in the life-cycle on cognitive ability of older people. Education may be considered an early-life mental-stimulation. Later-life stimulation can be seen in the spirit of the well-known “use-it-or-lose-it hypothesis”: absence from the labor market might in many cases lead to a depreciation of cognitive ability because the brain is challenged or stimulated less. We are interested in the interaction of education and retirement and their effect on cognitive abilities. It seems plausible that schooling has a direct effect on cognitive abilities and an indirect one through labor market participation.

Method

We directly test this using causal mediation analysis. That is, we test the direct effect of education on cognitive ability and the indirect effect through retirement. Since both education and retirement are endogenous we use exogenous variation from compulsory schooling reforms (education) and early retirement regulations (for retirement) as exogenous variation. We use data from the Survey of Health Ageing, and Retirement (SHARE), the Health and Retirement Study (HRS), and the English Longitudinal Study of Ageing (ELSA), three large biennial representative micro data sets providing information on health and other socioeconomic characteristics for individuals aged 50 and older. As a fist descriptive step, we estimate age-specific cognitive decline trajectories for individuals above the age of 50. We differentiate between individuals who were and were not affected by the compulsory-schooling reforms. The difference between both trajectories are age-specific causal effects of education on cognitive abilities. In addition, by unfolding the impact of compulsory schooling along age, we can empirically test whether part of the effect of education interferes with retirement decisions and a retirement-induced cognitive decline. This more descriptive approach is complemented by a more formal estimator in the spirit of Frölich and Huber (2017).

Results

Preliminary results: We find a direct effect of education on cognitive abilities. Moreover, education causally affects retirement behavior leading to an indirect effect of eduation on cognitive abilities through retirement.

Conclusion


Authors
Hendrik Schmitz, Universität Paderborn
Matthias Westphal, TU Dortmund