Age-specific incidence of need for long-term care for men and women in Germany 2015: Cross-sectional study comprising 82 million people.

Background: With the growing number of older people, the number of people in need of long-term care is increasing, too. Official statistics only report on the age-specific prevalence of long-term care. Therefore, there is no data on the age- and sex-specific incidence of the need for care at the population level for Germany available. Methods: Analytical relationships between age-specific prevalence, incidence rate, remission rate, all-cause mortality, and mortality rate ratio are used to estimate the age-specific incidence of long-term care among men and women in 2015. The data is based on the official prevalence data from the nursing care statistics for the years 2011 to 2019 and official mortality rates from the Federal Statistical Office. For Germany, there is no data on the mortality rate ratio of people with and without a need for care, which is why we use two extreme scenarios that were obtained in a systematic literature search to estimate the incidence. Results: The age-specific incidence is about 1 per 1000 person-years (PY) in men and women at the age of 50 and increases exponentially up to the age of 90. Up to about the age of 60, men have a higher incidence rate than women. Thereafter, women have a higher incidence. At the age of 90, women and men have an incidence rate of 145 to 200 and 94 to 153 per 1000 PY, respectively, depending on the scenario. Conclusion: We estimated the age-specific incidence of the need for long-term care for women and men in Germany for the first time. We observed a strong increase, leading to a huge number of people in need of long-term care in higher age groups. It is to be expected that this will result in an increased economic burden and a further increased need for nursing and medical staff.

Projected incidence trends of need for long-term care in German men and women from 2011 to 2021.

Background: The German Federal Statistical Office routinely collects and reports aggregated numbers of people in need of long-term care (NLTC) stratified by age and sex. Age- and sex-specific prevalence of NLTC from 2011 to 2021 is reported as well. One estimation of the incidence rate of NLTC based on the age- and sex-specific prevalence exists that did not explore possible trends in incidence [based on MRR (mortality rate ratio)], which is important for an adequate projection of the future number of people with NLTC. Objective: We aim to explore possible trends in age-specific incidence of NLTC in German men and women from 2011 to 2021 based on different scenarios about excess mortality (in terms of MRR). Methods: The incidence of NLTC was calculated based on an illness-death model and a related partial differential equation based on data from the Federal Statistical Office. Estimation of annual percent change (APC) of the incidence rate was conducted in eight scenarios. Results: There are consistent indications for trends in incidence for men and women aged 50-79 years with APC in incidence rate of more than +9% per year (up to nearly 19%). For ages 80+ the APC is between +0.4% and +12.5%. In all scenarios, women had higher age-specific APCs than men. Conclusion: We performed the first analysis of APC in the age- and sex-specific incidence rate of NLTC in Germany and revealed an increasing trend in the incidences. With these findings, a future prevalence of NLTC can be estimated which may exceed current prognoses.