Gender-linked determinants for utilization of long-term care in community-dwelling adults in Germany

Abstract

Abstract Background The number of people using long-term care (LTC) is increasing steadily worldwide. Hence, demand for adequate services is rising. The purpose of this exploratory study was to identify relevant gender-linked determinants for utilization of LTC in community-dwelling older adults. Methods We examined 4077 females (52.7%) and males ≥ 65 years old (range: 65-97) between 2011/12 (t1) and 2016 (t2). Data originated from the population-based Cooperative Health Research in the Region of Augsburg (KORA)-Age study in Germany. A descriptive analysis assessed the amount of LTC used. Cross-sectional generalized estimating equation logistic models identified determinants for utilization of (in)formal LTC. Determinants for transition to LTC between t1 and t2 were examined using a longitudinal logistic regression model. Potential determinants were chosen according to Andersen's Behavioral Model of Health Services Use. Results At t2, 820 (20.1%) were LTC users with 527 (64.3%) being female. The average amount of informal LTC was higher in males (158.0 minutes/day (m/d) (SD: 270.5) vs. 70.1 m/d (SD: 152.8)), whereas the amount of formal LTC was higher in females (89.7 m/d (SD: 224.7) vs. 28.5 m/d (SD: 23.3)). In both genders, higher age, multimorbidity, and disability were associated with utilization of and transition to LTC. Living alone was significantly associated with utilization of (formal) LTC in both genders, but its effect was almost two times stronger in males (men: OR: 3.48 (CI: 2.05-5.90) vs females: OR: 1.83 (CI: 1.25-2.69)). Thus, ‘living alone' is considered the essential gender-linked determinant. Conclusions Gender-linked determinants must be considered when establishing demand-oriented policies. Future health programs should specifically target older individuals, especially males, living alone to improve their capabilities in activities of daily living to allow them to remain living longer and more independently within community settings. Key messages Older individuals, especially men, living alone should be targeted in future health programs. Females tend to use a higher amount of formal long-term care than males.