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@PHDTHESIS{Ziegler:155341,
      author       = {Ziegler, Uta},
      title        = {{D}ementia in {G}ermany - {P}ast {T}rends and {F}uture
                      {D}evelopments},
      school       = {Universität Rostock},
      type         = {Dissertation},
      publisher    = {Universität Rostock},
      reportid     = {DZNE-2021-00608},
      pages        = {279 S., Ill.},
      year         = {2010},
      note         = {Dissertation, Universität Rostock, 2010},
      abstract     = {The aging of the population worldwide is an issue that is
                      attracting an increasing amount of attention. In the more
                      developed regions, including Europe and the United States,
                      every fifth person was older than 60 years in 2000. By 2050,
                      this figure will jump to $35\%.$ Worldwide the percentage of
                      people age 60 and above is also rising, and is expected to
                      grow from $10\%$ in 2000 to $21\%$ in 2050 (United Nations,
                      2005). The changes in the population structure will lead to
                      far-reaching rearrangements in societies and political
                      systems, as countries adjust to having a higher share of
                      older people. Disability and care need play an important
                      role in an aging population. How many people will be in need
                      of care, and who will care for them? Dementia and cognitive
                      impairments afflict a high proportion of elderly people who
                      are in need of care and who suffer from chronic illnesses.
                      In past centuries, relatively few people reached the ages at
                      which dementia typically occurs; thus, for a long time,
                      dementia was regarded as a natural consequence of aging. The
                      aging of the population has led to a greater focus on the
                      syndrome: as the number of elderly people has grown, the
                      number of demented people has increased as well. Today
                      mental and behavioral disorders represent four of the 10
                      leading causes of disability worldwide, and they are
                      estimated to account for $12\%$ of the global burden of
                      disease (World Health Organization, 2001). European and
                      Northern American studies show that about one-fourth of the
                      population above age 65 suffers from a mental health
                      problem. About $6\%$ to $10\%$ have severe dementia and
                      severe functional psychoses (Bickel, 2003; Hendrie, 1998).
                      For people above age 60, dementia accounts for $11.2\%$ of
                      all years lived with disability. The number of sufferers
                      from dementia in 2009 is estimated to about 34 million
                      people worldwide (Wimo et al., 2010), an increase of 5
                      million people within only 5 years (Wimo et al., 2007).
                      About $46\%$ of the demented people live in Asia, $30\%$ in
                      Europe and $12\%$ in North America (Wimo et al., 2003).
                      Estimates of the numbers of dementia patients in Europe for
                      the year 2000 range from 4.624 million Europeans (EU25)
                      between ages 30 and 99 (Eurostat, 2003) to 7.1 million
                      (European Commission, 2004). Due to their higher mean age,
                      more women are affected: 2.9 million women, compared with
                      1.7 million men (taking the numbers from Eurostat (2003)
                      into account). For the year 2006, the European Community
                      Concerted Action on the Epidemiology and Prevention of
                      Dementia (EURODEM) group (Alzheimer Europe, 2006) estimated
                      that there were about 5.37 million dementia cases. In
                      Germany, about one million people live with dementia
                      (Bickel, 2008; Hallauer, 2002). The quantification of
                      dementia is very diffcult, as the conflicting findings for
                      Europe make clear. Different definitions and measurement
                      methodologies lead to diverging results. A rising awareness
                      might further influence the number of affected cases,
                      because the syndrome is diagnosed earlier and more
                      frequently. Increasing attention is now devoted to the
                      topic, as can be seen from the larger number of journals,
                      programs and initiatives dealing with the topic, and the
                      growing number of studies analyzing the epidemiology of
                      dementia, the prevalence and incidence of dementing
                      illnesses, and the risk factors of the syndrome (Fratiglioni
                      et al., 1999; Larson et al., 1992). Still, the knowledge
                      about dementia is in the early stages. The dissertation is
                      structured into seven chapters. Following the introduction
                      in the first chapter, the second chapter provides a
                      literature overview of dementia, including its prevalence,
                      incidence rates, trends and determinants; as well as of the
                      efforts undertaken to medicate and prevent the syndrome. In
                      a systematic literature review, we look at the change in
                      dementia prevalence or incidence over time. The main
                      research question is derived from this information: How is
                      the number of people with dementia in Germany going to
                      develop taking past trends and determinants into account? In
                      the following chapters, the results of empirical analyses
                      for Germany are shown. Chapter 3 presents results on
                      dementia which are calculated with a unique dataset from the
                      German sickness funds, which includes more than 2.3 million
                      people. This is the first time information on prevalence and
                      incidence rates for Germany are calculated with a German
                      dataset for the entire country. Due to its large sample
                      size, results can not only be separated by age, but also by
                      gender and region. Finally, the co-morbidity of people with
                      prevalent and incident dementia is examined in chapter 4. In
                      chapter 5, data from the Survey of Health, Ageing and
                      Retirement in Europe (SHARE) are used to analyze severe
                      cognitive impairment. The dataset provides a variety of
                      socio-demographic, lifestyle and physical and mental health
                      variables which help to explain more completely the
                      influencing determinants. Furthermore, the longitudinal
                      design of the data allows for the analysis of trends of
                      severe cognitive impairment. The results presented in these
                      chapters provide the basis for different projection
                      scenarios of the future number of people with dementia in
                      Germany, which are presented in chapter 6. Projections are
                      always uncertain. On the one hand, all the people who will
                      turn 60 by the year 2050 – the group of people most likely
                      to contract the disease – have already been born; but, on
                      the other hand, there are more uncertain factors, such as
                      the development of life expectancy and of dementia
                      prevalence and incidence. So far for Germany, only constant
                      prevalence projections exist. Ziegler and Doblhammer (2010)
                      and Doblhammer et al. (2009) calculated prevalence
                      projections with decreasing prevalences. Here, multi-state
                      projections using incidence rates and different death rates
                      for the demented and not-demented population will be shown.
                      Dementia is one of the most costly diseases because of the
                      large amount of care sufferers require. Chapter 7 deals with
                      the current costs, and shows why it is so difficult to
                      estimate the true costs of the disease. Furthermore, cost
                      projections until 2050 are shown. Finally, a conclusion
                      based on the results is provided in chapter 8. What will the
                      future of the aging German population with dementia look
                      like?},
      cin          = {Working group sociodemography},
      ddc          = {610 Medical sciences Medicine},
      cid          = {I:(DE-2719)1510200},
      pnm          = {345 - Population Studies and Genetics (POF3-345)},
      pid          = {G:(DE-HGF)POF3-345},
      typ          = {PUB:(DE-HGF)11},
      urn          = {urn:nbn:de:gbv:28-diss2011-0039-1},
      doi          = {10.18453/ROSDOK_ID00000815},
      url          = {https://pub.dzne.de/record/155341},
}