Journal Article

DZNE-2025-00328

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Dementia as a predictor of palliative care: Uncovering patient patterns based on German claims data.

Rakuša, E. (First author)DZNE* ; Reinke, C. ; Doblhammer, G.DZNE* ; Radbruch, L. ; Schmid, M.DZNE* ; Welchowski, T.

2025
BioMed Central London

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Please use a persistent id in citations: doi:10.1186/s12904-025-01672-y

Abstract: Palliative care aims to ensure a dignified and self-determined life for people facing the end of life. While palliative care is established for tumor diseases, it's notably absent from German medical guidelines for other progressive diseases with an unfavorable prognosis such as dementia. This study will identify predictors of palliative care use in older patients and explore how these predictors relate to the probability of palliative care.We used data from the largest German health insurance company of people over 50 years of age from the period 2014-2019. The analysis focused on the last year of life. Outcomes were outpatient and inpatient palliative care and predictors were demographics, comorbidities, therapeutic remedies and rehabilitation, care and medical interventions, medication and patient group. Combined logistic regression models and discrete conditional inference survival forests were used to predict the utilization of outpatient and inpatient palliative care. For evaluation we used concordance-index and calibration plots. We identified the most important predictors by using a permutation approach and the log-loss metric.The study cohort for the analysis of inpatient palliative care comprised 43,896 patients, while the cohort for the analysis of outpatient palliative care included a total of 37,430 patients. The models had appropriate discriminatory power (inpatient palliative care: concordance-index = 0.737 (95%CI = 0.721-0.754); outpatient palliative care: concordance-index = 0.689; 95%CI = 0.675-0.704) and showed appropriate calibration. A diagnosis of dementia, like a diagnosis of cancer, is predictive of inpatient palliative care and outpatient palliative care. We observed a lower probability for inpatient and for outpatient palliative care for dementia patients compared to cancer patients.The findings highlight the need to focus palliative care on other patient groups besides cancer patients, such as dementia patients, and to facilitate access for all patients.

Keyword(s): Humans (MeSH) ; Palliative Care: methods (MeSH) ; Palliative Care: statistics & numerical data (MeSH) ; Palliative Care: standards (MeSH) ; Germany (MeSH) ; Female (MeSH) ; Male (MeSH) ; Aged (MeSH) ; Dementia: therapy (MeSH) ; Middle Aged (MeSH) ; Aged, 80 and over (MeSH) ; Cohort Studies (MeSH) ; Insurance Claim Review: statistics & numerical data (MeSH) ; Dementia ; End-of-life ; Machine learning ; Palliative care ; Predictions

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Contributing Institute(s):

1. Demographic Studies (AG Doblhammer)
2. Mathematics, statistics and informatics methods for support of population studies and clinical research (AG Schmid Bonn)

Research Program(s):

1. 354 - Disease Prevention and Healthy Aging (POF4-354) (POF4-354)
2. 353 - Clinical and Health Care Research (POF4-353) (POF4-353)

Appears in the scientific report 2025

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