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Significance and Costs of Complex Biopsychosocial Health Care Needs in Elderly People: Results of a Population-Based Study

Wild, Beate PhD; Heider, Dirk PhD; Maatouk, Imad MD; Slaets, Joris MD; König, Hans-Helmut MD; Niehoff, Dorothea MD; Saum, Kai-Uwe MD; Brenner, Hermann MD; Söllner, Wolfgang MD; Herzog, Wolfgang MD

doi: 10.1097/PSY.0000000000000080
Original Articles

Objective To improve health care for the elderly, a consideration of biopsychosocial health care needs may be of particular importance—especially because of the prevalence of multiple conditions, mental disorders, and social challenges facing elderly people. The aim of the study was to investigate significance and costs of biopsychosocial health care needs in elderly people.

Methods Data were derived from the 8-year follow-up of the ESTHER study—a German epidemiological study in the elderly population. A total of 3124 participants aged 57 to 84 years were visited at home by trained medical doctors. Biopsychosocial health care needs were assessed using the INTERMED for the Elderly (IM-E) interview. Health-related quality of life (HRQOL) was measured by the 12-Item Short-Form Health Survey, and psychosomatic burden was measured by the Patient Health Questionnaire.

Results The IM-E correlated with decreased mental (mental component score: r = −0.38, p < .0001) and physical HRQOL (physical component score: r = −0.45, p < .0001), increased depression severity (r = 0.53, p < .0001), and costs (R = 0.41, p < .0001). The proportion of the participants who had an IM-E score of at least 21 was 8.2%; according to previous studies, they were classified as complex patients (having complex biopsychosocial health care needs). Complex patients showed a highly reduced HRQOL compared with participants without complex health care needs (mental component score: 37.0 [10.8] versus 48.7 [8.8]; physical component score: 33.0 [9.1] versus 41.6 [9.5]). Mean health care costs per 3 months of complex patients were strongly increased (1651.1 € [3192.2] versus 764.5 € [1868.4]).

Conclusions Complex biopsychosocial health care needs are strongly associated with adverse health outcomes in elderly people. It should be evaluated if interdisciplinary treatment plans would improve the health outcomes for complex patients.

Supplemental digital content is available in the text.

From the Department of General Internal Medicine and Psychosomatics (B.W., I.M., D.N., W.H.), Medical University Hospital, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research (K.-U.S., H.B.), German Cancer Research Center, Heidelberg, Germany; Departments of Internal Medicine and Geriatrics (J.S.), University Hospital, Groningen, the Netherlands; Department of Psychosomatics and Psychotherapy (W.S.), General Hospital, Nürnberg, Germany; and Department of Health Economics and Health Services Research (D.H., H.-H.K.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Address correspondence and reprint requests to Beate Wild, PhD, Department of General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. E-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Received for publication October 5, 2013; revision received May 1, 2014.

Copyright © 2014 by American Psychosomatic Society
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