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Functional Status and Health Outcomes in Older Americans with Diabetes: Should Diabetes Management Be Targeted to Health Status?

Publication Abstract

Blaum, C., Mary Beth Ofstedal, K. Langa, and L. Wray. 2003. "Functional Status and Health Outcomes in Older Americans with Diabetes: Should Diabetes Management Be Targeted to Health Status?" Journal of the American Geriatrics Society, 51(6): 745-753.

OBJECTIVES:To determine how baseline functional status affects health outcomes in older adults with diabetes mellitus (DM).

DESIGN:Nationally representative cross-sectional and longitudinal health interview survey.

SETTING:Waves I (1993) and II (1995) of the Assets and Health Dynamics of the Oldest Old Survey (AHEAD) in the United States.

PARTICIPANTS:AHEAD respondents aged 70 and older (n = 7,447, including 995 with DM).

MEASUREMENTS:At baseline, the entire sample was divided into three groups: high-functioning group, defined as having no physical limitations or instrumental activities of daily living/activities of daily living (IADL/ADL) disabilities (39%); low-functioning group, having three or more limitations or IADL/ADL disabilities (24%); and intermediate-functioning group, those in the middle (36%). Older adults with and without DM, within each of the functioning groups, were compared at 2-year follow-up with respect to demographic characteristics, weight/body mass index, baseline and incident chronic diseases and conditions, and follow-up functioning.

RESULTS:Of people aged 70 and older, 28% with DM and 41% without were high functioning; 38% with DM and 22% without were low functioning (both P< .001). High-functioning people with DM remained high functioning at 2 years but had a significantly higher incidence of heart disease and mortality than high-functioning people without DM. Low-functioning people with DM were significantly more likely to have vascular comorbidities at baseline than low-functioning people without DM, but their 2-year outcomes were similar. The intermediate-functioning group showed the most differences between those with and without DM; those with DM were significantly (P< .01) more likely to have baseline vascular disease, low cognitive performance, increased incident vascular disease, and significantly worse 2-year functioning and to have experienced falls (P< .001).

CONCLUSION:Differences in baseline functional status in older adults with DM were associated with outcome differences. High-functioning older people with DM tended to remain high functioning but demonstrated significantly higher incidence of heart disease and mortality than those without DM, whereas low-functioning people with and without DM had similar outcomes. However, intermediate-functioning older diabetics had worse health and functioning outcomes than a similarly impaired group without DM. DM management adjusted to functional status can potentially address the most-relevant outcomes in the heterogeneous older population with DM.

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