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Many older adults receiving home care unaware of diabetes status
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Among older adults receiving care at home, many are not aware of their diabetes status, potentially contributing to diminished quality of life, according to findings reported in Diabetic Medicine.
“The ultimate goals for home care services are to maintain quality of life and functional status, and to replace expensive hospital care and nursing homes with care delivered in the person’s home,” Marit Graue, RN, PhD, of the Centre for Evidence-Based Practice, University of Oslo, Norway, and colleagues wrote in the study background. “However, home care service staff do not always have information about the person’s diagnoses and vital clinical information. Older people with diabetes are often characterized by progressive cognitive and functional decline and poor psychological well-being, all negatively influencing diabetes management.”
In the cross-sectional survey, researchers analyzed data from 377 adults aged at least 65 years receiving home care in Bergen, Western Norway, between May 2014 and March 2015. Researchers measured HbA1c levels and assessed diabetes status through self-report. Surveys utilized included the following: the Mini-Mental State Examination-NR, which assessed cognitive function, the Symptom Checklist, a 19-item questionnaire pertaining to symptoms associated with diabetes, two global items from WHO Quality of Life-BREF, the EuroQol EQ-5D-5L/EQ-5D-VAS, which evaluated health status, and WHO-Five Well-Being Index (WHO-5), which assessed psychological well-being.
The researchers estimated the prevalence of diabetes for the overall sample, for men and women separately, and for 10-year age strata using an offset-only generalized linear model.
Participants were classified as one of the following: no diabetes, diabetes by self-report only, diabetes by self-report and HbA1c, and diabetes by HbA1c only. Researchers compared these diabetes categories using exact Fisher’s chi-squared test (categorical variables) and one-way analysis of variance (continuous variables).
Within the cohort, 92 (24%) participants had diabetes. Men had a higher prevalence of diabetes vs. women (34% vs. 20%; age-adjusted P = .005). The prevalence of diabetes decreased with age, particularly in women, according to the researchers.
Among diabetes cases, 27 were identified by self-report only, 52 were identified by self-report and HbA1c level, and 13 were identified by HbA1c only.
Among the 27 individuals with diabetes identified by self-report and HbA1c, 20 received pharmacologic treatment. Additionally, 14% of those with diabetes had high HbA1c values without being aware of their diagnosis, with HbA1c ranging from 6.5% to 8.5%.
The diabetes categories showed differences in self-reported diabetes-related symptoms, with the two groups with high HbA1c reporting the most symptoms. In pair-wise comparisons for total number of symptoms and mean symptom score, between-group differences were seen between the group without diabetes and those with both self-reported diabetes and an HbA1c of at least 6.5%.
Additionally, the researchers observed differences in psychological well-being, overall health perception and health status between diabetes categories; individuals with undiagnosed diabetes reported lower psychological well-being and worse overall health and health status vs. the other categories, the researchers wrote.
“We found that having diabetes, either diagnosed or undiagnosed, was associated with more symptoms and poorer health status in this community-based study of people receiving care at home,” the researchers wrote. “Diabetes constitutes a large burden of disease among those receiving care at home and deserves increased case-finding efforts and allocation of resources to alleviate symptoms and the burden of inadequate diabetes care in people receiving care at home.” – by Jennifer Byrne
Disclosures: One author reports serving on advisory panels for or receiving consultant or speaking fees from Becton Dickinson, Calibra, Lilly, Novo Nordisk and Valeritas.
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