title: Functional status and health outcomes in older americans with diabetes mellitus.
abstract: OBJECTIVE
  To determine how baseline functional status affects health outcomes in older adults with diabetes mellitus (DM).
  
  
  METHODS
  Nationally representative cross-sectional and longitudinal health interview survey.
  
  
  METHODS
  Waves I (1993) and II (1995) of the Assets and Health Dynamics of the Oldest Old Survey (AHEAD) in the United States.
  
  
  METHODS
  AHEAD respondents aged 70 and older (n = 7,447, including 995 with DM).
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, The Institute for Social Research, and the Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, USA. cblaum@umich.edu
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Blaum
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Ofstedal
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Langa
authors.forename: Linda A
authors.initials: LA
authors.lastname: Wray
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D015577:Geriatric Assessment; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D013997:Time Factors