Functional status and health outcomes in older americans with diabetes mellitus.
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.
Blaum
Caroline S
CS
Department of Medicine, The Institute for Social Research, and the Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, USA. cblaum@umich.edu
Ofstedal
Mary Beth
MB
Langa
Kenneth M
KM
Wray
Linda A
LA
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