The role of nursing home admission and dementia status on care for diabetes mellitus.
OBJECTIVE
To study the role of nursing home (NH) admission and dementia status on the provision of five procedures related to diabetes mellitus.


METHODS
Retrospective cohort study using data from a large prospective study in which an expert panel determined the prevalence of dementia.


METHODS
Fifty-nine Maryland NHs.


METHODS
Three hundred ninety-nine new admission NH patients with diabetes mellitus.


METHODS
Medicare administrative claims records matched to the NH medical record data were used to measure procedures related to diabetes mellitus received in the year before NH admission and up to a year after admission (and before discharge). Procedures included glycosylated hemoglobin, fasting blood glucose, dilated eye examination, lipid profile, and serum creatinine.


RESULTS
For all but dilated eye examinations, higher rates of procedures related to diabetes mellitus were seen in the year after NH admission than in the year before. Residents without dementia received more procedures than those with dementia, although this was somewhat attenuated after controlling for demographic, health, and healthcare utilization variables. Persons without dementia experience greater increases in procedure rates after admission than those with dementia.


CONCLUSIONS
The structured environment of care provided by the NH may positively affect monitoring procedures provided to elderly persons with diabetes mellitus, especially those without dementia. Medical decisions related to the risks and benefits of intensive treatment for diabetes mellitus to patients of varying frailty and expected longevity may lead to lower rates of procedures for residents with dementia.
Quinn
Charlene C
CC
Division of Gerontology, Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, Maryland 21201, USA. cquinn@epi.umaryland.edu
Gruber-Baldini
Ann L
AL
Port
Cynthia L
CL
May
Conrad
C
Stuart
Bruce
B
Hebel
J Richard
JR
Zimmerman
Sheryl
S
Burton
Lynda
L
Zuckerman
Ilene H
IH
Fahlman
Cheryl
C
Magaziner
Jay
J
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000097:blood / Q000453:epidemiology / Q000451:nursing*; D001786:Blood Glucose / Q000378:metabolism; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology / Q000451:nursing*; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006442:Glycated Hemoglobin / Q000378:metabolism; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008396:Maryland; D009735:Nursing Homes / Q000706:statistics & numerical data*; D009887:Ophthalmoscopy / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data*
D001786:Blood Glucose; D003404:Creatinine; D006442:Glycated Hemoglobin; D008055:Lipids; C517652:hemoglobin A1c protein, human
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