The role of cognitive impairment and caregiver support in diabetes management of older outpatients.
OBJECTIVE
To examine the role of cognitive impairment and caregiver support in diabetes care adherence and glycemic control.


METHODS
Fifty-one veteran male outpatients (27 with caregivers) aged 60 years and older with type 2 diabetes were evaluated for cognitive impairment with the Cognitive Abilities Screening Instrument. Patients or caregivers completed diabetes self-care and depression scales. Medical morbidity information and HbA1c plasma levels at baseline and 1 year later were obtained from electronic medical records.


RESULTS
Greater cognitive impairment (F = 5.1, p < .05), and presence of a caregiver (F = 5.3, p < .05), were independently associated with worse diabetes care adherence (adjusting for age, education, medical comorbidity, and depression). In addition, Mean HbA1c levels were worse in the cognitively impaired group with caregivers relative to the three other groups (F = 4.10, p < .05, eta2 = .09). One year later, mean HbA1c levels rose from 7.7 to 8.2% in the cognitively impaired group with caregivers.


CONCLUSIONS
Cognitive impairment is associated with worse diabetes care management. Surprisingly, the presence of a caregiver is not protective. Further research is necessary to examine the healthcare needs of cognitively impaired, diabetic patients and their caregivers.
West Los Angeles VA Medical Center and University of California, Los Angeles, CA 90073, USA. denise.feil@va.gov
Denise G
DG
Feil
Ann
A
Pearman
Tara
T
Victor
Dylan
D
Harwood
Jane
J
Weinreb
Kristin
K
Kahle
Jürgen
J
Unützer
D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D003072:Cognition Disorders / Q000097:blood / Q000523:psychology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000097:blood / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006301:Health Services Needs and Demand; D006801:Humans; D008137:Longitudinal Studies; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D012648:Self Care / Q000523:psychology; D012944:Social Support; D014728:Veterans / Q000523:psychology*
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human