title: The characteristics of diabetic residents in European nursing homes: results from the SHELTER study.
abstract: OBJECTIVE
  The objectives of this study were to describe the prevalence of diabetes mellitus (DM) in European nursing homes (NHs), and the health and functional characteristics of diabetic residents (DMR) aged 60 years and older.
  
  
  METHODS
  Between 2009 and 2011, the Services and Health for Elderly in Long TERm care (SHELTER) project, a 12-month prospective cohort study, was conducted to assess NH residents across different health care systems in 7 European countries and Israel.
  
  
  METHODS
  The study included 59 NHs in 8 countries with a total of 4037 residents living in or admitted to a NH during the 3-month enrollment period. The multidimensional InterRAI instrument for Long-Term Care Facilities (InterRAI-LTCF) was used to assess health and functional status among residents. Descriptive statistics and linear, ordinal, and logistic regression were used to perform the analyses.
  
  
  RESULTS
  We found a 21.8% prevalence of DM among NH residents. Residents with DM (DMRs) were significantly younger compared with non-DMRs (82.3, SD ± 7.7; 84.6, SD ± 8.4; P < .001). DMRs were more frequently overweight or obese, and presented more often with ischemic heart disease, congestive heart failure, hypertension, and stroke than residents without DM. DMRs also took more drugs, had pressure ulcers (PU) or other wounds more often, and more frequently had urinary incontinence (UI); they also reported worse self-perceived health. DM independently of other factors increased risk of PU occurrence (odds ratio 1.38; 95% confidence interval [CI] 1.02-1.86; P = .036) and decreased probability of higher pain scores (B = -0.28; 95% CI -0.41 to -0.14; P < .001). DM was not associated with ADL dependency, cognitive impairment, and depression in NH residents.
  
  
  CONCLUSIONS
  Prevalence of DM in European NH residents is comparable to US national NH surveys, and to UK and German NH data based on glucose-level testing. DMRs compared with non-DMRs have more comorbid conditions, and a particularly higher incidence of cardiovascular diseases and obesity, PU, and severe UI. DMRs should be regarded as a specific group of residents who require an interdisciplinary approach in medical and nursing care.
authors.affiliation: Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland. Electronic address: katarzyna.szczerbinska@uj.edu.pl.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Szczerbińska
authors.affiliation: Department of Geriatrics, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Topinková
authors.affiliation: Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Brzyski
authors.affiliation: EMGO Institute for Health and Care Research, Department of General Practice and Elderly Care, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Henriëtte G
authors.initials: HG
authors.lastname: van der Roest
authors.affiliation: Department of Geriatrics, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Tomáš
authors.initials: T
authors.lastname: Richter
authors.affiliation: Unit for Ageing and Services, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Harriet
authors.initials: H
authors.lastname: Finne-Soveri
authors.affiliation: Agaplesion Bethesda Clinic, Geriatric Centre Ulm/Alb-Donau, University of Ulm, Ulm, Germany.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Denkinger
authors.affiliation: The Centre for Standards in Health and Disability, Research Authority, University of Haifa, Haifa, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Gindin
authors.affiliation: Centro Medicina dell'Invecchiamento, Università Cattolica Sacro Cuore, Rome, Italy.
authors.forename: Graziano
authors.initials: G
authors.lastname: Onder
authors.affiliation: Centro Medicina dell'Invecchiamento, Università Cattolica Sacro Cuore, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernabei
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D048909:Diabetes Complications / Q000175:diagnosis / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009735:Nursing Homes; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D015996:Survival Rate
keywords: Diabetes mellitus; nursing home; older adults