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Many Elderly Receiving Home Care for Diabetes May Be Unaware of Impact

Sep 22, 2018
 

Recent study explores link between disease and psychological well-being in older people with diabetes

“The ultimate goals for home care services are to maintain quality of life and functional status, and to replace expensive hospital care and nursing homes with care delivered in the person’s home,” Dr. Marit Graue of the Centre for Evidence-Based Practice, University of Oslo, Norway, and colleagues explain. “However, home care service staff do not always have information about the person’s diagnoses and vital clinical information. Older people with diabetes are often characterized by progressive cognitive and functional decline and poor psychological well-being, all negatively influencing diabetes management.” The elderly with diabetes have a higher risk of urinary incontinence, decline in cognitive function, and may experience falls due to low blood sugars. For this reason, older adults with or without diabetes who are receiving at home health care may experience symptoms that could be affecting their overall health and psychological well-being.

These patients with diabetes need closer monitoring and assistance compared to those without diabetes to avoid increased risk of cardiovascular disease and other comorbidities. To the author’s knowledge, this is the first study of its kind in which the prevalence of diabetes and the association between the disease and psychological well-being in elderly adults receiving in home care has been explored. This research is needed to modify resources when necessary and increase competence of health care services that are based at home.

Researchers examined data, using a cross-sectional survey from 377 adults age at least 65 years who were receiving care at home in Western Norway between May 2014 and March 2015. They assessed HbA1c levels by analyzing capillary blood samples spectrophotometrically using a DCA Vantage Analyzer, and diabetes status by use of self-report using surveys. The Mini Mental State Examination-NR (MMSE-NR) was used to examine cognitive function, a survey consisting of 19 questions pertaining to symptoms from diabetes (e.g. frequent urination, thirst, headache). Overall quality of life and health were evaluated using the WHO Quality of Life-BREF (WHOQOL-BREF). The EuroQol EQ-5D-5L was used to assess health status, which included depression/anxiety, mobility, pain/discomfort, and usual activities.

Participants were grouped as no diabetes, diabetes by self-report only, diabetes by self-report and HbA1c measurements, and diabetes by HbA1c only. These groups were compared using exact Fisher’s chi-squared test and one-way analysis of variance.

Within the study, 24% of participants had diabetes, with men having a higher prevalence than women (34% vs. 20%). Also, the prevalence decreased with age, mainly in women. Of the patients who had diabetes, 27 were self-reported, 52 were self-reported and HbA1c level, and 13 were HbA1c level only. Only 21 of the 27 participants who self-reported were pharmacologically treated, of whom five were taking insulin. Also, 14% of patients with diabetes had a HbA1c ranging from 6.5% to 8.5% and were unaware of the diagnosis.

A high portion of participants with undiagnosed diabetes reported symptoms relating to hyperglycemia, compared to the persons who were known to have diabetes. Additionally, these patients had a significantly lower overall health and a decrease in psychological well-being. These symptoms may be avoided and an improvement in quality of life can be established with proper diagnosis and treatment.

“We found that having diabetes, either diagnosed or undiagnosed, was associated with more symptoms and poorer health status in this community-based study of people receiving care at home,” the researchers explained. “Diabetes constitutes a large burden of disease among those receiving care at home and deserves increased case-finding efforts and allocation of resources to alleviate symptoms and the burden of inadequate diabetes care in people receiving care at home.”

Practice Pearls:

  • This is the first study of its kind in which the prevalence of diabetes and the association between the disease and psychological well-being in older people with diabetes receiving in home care has been explored.
  • A number of surveys, along with HbA1c levels, were used to establish patients’ classifications.
  • A high portion of participants using at home care were undiagnosed with diabetes and showed symptoms of hyperglycemia and a decrease in quality of life.
  • This research is needed to modify resources when necessary and increase competence of health care services that are based at home.

Reference:

Davies, T. T., et al. “Diabetes Prevalence among Older People Receiving Care at Home: Associations with Symptoms, Health Status and Psychological Well‐Being.” Diabetic Medicine. 2018;doi:10.1111/dme.13790.

Melissa Bailey, Pharm.D. Candidate, USF College of Pharmacy