A Community Survey of Diabetes in the Elderly

Abstract

All 98 elderly patients who were known to have diabetes on the lists of two inner-city general practices were interviewed and examined in their own homes. They were characterized in terms of their prevalence of vascular complications, metabolic control, perceived health (measured by the Nottingham Health Profile), frequency of hospital and general practice contacts and use of domiciliary 'support services' and compared to 98 control subjects with an identical age/gender distribution. Mean haemoglobin A1 in the diabetic patients was 9.9 +/- 2.5%, few of them had suffered severe hyperglycaemia (10%) or hypoglycaemia (5%) and they were little more obese than controls (mean body mass index 26.2 +/- 4.2 vs 24.6 +/- 4.1 kg m-2; 95% confidence interval for the difference 0.4-2.8; p < 0.01). All complications were more prevalent in diabetic patients and the difference was statistically significant for visual impairment, strokes, impaired mental test scores, absent vibration sense, and absent leg pulses. Cataract was more common than retinopathy as a cause of visual disability. Diabetic patients perceived their health to be much worse than controls and were more often depressed. No measure of perceived health correlated with haemoglobin A1. We conclude that care of the diabetic elderly should not be too narrowly focused on 'metabolic' goals.

Well-Being and Treatment Satisfaction in Older People With Diabetes

“…It was similar to the difference between men and women (6% of the scale maximum), and cannot definitely be ascribed to insulin per se because insulintreated patients were younger and had been diabetic longer. In previous studies we (5) and others (13,14) have found that patients with complications had worse perceived health. Insulin-treated patients in the present study may well have had more complications, confounding the apparent relationship between insulin treatment and well-being.…”

“…Mean age was 71 ± 7 years for the responders, 72 ± 7 years for the patients who did not reply (nonresponders), and 72 ± 7 years for the 793 patients who were not selected. Median duration of diabetes was 8 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) years in all groups. Women constituted 49% of responders, 50% of nonresponders, and 49% of nonselected patients.…”

“…A number of investigators have used generic instruments on people with diabetes (5,(12)(13)(14). For example, Glasgow et al (14) recently found that quality of life deteriorated with increasing age, lower socioeconomic status, the presence of complications, and the use of insulin in a large heterogenous sample of diabetic patients drawn from across the U.S. Generic instruments are usually well validated and have the advantage that the impact of diabetes can be compared with other diseases, but they may be less sensitive than disease-specific instruments (13).…”

“…Older people constitute half the diabetic population but are less likely to attend a hospital (4) and are more likely than younger people to be missed by surveys in the specialist "centers of excellence" recommended in the St. Vincent Declaration (1). They are very prone to macrovascular disease, may be socially isolated, and may receive many drugs (5). They will increase in number with growth of the older population.…”

Influence of clinical and demographic variables on quality of life in patients with Parkinson's disease

“…22 23 However, a lack of agreement on the definition of quality of life means that a wide range of quality of life profiles and indices are used to assess health related distress. Such variety has complicated the validation and comparison of findings.…”