Correlates of the incidence of disability and mortality among older adult Brazilians with and without diabetes mellitus and stroke

Abstract

BackgroundThe combined effect of diabetes and stroke on disability and mortality remains largely unexplored in Brazil and Latin America. Previous studies have been based primarily on data from developed countries. This study addresses the empirical gap by evaluating the combined impact of diabetes and stroke on disability and mortality in Brazil.MethodsThe sample was drawn from two waves of the Survey on Health and Well-being of the Elderly, which followed 2,143 older adults in São Paulo, Brazil, from 2000 to 2006. Disability was assessed via measures of activities of daily living (ADL) limitations, severe ADL limitations, and receiving assistance to perform these activities. Logistic and multinomial regression models controlling for sociodemographic and health conditions were used to address the influence of diabetes and stroke on disability and mortality.ResultsBy itself, the presence of diabetes did not increase the risk of disability or the need for assistance; however, diabetes was related to increased risks when assessed in combination with stroke. After controlling for demographic, social and health conditions, individuals who had experienced stroke but not diabetes were 3.4 times more likely to have ADL limitations than those with neither condition (95% CI 2.26-5.04). This elevated risk more than doubled for those suffering from a combination of diabetes and stroke (OR 7.34, 95% CI 3.73-14.46). Similar effects from the combination of diabetes and stroke were observed for severe ADL limitations (OR 19.75, 95% CI 9.81- 39.76) and receiving ADL assistance (OR 16.57, 95% CI 8.39-32.73). Over time, older adults who had experienced a stroke were at higher risk of remaining disabled (RRR 4.28, 95% CI 1.53,11.95) and of mortality (RRR 3.42, 95% CI 1.65,7.09). However, risks were even higher for those who had experienced both diabetes and stroke. Diabetes was associated with higher mortality.ConclusionsFindings indicate that a combined history of stroke and diabetes has a great impact on disability prevalence and mortality among older adults in São Paulo, Brazil.

Global disability burden and its predictors among adult Nigerians living with Type- 2 diabetes

“…Our result that a unit increase in HbA1c and SBP corresponds to 6.2% and 0.5% respective increase in global disability suggests that people with T2DM, poor BP and glycaemic control are at high risk of burden of global disability. These observations are in agreement with previous report that T2DM with co-morbid conditions and poor glycaemic control (defined by HbA1c ≥ 7.0%) had a higher prevalence of functional disability 7,12. Indeed, all patients with T2DM require close monitoring in terms of health education, adjusted lifestyle assistance and lifestyle management to reduce disease burden.…”

“…Socio-economic status, obesity and exercise have been shown to explain the association between T2DM and disability 11. Other factors like gender, racial differences in functional limitations and co-existence of stroke and T2DM are reported to have great impact on disability prevalence 12,13. Gender and educational level are reported to affect work disability with the females more at risk 10.…”

Septic arthritis significantly increased the long-term mortality in geriatric patients

“…One of them is the dysfunction of the joint despite proper treatment, which results in subsequent disability of daily activity [ 16 ]. A study reported that severe activity of daily life (ADL) limitations and receiving ADL assistance significantly increased the subsequent mortality [odds ratio (OR): 19.75, 95% CI 9.81–39.76 and OR: 16.57, 95% CI 8.39–32.73, respectively] [ 17 ]. Another study reported that the disability for at least one ADL item predicted in-hospital death in the admitted geriatric patients (OR: 2.16, 95% CI: 1.55–2.99) [ 18 ].…”

Impact of Diabetes on Complications, Long Term Mortality and Recurrence in 608,890 Hospitalised Patients with Stroke

“…Patients with DM have been found to have an increased risk of overall stroke incidence and recurrence [2][3][4][5][6][7][8]. Previous studies have also confirmed that patients with diabetes are more likely to experience functional disability and suffer physical limitations after stroke [9]. However, research on the influence of DM on stroke outcomes, stratifying by event type (either ischaemic -IS or haemorrhagic -HS), is currently limited.…”