Geriatric syndromes and quality of life in older adults with diabetes

Yang, Yi Ching; Lin, Ming Hsing; Wang, Chong Shan; Lu, Feng Hwa; Wu, Jin Shang; Cheng, Hui; Lin, Shunfu

doi:10.1111/ggi.13654

Cited by 28 publications

(32 citation statements)

References 46 publications

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“…Uncontrolled diabetes results in metabolic disorders such as ketoacidosis, hyperosmosmolar syndromes, and dehydration, which may be life-threatening for an older person. It also significantly contributes to the development of the already mentioned geriatric comorbidities and deteriorates quality of life [12]. Therefore, an individual approach to a patient and hypoglycemic treatment modification based on the patient’s clinical condition, especially nutritional status, coexisting diseases, the degree of liver and kidney function, as well as the individual goals to be achieved are also important [38].…”

Section: Discussionmentioning

confidence: 99%

“…The necessity of therapy individualization based on patients’ characteristics was emphasized, in particular- their ability to identify and manage hypoglycemia. In older patients, this ability may be significantly adversely affected by common geriatric comorbidities such as functional disability, depression or dementia, to which diabetes predisposes [12, 13]. These comorbidities also adversely affect long-term survival prognosis [14].…”

Section: Introductionmentioning

confidence: 99%

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A retrospective cross-sectional study of type 2 diabetes overtreatment in patients admitted to the geriatric ward

Wojszel

Kasiukiewicz

2019

BMC Geriatr

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Background Glycemic control targets in older patients should be individualized according to functional status and comorbidities. The aim of the study was to identify high-risk patients who had evidence of tight glycemic control and thus at risk of serious hypoglycemia. Methods Retrospective cross-sectional study of type 2 diabetes patients admitted to the geriatric ward receiving diabetes medications. Patients’ hospital records were analyzed. The high risk of hypoglycemia group constituted patients who were aged 80+ years, diagnosed with dementia, with end- stage renal disease, or with a history of macrovascular complications. The primary outcome measure was hemoglobin A 1C (HbA 1C ) ≤ 7.0% [53 mmol/mol]. Results Two hundred thirteen patients were included (77.5% women; 49.3% 80+ year-old). 65.3% received sulfonylurea, 39,4%- metformin, 32.9%- insulin, and 4.2%- acarbose (in 61.5% as monotherapy, and in 38.5% combination therapy). We identified 130 patients (60%) as the denominator for the primary outcome measure; 73.1% had a HbA 1C value ≤7.0% [53.3 mmol/mol], but 55.4% ≤6,5% [48.8 mmol/mol], and 40.8% ≤6.0% [42 mmol/mol]. Conclusions The results show a very high rate of tight glycemic control in older patients admitted to the geriatric ward, for whom higher HbA 1C targets are recommended. This indicates the high probability of diabetes overtreatment in this group, associated with a high risk of recurrent hypoglycemia. This is all the more likely because most of them received medications known to cause hypoglycemia. This points to the need of paying more attention to specific difficulties in diabetes treatment in older people, especially those suffering from various geriatric syndromes and diseases worsening their prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A retrospective cross-sectional study of type 2 diabetes overtreatment in patients admitted to the geriatric ward

Wojszel

Kasiukiewicz

2019

BMC Geriatr

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“…Cognitive status was assessed with the S-MMSE (range 0-30), with higher scores indicating less cognitive impairment [19]. The disease severity was defined as mild (S-MMSE > 21), moderate (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21), or severe (< 10) [20]. Participants who were unable to perform the S-MMSE due to cognitive or functional impairment were placed into the "severe dementia" group.…”

Section: Sample Characteristicsmentioning

confidence: 99%

“…Geriatric syndromes are known to predict an increased likelihood of hospitalisation, affect quality of life [11], increase the use and cost of health care, and raise overall mortality among the general older population [12,13]. However, relevant geriatric syndromes such as malnutrition or falls have not been evaluated as potential factors associated with hospital admissions in the studies involving people with dementia [9].…”

Section: Introductionmentioning

confidence: 99%

Emergency department and hospital admissions among people with dementia living at home or in nursing homes: results of the European RightTimePlaceCare project on their frequency, associated factors and costs

et al. 2020

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Background Evidence is lacking on the differences between hospitalisation of people with dementia living in nursing homes and those living in the community. The objectives of this study were: 1) to describe the frequency of hospital admission among people with dementia in eight European countries living in nursing homes or in the community, 2) to examine the factors associated with hospitalisation in each setting, and 3) to evaluate the costs associated with it. Methods The present study is a secondary data analysis of the RightTimePlaceCare European project. A cross-sectional survey was conducted with data collected from people with dementia living at home or who had been admitted to a nursing home in the last 3 months, as well as from their caregivers. Data on hospital admissions at 3 months, cognitive and functional status, neuropsychiatric symptoms, comorbidity, polypharmacy, caregiver burden, nutritional status, and falls were assessed using validated instruments. Multivariate regression models were used to investigate the factors associated with hospital admission for each setting. Costs were estimated by multiplying quantities of resources used with the unit cost of each resource and inflated to the year 2019. Results The study sample comprised 1700 people with dementia living in the community and nursing homes. Within 3 months, 13.8 and 18.5% of people living in nursing homes and home care, respectively, experienced ≥1 hospital admission. In the nursing home setting, only polypharmacy was associated with a higher chance of hospital admission, while in the home care setting, unintentional weight loss, polypharmacy, falls, and more severe caregiver burden were associated with hospital admission. Overall, the estimated average costs per person with dementia/year among participants living in a nursing home were lower than those receiving home care. Conclusion Admission to hospital is frequent among people with dementia, especially among those living in the community, and seems to impose a remarkable economic burden. The identification and establishment of an individualised care plan for those people with dementia with polypharmacy in nursing homes, and those with involuntary weight loss, accidental falls, polypharmacy and higher caregiver burden in the home care setting, might help preventing unnecessary hospital admissions.

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“…Our study evaluated geriatric syndromes as markers of vulnerability and complexity in people with dementia. Geriatric syndromes are known to predict an increased likelihood of hospitalization, affect quality of life (50), increase the use and cost of health care, and raise overall mortality among the general elderly population (51). In the present study, the presence of three geriatric syndromes (malnutrition, history of falls or polypharmacy) was associated with a higher risk of hospital transfer.…”

Section: Discussionmentioning

confidence: 52%

Hospital transfer of people with dementia: results of the European RightTimePlaceCare project on their frequency, factors associated and costs

Afonso-Argilés¹,

Meyer²,

Stephan³

et al. 2020

Preprint

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Background Hospitalisation is a critical moment for people with dementia and a major challenge for health care systems. The aims of this study were 1) to describe the frequency of hospital transfer among people with dementia from eight European countries, 2) to examine the factors associated with hospital transfer and 3) to evaluate the costs related with it. Methods The present study is a secondary data analysis of the RightTimePlaceCare European project. A cross-sectional survey was carried out with data collected from people with dementia who lived either at home or had been admitted to a nursing home in the last three months, as well as from their caregivers. Data on hospital transfers at three months were gathered with the "The Resource Utilization in Dementia" instrument. Demographic data, functional, cognitive and neuropsychiatric symptoms, comorbidity, polypharmacy, caregiver burden, nutritional status and falls were evaluated with validated tools. Multivariate regression models were used to investigate the factors associated with hospital transfers. Costs were estimated by multiplying quantities of resources used with the unit cost of each resource and inflated to the year 2018. Results The study sample comprised 1,700 people with dementia and their informal caregivers. Within three months, 16.7% experienced ≥ 1 hospital transfers. Multivariate logistic regression model showed a higher probability of hospital transfers among people with dementia with unintentional weight loss, polypharmacy, falls and those living in the community. The estimated costs per person with dementia/year among the participants living in a nursing home were 980.56 euros and 2,535.39 euros among those receiving home care. Conclusion Transfer to hospital is frequent among people with dementia, especially among those living in the community. These events are associated with the onset of geriatric syndromes such as involuntary weight loss, accidental falls and polypharmacy, and impose a remarkable economic burden. These results suggest that there is a need to develop and implement cost-effective supportive interventions that focus on the identification of people with dementia at risk of hospital transfer, the assessment and management of these geriatric syndromes and the promotion of individualised care planning for them, in order to prevent unnecessary hospital transfers.

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Geriatric syndromes and quality of life in older adults with diabetes

Cited by 28 publications

References 46 publications

A retrospective cross-sectional study of type 2 diabetes overtreatment in patients admitted to the geriatric ward

A retrospective cross-sectional study of type 2 diabetes overtreatment in patients admitted to the geriatric ward

Emergency department and hospital admissions among people with dementia living at home or in nursing homes: results of the European RightTimePlaceCare project on their frequency, associated factors and costs

Hospital transfer of people with dementia: results of the European RightTimePlaceCare project on their frequency, factors associated and costs

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