Health-Related Social Disengagement in Elderly Diabetic Patients

Abstract

OBJECTIVE -We examined the relationship between health-related social disengagements, as opposed to disengagements related to financial and other non-health-related factors, and subsequent risk of disability and death among initially nondisabled elderly diabetic patients enrolled in Medicare Managed Care plans. RESEARCH DESIGN AND METHODS -We used data from the Medicare HealthOutcomes Survey (HOS) Cohort 1 Baseline (1998) and Cohort 1 Follow-Up (2000). Through mail and telephone surveys, trained interviewers collected information on sociodemographic variables, physical and mental health functioning (using Medical Outcomes Study Short Form-36 ), activities of daily living (ADL), and medical conditions. This study reported on diabetic subjects aged Ն65 years with no ADL disability at baseline (n ϭ 8,949). Healthrelated social disengagement (degree to which physical health or emotional problems interfere with social activities) was derived from the social functioning subscale of SF-36 (range 0 -100; higher scores depicting better social functioning).RESULTS -For each 10-point increase in social functioning score at baseline, older diabetic subjects in our study experienced an 18% less chance of any ADL disability (odds ratio [OR] 0.82, 95% CI 0.75-0.89; P Ͻ 0.001) and a 12% less chance of death (0.88, 0.78 -1.00; P ϭ 0.043) over a 2-year period, adjusting for demographic factors, comorbidities, depression, and general health (assessed by the SF-36).CONCLUSIONS -Among initially nondisabled older diabetic subjects, health-related interferences with social activities at baseline may be early warning signs of subsequent ADL disability and premature death, independent of other measures of health status. Diabetes Care 27:1630 -1637, 2004T he disablement process in patients with diabetes involves several steps: progressive accumulation of comorbidities (such as stroke, heart attack, renal failure, and limb amputations), physiologic and anatomic impairments (such as peripheral nerve dysfunction, peripheral artery disease, and visual impairment), and functional limitations (such as walking limitations and poor balance) (1-11). Research on the disablement process has influenced current research and clinical efforts directed at reducing diabetesrelated disability and mortality. For example, data from the Diabetes Control and Complications Trial (DCCT) Research Group and the U.K. Prospective Diabetes Study (UKPDS) Group studies showed that optimal control of blood pressure, blood glucose levels, and lipid levels significantly decreased the risks of diabetic complications and diabetesrelated disability (1,4).However, comorbidities secondary to diabetes do not fully explain the relationship between diabetes and disability (5,6,9). For instance, Gregg et al. (6), in a study of 527 women with diabetes aged Ն65 years, reported a 42% increased risk of incident disability (inability to walk, climb stairs, and perform household chores, among others) over a 12-year period, even after adjustments were made for comorbidities (such as s...

Can Self-Rated Health Scores Be Used for Risk Prediction in Patients With Type 2 Diabetes?

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Depression and Risk of Mortality in People with Diabetes Mellitus: A Systematic Review and Meta-Analysis

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Age of Migration and the Incidence of Cognitive Impairment: A Cohort Study of Elder Mexican-Americans

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