%0 Journal Article %J Journal of the American Geriatrics Society %D 2015 %T Older Adults Reporting More Diabetes Mellitus Care Have Greater 9 Year Survival %A Benjamin H Han %A Caroline S Blaum %A Rosie Ferris %A Lillian C. Min %A Pearl G. Lee %K Health Conditions and Status %K Healthcare %X To determine whether receiving more recommended diabetes mellitus (DM) care processes (tests and screenings) would translate into better 9-year survival for middle-aged and older adults. Longitudinal mortality analysis using the Health and Retirement Study Diabetes Mailout Survey. Health and Retirement Study (HRS). Individuals aged 51 and older (n = 1,879; mean age 68.8 or - 8.7, 26.5 aged a yen 75) with self-reported DM who completed the Diabetes Mailout Survey and the core 2002 HRS survey. A composite measure of five self-reported diabetes mellitus care process measures were dichotomized as greater (3-5 processes) versus fewer (0-2 processes) care processes provided. Cox proportional hazards models were used to test relationships between reported measures and mortality, controlling for sociodemographic characteristics, function, comorbidities, geriatric conditions, and insulin use. Prevalence of self-reported care processes was 80.1 for glycosylated hemoglobin test, 75.9 for urine test, 67.5 for eye examination, 67.7 for aspirin counseling, and 48.2 for diabetes education. In 9 years, 32.1 respondents died. Greater care correlated with 24 lower risk of dying (adjusted hazard ratio = 0.76, 95 confidence interval = 0.64-0.91) at 9-year follow up. When respondents were age-stratified (a yen 75 vs 75) longer survival was statistically significant only in the older age group. Although it is not possible to account for differences in adherence to care that may also affect survival, this study demonstrates that monitoring of and counseling about types of DM care processes are associated with long-term survival benefit even in individuals aged 75 and older with DM. %B Journal of the American Geriatrics Society %I 63 %V 63 %P 2455 %G eng %N 12 %4 diabetes mellitus/process of care measures/quality of care/Hemoglobin/Diabetes therapy/Diabetes %$ 999999 %0 Journal Article %J Diabetes Care %D 2013 %T Physical Function Limitations Among Middle-Aged and Older Adults With Prediabetes One exercise prescription may not fit all %A Pearl G. Lee %A Christine T Cigolle %A Ha, Jinkyung %A Lillian C. Min %A Susan L Murphy %A Caroline S Blaum %A Herman, William H. %K Demographics %K Disabilities %K Event History/Life Cycle %K Health Conditions and Status %K Other %K Risk Taking %X OBJECTIVETo describe the prevalence of physical function limitations among a nationally representative sample of adults with prediabetes.RESEARCH DESIGN AND METHODSWe performed a cross-sectional analysis of 5,991 respondents 53 years of age from the 2006 wave of the Health and Retirement Study. All respondents self-reported physical function limitations and comorbidities (chronic diseases and geriatric conditions). Respondents with prediabetes reported no diabetes and had a measured glycosylated hemoglobin (HbA(1c)) of 5.7-6.4 . Descriptive analyses and logistic regressions were used to compare respondents with prediabetes versus diabetes (diabetes history or HbA(1c) 6.5 ) or normoglycemia (no diabetes history and HbA(1c) 5.7 ).RESULTSTwenty-eight percent of respondents 53 years of age had prediabetes; 32 had mobility limitations (walking several blocks and/or climbing a flight of stairs); 56 had lower-extremity limitations (getting up from a chair and/or stooping, kneeling, or crouching); and 33 had upper-extremity limitations (pushing or pulling heavy objects and/or lifting 10 lb). Respondents with diabetes had the highest prevalence of comorbidities and physical function limitations, followed by those with prediabetes, and then normoglycemia (P 0.05). Compared with respondents with normoglycemia, respondents with prediabetes had a higher odds of having functional limitations that affected mobility (odds ratio OR 1.48), the lower extremities (OR 1.35), and the upper extremities (OR 1.37) (all P 0.01). The higher odds of having lower-extremity limitations remained after adjusting for age, sex, and body mass index (OR 1.21, P 0.05).CONCLUSIONSComorbidities and physical function limitations are prevalent among middle-aged and older adults with prediabetes. Effective lifestyle interventions to prevent diabetes must accommodate physical function limitations. %B Diabetes Care %I 36 %V 36 %P 3076-3083 %G eng %N 10 %4 Impaired Glucose Tolerance/Geriatric Conditions/United-States/Life Style/Disability/Disability/Health/Prevalence/Reduction/Risk Factor %$ 999999 %R 10.2337/dc13-0412 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2012 %T Clinical complexity and mortality in middle-aged and older adults with diabetes. %A Christine T Cigolle %A Mohammed U Kabeto %A Pearl G. Lee %A Caroline S Blaum %K Activities of Daily Living %K Aged %K Comorbidity %K Diabetes Complications %K Diabetes Mellitus %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Proportional Hazards Models %K Self Care %X

BACKGROUND: Middle-aged and older adults with diabetes are heterogeneous and may be characterized as belonging to one of three clinical groups: a relatively healthy group, a group having characteristics likely to make diabetes self-management difficult, and a group with poor health status for whom current management targets have uncertain benefit.

METHODS: We analyzed waves 2004-2008 of the Health and Retirement Study and the supplemental Health and Retirement Study 2003 Diabetes Study. The sample included adults with diabetes 51 years and older (n = 3,507, representing 13.6 million in 2004). We investigated the mortality outcomes for the three clinical groups, using survival analysis and Cox proportional hazard models.

RESULTS: The 5-year survival probabilities were Relatively Healthy Group, 90.8%; Self-Management Difficulty Group, 79.4%; and Uncertain Benefit Group, 52.5%. For all age groups and clinical groups, except those 76 years and older in the Uncertain Benefit Group, survival exceeded 50%.

CONCLUSIONS: This study reveals the substantial survival of middle-aged and older adults with diabetes, regardless of health status. These findings have implications for the clinical management of and future research about diabetes patients with multiple comorbidities.

%B J Gerontol A Biol Sci Med Sci %I 67 %V 67 %P 1313-20 %8 2012 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/22492022?dopt=Abstract %4 Mortality/Diabetes Mellitus/Disease management/Physiological aspects/Prevalence/Demographic aspects/Diabetics/Health aspects/Older people %$ 69726 %R 10.1093/gerona/gls095 %0 Journal Article %J J Gen Intern Med %D 2011 %T Geriatric conditions develop in middle-aged adults with diabetes. %A Christine T Cigolle %A Pearl G. Lee %A Kenneth M. Langa %A Lee, Yuo-Yu %A Zhiyi Tian %A Caroline S Blaum %K Accidental Falls %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Diabetes Mellitus %K Dizziness %K Female %K Geriatric Assessment %K Health Status %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K pain %K Urinary incontinence %X

BACKGROUND: Geriatric conditions, collections of symptoms common in older adults and not necessarily associated with a specific disease, increase in prevalence with advancing age. These conditions are important contributors to the complex health status of older adults. Diabetes mellitus is known to co-occur with geriatric conditions in older adults and has been implicated in the pathogenesis of some conditions.

OBJECTIVE: To investigate the prevalence and incidence of geriatric conditions in middle-aged and older-aged adults with diabetes.

DESIGN: Secondary analysis of nationally-representative, longitudinal health interview survey data (Health and Retirement Study waves 2004 and 2006).

PARTICIPANTS: Respondents 51 years and older in 2004 (n=18,908).

MAIN MEASURES: Diabetes mellitus. Eight geriatric conditions: cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment, hearing impairment, pain.

KEY RESULTS: Adults with diabetes, compared to those without, had increased prevalence and increased incidence of geriatric conditions across the age spectrum (p< 0.01 for each age group from 51-54 years old to 75-79 years old). Differences between adults with and without diabetes were most marked in middle-age. Diabetes was associated with the two-year cumulative incidence of acquiring new geriatric conditions (odds ratio, 95% confidence interval: 1.8, 1.6-2.0). A diabetes-age interaction was discovered: as age increased, the association of diabetes with new geriatric conditions decreased.

CONCLUSIONS: Middle-aged, as well as older-aged, adults with diabetes are at increased risk for the development of geriatric conditions, which contribute substantially to their morbidity and functional impairment. Our findings suggest that adults with diabetes should be monitored for the development of these conditions beginning at a younger age than previously thought.

%B J Gen Intern Med %I 26 %V 26 %P 272-9 %8 2011 Mar %G eng %N 3 %L newpubs20110418_Cigolle.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/20878496?dopt=Abstract %2 PMC3043187 %4 geriatric conditions/diabetes/cognitive Impairment/falls/Incontinence/Vision Disorders/Hearing Disorders %$ 24780 %R 10.1007/s11606-010-1510-y %0 Journal Article %J J Am Geriatr Soc %D 2009 %T The co-occurrence of chronic diseases and geriatric syndromes: the health and retirement study. %A Pearl G. Lee %A Christine T Cigolle %A Caroline S Blaum %K Accidental Falls %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Angina Pectoris %K Comorbidity %K Cross-Sectional Studies %K Diabetes Mellitus, Type 2 %K Female %K Geriatric Assessment %K Health Surveys %K Heart Failure %K Humans %K Male %K Myocardial Infarction %K Sick Role %K Syndrome %K United States %K Urinary incontinence %X

OBJECTIVES: To analyze the co-occurrence, in adults aged 65 and older, of five conditions that are highly prevalent, lead to substantial morbidity, and have evidence-based guidelines for management and well-developed measures of medical care quality.

DESIGN: Secondary data analysis of the 2004 wave of the Health and Retirement Study (HRS).

SETTING: Nationally representative health interview survey.

PARTICIPANTS: Respondents in the 2004 wave of the HRS aged 65 and older.

MEASUREMENTS: Self-reported presence of five index conditions (three chronic diseases (coronary artery disease, congestive heart failure, and diabetes mellitus) and two geriatric syndromes (urinary incontinence and injurious falls)) and demographic information (age, sex, race, living situation, net worth, and education).

RESULTS: Eleven thousand one hundred thirteen adults, representing 37.1 million Americans aged 65 and older, were interviewed. Forty-five percent were aged 76 and older, 58% were female, 8% were African American, and 4% resided in a nursing home. Respondents with more conditions were older and more likely to be female, single, and residing in a nursing home (all P<.001). Fifty-six percent had at least one of the five index conditions, and 23% had two or more. Of respondents with one condition, 20% to 55% (depending on the index condition) had two or more additional conditions.

CONCLUSION: Five common conditions (3 chronic diseases, 2 geriatric syndromes) often co-occur in older adults, suggesting that coordinated management of comorbid conditions, both diseases and geriatric syndromes, is important. Care guidelines and quality indicators, rather than considering one condition at a time, should be developed to address comprehensive and coordinated management of co-occurring diseases and geriatric syndromes.

%B J Am Geriatr Soc %I 57 %V 57 %P 511-6 %8 2009 Mar %G eng %N 3 %L newpubs20090908/LeeJAG.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19187416?dopt=Abstract %3 19187416 %4 COMORBIDITY/Chronic Disease/Diabetes Mellitus/Heart Diseases %$ 20340 %R 10.1111/j.1532-5415.2008.02150.x