THE EFFECT OF ADHERENCE TO DIABETES GUIDELINES ON NURSING HOME ENTRY AND HEALTH AT TIME OF ADMISSION

Abstract

Diabetes Mellitus (DM) is a chronic disease that is highly prevalent in the U.S. and is associated with multiple co-morbidities as well as reduced physical and cognitive function. When admitted to nursing homes, beneficiaries with DM are characterized by comparatively high levels of functional disability, the presence of many co-morbid conditions, and could represent a sub-population of residents requiring especially intensive care and representing a dis-proportional social and financial burden. Adherence to diabetes management guidelines such as those provided by the American Diabetes Association (ADA) have been shown to be protective against many diabetes-related adverse health outcomes, but the role of adherence in reducing the risk of requiring nursing home care and/or improving the overall health status at time of admission has not been fully addressed. The purpose of this paper is to identify how adherence to ADA guidelines in U.S. Medicare beneficiaries age 65+ affects the risk of nursing home entry and functional, cognitive and co-morbidity status at the time of admission. Data from the Health and Retirement Study, linked to Medicare administrative claims was used to identify the presence of a new diagnosis of DM, the presence of co-morbidities and adherence to guidelines. Data on new nursing home admissions as well as detailed, professional in-person new resident assessments were drawn from the HRS-linked Minimum Dataset. The results of this study will aid in public health awareness efforts aimed at combating the diabetes pandemic and reducing the burden of DM to both the patient and society.