The excess mortality risk of diabetes associated with functional decline in older adults: Results from a 7-year follow-up of a nationwide cohort in Taiwan

Chia-Lin Li,Yea-Ing L Shyu,Hsing-Yi Chang

doi:10.1186/1471-2458-11-953

Chia-Lin Li, Yea-Ing L Shyu + Show 1 more

Open Access

https://doi.org/10.1186/1471-2458-11-953

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Abstract

BackgroundDiabetes is associated with an increased risk of functional decline in older adults. Few studies have investigated the contribution of functional decline to excess mortality risk in older people with diabetes. The aim of this study was to examine how diabetes in combination with different levels of functional decline affects 7-year mortality in older adults.MethodsWe analyzed data from a nationally representative sample of people aged 65 years and over, participating in the 2001 National Health Interview Survey in Taiwan. A total of 1873 participants were followed through 2002-2008, of whom 286 (15.3%) had a history of diabetes confirmed by a medical professional. Participants were divided into three functional status groups: (1) high functioning-no limitations involving activities of daily living (ADLs), instrumental activities of daily living (IADLs), or physical functioning; (2) low functioning-limitations in one or more ADLs; (3) middle functioning-all participants in between groups 1 and 2.ResultsThe crude mortality rate was 52.7 per 1,000 person-years in those with diabetes and 34.1 per 1,000 person-years in those without diabetes. After adjustment for other factors, diabetes alone was not associated with an increased mortality risk in those with high functioning. However, diabetes alone had a hazard ratio (HR) for mortality of 1.90 (95%CI = [1.02-3.53]) in those with middle functioning and 3.67 (95%CI = [1.55-8.69]) in those with low functioning. The presence of diabetes and one or more other chronic conditions was associated with a HR for mortality of 2.46 (95%CI = [1.61-3.77]) in those with middle functioning and 4.03 (95%CI = [2.31-7.03]) in those with low functioning.ConclusionsOur results indicate that diabetes is not associated with increased mortality in those with high functioning. There was a gradient effect of functional decline on mortality in individuals with diabetes. Additionally, among participants with other chronic conditions, functional decline was associated with a greater burden of mortality in older adults with diabetes. These findings highlight the critical importance of the prevention of cardiovascular disease morbidity and the maintenance of functional abilities in order to reduce mortality risk in older adults with diabetes.

Highlights

Diabetes is associated with an increased risk of functional decline in older adults
We found that among participants with other chronic conditions, diabetes combined with functional decline was associated with a greater burden of mortality in older adults
Our study differs from most previous studies in that we further explored the effects of combinations of functional decline which more accurately reflect the true picture in the heterogeneous population of older people with diabetes

Summary

Introduction

Diabetes is associated with an increased risk of functional decline in older adults. Few studies have investigated the contribution of functional decline to excess mortality risk in older people with diabetes. Past studies have not explored whether this functional decline contributes to the excess mortality risk associated with diabetes in Epidemiological data from a nationally representative sample of U.S older adults, the National Health and Nutrition Examination Survey (NHANES 1999-2006), found that diabetes-related comorbidities such as cardiovascular disease may contribute to a greater burden of disability in those with diabetes [7]. In the Hoorn Study, Spijkerman et al [10] demonstrated that among participants aged 50 to 75 years with a short diabetes duration, mortality risk could largely be attributed to cardiovascular risk factors These findings indicate that comorbid cardiovascular disease is associated with both functional decline and mortality in older adults with diabetes. Few studies have examined the interrelationship between comorbidities, functional decline and risk of mortality in older adults with diabetes

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