Diabetes in the Elderly an Epidemiological Perspective

Abstract

A survey was performed to identify all known diabetics i n s defined population whose age distribution was similar to that of the UK. The study population consisted of all 90,660 patients registered with 40 general practitioners. Of these, 15,411 (17%) were elderly, ie aged 65 years or more Nine hundred and seventeen diabetics were identified from the total population, resulting in a prevalence for all ages of 1.01%. More than half (479) of all the diabetics were aged 65 years or over. Thus the prevalence for diabetes in the elderly was 3.1%. Age-specific rates for diabetes in the age group 65-74 years were 33.2/1000 for males and 24.8/1000 for females. In those over 75 years the rates increased to 45.7/1000 for males and 29.0/1000 for females.A detailed study of the 50 elderly diabetics from one of the group practices revealed a high prevalence of both cardiovascular disease (96%) and eye disease (40%). In the planning of diabetic services, specific provision must be made for the elderlv. who form a substantial Dart of the diabetic communitv. associated with a high morbidity.(6) Gardin J M, Henry W L, Savidge D D, Ware J H, Burn C, Borer J S. Echocardiographic measurements in normal subjects. Evaluation of an adult population without clinically apparent heart disease.A statistical and genetic study of diabetes.(1) Prevalence and morbidity. Annals Hum Genet Lond, 1971; 3 4 347-69.(9) Hill R D.Community care service for diabetes in the mole area. Br Med J, 1976; 1: 1137-9.(10)Thorne P A, Russell R G. Diabetic clinics today and tomorrow: mini clinics in general practice. Br Med J, 193; 2: 534-6.

Neurological disorders in the ageing population and their urological implications

“…Some 15–20% of individuals >65 years have hyperglycaemia or frank diabetes mellitus and studies suggest that up to 40% of those with diabetes will have some form of voiding dysfunction [ 15]. However, urinary symptoms are prominent by their absence in most epidemiological surveys of diabetes [ 16]. Diabetic cystopathy is part of a spectrum of autonomic dysfunction including gastro‐oesophageal atonia, hyperhydrosis, nocturnal diarrhoea, postural hypotension, erectile dysfunction and autonomic cardiac abnormalities.…”

“…However, some patients who are severely demented remain continent and possibly mobility rather than dementia per se is the best predictor of continence, followed by cognitive impairment, behavioural disturbance, restraints, comorbid conditions and drugs [ 23, 51]. Incontinence in demented patients was thought to be due to detrusor hyper‐reflexia, but this was based on a study with no urodynamics which diagnosed detrusor hyper‐reflexia in 93% of women and 97% of men [ 16], and on the theory that cerebral disease results in decreased inhibition of the micturition reflex. However, in a study of 133 incontinent female nursing‐home residents, 88% of whom had some degree of dementia, 41% had a normal bladder, 38% had detrusor instability, 16% had stress incontinence and 5% had retention with overflow [ 51].…”

Diabetes in the Elderly: Epidemiology

“…Tablet and insulin therapy in type 2 diabetes in the elderly Paper read to Section of Geriatrics & Gerontology, 29 September 1993 A H Barnett MD Professor of Diabetic Medicine, Undergraduate Centre, University of Birmingham and Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK Keywords: diabetes; elderly; oral hypoglycaemics; insulin therapy Summary There are a range oftherapeutic options available for the management oftype 2 diabetes in the elderly. Diet remains the mainstay of treatment although this must be realistic.…”