Reexamining the Classification of Older Adults With Diabetes by Comorbidities and Exploring Relationships With Frailty, Disability, and 5-year Mortality

Abstract

Background Limited research has been conducted to risk stratify older adults with diabetes. Our objective was to re-examine the 2005-06 classification systems in participants who are now five years older. Methods We examined a subsample of 884 community-residing older adults with the diagnosis of diabetes from the National Social Life, Health, and Aging Project (NSHAP). The primary objective was to utilize a latent class analysis (LCA) to fit a model to 11 comorbidities, comparing the 2010-11 LCA model to that of 2005-6. The secondary objective was to evaluate the association of the identified classes with frailty, disability, and five-year mortality. Results Both 2005-6 LCA and the 2010-11 LCA model fit three similar comorbidity profiles: Class 1 with the lowest rates of nearly all comorbidities, Class 2 had highest rates of obesity, hypertension, arthritis, and incontinence, and Class 3 had the higher rates of myocardial infarctions, congestive heart failure, and stroke. When compared to the healthier Class 1 (class probability=0.67), participants with a comorbidity profile with more prevalent cardiovascular conditions (Class 3; 0.09) were at higher risk of frailty and mortality, but not disability; whereas participants with a comorbidity profile with more prevalent geriatric syndrome conditions (Class 2; 0.24) were at higher risk of frailty and disability, but not mortality. Conclusions We reconfirmed three latent-classes with distinct comorbidity profiles among older adults with diabetes. However, the complex relationships between comorbidity classes with frailty, disability, and mortality will likely require revision of the current rationale for stratified goal setting and treatment selection.

13. Older Adults: Standards of Care in Diabetes—2023

“…While Table 13.1 provides overall guidance for identifying complex and very complex patients, there is not yet global consensus on geriatric patient classification. Ongoing empiric research on the classification of older adults with diabetes based on comorbid illness has repeatedly found three major classes of patients: a healthy, a geriatric, and a cardiovascular class (9,57). The geriatric class has the highest prevalence of obesity, hypertension, arthritis, and incontinence, and the cardiovascular class has the highest prevalence of myocardial infarctions, heart failure, and stroke.…”

The pattern of physical disability and determinants of activities of daily living among people with diabetes in Bangladesh

“…An excess risk of disability among patients with diabetes is not surprising given the associated multi‐morbidities 28,30 . As comorbidities are prevalent, 24 interventional programs promoting effective chronic disease management are indicated to promote active participation and to help delay the onset of ADL disabilities 31 .…”

“…An excess risk of disability among patients with diabetes is not surprising given the associated multi‐morbidities. 28 , 30 As comorbidities are prevalent, 24 interventional programs promoting effective chronic disease management are indicated to promote active participation and to help delay the onset of ADL disabilities. 31 Earlier studies among the US population reported that only controlling for existing comorbidities along with BMI can reduce the diabetes‐related odds by 52%.…”

Self-Care Experiences of Empty-Nest Elderly Living With Type 2 Diabetes Mellitus: A Qualitative Study From China

“…Comorbidities are common in older adults with diabetes, more than 97% of them had at least one of the comorbidities (43). Comorbidities not only increase the health care needs, utilization and mortality of people with diabetes (44)(45)(46), they also increase the complexity of disease management and the burden of self-management (47,48) which is a challenge for empty-nester patients to cope with. Decelerated physical function and care for a sick spouse in an empty-nester may be associated with reduced self-care, leading to decreased selfmanagement of diabetes.…”