Diabetes Health Burden Negatively Impacts Quality of Life in Elderly Patients


A study published in Primary Care Diabetes pinpoints those at most risk and recommends education to improve the quality of life in diagnosed elderly patients.

Understanding diabetes, a common chronic condition in adults over 65, and its effects on quality of life (QoL), can reduce health burdens and result in better management and treatments.1

The disease can cause physical complications, such as coronary artery disease, stroke, retinopathy, neuropathy, and nephropathy. It can also cause negative social, emotional, and psychological impacts, researchers said. This can result in anxiety and stress that increase negative health outcomes.1

To measure how diabetes impacts QoL of people over 65, researchers performed a correlational and descriptive study between September 20, 2022, and November 20, 2022. They selected 207 elderly diabetes patients from private and public diabetes clinic settings in Istanbul, Turkey.

Participants were given a personal information form that collected socio-demographic and diabetes-related information. A majority of the participants (65.2%) were between 65 and 74 years old, and almost 88% reported having health insurance. Nearly half (48.8%) identified as female. Researchers said 27.2% of participants had primary school degrees. Over 84% were married, but only 34.8% reported living at home with their spouse. Just over 61% reported having average income. Almost 37% had been living with the condition for 6 to 10 years. Over 60% relied on oral antidiabetic medications and 32.9% used insulin to manage their diabetes. Nearly 80% of the participants did not report having any other chronic diseases.

Participants then filled out the “Elderly Diabetes Burden Scale (EDBS),” which contains 22 multiple-choice scale questions about 6 areas: symptom burden, social burden, dietary restrictions, worry about diabetes, treatment dissatisfaction, and burden by tablets or insulin. The scale is scored between 18 and 88, with higher numbers indicating greater burden.

The final survey for participants was the Quality of Life in the Elderly (CASP-19) Scale, which has 13 questions and examines autonomy and satisfaction perception, and barrier perception. Rating selection choices are 0/never, 1/seldom, 2/sometimes, and 3/always responses. Researchers noted that questions 1, 2, and 4 are reverse-graded and that a higher total score means a higher quality of life.

Researchers reported that the EDBS mean total score was 47.13 ± 11.95 and CASP-19 was 19.36 ± 7.00.1

For the EDBS, a statistically significant correlation was found between disease burden and use of oral antidiabetics, education level, gender, and who the patient lived with. The authors highlighted that these findings match previous studies.

Men were more likely to have a higher disease burden than women. “In this study, we think that women are more effective in self-management and care than men, since the sample is elderly individuals,” the authors wrote. Researchers found that those with lower education levels had a higher burden than more educated individuals. Using oral antidiabetics and living alone also correlated with a higher burden.

“Elderly individuals living alone and especially with chronic diseases are in the group with priority care compared to other individuals because they are more deficient in bio-psycho-social aspects,” researcher said. “For this reason, we thought that elderly individuals living alone had a higher diabetes burden due to their low diabetes self-management skills.”

For CASP-19, the connections between income level and the presence of other chronic diseases were the only statistically significant correlations. A negative correlation was found between CASP-19 and EDBS scale total scores. “It was also found that there was negative correlation between the CASP-19 scale total score and ‘worry about diabetes subscale’ and ‘burden by tablets or insulin subscale,’” researchers said.

The authors concluded that the elderly experience a moderate burden from diabetes based on the data. They said that to increase QoL, the diabetes burden needs to be reduced through targeted education programs to at-risk populations, such as those found in this and corroborating studies: men, those with lower education levels, those with lower incomes, those on oral antidiabetics, and those living alone.

1. Yildirim G, Rashidi M, Karaman F, et al. The relationship between diabetes burden and health-related quality of life in elderly people with diabetes [published online ahead of print, 2023 Sep 4]. Prim Care Diabetes. 2023;S1751-9918(23)00145-6. doi:10.1016/j.pcd.2023.08.007
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