Comorbidities and Cognitive Impairment and Functional Decline in Older Adults with Diabetes: Impact on Health Care Utilization

Background: Considerable efforts have been made to implement diabetes care management strategies to improve diabetes outcomes. These strategies have been aimed not only at limiting the adverse impact of diabetes on health but at reducing the enormous impact of diabetes on health care costs. Few studies have examined the association between clinical complex health status and diabetes care management and health care service utilization among older adults with diabetes. Objective: The objectives of this study are shown as followed. First year: We defined 3 health status groups of older adults with diabetes based on the literature. To investigate the distribution of complex health status and its impact on diabetes care management. We also aimed to explore the association between socioeconomic factors and clinical complex health status in older adults with diabetes. Second year: To examine the impact of complex health status and diabetes care management on health care service utilization among older adults with diabetes. Method: The study population included participants in the National Health Interview Survey (NHIS) in Taiwan in 2005 and 2009. Those individuals with diabetes aged 65 and above will be included in this study. Of the potential participants, those who provided consent for data linkage to 2005-2007 and 2009-2011 claims data from the Bureau of National Health Insurance could be obtained, will be eligible for analysis to explore the association between the complex health status and health care utilization in the present study. In this study, the Mini-Mental State Examination was used to assess cognitive function. Functional status was examined as reporting limitations in one or more tasks of activities of daily living (ADL), instrumental activities of daily living (IADL) or general physical activities (GPA). We defined 3 health status groups based on the literature of comorbidities and cognitive function and functional status. Statistical analysis: Logistic regression analysis will be performed to assess the association between complex health status and diabetes care management. Negative binomial regression and Generalized linear models will be used to estimate the parameters specified in the health care utilization model. We used the SAS (SAS Institute, Cary, NC)-callable SUDAAN (RTI Inc., Research Triangle Park, NC) for all analyses.

Project ID:PF10501-2237
External Project ID:MOST104-2410-H182-024-MY2