About 50% of adults with diabetes are ages 50 and older. As individuals age, their living situation changes which may impact self-care and glycemic control (GC). We examined predictors of GC among older adults with diabetes stratified by living environment; defined as living independently, living at home with a caregiver, or living in a nursing home.
Data on 2370 adults ages 50 and older with diabetes from the Health and Retirement Study (2006 - 2014) was analyzed. Generalized estimating equations were used to assess the association between HbA1c and living environment. GC was the outcome and living environment was the primary independent variable. Covariates were socioeconomic factors, cognitive impairment, functional limitations, health status, lifestyle, and comorbidities. We also identified predictors of GC stratified by living environment.
Unadjusted models showed no difference in HbA1c for individuals living with a caregiver compared to those living independently. Living in a nursing home was associated with lower HbA1c (β -0.33; p=0.011), however after adjusting for covariates the relationship was not significant. Predictors of GC among older adults living independently were: age (β -0.018; p<0.001), being female (β -0.20; p=0.007), non-Hispanic Black (β 0.53; p<0.001), Hispanic/Other (β 0.47; p<0.001), no physical activity (β -0.20; p=0.032). Predictors of GC among older adults living at home with a caregiver were: having a GED/high school diploma (β -0.49; p=0.029), not being physically active (β -0.45; p=0.013), and ADLs (β 0.12; p=0.03). Predictors of GC among older adults living in a nursing home were being Hispanic/Other (β 0.94; p=0.048).
In this nationally representative sample, type of living environment does not have an effect on GC, however predictors of GC varied across living environment. Interventions need to be tailored to living environment of seniors.
A.Z. Dawson: None. K. Lu: None. R.J. Walker: None. L.E. Egede: None.
American Diabetes Association (1-19-JDF-075 to R.J.W.); National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699, R01DK118038, R01DK120861); National Institute on Minority Health and Health Disparities (R01MD013826)