The assessment and management of quality of life of older adults with diabetes mellitus

ABSTRACT

Introduction: As the population ages, the number of older adults with diabetes mellitus will continue to rise. The burden of diabetes on older adults is significant due to the disease itself, its complications, and its treatments. This is compounded by geriatric syndromes such as frailty and cognitive dysfunction. Consequently, health and diabetes-related quality of life (QoL) are diminished.

Areas covered: This article reviews the value of assessing QoL in providing patient-centered care and the associations between QoL measures and health outcomes. The determinants of QoL particular to diabetes and the older population are reviewed, including psychosocial, physical, and cognitive burdens of diabetes and aging and the impact of hypoglycemia on QoL. Strategies are described to alleviate these burdens and improve QoL, and barriers to multidisciplinary patient-centered care are discussed. QoL measurement instruments are reviewed.

Expert opinion: The goals of treating diabetes and its complications should be considered carefully along with each patient’s capacity to withstand the burdens of treatment. This capacity is reduced by socioeconomic, psychological, cognitive, and physical factors reduces this capacity. Incorporating measurement of HRQoL into clinical practices is possible, but deficiencies in the systems of health-care delivery need to be addressed to facilitate their use.

KEYWORDS:

• Diabetes
• elderly
• quality of life
• diabetes distress
• treatment burden
• geriatric syndromes

Article highlights

• Patients with diabetes experience a large burden both from the disease and its complications as well as from its treatments. Quality of life is reduced when the burden of disease exceeds the patient’s capacity to cope.

• The burden of diabetes affects the older adult particularly due to vulnerabilities from comorbidities, psychosocial factors, and geriatric syndromes including frailty and cognitive impairment.

• There is often a disconnect between the physician’s perception of the burden of care and the patient’s assessment of his/her quality of life and health status.

• Assessments of general and diabetes-specific quality of life provide an opportunity for shared decision-making and help physicians provide interventions to alleviate the burden of care when possible.

• Significant changes to the health-care system are needed to incorporate discussions of quality of care into daily practice without placing the burden solely on the physician.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by the Department of Veterans Affairs Health Services Research & Development Service (HSR&D) PPO 18-051 (PI: D. Aron).