The Role of Cognitive Impairment and Caregiver Support in Diabetes Management of Older Outpatients

Abstract

Objectives:

To examine the role of cognitive impairment and caregiver support in diabetes care adherence and glycemic control.

Methods:

Fifty-one veteran male outpatients (27 with caregivers) aged 60 years and older with type 2 diabetes were evaluated for cognitive impairment with the Cognitive Abilities Screening Instrument. Patients or caregivers completed diabetes self-care and depression scales. Medical morbidity information and HbA1c plasma levels at baseline and 1 year later were obtained from electronic medical records.

Results:

Greater cognitive impairment (F = 5.1, p < .05), and presence of a caregiver (F = 5.3, p < .05), were independently associated with worse diabetes care adherence (adjusting for age, education, medical comorbidity, and depression). In addition, Mean HbA_1c levels were worse in the cognitively impaired group with caregivers relative to the three other groups (F = 4.10, p < .05, η² =.09). One year later, mean HbA_1c levels rose from 7.7 to 8.2% in the cognitively impaired group with caregivers.

Conclusion:

Cognitive impairment is associated with worse diabetes care management. Surprisingly, the presence of a caregiver is not protective. Further research is necessary to examine the healthcare needs of cognitively impaired, diabetic patients and their caregivers.

Keywords

cognitive impairment dementia diabetes mellitus self-care caregivers

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