Diabetes patients are a large and heterogeneous group. It is not clear if current pharmacotherapy and clinical services can handle the complexity of diabetes patients or whether this therapy can prevent or mitigate disability in older people.
The health and retirement study (HRS) has provided an insight into the percentage of people with various diseases that correlate to diabetes. For example, in the 51-60 years old age group diabetes is linked to cognitive impairment, which is absent in those without diabetes. In the group a decade older the same phenomenon is found with falls, and it is only in the very elderly that the effect of diabetes appears to go away. Thus diabetes exaggerates the effect of aging in terms of “geriatric conditions” until people are very elderly.
Between 1995 and 2006 in the HRS there was an increase in doctor visits and recorded co-morbidities. In this time ADL dependencies declined for those aged 80-90 years. However there was no reduction in ADL disability rates in people with diabetes who were in their seventies. In general, diabetes management improved during the period of this study which suggests that improved diabetes management did not improve ADL outcomes in the 70-80 years old age group.
There is some emerging evidence that in a more elderly group, steep declines in systolic and diastolic blood pressure may be linked to the risk of death. Thus there may be a case to reduce antihypertensive medication in the elderly if there are any concerns about medication side effects.
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