Table 1.
Characteristics of older Veterans with potentially overtreated diabetes living in Community Living Centers with limited life expectancy or advanced dementia, overall and stratified by baseline HbA1c (N=3,056).
| Stratified by baseline HbA1c, % |
|||||
|---|---|---|---|---|---|
| Characteristics, % | Overall (N=3,056) | <6.0 (n=811) | 6.0-<6.5 (n=769) | 6.5-<7.0 (n=816) | 7.0–7.5 (n=660) |
| Age in years | |||||
| 65–74 | 37.9 | 43.3 | 37.5 | 35.2 | 35.0 |
| 75–84 | 41.0 | 39.7 | 41.2 | 41.4 | 41.7 |
| ≥85 | 21.2 | 17.0 | 21.3 | 23.4 | 23.3 |
| Racial/ethnic minority | 24.2 | 26.1 | 23.1 | 24.1 | 23.0 |
| Married | 53.1 | 51.4 | 54.2 | 53.7 | 53.0 |
| Nursing home source of admission | |||||
| Acute hospital | 67.5 | 68.8 | 65.8 | 67.0 | 68.3 |
| Home / assisted living | 21.6 | 21.7 | 22.6 | 21.3 | 20.8 |
| Nursing home | 8.0 | 6.3 | 8.8 | 8.6 | 8.2 |
| Other | 2.9 | 3.2 | 2.7 | 3.1 | 2.7 |
| End of life conditions | |||||
| Advanced dementia1 | 29.0 | 25.2 | 31.9 | 29.3 | 29.8 |
| Documentation of end-of-life prognosis2 | 13.8 | 12.1 | 12.6 | 12.7 | 18.5 |
| Physical functioning3 | |||||
| Requiring extensive dependence | 38.9 | 37.7 | 39.8 | 35.2 | 43.8 |
| Physically dependent | 37.1 | 39.3 | 36.8 | 37.9 | 33.8 |
| Pain in the five days preceding MDS admission assessment | 67.7 | 67.9 | 66.8 | 66.2 | 70.5 |
| Body mass index | |||||
| Underweight | 3.8 | 4.3 | 3.4 | 3.1 | 4.5 |
| Normal or healthy weight | 33.8 | 33.3 | 35.2 | 35.4 | 30.9 |
| Overweight | 32.0 | 33.4 | 31.3 | 31.1 | 32.3 |
| Obese | 30.3 | 29.0 | 30.0 | 30.4 | 32.3 |
| Number of Elixhauser comorbidities | |||||
| 0–1 | 8.8 | 9.5 | 7.3 | 9.2 | 9.2 |
| 2–3 | 21.6 | 18.0 | 22.4 | 25.1 | 20.6 |
| 4–5 | 30.2 | 28.7 | 29.6 | 31.1 | 31.7 |
| ≥6 | 39.4 | 43.8 | 40.7 | 34.6 | 38.5 |
| Cardiovascular disease | |||||
| Coronary artery disease | 68.4 | 67.2 | 68.7 | 69.0 | 68.8 |
| Congestive heart failure | 44.9 | 46.7 | 45.3 | 44.2 | 43.2 |
| Stroke | 29.0 | 28.1 | 30.7 | 29.3 | 27.7 |
| Hypertension | 95.4 | 95.6 | 95.2 | 96.1 | 94.7 |
| Potential diabetes-related complications | |||||
| End-stage renal disease | 26.8 | 31.7 | 25.6 | 23.2 | 26.5 |
| Peripheral vascular disease | 31.9 | 34.3 | 31.3 | 30.6 | 31.2 |
| Diabetic eye disease | 16.7 | 16.3 | 14.8 | 17.3 | 18.8 |
| Lower extremity ulcers | 22.6 | 26.0 | 19.6 | 22.5 | 22.0 |
| Serious hypoglycemic event | 8.5 | 8.9 | 7.2 | 8.5 | 9.8 |
| Difficulty swallowing | 18.1 | 19.2 | 19.8 | 17.3 | 15.6 |
| Recent weight loss | 48.9 | 53.8 | 49.9 | 49.5 | 41.1 |
| History of falls / fractures | 47.1 | 44.0 | 47.5 | 48.7 | 48.5 |
| Specific medications | |||||
| Antidepressants | 39.3 | 39.8 | 43.6 | 37.6 | 35.9 |
| Antipsychotics | 15.6 | 14.9 | 17.4 | 14.7 | 15.3 |
Abbreviations: MDS: Minimum Data Set; MMRI-R: MDS Mortality Risk Index – Revised.
Advanced dementia was defined as having a Brief Interview for Mental Status score ≤7 (range: 0–15) or a Cognitive Performance Score ≥4 (range: 0–6).
Documentation of end-of-life prognosis was defined as having hospice treatment specialty, receiving hospice care in the 14 days prior to the MDS admission assessment, or having ≤6 months life expectancy documented on the MDS assessment.
Physical functioning was defined using the MDS Activities of Daily Living Self-Performance Hierarchy (range: 0–6) to categorize residents as being independent to requiring mild assistance (0–2), requiring extensive assistance (3–4), or being physically dependent (5–6).