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Health-Related Social Disengagement in Elderly Diabetic Patients

Association with subsequent disability and survival

¹ Center on Aging, University of Texas Medical Branch, Galveston, Texas
² Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
³ Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas

Address correspondence and reprint requests to Yong-Fang Kuo, PhD, Sealy Center on Aging, The University of Texas Medical Branch Galveston, TX 77555-0460. E-mail: yokuo{at}utmb.edu

OBJECTIVE—We examined the relationship between health-related social disengagements, as opposed to disengagements related to financial and other non–health-related factors, and subsequent risk of disability and death among initially nondisabled elderly diabetic patients enrolled in Medicare Managed Care plans.

RESEARCH DESIGN AND METHODS—We used data from the Medicare Health Outcomes Survey (HOS) Cohort 1 Baseline (1998) and Cohort 1 Follow-Up (2000). Through mail and telephone surveys, trained interviewers collected information on sociodemographic variables, physical and mental health functioning (using Medical Outcomes Study Short Form-36 [SF-36]), activities of daily living (ADL), and medical conditions. This study reported on diabetic subjects aged 65 years with no ADL disability at baseline (n = 8,949). Health-related social disengagement (degree to which physical health or emotional problems interfere with social activities) was derived from the social functioning subscale of SF-36 (range 0–100; higher scores depicting better social functioning).

RESULTS—For each 10-point increase in social functioning score at baseline, older diabetic subjects in our study experienced an 18% less chance of any ADL disability (odds ratio [OR] 0.82, 95% CI 0.75–0.89; P < 0.001) and a 12% less chance of death (0.88, 0.78–1.00; P = 0.043) over a 2-year period, adjusting for demographic factors, comorbidities, depression, and general health (assessed by the SF-36).

CONCLUSIONS—Among initially nondisabled older diabetic subjects, health-related interferences with social activities at baseline may be early warning signs of subsequent ADL disability and premature death, independent of other measures of health status.

Abbreviations: ADL, activities of daily living • CMS, Center for Medicare and Medicaid Services • COPD, chronic obstructive pulmonary disease • HEDIS, Health Plan Employer Data and Information Set • HOS, Health Outcomes Survey • NCQA, National Committee for Quality Assurance • SF-36, Medical Outcomes Study Short Form-36

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