Progression of Lower-Extremity Disability in Older Women With Diabetes
The Women’s Health and Aging Study
- Stefano Volpato, MD, MPH12,
- Luigi Ferrucci, MD, PHD3,
- Caroline Blaum, MD4,
- Glenn Ostir, PHD12345,
- Anne Cappola, MD, SCM6,
- Linda P. Fried, MD, MPH4,
- Renato Fellin, MD, PHD2 and
- Jack M. Guralnik, MD, PHD1
- 1Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, Maryland
- 2Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy
- 3Geriatric Department, Italian National Institute for Research and Care on Aging (INRCA), Florence, Italy
- 4Departments of Medicine and Epidemiology, the Johns Hopkins Medical Institutions, Baltimore, Maryland
- 5Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
- 6Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland
Abstract
OBJECTIVE—Older patients with diabetes are more likely to have a higher prevalence of multiple risk factors for physical disability, as a result of diabetic complications. We evaluated the pace of decline in lower-extremity function and the risk for progression of disability in older women with diabetes.
RESEARCH DESIGN AND METHODS—We conducted a 3-year longitudinal cohort study of a random sample of 729 physically impaired older women (age ≥65 years) living in the community (Baltimore, MD). Diabetes was ascertained by standard criteria. Self-reported functional status and objective performance measures were assessed at baseline and over six semiannual follow-up visits.
RESULTS—The baseline prevalence of diabetes was 14.4%. After adjustment for age and compared with women without diabetes, those with diabetes had an RR of 1.8 (95% CI 1.3–2.5) for incident mobility disability and 1.6 (1.2–2.1) for incident activity of daily living disability. The increased incidence of new disability associated with diabetes was paralleled by a greater decline in objective measures of lower-extremity function. Adjustment for multiple risk factors for disability did not significantly attenuate the risk for disability associated with diabetes.
CONCLUSIONS—In older patients, impaired lower-extremity function is a long-term diabetic complication. Comprehensive assessment of older diabetic patients should include a standardized evaluation of lower-extremity performance.
Footnotes
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Address correspondence and reprint requests to Stefano Volpato, MD, MPH, Department of Clinical and Experimental Medicine, University of Ferrara, Section of Internal Medicine II, Via Savonarola, 9, I-44100 Ferrara, Italy. E-mail: vlt{at}unife.it.
Received for publication 7 May 2002 and accepted in revised form 3 October 2002.
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