Disease Burden in the Community Dwelling Medicare Population and Impact on Lifestyle Interventions

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 839-872-Diabetes & Obesity Management
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-869
Elizabeth A Koller*1, Luping Qu2 and Gerald Adler2
1Centers for Medicare & Medicaid Services, MD, 2Centers for Medicare and Medicaid Services
BACKGROUND: Lifestyle changes have been promoted for diabetes (DM) management and prevention. How co-morbid disease and life expectancy affect translation to geriatric populations is not well understood.

METHODS: De-identified, x-sectional data were extracted from the 2004 Medicare Current Beneficiary Survey in which 15559 beneficiaries, residing in the community or chronic care facilities, or their caregivers were interviewed. General questions provided data about demographic traits, functional status, and disease burden. Supplemental questions provided DM data. Descriptive statistics were used to characterize the population.

RESULTS: 14500 community dwelling beneficiaries were identified (eligible by age alone [EBA] ≥65 yrs: 11015; eligible by disability [EBD] and ≥65 yrs: 1003; EBD and <65 yrs: 2482). In these 3 populations, obesity (BMI ≥30 kg/m2) prevalence was 20, 30, and 41% while pre/borderline diabetes (PBD) + DM prevalence was 19, 32, and 21%.

Exercise (E) alone, diet (D) alone, D + E, or neither were used by 8, 33, 47, and 12% of EBA patients with DM. 23% of D alone users and 20% of non-users reported difficulties with basic activities of daily living (ADLs).

Obese, non-DM EBA beneficiaries ≥75 yrs were 4x as likely to report difficulties with ADLs as younger, non-obese patients. Obese patients with ADL difficulties were 5 yrs older than those without ADL difficulties and 4 yrs younger than non-obese patients with ADL difficulties.  

Coronary heart disease (CHD) and arthritic-orthopedic conditions were the most common co-morbidities that could impact exercise capacity. Some co-morbidities that could impact function and/or survival were more common in those with DM, e.g., CHD, stroke, and impaired vision, whereas others, e.g., history of non-skin cancer (14%), were not. The number of concurrent co-morbidities increased with age.

Disease burden was even greater in EBD beneficiaries. Despite the median age of 45 for the EBD <65 yrs cohort, the disorders  resulting in Medicare eligibility (psychiatric [21%], arthritic-orthopedic [20%], neurologic [12%], intellectual [11%], cardiovascular [7%]) themselves decrease function (68% with mobility limitations) and pre-dispose to additional subsequent co-morbidity, e.g., CHD prevalence in EBD rose from 18% in those <65 yrs to 43% in those ≥65 yrs (vs 27% in EBA).

CONCLUSION: Pre-existing disability and disease accrued with age may limit the feasibility of implementing lifestyle interventions with exercise.

Nothing to Disclose: EAK, LQ, GA

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: No financial support Disclaimer: The views expressed represent those of the authors and not necessarily the Centers for Medicare and Medicaid Services or the U.S. Federal Government