The Role of Nursing Home Admission and Dementia Status on Care for Diabetes Mellitus

Authors

  • Charlene C. Quinn RN, PhD,

    1. From the *Division of Gerontology, Department of Epidemiology and Preventive Medicine and Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland and Geriatrics Service, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland; §Peter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; #Department of Health Policy Management, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland; and **National Opinion Research Center, University of Chicago, Bethesda, Maryland.
    Search for more papers by this author
  • Ann L. Gruber-Baldini PhD,

    1. From the *Division of Gerontology, Department of Epidemiology and Preventive Medicine and Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland and Geriatrics Service, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland; §Peter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; #Department of Health Policy Management, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland; and **National Opinion Research Center, University of Chicago, Bethesda, Maryland.
    Search for more papers by this author
  • Cynthia L. Port PhD,

    1. From the *Division of Gerontology, Department of Epidemiology and Preventive Medicine and Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland and Geriatrics Service, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland; §Peter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; #Department of Health Policy Management, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland; and **National Opinion Research Center, University of Chicago, Bethesda, Maryland.
    Search for more papers by this author
  • Conrad May MD,

    1. From the *Division of Gerontology, Department of Epidemiology and Preventive Medicine and Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland and Geriatrics Service, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland; §Peter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; #Department of Health Policy Management, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland; and **National Opinion Research Center, University of Chicago, Bethesda, Maryland.
    Search for more papers by this author
  • Bruce Stuart PhD,

    1. From the *Division of Gerontology, Department of Epidemiology and Preventive Medicine and Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland and Geriatrics Service, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland; §Peter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; #Department of Health Policy Management, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland; and **National Opinion Research Center, University of Chicago, Bethesda, Maryland.
    Search for more papers by this author
  • J. Richard Hebel PhD,

    1. From the *Division of Gerontology, Department of Epidemiology and Preventive Medicine and Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland and Geriatrics Service, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland; §Peter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; #Department of Health Policy Management, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland; and **National Opinion Research Center, University of Chicago, Bethesda, Maryland.
    Search for more papers by this author
  • Sheryl Zimmerman PhD,

    1. From the *Division of Gerontology, Department of Epidemiology and Preventive Medicine and Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland and Geriatrics Service, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland; §Peter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; #Department of Health Policy Management, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland; and **National Opinion Research Center, University of Chicago, Bethesda, Maryland.
    Search for more papers by this author
  • Lynda Burton ScD,

    1. From the *Division of Gerontology, Department of Epidemiology and Preventive Medicine and Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland and Geriatrics Service, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland; §Peter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; #Department of Health Policy Management, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland; and **National Opinion Research Center, University of Chicago, Bethesda, Maryland.
    Search for more papers by this author
  • Ilene H. Zuckerman PharmD, PhD,

    1. From the *Division of Gerontology, Department of Epidemiology and Preventive Medicine and Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland and Geriatrics Service, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland; §Peter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; #Department of Health Policy Management, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland; and **National Opinion Research Center, University of Chicago, Bethesda, Maryland.
    Search for more papers by this author
  • Cheryl Fahlman PhD,

    1. From the *Division of Gerontology, Department of Epidemiology and Preventive Medicine and Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland and Geriatrics Service, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland; §Peter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; #Department of Health Policy Management, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland; and **National Opinion Research Center, University of Chicago, Bethesda, Maryland.
    Search for more papers by this author
  • Jay Magaziner PhD

    1. From the *Division of Gerontology, Department of Epidemiology and Preventive Medicine and Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland and Geriatrics Service, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland; §Peter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; #Department of Health Policy Management, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland; and **National Opinion Research Center, University of Chicago, Bethesda, Maryland.
    Search for more papers by this author

Address correspondence to Charlene C. Quinn, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 660 W. Redwood Street, Baltimore, MD 21201. E-mail: cquinn@epi.umaryland.edu

Abstract

OBJECTIVES: To study the role of nursing home (NH) admission and dementia status on the provision of five procedures related to diabetes mellitus.

DESIGN: Retrospective cohort study using data from a large prospective study in which an expert panel determined the prevalence of dementia.

SETTING: Fifty-nine Maryland NHs.

PARTICIPANTS: Three hundred ninety-nine new admission NH patients with diabetes mellitus.

MEASUREMENTS: Medicare administrative claims records matched to the NH medical record data were used to measure procedures related to diabetes mellitus received in the year before NH admission and up to a year after admission (and before discharge). Procedures included glycosylated hemoglobin, fasting blood glucose, dilated eye examination, lipid profile, and serum creatinine.

RESULTS: For all but dilated eye examinations, higher rates of procedures related to diabetes mellitus were seen in the year after NH admission than in the year before. Residents without dementia received more procedures than those with dementia, although this was somewhat attenuated after controlling for demographic, health, and healthcare utilization variables. Persons without dementia experience greater increases in procedure rates after admission than those with dementia.

CONCLUSION: The structured environment of care provided by the NH may positively affect monitoring procedures provided to elderly persons with diabetes mellitus, especially those without dementia. Medical decisions related to the risks and benefits of intensive treatment for diabetes mellitus to patients of varying frailty and expected longevity may lead to lower rates of procedures for residents with dementia.

Ancillary