Category: Geriatric Rehabilitation; Health Services Research
To investigate explanatory mechanisms underlying the well-established relationship between diabetes and health-related quality of life (HRQOL) among older Mexican Americans1. We hypothesized that 1) physical, 2) emotional, and 3) cognitive functioning would mediate the relationship between diabetes and both the physical and mental domains of HRQOL.
Secondary analysis of cross-sectional data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly Disabling Process Study (wave 1). We used path analysis to investigate hypotheses.
Setting : Community.
Participants (or Animals, Specimens, Cadavers) :
619 Mexican Americans aged 65 years and older. Subjects selected using area probability sampling procedures.
Interventions : Not applicable.
Main Outcome Measure(s) :
Presence of diabetes; physical (Short Physical Performance Battery), emotional (Center for Epidemiologic Studies – Depression), and cognitive functioning (Mini-Mental State Exam); HRQOL (physical and mental components of the SF-36 Survey). We controlled for age, sex, marital status, comorbidities (stroke, heart attack, hypertension), and smoking status.
31.2% reported diabetes. Compared to those without diabetes, those with diabetes scored lower on the physical (b=-9.06, p<.001, 95% CI=-5.86, -0.96), but not the mental (b=-1.25, p=.150, 95% CI=-1.70, 1.50), domain of HRQOL. Indirect effects derived using path analysis revealed that physical (b=-5.11, p<.001, 95% CI=-6.97, -3.25) and emotional (b=-0.40, p=.030, 95% CI=-0.76, -0.04) functioning mediated the relationship between diabetes and the physical domain of HRQOL.
Conclusions : Diabetes was associated with worse physical and emotional functioning, which in turn diminished the physical domain of HRQOL. Physical and emotional functioning are both responsive to rehabilitation interventions. Additional study is needed to determine whether targeting physical and emotional functioning can effectively diminish the relationship between diabetes and poor health-related quality of life in older Mexican Americans.