The role of nursing home admission and dementia status on care for diabetes mellitus.

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.