Li Chia-Lin, Chiu Yi-Chen, Bai Yuh-Bin, Lin Jen-Der, Stanaway Fiona, Chang Hsing-Yi
Department of Health Care Management, College of Management, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan 333, Taiwan; Healthy Aging Research Center, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan 333, Taiwan; Division of Endocrinology and Metabolism, Departments of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan.
Healthy Aging Research Center, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan 333, Taiwan; School of Nursing, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan 333, Taiwan; Department of Neurology and Dementia Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
Diabetes Res Clin Pract. 2017 Jul;129:73-78. doi: 10.1016/j.diabres.2017.03.025. Epub 2017 May 5.
The aims of the present study were to investigate the co-occurrence of depressive symptoms and cognitive impairment in community dwelling older adults with diabetes and its relationship with specific diabetes self-care behaviors.
We analyzed data from two national samples of older adults (65years or older) with self-reported physician-diagnosed diabetes (N=1034), who participated in the 2005 or 2009 National Health Interview Survey in Taiwan. The Mini-Mental State Examination was used to assess cognitive function. The Center for Epidemiologic Studies Depression Scale was used to assess depressive symptoms. The study assessed self-care behaviors including medication adherence, exercise, healthy diet, and self-monitoring of blood glucose.
In this study, 8.8% of participants with diabetes had both depressive symptoms and cognitive impairment. After adjusting for other factors, participants with both cognitive impairment and depressive symptoms were less likely to exercise (Prevalence Ratios (PR)=0.66; 95% Confidence Intervals (CI)=[0.47-0.91]; P-value=0.011), and have a healthy diet (PR=0.82; 95%CI=[0.70-0.96]; P-value=0.012).
Our results illustrate the high prevalence of combined depressive symptoms and cognitive impairment and that this combination is associated with worse self-care behaviors in older adults with diabetes. These findings highlight the difficulty that some older adults with diabetes may have in maintaining self-care behaviors in the presence of depressed mood and cognitive impairment, particularly in the areas of diet and exercise. The results emphasize the importance of providing more support for these aspects of self-care to such older adults.
本研究旨在调查社区中患有糖尿病的老年人抑郁症状与认知障碍的共现情况及其与特定糖尿病自我护理行为的关系。
我们分析了来自两个全国性老年样本（65岁及以上）的数据，这些老年人自我报告经医生诊断患有糖尿病（N = 1034），他们参与了2005年或2009年台湾国民健康访问调查。使用简易精神状态检查表评估认知功能。使用流行病学研究中心抑郁量表评估抑郁症状。该研究评估了自我护理行为，包括药物依从性、运动、健康饮食和血糖自我监测。
在本研究中，8.8% 的糖尿病患者同时患有抑郁症状和认知障碍。在调整其他因素后，同时患有认知障碍和抑郁症状的参与者进行运动的可能性较小（患病率比（PR）= 0.66；95% 置信区间（CI）= [0.47 - 0.91]；P值 = 0.011），并且保持健康饮食的可能性较小（PR = 0.82；95%CI = [0.70 - 0.96]；P值 = 0.012）。
我们的结果表明抑郁症状和认知障碍合并存在的高患病率，并且这种合并情况与患有糖尿病的老年人较差的自我护理行为相关。这些发现凸显了一些患有糖尿病的老年人在存在抑郁情绪和认知障碍时可能在维持自我护理行为方面存在困难，特别是在饮食和运动方面。结果强调了为这些老年人在自我护理的这些方面提供更多支持的重要性。
