HEALTH-RELATED QUALITY OF LIFE IN ELDERLY PATIENTS WITH DIABETES AT HA DONG TRADITIONAL MEDICINE HOSPITAL
Nguyen Thi Thu Huong2, Nguyen Trung Anh1
1 National Geriatric Hospital, 2 Hanoi Medical University
Background: Health-related quality of life is one of the most widely-used measures to self- assess the effect of the management of chronic disease on health, and monitors the physical, psychological and social aspects of personal health. These data in elderly diabetic Vietnamese is currently limited. Objectives: To measure health-related quality of life in elderly diabetic patients at Ha Dong Traditional Medicine Hospital. Methods: A cross-sectional study was performed in 107 patients aged 60 years or older, who was examined and treated at the Ha Dong Traditional Medicine Hospital. The subjects were interviewed by a designed questionnaire. Health-related quality of life was measured using SF-36 questionnaire. Results: Among 107 participants, the mean age was 66.1 ± 6.4 years; women account for 66.4%. The average duration of diabetes was 9.6 ± 5.0 (years). The percentage of patients with blood glucose control and HbA1c reaching their targets is 44.9% and 62.6%, respectively. The mean number of complications was 1.3 ± 0.7. Average quality of life score of study subjects was: 43.49 ± 9.30. Average score of mental health (49.32 ± 8.58) which was higher than physical health (37.85 ± 10.93) indicates that the patient has a quality of life related to mental health better than physical health. Conclusion: The quality of life for diabetic elderly patients at Ha Dong Traditional Medicine Hospital was not good, especially the quality of life related to physical health. Good control of blood glucose, prevention and treatment of comorbidities and minimizing complications of diabetes help improve the quality of life for patients.
Keywords: Diabetes; Older person; Health- related quality of life
Main Correspondence: Nguyen Trung Anh Submission date: 20th April 2021
Revised day: 26th April 2021
Acceptance date: 26th May 2021 Email: email@example.com Tel: 0903480774
Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels . The rapid increase in the number of people with diabetes has made the disease a worrying public health problem. In 2000: 151 million with diabetes , 2010: 285 million with diabetes . In 2017, according to IDF, there were 425 million people with diabetes, expected to increase to 629 million people by 2045 . According to the World Health Organization (WHO) by 2030, more than half of the diabetes cases in the world will be Asian and more than half of these patients are over the age of 60 . The report of National Hospital of Endocrinology, Vietnam (2012) on more than 11,000 people from 30 to 69 years old in 6 ecological regions showed that the prevalence of diabetes in our country had increased by 6%. The number of people with diabetes in Vietnam is expected to double by 2030 compared to 2010 .
Health-related quality of life (HRQoL) is one of the most widely-used measures to self-assess the effect of the management of chronic disease on health, and monitors the physical, psychological and social aspects of personal health . It is influenced by a person’s expectations, beliefs, perceptions and experiences . Most cross-sectional studies found that HRQoL of an individual with diabetes is worse than that of a similarly aged person without diabetes ,. Once the quality of life has been affected, self management, the adherence to therapeutic regimen and treatment success are in peril . Therefore, efforts to improve quality of life will lead to better management of the disease for a satisfactory outcome.
Ha Dong Traditional Medicine Hospital is a specialized hospital at the provincial level with an increasing number of diabetic patients providing outpatient examination and treatment. However, quality of life in elderly patients with diabetes has not been paid much attention. Learning about this problem helps to improve the quality and effectiveness of treatment for patients. Therefore, we conduct this research on this topic with the aim of assessing the quality of life of elderly diabetic patients at Ha Dong Traditional Medicine Hospital.
2. SUBJECTS AND METHODS
The study was performed on 107 elderly diabetic patients examined and treated at Ha Dong Traditional Medicine Hospital from May 2019 to November 2019.
Inclusion criteria: diabetic patients aged 60 years old or over were examined and treated at Ha Dong Traditional Medicine Hospital.
Exclusion criteria: patients with cognitive impairment, severe or acute illness unable to participate or unable to complete interview questionnaire; patients did not agree to participate in the study.
2.2. Study design: cross-sectional study with total population sampling method. The examination process was conducted according to a designed
- General information about the subjects: age, sex, education level, place of residence, co- morbidity, history of diabete, diabetes duration, hypoglycemia medication, complications of diabetes.
- Body mass index (BMI) was classified into three groups: underweight (BMI <18.4kg/m2); normal (18.5≤BMI≤22.9 kg/m2); overweight and obese (BMI ≥ 23kg/m2).
- Health-related quality of life was assessed by SF-36 questionnaire . The questionnaire consisted of 36 questions assessing 8 areas of quality of life (physical activity, limited role due to physical health, pain, general health, limiting role due to mental problems, vital energy/fatigue, psychological state, social function). Each area was scored from 0-100, the total SF-36 score was equal to the average score of 36 questions: the higher the score, the higher the quality of
- Blood test: fasting blood glucose (FBG ≤ 7.2mmol / l: good control; FBG> 7.2 mmol / l: poor control); HbA1c (HbA1c <7.0%: good control; HbA1c ≥ 7.0%: poor control).
2.4. Data analysis
Data were processed and analyzed by medical statistical software SPSS 22.0, using algorithms: calculate percentages, calculate average value.
3.1. General characteristics
After evaluating on 107 elderly diabetic patients examined and treated at Ha Dong Traditional Medicine Hospital from May to November 2019, we have obtained the following results:
Table 1. General characteristics (n=107)
Of the 107 study subjects, there were 71 female patients, accounting for 66.4%, higher than male patients (36 patients), accounting for 33.6%. The mean age of the patients was 66.1 ± 6.4 (years). The patients’ group aged <70 years old accounts for a high rate of 81.3%. The average number of comorbidities was 2.72 ± 0.76.
Figure 1. Body mass index classification (n=107)
In the study group, 53.3% of patients were overweight and obese, 43% patients had normal BMI and 3.7% were underweight.
Table 2. Characteristics of diabetes (n = 107)
The average duration of diabetes was 9.6 ± 5.0 (years). The majority of patients used metformin (80.4%) and sulfunylure (82.2%). The percentage of patients with blood glucose control and HbA1c reaching their targets is 44.9% and 62.6%, respectively. The mean number of complications was 1.3 ± 0.7.
3.2. Health-related quality of life in elderly diabetic patients
Table 3. Health-related quality of life in elderly diabetic patients (SF-36)
Average quality of life score of study subjects was: 43.49 ± 9.30. Average score of mental health (49.32 ± 8.58) which was higher than physical health (37.85 ± 10.93) indicates that the patient has a quality of life related to mental health better than physical health.
This study aims to evaluate the quality of life of elderly patients with diabetes who were treated at Ha Dong Traditional Medicine Hospital. Our study recorded the average age of study subjects was 66.1 ± 6.4 (years). This result is similar to the study in Thailand (67.8 ± 7.1) but lower than in the previous study in China, the mean age of the participants was 72.2 ± 8.3 (years) ,. The proportion of patients in the 60 – 69 year-old group accounts for 81.3%, the group aged 70 year old or over accounts for 18.7%. This result was contrary to the above study (in China), the proportion of people aged 60-69 years accounts for 32.1% and 52.5% in people ≥ 80 years old . This result can be explained by the smaller sample size in this study compared with the sample in the Chinese study (1086 participants) and the study subject at Ha Dong Traditional Medicine Hospital for diverse examination statues.
The proportion of women in the study was 66.4%, higher than that of men was 33.6%. The results of our research were similar to the research in China: the proportion of women accounts for 55.7% and male accounts for 44.3% and the study in Thailand had 59.4% female and 40.6% male ,. This result was similar to other previous studies in Vietnam because female patients were often higher than men.
Our study recorded the average diabetes duration of study subjects was 9.6 ± 4.9 (years). This result was similar to the research results of Luyster et al (2011) on 300 type 2 diabetic patients recorded average diabetes duration of 9.44 ± 7.32 (years) . Among diabetes drug groups, the rate of using metformin was 80.4%, the rate of using sulfunylure drugs was 82.2%. The average number of complications of study subjects was 1.33 ± 0.7, this result was higher than in Luyster’s study with the average number of complications of diabetes was 0.72 ± 0.97 (complications) . The percentage of patients with blood glucose control and HbA1c reaching their targets were 44.9% and 62.6%, respectively.
The results of our study showed that the average total score of health-related quality of life of the study subjects (SF-36) was: 43.49 ± 9.30. Average score of mental health (49.32 ± 8.58) which was higher than physical health (37.85 ± 10.93) indicated that the patient had a quality of life related to mental health better than physical health. According to the areas of the SF-36 scale, patients reported that there were health-related quality of life associated with deteriorating physical health compared with problems related to mental health. In particular, aspects of the role limitation due to physical health and general health situation showed the lowest decline with the mean score of 31.13 ± 20.93 and 35.69 ± 21.08 respectively. This result was similar to the study of Luyster et al. (2011) . The quality of life of the study subjects was not high possibly due to the elderly having many comorbid diseases, not having good control of blood glucose and the majority of patients have complications of diabetes.
The quality of life for diabetic elderly patients at Ha Dong Traditional Medicine Hospital was not good, especially the quality of life related to physical health. Good control of blood glucose, prevention and treatment of comorbidities and minimizing complications of diabetes help improve the quality of life for patients.
- American Diabetes Association (2010). Standards of medical care in diabetes– 2010. Diabetes Care, 33 Suppl 1, S11-61.
- Zimmet P, Alberti K. G and Shaw J (2001). Global and societal implications of the diabetes Nature, 414 (6865), 782- 787.
- L. Chen, D.J. Magliano and P.Z. Zimmet (2011). The worldwide epidemiology of type 2 diabetes mellitus–present and future perspectives. Nat Rev Endocrinol, 8 (4), 228-236.
- International Diabetes Federation (2017). IDF DIABETES ATLAS Eighth edition 2017.
- Gupta V and Suri P (2002). Diabetes in Elderly JK Pract, 91 (4), 258 – 259.
- J. E. Shaw, R.A. Sicree and P.Z. Zimmet (2010). Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Research and Clinical Practice, 87, 4-14.
- D’Souza MS, Venkatesaperumal R, Ruppert SD, et al (2016). Health related quality of life among Omani men and women with type 2 diabetes. J Diabetes Res, 2016:8293579.
- Grandy S, Sternhufvud C, Ryden A, et al (2016). Patient-reported Outcomes among type 2 diabetes mellitus patients treated with Dapagliflozin in triple therapy regimen for 52 weeks. Diabetes Obes Metab;18(3):306–9.
- Grandy S, Fox KM (2008). EQ-5D visual analog scale and utility index values in individuals with diabetes and at risk for diabetes: findings from the study to help improve early evaluation and management of risk factors leading to diabetes (SHIELD). Health Qual Life Outcomes;6:18.
- Hourani EM, Hammad SM, Shaheen A, et al (2016). Health-related quality of life among Jordanian adolescents. Clin Nurs Res; 337–53.
- Bott U, Muhlhauser I, Overmann H, Berger M (1998). Validation of a diabetes-specific quality-of-life scale for patients with type 1 diabetes. Diabetes Care, 21(5):757–769. doi: 2337/diacare.21.5.757.
- SF 36 https://www.rand.org/health/surveys_tools/mos/mos_ core_36item .html,
- J. Luo, et al (2013). Prevalence and risk factors of poor sleep quality among Chinese elderly in an urban community: results from the Shanghai aging study. PloS one, 8(11): p. e81261.
- W. Thichumpa, et al (2018). Sleep quality and associated factors among the elderly living in rural Chiang Rai, northern Thailand. Epidemiology and health, 40.
- F. S. Luyster and J. Dunbar-Jacob (2011). Sleep quality and quality of life in adults with type 2 diabetes. Diabetes Educ, 37 (3), 347-355.