STEP as a Useful Tool to Screen for Diabetes-Specific Health-Related
Problems in Community-Based Geriatric Patients- An Exploratory Secondary
Analysis of Cross-Sectional Data

Solveig Carmienke; Anne-Kathrin Geier; Tobias Deutsch; Franz Maximilian Rasche; Thomas Frese

doi:10.1055/a-0803-0362

Experimental and Clinical Endocrinology & Diabetes, Inhaltsverzeichnis

Exp Clin Endocrinol Diabetes 2020; 128(03): 190-198
DOI: 10.1055/a-0803-0362

Article

STEP as a Useful Tool to Screen for Diabetes-Specific Health-Related Problems in Community-Based Geriatric Patients- An Exploratory Secondary Analysis of Cross-Sectional Data

Solveig Carmienke

¹Institute of General Practice and Family Medicine, Medical Faculty of Martin-Luther-University Halle-Wittenberg, Halle, Germany

,

Anne-Kathrin Geier

²Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany

,

Tobias Deutsch

²Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany

,

Franz Maximilian Rasche

¹Institute of General Practice and Family Medicine, Medical Faculty of Martin-Luther-University Halle-Wittenberg, Halle, Germany

³KfH Kuratorium für Dialyse und Nierentransplantation e.V., Neu-Isenburg, Germany

⁴Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Diabetology and Nephrology, University of Leipzig, Leipzig, Germany

,

Thomas Frese

¹Institute of General Practice and Family Medicine, Medical Faculty of Martin-Luther-University Halle-Wittenberg, Halle, Germany

› Institutsangaben

Abstract

Background and Aims Comprehensive geriatric assessments are established tools for the identification of health problems in the elderly. So far, little is known about tailoring and targeting to facilitate their application. As a starting point for a tailored assessment of patients with diabetes, a highly prevalent health condition, we aimed to assess if the Standardized Assessment of Elderly People (STEP) is able to identify relevant differences in self-reported health problems between diabetic and non-diabetic patients.

Patients and Methods We performed a secondary analysis of a cross-sectional study including 1007 adults (aged 65 and older) from 28 German general practices, evaluating the feasibility and usefulness of the self-administered STEP version. For this exploratory study we re-analysed the data and compared patients with and without diabetes.

Results Out of 940 patients included in the secondary analysis, 248 (26.4%) had diabetes. Compared to non-diabetic patients, geriatric diabetic patients reported more often problems in activities of daily living, physical problems typically associated with diabetes such as urinary incontinence, visual impairment, mood disturbances, as well as the use of medical or social services. Most of our results were stable after adjusting for age, sex and body mass index.

Conclusion We conclude that the self-administered version of the STEP tool may be used to screen for health problems typically associated with diabetes. Our results may guide the development of a tailored STEP-version specifically for diabetic patients. Further research might evaluate the adoption and usefulness of such a tool in every-day general practice.

Key words

general practice - primary care - comprehensive geriatric assessment - STEP questionnaire - diabetes mellitus

Volltext

Referenzen

References
1 Junius U, Fischer G. [Geriatric assessment in family practice – results of concerted action by 7 European countries]. Z Gerontol Geriatr 2002; 35: 210-223
2 Ellis G, Langhorne P. Comprehensive geriatric assessment for older hospital patients. Br Med Bull 2004; 71: 45-59
3 Beswick AD, Rees K, Dieppe P. et al. Complex interventions to improve physical function and maintain independent living in elderly people: A systematic review and meta-analysis. Lancet 2008; 371: 725-735
4 Stuck AE, Siu AL, Wieland GD. et al. Comprehensive geriatric assessment: A meta-analysis of controlled trials. Lancet 1993; 342: 1032-1036
5 Palmer K, Onder G. Comprehensive geriatric assessment: Benefits and limitations. Eur J Intern Med 2018; 54: e8-e9
6 Pilotto A, Cella A, Pilotto A. et al. Three decades of comprehensive geriatric assessment: Evidence coming from different healthcare settings and specific clinical conditions. J Am Med Dir Assoc 2017; 18: 192.e1-192.e11
7 Sandholzer H, Hellenbrand W, Renteln-Kruse W. et al. [STEP-standard assessment of elderly people in primary care]. Dtsch Med Wochenschr 2004; 129 (Suppl. 04) 183-226
8 Piccoliori G, Gerolimon E, Abholz H-H. Geriatric assessment in general practice using a screening instrument: Is it worth the effort? Results of a South Tyrol Study. Age Ageing 2008; 37: 647-652
9 Frese T, Deutsch T, Keyser M. et al. In-home preventive comprehensive geriatric assessment (CGA) reduces mortality—a randomized controlled trial. Arch Gerontol Geriatr 2012; 55: 639-644
10 Frese T, Hein S, Sandholzer H. Feasibility, understandability, and usefulness of the STEP self-rating questionnaire: Results of a cross-sectional study. Clin Interv Aging 2013; 8: 515-521
11 Barkhausen T, Junius-Walker U, Hummers-Pradier E. et al. “It’s MAGIC”—development of a manageable geriatric assessment for general practice use. BMC Fam Pract 2015; 16: 4
12 Seematter-Bagnoud L, Büla C. Brief assessments and screening for geriatric conditions in older primary care patients: A pragmatic approach. Public Health Rev 2018; 39: 8
13 Tamayo T, Brinks R, Hoyer A. et al. The prevalence and incidence of diabetes in Germany. Dtsch Arztebl Int 2016; 113: 177-182
14 Jacobs E, Hoyer A, Brinks R. et al. Burden of mortality attributable to diagnosed diabetes: A nationwide analysis based on claims data from 65 million people in Germany. Diabetes Care 2017; 40: 1703-1709
15 Croxson SC, Burden AC, Bodington M. et al. The prevalence of diabetes in elderly people. Diabet Med 1991; 8: 28-31
16 Araki A, Ito H. Diabetes mellitus and geriatric syndromes. Geriatr Gerontol Int 2009; 9: 105-114
17 Junius U, Schulz C, Fischer G. et al. [Evidence based preventative assessment for older patients: The implementation of the results of a European study in a concrete medical check-up in Germany. Z Allg Med 2003; 143-148
18 Sandholzer H, Hellenbrand W, Renteln-Kruse W. et al. The standardised proactive assessment instrument. Occas Pap R Coll Gen Pract 2002; 31-34
19 Victor A, Elsässer A, Hommel G. et al. Judging a plethora of p-values: How to contend with the problem of multiple testing—part 10 of a series on evaluation of scientific publications. Dtsch Arztebl Int 2010; 107: 50-56
20 Nelson E, Wasson J, Kirk J. et al. Assessment of function in routine clinical practice: Description of the COOP Chart method and preliminary findings. J Chronic Dis 1987; 40 (Suppl. 01) 55S-69S
21 Kinnersley P, Peters T, Stott N. Measuring functional health status in primary care using the COOP-WONCA charts: Acceptability, range of scores, construct validity, reliability and sensitivity to change. Br J Gen Pract 1994; 44: 545-549
22 Formiga F, Ferrer A, Padrós G. et al. Diabetes mellitus as a risk factor for functional and cognitive decline in very old people: The Octabaix study. J Am Med Dir Assoc 2014; 15: 924-928
23 Palmer RF, Espino DV, Dergance JM. et al. The role of physical activity and diabetes status as a moderator: Functional disability among older Mexican Americans. Age Ageing 2012; 41: 752-758
24 Kim DH, Newman AB, Lipsitz LA. Prediction of severe, persistent activity-of-daily-living disability in older adults. Am J Epidemiol 2013; 178: 1085-1093
25 Enkvist Å, Ekström H, Elmståhl S. Associations between functional ability and life satisfaction in the oldest old: Results from the longitudinal population study Good Aging in Skåne. Clin Interv Aging 2012; 7: 313-320
26 Stineman MG, Xie D, Streim JE. et al. Home accessibility, living circumstances, stage of activity limitation, and nursing home use. Arch Phys Med Rehabil 2012; 93: 1609-1616
27 Kurichi JE, Streim JE, Xie D. et al. The association between activity limitation stages and admission to facilities providing long-term care among older medicare beneficiaries. Am J Phys Med Rehabil 2017; 96: 464-472
28 Bean JF, Herman S, Kiely DK. et al. Increased velocity exercise specific to task (InVEST) training: A pilot study exploring effects on leg power, balance, and mobility in community-dwelling older women. J Am Geriatr Soc 2004; 52: 799-804
29 Phillips SM, Wójcicki TR, McAuley E. Physical activity and quality of life in older adults: An 18-month panel analysis. Qual Life Res 2013; 22: 1647-1654
30 Turnbull PJ, Sinclair AJ. Evaluation of nutritional status and its relationship with functional status in older citizens with diabetes mellitus using the mini nutritional assessment (MNA) tool—a preliminary investigation. J Nutr Health Aging 2002; 6: 185-189
31 Sanz París A, García JM, Gómez-Candela C. et al. Malnutrition prevalence in hospitalized elderly diabetic patients. Nutr Hosp 2013; 28: 592-599
32 Sampson G. Weight loss and malnutrition in the elderly—the shared role of GPs and APDs. Aust Fam Physician 2009; 38: 507-510
33 Vischer UM, Perrenoud L, Genet C. et al. The high prevalence of malnutrition in elderly diabetic patients: Implications for anti-diabetic drug treatments. Diabet Med 2010; 27: 918-924
34 Reynolds MW, Fredman L, Langenberg P. et al. Weight, weight change, and mortality in a random sample of older community-dwelling women. J Am Geriatr Soc 1999; 47: 1409-1414
35 Brown JS, Vittinghoff E, Lin F. et al. Prevalence and risk factors for urinary incontinence in women with type 2 diabetes and impaired fasting glucose: Findings from the national health and nutrition examination survey (NHANES) 2001-2002. Diabetes Care 2006; 29: 1307-1312
36 Lifford KL, Curhan GC, Hu FB. et al. Type 2 diabetes mellitus and risk of developing urinary incontinence. J Am Geriatr Soc 2005; 53: 1851-1857
37 Jackson SL, Scholes D, Boyko EJ. et al. Urinary Incontinence and diabetes in postmenopausal Women. Diabetes Care 2005; 28: 1730-1738
38 Deutsche Diabetes Gesellschaft. S2-k Leitlinie Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Alter. 2. edition Berlin: Deutsche Diabetes Gesellschaft; 2018. https://www.deutsche-diabetes-gesellschaft.de/fileadmin/Redakteur/Leitlinien/Evidenzbasierte_Leitlinien/2018/057_017_LL_Alter_Gesamtdokument_20180713.pdf (accessed October 11, 2018)
39 Sinclair AJ, Bayer AJ, Girling AJ. et al. Older adults, diabetes mellitus and visual acuity: A community-based case-control study. Age Ageing 2000; 29: 335-339
40 de Jonge P, Roy JF, Saz P. et al. Prevalent and incident depression in community-dwelling elderly persons with diabetes mellitus: Results from the ZARADEMP project. Diabetologia 2006; 49: 2627-2633
41 Black SA, Markides KS, Ray LA. Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care 2003; 26: 2822-2828
42 Whooley MA, Avins AL, Miranda J. et al. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med 1997; 12: 439-445
43 Huxley RR, Filion KB, Konety S. et al. Meta-analysis of cohort and case-control studies of type 2 diabetes mellitus and risk of atrial fibrillation. Am J Cardiol 2011; 108: 56-62
44 Tadic M, Cuspidi C. Type 2 diabetes mellitus and atrial fibrillation: From mechanisms to clinical practice. Arch Cardiovasc Dis 2015; 108: 269-276
45 Cukierman T, Gerstein HC, Williamson JD. Cognitive decline and dementia in diabetes—systematic overview of prospective observational studies. Diabetologia 2005; 48: 2460-2469
46 Sinclair AJ, Rodriguez-Mañas L. Diabetes and frailty: Two converging conditions?. Can J Diabetes 2016; 40: 77-83
47 Rockwood K, Song X, MacKnight C. et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173: 489-495
48 Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. Sci World J 2001; 1 32 36
49 Searle SD, Mitnitski A, Gahbauer EA. et al. A standard procedure for creating a frailty index. BMC Geriatr 2008; 8: 24
50 Fried LP, Tangen CM, Walston J. et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146-M156
51 García-Esquinas E, Graciani A, Guallar-Castillón P. et al. Diabetes and risk of frailty and its potential mechanisms: A prospective cohort study of older adults. J Am Med Dir Assoc 2015; 16: 748-754
52 Theile G, Winter A, Hummers-Pradier E. et al. [Use and acceptance of a basic geriatric assessment in primary care setting]. Z Gerontol Geriatr 2012; 45: 323-330
53 Frese T, Sandholzer H, Voigt S. et al. Epidemiology of diabetes mellitus in German general practitioners’ consultation—results of the SESAM 2-study. Exp Clin Endocrinol Diabetes 2008; 116: 326-328
54 Coman L, Richardson J. Relationship between self-report and performance measures of function: A systematic review. Can J Aging 2006; 25: 253-270
55 Merrill SS, Seeman TE, Kasl SV. et al. Gender differences in the comparison of self-reported disability and performance measures. J Gerontol A Biol Sci Med Sci 1997; 52: M19-M26

Zusatzmaterial

Supplementary Material