Psychosocial Factors and Ethnic Disparities in Diabetes Diagnosis and Treatment among Older Adults

By Bertera, Elizabeth M. | Health and Social Work, February 2003 | Go to article overview

Psychosocial Factors and Ethnic Disparities in Diabetes Diagnosis and Treatment among Older Adults


Bertera, Elizabeth M., Health and Social Work


The prevalence of non--insulin-dependent diabetes mellitus type 2 (NIDDM) increases with age, and more than 50 percent of patients with diabetes are over the age of 65 (U.S. Department of Health and Human Services and Office of Public Health and Science, 1998). It is estimated that 3.6 million people age 65 or older are afflicted with this disease, the majority of whom have type 2, noninsulin-dependent diabetes mellitus (NIDDM) (Rubin, Altman, Altman, & Mendelson, 1994). The prevalence of diabetes at age 60 is 10 percent, and by age 80 it rises to 16 percent to 20 percent for white people. The death rate for cardiovascular disease among elderly diabetic patients is twice that of people without diabetes in the same age range (Harris, 1990a).

Not only is diabetes a heavy burden on older adults, but also is expensive to society in terms of disability, mortality, and health care costs. The majority of health care expenses are for inpatient costs, with most being attributed to the care of cardiovascular complications. Per capita expenditures for confirmed diabetics were more than four times greater than for people without diabetes (Caruso & Silliman, 1999; Rubin et al., 1994). People age 65 or older with diabetes make an average of 3.7 visits per year to physicians specifically for care of their diabetes. These diabetes care visits represented 7.7 percent of visits for all health causes in this age group. About 30 percent of diabetics 65 to 74 years of age are hospitalized each year, a rate almost twice that for nondiabetic elderly people (Harris, 1990a, 1990b).By any measurement, diabetes is a major health concern for older adults in this country (Haan & Weldon, 1996), yet one-third of those affected by the disease are unaware they have it (CDC Diab etes Cost-Effectiveness Study Group, 1998). Information is limited about people who have diabetes but are not yet in treatment. Undiagnosed diabetes in older adults presents a challenge, as this group's elevated blood sugar levels seem to carry an elevated risk of morbidity and mortality compared with those of older adults with a diagnosis of diabetes who are in treatment. In a comparison study of older men and women who were not previously known to have diabetes and older men and women who had diabetes, one-third of undiagnosed people had elevated serum glucose levels compared with those already diagnosed (DECODE Study Group, 1999).

RACIAL AND ETHNIC FACTORS

A number of cross-sectional and prospective studies have found that the risk factors for development of type 2 diabetes among African Americans, Hispanics, and Native Americans are approximately2, 2.5, and 5 times greater, respectively, than for white people (Haffner, 1998; Harris, Eastman, Cowie, Flegal, & Eberhardt, 1999; Harris, Sherman, & Georgopoulos, 1999). Lower socioeconomic status (SES) has been associated with risk of developing the disease (Gaillard, Schuster, Bossetti, Green, & Osei, 1997) as well as with the prognosis for compliance with treatment and achieving control of blood glucose levels (Hooyman & Asuman, 1999; Terpstra & Terpstra, 1998). There is also evidence that racial and ethnic differences may influence the severity of the disease and its complications. For example, one study noted that people of minority racial and ethnic groups had higher glycohemoglobin levels than white people (Delamater et al., 1999). Harris s review indicated that black people experience vision loss, amputations , and renal disease rates one and a half to four times higher than white people (Harris, 1990b). Harris also found that white people with diabetes have approximately 40 percent more visits to office-based physicians each year than people of color (Harris, 1990b), suggesting differences in access to and use of health care services. In a national survey, Mexican American men and African American women had the poorest glycemic control and were least likely to self-monitor blood glucose levels compared with other patient subgroups (Harris, Eastman, et al. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Psychosocial Factors and Ethnic Disparities in Diabetes Diagnosis and Treatment among Older Adults
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.