Background and Introduction: The rapidly increasing incidence and prevalence of diabetes and the progressively ageing population are unstoppable global trends. In a real-world setting, older people often suffer from multiple chronic physical or mental disorders, and it is, therefore, necessary to evaluate the impact of these disorders on hospital utilisation and mortality among older adults with diabetes.
Methods: A systematic review was conducted to understand the associations between mental/physical disabilities and medical utilisation/cost among elderly patients with diabetes. Three observational studies by using HES inpatient database were also conducted. From 2011-12 to 2013-14, patients who were 65 years old or above with diabetes were included. Multivariate regression models were performed to examine: (1) the impact of mental and physical disorders on hospital length of stay (2) the impact of physical or mental disorders on in-hospital mortality (3) the impact of mental and physical disorders on length of stay in hospital and in-hospital mortality of patients in different treatment units.
Results: Male gender, increasing age, white ethnicity, patients who lived in more deprived areas, and patients with mental or physical disorders had a higher risk for longer hospital length of stay and in-hospital mortality. Elderly patients with mental disorders had 5.88 times greater incidence Rate Ratio (IRR) for hospitalisation, and 10.96 times risk for in-hospital mortality. Patients with mood disorders had 6.54 times greater IRR for hospitalisation, and patients with dementia had 13.9 times risk for in-hospital mortality. Patients with mental disorders in ophthalmology department had 15 times higher IRR for hospitalisation.
Conclusions: Elderly diabetic patients with mental disorders have higher medical costs and in-hospital mortality than patients with diabetes only. Patients with dementia and mood disorders are the high-risk groups. To reduce medical costs and improve quality of care, early intervention and prevention for elderly diabetic patients with dementia and mood disorders are needed. Because the HES database does not include the relevant biochemical data during the patient’s hospitalisation, further studies to connect to the hospital-level database to investigate the key reasons why patients with mental disorders can have a high risk for longer hospital length of stay and in-hospital mortality would be the future research.