About 1 in 5 older Canadian adults with diabetes who had no functional limitations before the COVID-19 pandemic developed at least 1 during the public health crisis, compared to 1 in 8 older adults without diabetes, according to new research published in the Canadian Journal of Diabetes.1
The difference translated to a 1.28-fold (95% CI 1.02 to 1.60) increase in odds of developing functional limitations due to diabetes alone.
Key Takeaways
- The study showed a substantial increase in functional limitations among older adults with diabetes compared to those without, during the COVID-19 pandemic.
- The pandemic restrictions and fear of COVID-19 exposure likely led to decreased physical activity among older adults with diabetes. Social isolation and other pandemic-related factors may have also played a role.
- The study found a much stronger association between lower income and functional limitations, highlighting the need for interventions that address social determinants of health.
Functional status, which refers to the ability to perform tasks like walking 2 to 3 blocks, standing up from a chair, and climbing stairs, is a key determinant in the longevity and quality of life among patients with diabetes. Engaging in regular physical activity is important for maintaining functional status and avoiding the development of functional limitations.
However, amid stay-at-home orders and lockdowns during the COVID-19 pandemic, there was a substantial decrease in physical activity among older adults. This may be because older adults with diabetes, who face a higher risk of serious complications from COVID-19, were worried about COVID-19 exposure associated with certain modes of physical activity, such as going outside for walks.
The COVID-19 pandemic also increased unhealthy behaviors such as alcohol consumption and cigarette use, loneliness, the prevalence of pre-frailty and frailty, and disruptions to health care routines among older adults with diabetes, all of which have been identified as risk factors for worsening functional limitations.
“Functional status is an important predictor of longevity and quality of life among older adults, and individuals with diabetes face a higher risk of functional decline than the general population,” said Andie MacNeil, lead investigator and research assistant at the Factor-Inwentash Faculty of Social Work (FISFW) and the Institute for Life Course and Aging at the University of Toronto.2 “Because the pandemic exacerbated many risk factors for functional decline, such as social isolation and physical inactivity, we wanted to examine changes in functional status among this population.”
To capture longitudinal data on functional status among older adults with diabetes and understand how the COVID-19 pandemic might have affected them, researchers collected data at 4 different timepoints: a baseline period from 2011 to 2015 served as a reference point before the pandemic; a follow-up period from 2014 to 2018 provided insights into changes over time; a COVID-19 baseline period from April to May 2020 assessed functional status at the beginning of the pandemic; and exit questionnaires from September to December 2020 assessed the impact of the pandemic over several months.
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The study included 6045 participants of the Canadian Longitudinal Study on Aging (CLSA) aged between 45 and 85 in Canada who had no functional limitations before the pandemic.
Overall, older adults with diabetes faced a 53% higher risk of developing at least 1 functional limitation during the pandemic compared to older adults without diabetes.
Even after accounting for factors like low income, obesity, and multimorbidity—identified by investigators as the main risk factors of developing at least 1 functional limitation among patients with diabetes—older adults with diabetes still faced a 28% increased risk compared to those without diabetes.
Although socioeconomic status proved to be an important determinant of functional decline among participants with and without diabetes, the difference was much more dramatic for participants with diabetes. The chances of developing at least 1 functional limitation were 5-fold higher for older adults with diabetes and an annual income of less than $20,000 compared to those with an annual income of more than $100,000. The risk was 2-fold higher for older adults without diabetes and an annual income of less than $20,000 compared to those with an annual income of $100,000 or more.
In light of their findings, investigators called for better interventions to target modifiable risk factors, such as physical activity, and mitigate the risk of developing functional limitations among older adults with diabetes. Future research should also consider implementing potential interventions that address social determinants of health to ensure equitable functional outcomes across socioeconomic groups.
“Poverty remains a major barrier to nutrition and food security,” concluded Esme Fuller-Thomson, PhD, senior study author, professor at the University of Toronto’s FIFSW and director of the Institute for Life Course & Aging.2 “It is important to think about broader strategies to decrease poverty and improve food access in Canada in order to promote better physical functioning among older adults.”
READ MORE: Diabetes Resource Center
References
1. MacNeil A, Cottagiri SA, Villenueve PJ, Jiang Y, de Groh M, Fuller-Thomson E. Incident functional limitations among older adults with diabetes during the COVID-19 pandemic: An analysis of prospective data from the Canadian Longitudinal Study on Aging. Can J. Diabetes. Published April 16, 2024. doi.org/10.1016/j.jcjd.2024.02.005
2. Older adults with diabetes experienced functional decline during the COVID-19 pandemic. News release. EurekAlert. Published April 17, 2024. Accessed April 17, 2024. https://www.eurekalert.org/news-releases/1041270
