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Health-related quality of life (HRQOL) and well-being has been identified as a new topic area for Healthy People 2020, a national health initiative by the U.S. Department of Health and Human Services. Diabetes has significant adverse effects on HRQOL and while diabetes cannot be cured, it can be managed successfully with healthy lifestyle choices. Although previous studies have investigated the impact of diabetes on HRQOL, little is known regarding the association between health habits and HRQOL among older adults with diabetes. The purpose of this study is to examine the associations between HRQOL and health habits among older adults with diabetes. It is hypothesized that older adults with diabetes who presented good health habits will be more likely to report good HRQOL compared to those who did not.
Methods
This study used data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS). The sample included older adults 50 and over who have diabetes (N=54,600). HRQOL is composed of four measures including self-reported general health (good versus poor), days of poor physical health in the past month, days of poor mental health in the past month, and days of limited activities due to poor physical or mental health in the past month (≥14 days versus <14 days). Health habits included exercise, current cigarette use, and heavy alcohol drinking. Weighted multivariate logistic regression was performed to investigate the association between health habits and HRQOL measures. Covariates included demographic variables such as gender, race, age group (50 to 64, 65 to 79, 80 and above), education level (post-secondary or not), and income (having an annual household income <$15,000). Additional adjustments were made for disability status, insulin treatment, and body mass index.
Results
Among the health habits, not smoking and exercise were significantly associated with all four measures of good HRQOL. Interestingly, the odds of having 14 or more unhealthy days (physical, mental, limited activities) decreased with older age. Having disabilities and receiving insulin treatment were associated with poor HRQOL, whereas having high school education and above $15,000 annual household income were associated with good HRQOL.
Conclusion
The findings reinforce the importance of health promotion and diabetes education programs that emphasize healthy lifestyle to help older adults with diabetes successfully control their conditions and achieve good HRQOL. Older adults who are at age of 50 to 64 had the poorer HRQOL compared to older age groups. Those who are still working may experience additional difficulties managing diabetes suggesting that diabetes education should be promoted more in workplace. Also, appropriate education and support is needed for older adults who are receiving insulin treatment. Further research is needed to address modifiable behavioral risk factors and promote healthy lifestyle in this population, especially those who may not have access to resources. Such research can guide practitioners design and implement health promotion programs that will maximize the quality of life for this at risk population.