Health Behavior Changes after a Diagnosis of Diabetes Among Older Adults

Background and Purpose

The growing disease burdens of diabetes among older adults highlight the importance of health behaviors in this population. A new diagnosis of diabetes can be both a teachable moment and a stressful event that affect older adults’ subsequent health behaviors. The study objectives are to determine whether older adults reduce their health-risking behaviors following a diagnosis of diabetes. Specifically, the research question is: do older adults lower their alcohol consumption, quit smoking, reduce physical inactivity, and engage in preventive care services (flu shot, blood test for cholesterol, prostate cancer screening in men, and mammogram in women) after a diagnosis of diabetes? The study hypothesize that older adults will adopt health-promoting behaviors (reducing alcohol intake, non-smoking, and more physical activity) and engage in preventive care services after a diagnosis of diabetes.

Methods

The study sample was selected from the Health and Retirement Study (HRS), a national cohort study with core data available to the public. HRS waves of 2006 to 2016 (six waves) were used for the present study. The sample included 17,001 adults aged 50 or older without diabetes at baseline. The and person-level sampling weights were applied to generate nationally representative estimates. A new diagnosis of diabetes is measured by self-reported physician-diagnosed diabetes among participants in the follow-up waves. Health behaviors were all dichotomized variables. Alcohol consumption was coded as no or moderate drinking vs. excessive drinking. Smoking status was determined as current smoking vs. non-smoking. Physical activity was coded as physical inactivity vs. engagement in recommended physical activity. A case-control difference-in-differences (DID) estimator approach was used to assess the effects of a diagnosis of diabetes on health behavior changes. Respondents who had a diagnosis of diabetes (cases) were one-to-one matched to those free of diabetes (controls) throughout the selected study waves by using nearest neighbor matching with Mahalanobis distance. An interaction term between diagnosis and time was created to model the DID estimator.

Results

After a diagnosis of diabetes, 45 per 1,000 persons reduced alcohol consumption from excessive drinking to moderate or no consumption, 65 per 1000 persons received blood test for cholesterol, and 59 per 1000 persons received flu shot. No changes were found in smoking, physical inactivity, and receiving prostate cancer screening in men and mammogram in women.

Conclusions and Implications

A diagnosis of diabetes can be a significant health event that serves as a teachable moment that enhances older adults’ cognitive process in adopting health-promoting behaviors. After a diagnosis of diabetes, older adults may perceive excessive drinking as unhealthy behavior and considerably reduce the alcohol consumption. Also, study findings suggest that a diagnosis of diabetes can increase the awareness of preventing health complications by undergoing preventive care services. Overall, the timing of a diabetes diagnosis may be an opportunity to motivate older adults to engage in healthy behaviors. Receiving health behavior interventions at the time of diabetes diagnosis may augment the success of health behavior changes and diabetes management among older adults.