Psychosocial Factors and Mortality Among Older Adults with Diabetes

Background and Purpose: Type 2 Diabetes affects over a quarter of Americans aged 65 years and older, increasing the risk of a wide array of adverse health outcomes including declined cognition, functional disability, depressive symptoms, and lowered quality of life. Successful management of diabetes (i.e., medication adherence, physical activity, balanced diets, etc.) plays an important role in quality of life among older adults with diabetes. While existing research suggests that psychosocial factors improve diabetes management outcomes, the long-term effects on mortality among older adults with diabetes remain unaddressed. To bridge this gap, the present study aims to examine the extent to which self-efficacy, social support, and perceived importance of self-management are associated with 17-year mortality among older adults with diabetes.

Methods: The study sample of older adults with diabetes came from the Health and Retirement Study (HRS)’s 2003 Diabetes Study (N = 1148). The HRS is a national panel survey study that is representative of older adults aged 51 or older. The year of death was ascertained by exit interview or spouse respondents up to 2020. Time-to-event was calculated using year of death minus 2003. Attrition due to reasons other than death was treated as censored observations. Psychosocial predictor variables were from 2003. The perceived importance of diabetes management activities was measured with an 8-item scale that asked participants’ perceived importance of engaged in diabetes management activities such as following a meal plan. Social support was assessed with a 7-item scale that indicated whether participants could count on their family or friends to help with diabetes management. Self-efficacy was measured using a 6-item scale that measured participants’ confidence in performing diabetes activities. Cox proportional hazards models were performed to test the study aims, adjusting for complex survey design to generate weighted estimates.

Results: Participants had an average age of 69.8 years and slightly over half were women (52.7%). From 2003 to 2020, about one third participants died (33.6%). Significant associations linking self-efficacy and perceived importance to mortality were observed. Specifically, a higher level of self-efficacy was associated with 14% lower hazard of death (hazard ratio [HR] = 0.86, P = 0.049). Also, one-unit increase in perceived importance of diabetes management activities was associated with 16% lower hazard of death (HR=0.83, P = 0.015). However, no significant relationship was observed between social support and mortality.

Conclusions and Implications: The study findings suggest the importance of improving psychosocial factors related to diabetes. Older adults with diabetes who have more confidence and perceive diabetes management as more important tend to have a longer life expectancy. We did not find an association between social support and mortality. One possible explanation is that older adults who receive a higher level of social support may have more severe and complex health needs. The findings are also important to health social work practice. Social workers are uniquely positioned to identify psychosocial barriers to successful diabetes management and can play meaningful roles in promoting quality of life among older adults with diabetes and prolong the life expectancy.