Psychological Resilience May Increase Healthy Aging for Older Adults with Type 2 Diabetes

Journal of the American Geriatrics Society Research Summary

The Journal of the American Geriatrics Society recently published a study about healthy aging for older adults with type 2 diabetes. The researchers looked into the role of psychological resilience in helping people with diabetes stay healthy as they get older. Psychological resilience is the attitudes and behaviors that help us adapt to stress and avoid its negative impact. In general, researchers are eager to find ways to support people in healthy aging, instead of focusing only on problems that can occur as people get older. This study highlights opportunities to promote ways for older adults with type 2 diabetes to age better.

Why Does this Matter?

We all hope to have a positive and healthy experience as we age. Researchers and clinicians are evaluating different ways we can enhance people’s later years of life. Existing research suggests that among older adults, higher psychological resilience has been linked to better well-being, a healthier lifestyle, and a reduced risk of death.

People with type 2 diabetes face many challenges, including the risk of developing other chronic conditions and declines in cognitive and physical function. Because of these challenges, this study looks at how psychological resilience impacts these older adults specifically.

How is Psychological Resilience Measured?

Participants in the study were evaluated using the Brief Resilience Scale (BRS). The BRS is a 6-question survey that asks people to report how well they think they adapt to or avoid the negative outcomes of stress. A higher score means the person has greater resilience.

What Was Learned from this Study?

The study found that older people with a history of type 2 diabetes who had higher scores of psychological resilience experience better health as they age compared to those who had lower scores.

Those with higher resilience had many positive health outcomes compared to people with lower resilience. The researchers found that the study participants with higher resilience had the following positive outcomes:

  • They were hospitalized less frequently over the past year
  • They had better physical functioning
  • They reported having fewer disabilities
  • They showed fewer depressive symptoms
  • They had a better mental and physical quality of life
  • They were less likely to have frailty (feeling weak, having less energy, and difficulty performing daily activities)

These results suggest that resilience may help an individual do better during a medical challenge, or that individuals may view themselves as more resilient when they face a medical challenge. Understanding how resilience provides helpful health benefits will help researchers find out what interventions can help improve aging.

How the Researchers Conducted the Study

The study included 3,199 older adults with type 2 diabetes who were enrolled in a program called Look AHEAD. Look AHEAD was a clinical trial that took place at multiple sites and assigned participants to random study groups. The study compared lifestyle interventions with education and whether those changes helped a patient to lose weight. After the Look AHEAD trial finished, the researchers continued to follow the participants for ten years. An assessment was carried out after approximately 14 years.

Researchers analyzed the participants’ information such as basic demographics, diabetes status, number of overnight hospitalizations, BRS score, quality of life, depressive symptoms, disability, physical function, and frailty.

What are the Study’s Limitations?

It is possible that some connections between resilience and health may be different, depending on a person’s race or ethnicity. Because these differences have not been fully studied yet, the authors stress that it is important to conduct additional research.

Previously published research also suggests that greater psychological resilience also may protect against the onset of diabetes and help improve management of the disease. However, further studies are needed to fully understand this connection.

What the Study Means for You

The researchers believe that being psychologically resilient may provide many benefits to older adults with type 2 diabetes. With further research, they believe interventions and support to promote better aging could be developed.

This summary is from “Psychological resilience in older adults with type 2 diabetes from the Look AHEAD Trial.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study’s authors are KayLoni L. Olson, PhD; Marjorie Howard, MS; Jeanne M. McCaffery, PhD; Gareth R. Dutton, PhD; Mark A. Espeland, PhD; Felicia R. Simpson, PhD; Karen C. Johnson, MD, MPH; Medha Munshi, MD; Thomas A. Wadden, PhD; Rena R. Wing, PhD; and the Look AHEAD Research Group.

Should Diabetes Treatment Lessen for Older Adults Approaching the End of Life?

Journal of the American Geriatrics Society Research Summary

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One in four people aged 65 or older has diabetes. The disease is the seventh leading cause of death in the United States and a major contributor to heart disease. Experts have recommended that the best way to slow the progression of diabetes—and help prevent its many complications—is to maintain strict control of blood sugar levels. For healthy younger people, this means keeping the target blood sugar level (known as A1c or HbA1c) lower than 6.5 percent to 7.0 percent.

For older adults who have a limited life expectancy or who have advanced dementia, however, maintaining that target blood sugar level may cause more harm than good. For example, these older adults may not live long enough to experience potential benefits. What’s more, maintaining these strict blood sugar levels can raise the risk of potentially harmful events such as low blood sugar (also known as hypoglycemia). This can cause falls or loss of consciousness.

For these reasons, many guidelines now suggest targeting higher HbA1c targets—such as between 8.0 percent and 9.0 percent—for older adults who have multiple chronic conditions or limited life expectancy, or who live in nursing homes.

There is not much existing research to guide health care practitioners as to what the appropriate levels of diabetes medications are for this group of older adults. There is also little information about the effects for these individuals of taking fewer or lower dose of diabetes medications.

Experts suspect that lessening diabetes treatment in these older adults has the potential to prevent unnecessary hospitalizations due to lowering the risk for harmful drug events and increasing the patients’ comfort.

In order to investigate the issue, a team of researchers conducted a study—one of the first national studies to examine potential overtreatment and deintensification of diabetes management in nursing home residents with limited life expectancy or dementia. The researchers chose nursing home residents to study because admission to a nursing home could give healthcare practitioners a chance to learn more about patient goals and preferences and to review and adjust medications accordingly. The researchers published their results in the Journal of the American Geriatrics Society. Continue reading

Acetaminophen Safe for Most Older Adults—But May Increase Stroke Risk for Those with Diabetes

Journal of the American Geriatrics Society Research Summary

Acetaminophen (otherwise known by brand names such as Tylenol) is one of the most widely used pain relievers. Almost 60 years of widespread use have made acetaminophen a household product. It’s distributed over the counter (OTC) in most countries and judged safe by the scientific community. However, acetaminophen is also one of the most common medications involved in overdoses (the medical term for taking more of a medicine than you should) and is the most common cause of drug-induced liver failure.

Surprisingly, we are only now coming to understand how acetaminophen works—and recent research shows that we may need to develop a better understanding of the need for caution when using acetaminophen, especially when it comes to avoiding some of the risks associated with its use. Past research suggests these can range from increased asthma to interactions with other medications or the risk for developing other health concerns (such as kidney toxicity, bone fractures, or blood cancers).

Another important reason to look more carefully at all medications is that our bodies may react to these treatments differently as we age. Older adults experience physical changes as they age including, for example, reduced muscle mass, more fat tissue, changes in body composition, and less fluid in the body systems. Older people may also have multiple chronic conditions and take several different medications. These issues affect many different body functions, and that can raise your risk of having an unwanted reaction to a medication.

For all these reasons, a team of researchers decided to study the safety of acetaminophen in a nursing home setting. Their study was published in the Journal of the American Geriatrics Society. Continue reading

Should Older Adults with Diabetes Maintain Tight Blood Sugar Control?

Journal of the American Geriatrics Society Research Summary

More than 25 percent of adults aged 65 or older have diabetes. Diabetes develops when the amount of sugar (or glucose) in your blood becomes too high. This happens either because your body doesn’t make enough insulin (type 1 diabetes), or because your body doesn’t respond to the insulin it makes (type 2 diabetes).

Older adults are especially likely to develop type 2 diabetes, because as we age, our bodies are less able to process sugars. What’s more, being overweight can increase our chances of developing the condition.

If you’re an older adult with type 2 diabetes, it’s likely that your healthcare provider has recommended that you carefully maintain your blood sugar levels with diet, exercise, and perhaps even medication. Blood sugar levels are typically monitored with a simple blood test that gives you a result called your “A1c level.” This is the percentage measurement of glucose levels in your blood over about three months.

But what should your target blood sugar level (A1c) be? If it’s too low, you could be at risk for hypoglycemia, or low blood sugar. When this occurs, you can fall or lose consciousness.

In a new study published in the Journal of the American Geriatrics Society, researchers say the evidence against “tightly” controlling blood sugar levels for older adults—the practice of targeting a more specific A1c level, often through the use of medications—hasn’t filtered down to clinics and primary care practices, where there may be value in pursuing looser target levels for blood sugar.

In their study, researchers examined records from the Diabetes Collaborative Registry for more than 30,000 adults aged 75 or older. In the study, 26 percent of older adults with diabetes had A1c levels less than 7 percent. They were treated with medications that have a high risk for lowering blood sugar to the point that someone could be at increased risk for a fall or losing consciousness.

Contrary to what researchers thought, these factors were each linked to having tight blood sugar control using a “high-risk” medication: older age, being male, or having heart failure, chronic kidney disease, and coronary artery disease. According to the researchers, people with these characteristics or conditions have the most potential to be harmed if they experience hypoglycemia and their A1c goals should be more relaxed.

The researchers concluded that we need more specific guidance about how to safely treat older adults with diabetes, and that we need to translate that guidance to help busy clinicians and their patients.

 This summary is from “Use of Intensive Glycemic Management in Older Adults with Diabetes.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Suzanne V. Arnold, MD, MHA; Kasia J. Lipska MD; Jingyan Wang MS; Leo Seman, MD PhD; Sanjeev N. Mehta MD, MPH; and Mikhail Kosiborod MD.

For Older Adults with Diabetes, Losing Weight through Diet and Exercise Can Improve Blood Circulation in the Brain

JAGS graphicJournal of the American Geriatrics Society Research Summary

Type 2 diabetes affects blood circulation. The disease stiffens blood vessels and reduces the amount of oxygen that circulates throughout your body. This includes your brain. When blood flow in the brain is impaired, it can affect the way we think and make decisions.

People who have type 2 diabetes are often overweight or obese. These are conditions that may also be linked to cognitive problems (problems with thinking abilities). Lowering calorie intake and increasing physical activity are known to reduce the negative effects of type 2 diabetes on the body. However, the effects of these interventions on cognition and the brain are not clear.

Recently, researchers examined information from a 10-year-long study called Action for Health in Diabetes (Look AHEAD). In this study, participants learned how to adopt healthy, long-term behavior changes. In their new study, the researchers focused on whether participants with type 2 diabetes who lowered calories in their diet and increased physical activity had better blood flow to the brain. The researchers published their findings in the Journal of the American Geriatrics Society. Continue reading