The co-occurrence of depressive symptoms and cognitive impairment and its relationship with diabetes self-care behaviors

[[abstract]]Background: Depressive symptoms or cognitive impairment is prevalent in older adults with diabetes. To date the epidemiology of the coexisting diabetes, depressive symptoms, and cognitive impairment among older persons has yet to be adequately characterized. Little is known about how depressive symptoms in combination with cognitive impairment associated with diabetes self-management. Aim: The main aim of the present study was to investigate the co-occurrence of depressive symptoms and cognitive impairment in community dwelling older adults with diabetes and its relationship with specific diabetes self-care behaviors. Methods: We analyzed data from two national sample of older adults (65 years or older) with self-reported physician-diag-nosed diabetes (N = 1,034), who participated in the 2005 or 2009 National Health Interview Survey in Taiwan. The Mini-Mental State Examination (MMSE) was used to assess cognitive function. The Center for Epidemiologic Studies Depression Scale (CESD) was used to assess depressive symptoms. The study assessed self-care behaviors including adherence medication, exercise, healthy diet, and self-monitoring of blood glucose. We excluded 77 persons who had diagnosed dementia or depression and 86 persons who had incomplete data for MMSE or CESD. This resulted in 871 eligible participants for analysis. We conducted logistic regression on the effects of cognitive impairment and depressive symptoms on respondents’ self-care behaviors after controlling for demographics, comorbidities, diabetics-related attributes, and health care utilization. Results: We found that among participants with diabetes, 13.4% had depressive symptoms only, 16.4% had cognitive impairment only, and 8.8% had both depressive symptoms and cognitive impairment. After adjusted for other factors, participants with depressive symptoms alone were less likely to adhere to exercise (Adjusted Odds Ratio [AOR] = 0.63; 95% CI = [0.39–0.99]). Participants combined with cognitive impairment and depressive symptoms were less likely to adhere to exercise (AOR = 0.39; 95% CI = [0.21–0.71]), to healthy diet (AOR = 0.30; 95% CI = [0.15–0.61]), and to self-monitoring of blood glucose (AOR = 0.46; 95% CI = [0.21–0.99]). Conclusion: Our results highlight the combined presence of depressive symptoms and cognitive impairment was prevalent in older adults with diabetes. Furthermore, this combination was associated with worse self-care behaviors, especially exercising, healthy diet, and self-monitoring of blood glucose for older adults with diabetes. These findings highlight the importance of improving depressed mood and cognitive function in older to performing self-care behaviors for older adults with diabetes