June 27, 2013

Elderly with Diabetes Discriminated Against

If you are in the elderly group like I am and over the age of 64, you are being discriminated against. Yes, and this is because of our age and for other reasons. This arbitrary age distinction is made to avoid the elderly that may have more than one chronic disease and have other medical problems. I will quote my blog here which did include ages up to 75.

One statement that seems to sum up how researchers feel about the elderly is this. Finally, we did not recruit adults aged 76 years and greater because these individuals may present with unique clinical (e.g., comorbidity, complications) and functional (e.g., impairment, disability) challenges that require special attention. For example, older diabetes patients are at greater risk for several geriatric syndromes, including depression, cognitive impairment, injurious falls, neuropathic pain, and urinary incontinence. These syndromes can have a deleterious effect on diabetes self-care, health status, and quality of life. Thus, the value of group versus individual diabetes education needs to be evaluated in the age 76 and up population. Importantly, future diabetes behavioral interventions need to address changes in older adult functional, cognitive, and psychosocial states and how best to assess and address these factors.”

This is still very discriminatory and shows why most researchers will not include them in most studies. Fortunately, this study was positive for showing that the elderly can benefit from group education. However, even with this outcome, our understanding of geriatric diabetes is still not enhanced and we still need more research on geriatric diabetes. This is because over half of those with type 2 diabetes are over the age of 65.

A study in the Journal of the American Geriatrics Society shows that things are not changing and discrimination still prevails. This link will only take you to the abstract, but it still says a lot.

The information in this blog is important enough to quote. “The authors analyzed 440 protocols of ongoing studies of type 2 diabetes. The findings are very discouraging:
  • 66% of studies excluded subjects using an arbitrary upper age limit.  Upper age limits are almost never justified. Even when drugs are tested in mostly younger patients, they get heavily marketed and used by older patients
  • 77% of studies excluded subjects with comorbid conditions--diseases in addition to diabetes. An acceptable justification for exclusions based on comorbidity was provided less than a 25% of the time. The vast majority of patients with diabetes have comorbidity. It is crucial we learn how comorbidity impacts the outcomes of treatment. Exclusions based on comorbidity often makes the real world application of diabetes studies uninterpretable.
The authors note that responsibility for age discrimination rests with multiple players and notes responsibility of these players going forward:
  • Regulatory agencies such as the FDA must develop clear regulations that demand drugs will be tested in the patients that actually will use them before they are allowed to be widely used
  • Funders such as the NIH should stop turning a blind eye towards ageism in clinical research
  • Human subjects committees should avoid approving protocols that needlessly exclude older subjects
  • Older patients and those who care about them should insist that research that improves their care is a major societal need”

In addition, since the elderly is the largest group being prescribed the diabetes drugs, we need the studies for treatment guidelines and to show how the different drugs impact the problems older persons care about such as functional impairment, cognitive function, falls, and incontinence. Researchers need to make changes in the procedures they use for studies and the above players need to step up and take responsibility.

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