Study Examines Effects of COVID-19 Social Isolation on Older Patients With T1D

New research explores the impact of pandemic-induced isolation on disease management and overall quality of life in older adults with type 1 diabetes (T1D).

Findings, published in Scientific Reports, identify modifiable barriers and challenges faced by this population.

“As this population has a higher risk of decline in physical and psychosocial support even during nonpandemic times, clinicians will benefit from understanding these issues to improve care of this population,” authors wrote.

Older adults with T1D may experience declines in physical and cognitive status as they age, in addition to other medical comorbidities, potentially worsening their ability to manage diabetes self-care regimens.

Little information is available on how older adults with T1D cope with and manage their diabetes during difficult periods in their later life, the researchers noted. To address this knowledge gap, they assessed older adults with T1D during the COVID-19 lockdown to understand how they managed their disease when their support system is disrupted. Although pandemics are unlikely to happen with frequency, similar disruptions may occur if a spouse or caregiver passes away or anxiety results from a new medical diagnosis.

Researchers carried out semi-structured interviews with 34 older adults between May and August 2020. The mean patient age was 71 (5) years and all were receiving care at a tertiary care diabetes center. Ninety-seven percent of patients were White, and the average diabetes duration was 38 (7) years.

Analyses identified 3 themes related to diabetes self-care as influence by isolation:

• Diabetes management and self-care behaviors (how isolation prompted changes in physical activity and dietary habits)
• Emotional stress and anxiety (related to isolation and lack of support system, economic concerns)
• Concerns regarding the COVID-19 pandemic (impact on timely medical care and access to information)

Results showed older adults were almost equally split on the positive or negative impact of isolation on self-care behaviors. Although some used more time at home to improve their diet by cooking more healthy meals, others ate out more often.

In addition, those with better family connections and support systems tended to report less stress and anxiety in general, while some patients reported stress regarding the impact the pandemic had on their medical care, like uncertainty around the timing of visits.

“Overall, we found many in the study coped well during these new challenges and maintained a positive attitude. This success and optimism might be due to their inherent capacity to cope with difficult situations, as many have done since being diagnosed with T1D many decades ago,” the authors wrote.

Many participants reported the controlled environment of being homebound allowed for better eating habits and more time to do exercise, leading to improvements in glucose control. Negative impacts to exercise regimens stemmed from patients’ inability to access familiar exercise venues.

The cohort included in the study was largely homogeneous, marking a limitation. This study population was also better educated and had more financial resources than average, which is likely due to the geographical nature of the tertiary care center, the authors added.

“Our results will help clinicians to understand the needs and barriers faced by this population,” the researchers concluded. “Identifying procedures to overcome these barriers when isolation arises, such as counseling about changing dietary habits and physical activity routines, as well as how to connect with both health care professionals and mental health resources, can mitigate the impact of isolation.”

Reference:

Munshi M, Slyne C, Weinger K, et al. Self-care barriers and facilitators in older adults with T1D during a time of sudden isolation. Sci Rep. Published online April 29, 2023. doi:10.1038/s41598-023-33746-3