Activities of Daily Living (ADL) are more impaired among Geriatric Diabetic Patients compared to Non-Diabetic Subjects A. Zeyfang and T. Nikolaus Geriatrische Reha-Klinik Aalen, Jahnstr , Aalen Bethesda Geriatrische Klinik Ulm, Zollernring 26, Ulm/Donau, Germany

Geriatric Syndromes (the 5 Geriatric I`s) Incontinence Instability Immobility Intellectual Decline Iatrogeneous Damage

Patients Collective n=792 consecutive patients of a geriatric clinic, 2/3 females

Collective of Diabetics n=271 consecutive diabetics (34,2%) 14,5% newly recognized 96% type-2 (4% type-1, LADA) 2/3 f

Leading Diagnoses

Diagnoses and Geriatric Syndromes p<0,001 p<0,05

Differences between the Groups p<0,01 p<0,05 n.s.

Activities of Daily Living (ADL) 1. The index should be used as a record of what a patient does, not as a record of what a patient could do. 2. The main aim is to establish degree of independence from any help, physical or verbal, however minor and for whatever reason. 3. The need for supervision renders the patient not independent. 4. A patient's performance should be established using the best available evidence. Asking the patient, friends/relatives and nurses are the usual sources, but direct observation and common sense are also important. However direct testing is not needed. 5. Usually the patient's performance over the preceding hours is important, but occasionally longer periods will be relevant. 6. Middle categories imply that the patient supplies over 50 per cent of the effort. 7. Use of aids to be independent is allowed.

Activities of Daily Living (ADL) Feeding Bathing Grooming Dressing Bowels Bladder Toilet Use Transfers (bed to chair and back) Mobility (on level surfaces) Stairs

ADL at Admission and Discharge all Pt. p<0,01

ADL at Admission and Discharge without Stroke p<0,01

ADL Differences D vs. ND AdmissionDischarge% with full score prior to discharge Eating Showering- bathing WashingP<0.05 Dressing/Un.

ADL Differences D vs. ND AdmissionDischarge% with full score prior to discharge Bowel Control P< vs Bladder Control P<0.01P< vs Toilette useP<0.01

ADL Differences D vs. ND AdmissionDischarge% with full score p.d. Transfer Bed-Chair P<0.05 Standing Up&Walk P< vs Climbing Stairs P< vs. 20.3

AdmissionDischarge% with full score prior to discharge Transfer Bed-Chair P<0.05 Standing Up&Walk P< vs Climbing Stairs P< vs. 20.3

Urinary continence D vs. ND p <0,01

Stair climbing D vs. ND p<0,01

Differences in the Geriatric Assessment Tools Significant differences in: Handgrip (Chi , p=0.02) Tandem Standing (Chi , p=0.02) No Significant differences in: Timed Up&Go Test Tinetti Balance & Gait Test Chair-rising test Transfer-scale Standardized Gait Stair-climbing Romberg Testing Semi-Tandem standing

Reason for Disabilities: Diabetes itself! Geriatric Patients with Diabetes suffer from: –Higher morbidity –More geriatric syndromes –ADL are reduced in mobility and continence –Causing relevant disability in daily living

ADL after 1 Year in n=188 D