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Executive Function Associated With Quality of Life, Negative Emotion in Older Adults With Diabetes


A longitudinal study found that executive function was more predictive than pain for present and future quality of life in older adults with diabetes.

Executive function (EF) is a more predictive measurement of quality of life (QoL) and negative emotion compared with pain in older adults with diabetes, according to a recent study.

Previous studies have found that less than half of individuals with diabetes have a good QoL in the physical (7.1%), psychological (16.2%), social (17.25%), and environmental (40.1%) domains of their life. A study published in Primary Care Diabetes sought to identify the current and future predictors of QoL and negative emotion.

Older adults with diabetes aged 60 years and older were recruited from outpatient clinics in Taiwan for this study. Patients with severe cognitive impairments and a history of depression were excluded from this study. All demographic information and health and medical conditions were collected during face-to-face interviews and reviewing medical charts.

There were 128 participants who were recruited in the first year (Time 1), 98 remained for the second year (Time 2), and 63 continued for the third year (Time 3). The reasons participants dropped out included poor health, death, if they considered the study unhelpful or unnecessary, or if researchers had lost contact.

Participants were asked to complete surveys, including the Brief Pain Inventory (BPI), Barthel Index (BI) the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF), and the Lawton Instrumental Activities of Daily Living (IADL), among others. The Chinese version of the Mini-Mental State Examination (MMSE-C) was also used. The Executive Function Scale – Short Version (EFS-S) was used to assess EF.

There were no significant differences between the 3 groups in demographics. Approximately half of the participants had a hemoglobin A1C (HbA1c) of greater than or equal to 7% and prevalence of pain ranged from 39.7% to 41.4%.

A higher WHOQOL-BREF score was significantly associated with a higher EFS-S score and lower BPI score in Time 1 and Time 2, and a lower number of medications and IADL scores correlated to higher scores in Time 2 and Time 3, respectively. A higher EFS-S, BI, and IADL scores, lower BPI score, and lower HbA1c were associated with a higher WHOQOL-BREF score in the health domain across all groups.

Higher EFS-S score and lower BPI score were associated with a higher score in the psychological health domain in both Time 1 and Time 2 and EFS-S score showed a positive correlation to the score for Time 3. The social relationships domain was correlated with the EFS-S score in all 3 groups, with higher education also associated with the social domain.

A lower EFS-S and higher BPI scores were associated with higher Geriatric Depress Scale Short Form (GDS-S) score in Time 1 and Time 2. There was a negative correlation between the EFS-S and GDS-S scores in the Time 3 group.

The researchers found that the EFS-S score was the strongest predictor of the overall WHOQOL-BREF score at all 3 times, as it contributed 31.5% of the variability at Time 1, 36.2% at Time 2, and 23.0% at Time 3. The BPI score was another common predictor as it contributed 5.1% of the variability at Time 1, 3.2% of the variability at Time 2, and 5.8% at Time 3.

The EFS-S score was the strongest predictor for the physical domain at all 3 time points with 25.8% of variability at Time 1, 20.6% at Time 2, and 13.0% at Time 3. The BPI score was the other common predictor with 8.3%, 7.0%, and 10.0% of the variability at Times 1, 2, and 3, respectively.

The EFS-S score was the strongest predictor of the psychological domain with 28.9%, 26.7%, and 20.6% of the variability at Times 1, 2, and 3. The strongest predictor of the environmental domain was also the EFS-S, which contributed 17.9%, 35.5%, and 13.7% of the variability at Times 1, 2, and 3. The strongest predictor of the GDS-S score was the EFS-S score.

The limitation of this study is that this study utilized a small sample population, which makes it not large enough to confirm if the finding of this study exists in other older adults with diabetes who have more heterogeneous variables.

The researchers concluded that EF was the most predictive factor of QoL and negative emotion in older adults with diabetes.


Ho HT, Lin SI, Guo NW, Yang YC, Lin MH, Wang CS. Executive function predict the quality of life and negative emotion in older adults with diabetes: a longitudinal study. Prim Care Diabetes. 2022;16:537-542. doi:10.1016/j.ped.2022.05.002

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