Australian Institute of Health and Welfare 2018. Older Australia at a glance. Cat. no. AGE 87. Canberra: AIHW. Viewed 17 October 2021, https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance
Australian Institute of Health and Welfare. (2018). Older Australia at a glance. Retrieved from https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance
Older Australia at a glance. Australian Institute of Health and Welfare, 10 September 2018, https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance
Australian Institute of Health and Welfare. Older Australia at a glance [Internet]. Canberra: Australian Institute of Health and Welfare, 2018 [cited 2021 Oct. 17]. Available from: https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance
Australian Institute of Health and Welfare (AIHW) 2018, Older Australia at a glance, viewed 17 October 2021, https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance
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Diabetes is a chronic condition characterised by high levels of glucose in the blood. It is caused either by the body’s inability to produce insulin (a hormone produced by the pancreas to control blood glucose (sugar) levels), or by the body not being able to use insulin effectively . There are 3 main types of diabetes:
Based on the Australian Bureau of Statistics (ABS) 2014–15 National Health Survey (NHS), around 1 in 6 people aged over 65 reported having diabetes—just over 574,000 people . The rate of diabetes tends to increase with age, with the highest prevalence (19.4%) reported in people aged 85 and over. Men reported slightly higher rates of diabetes than women, accounting for 55% of cases in people aged 65 and over. Consistent with the wider population, the most common type of diabetes reported by people aged 65 and over was type 2 diabetes—accounting for more than 9 in 10 cases (90%) (Figure 1) .
The rate of self-reported diabetes for people aged 65 and over has doubled over the last 2 decades—from 8.5% in 1995 to 17.4% in 2014–15 (Figure 2). This increase is likely due to a number of factors including: an increased prevalence of risk factors, improved public awareness, better detection techniques, improved survival through management techniques, and an ageing population .
The cause of type 1 diabetes is unknown, although it is believed to result from genetic predisposition and environmental factors. Type 2 diabetes also has a strong genetic component, and is more likely to affect people with a family history of the condition. Certain lifestyle risk factors also increase the risk of developing this condition, such as a high body mass index (BMI) and high blood pressure, and this risk increases with age . Further information on the prevalence of some of the main lifestyle risk factors in the older population is given in Healthy ageing.
Diabetes can result in a number of acute and chronic health conditions, including heart attack and stroke, kidney damage, vision loss, nerve damage (neuropathy) and delayed wound healing, which can lead also to lower limb amputation. Early and intensive management of blood sugar levels can delay the onset or slow the progression of these complications .
Management of type 2 diabetes in older people using medication is more complex. For older people, the benefits of intensive glucose control need to be weighed against the associated risks, such as the impact of medications on the kidneys and the risk of interaction with other medicines used for managing multiple conditions (polypharmacy) .
In 2012, the pharmacological management of type 2 diabetes in a concessional population of people aged 65 and over was examined, and the following key findings were made :
Diabetes was recorded as a diagnosis for over 1 million hospitalisations in 2015– 16—representing 10% of all hospitalisations that year. There were 59,900 hospitalisations related to type 1 diabetes, and 980,000 hospitalisations related to type 2 diabetes .
Hospitalisation rates for type 2 diabetes increased with age, with the majority (87%) of hospitalisations recorded in people aged 55 and over. The hospitalisation rate is highest in people aged 75–84, at 22,500 per 100,000 population (Figure 3).
In 2016 diabetes was the seventh leading cause of death in Australia. A total of 16,500 deaths were related to diabetes, accounting for 10.4% of all deaths that year. Diabetes mellitus was the underlying cause for 4,770 of these deaths (29% of all diabetes deaths) and an associated cause of death for a further 8,330 deaths .
Diabetes mellitus death rates increase with age (Figure 4). In 2014–16, the death rate for people aged 85–94 was almost 3 times as high as those aged 75–84 .
Diabetes is an important health issue for older Aboriginal and Torres Strait Islander people, based on data from the ABS 2011–13 Australian Aboriginal and Torres Strait Islander Health Survey. Just under 2 in 5 (38%) Indigenous people aged 55 and over were diagnosed with diabetes (based on HbA1c testing), compared with 12% of non-Indigenous Australians .
There were more than 52,000 hospitalisations related to diabetes for Indigenous people in 2013–14, and 90% of these hospitalisations had either a principal or additional diagnosis of type 2 diabetes. The type 2 diabetes hospitalisation rate was 4 times the rate of non-Indigenous Australians, and the rate of hospitalisation increased with age (Figure 5). The highest rate was observed for people aged 65–74 (around 40,000 per 100,000) .
According to the ABS, diabetes was the second leading cause of death in Aboriginal and Torres Strait Islander people in 2016. The standardised death rate was 5.0 times the rate in non-Indigenous people (81.2 and 16.4 deaths per 100,000 people, respectively) .
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