OBJECTIVES : Both older age and diabetes increase risk for functional limitations. We assessed association between patient activation (PA) and change in functional limitations among Medicare beneficiaries with type 2 diabetes.

METHODS : Medicare Current Beneficiary Survey (MCBS) data from 2009 through 2013 was analyzed. PA was measured with the MCBS PA Supplement. Functional limitations, i.e., Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), were classified as “none,” “mild limitation,” “moderate limitation,” “severe limitation,” or “complete limitation.” Inclusion criteria were type 2 diabetes and age ≥ 65 years. Exclusion criteria were missing responses to more than 1/2 of PA items, missing responses to any ADL or IADL items, not community-dwelling, Alzheimer’s disease, dementia, mental retardation or mental disorders. SAS 9.4 for Unix and an alpha of 0.05 were used for analyses. Weighted ordinal logistic regression assessed association between PA and change in ADL or IADL over 2 years adjusting for covariates.

RESULTS : The sample included 1,395 persons, with mean PA score of 3.24. Most patients maintained ADL stage, 17.9% declined in ADL, and 14.0% improved in ADL. Similarly, most maintained IADL stage, 15.5% had IADL decline, and 10.2% had IADL improvement. In bivariate analysis, PA was not associated with change in ADL (Odds ratio, O.R. = 1.09, 95% confidence interval [0.81 – 1.47], p = 0.57) or change in IADL (O.R. = 1.04 [0.75 – 1.45], p = 0.80). After adjusting for age, gender, marital status, employment, education, income, insurance type, obesity, hypertension, coronary heart disease, valvular heart disease, arrhythmia, osteoporosis, arthritis, depression, stroke, and Charlson Comorbidity Index, PA score was still not associated with change in ADL (O.R. = 1.02 [0.70 – 1.50], p = 0.91) or IADL (O.R. = 1.18 [0.76 – 1.81], p = 0.46).

CONCLUSIONS : Patient activation score was not associated with change in ADL or IADL.