# Diabetes, Dementia, and Aging at Home

> **NIH NIH R01** · VANDERBILT UNIVERSITY MEDICAL CENTER · 2020 · $282,525

## Abstract

PROJECT SUMMARY
 Managing diabetes may be a significant barrier to aging at home for older adults, especially for those
with Alzheimer’s disease or related dementias (ADRD). Over 40% percent of low-income older adults with
Medicare and Medicaid have diabetes, but there is limited access to Medicaid home-and-community-based
services (HCBS) that can assist with daily tasks like insulin injections, meal preparation, and monitoring
glucose levels. Even though 25-40% of patients with dementia also have diabetes, little is known about
diabetes management in this population. Without family members or other caregivers to assist, low-income
older adults with diabetes may face unnecessary hospitalizations for diabetes and nursing home entry.
Hypoglycemia, which can lead to falls, injuries, and loss of consciousness, is a large health risk for older adults
with diabetes, especially if they are black, use insulin, or have dementia.
 Such issues are particularly concerning in the Southeast due to the region’s high prevalence of
diabetes and ADRD. The Southern Community Cohort Study, a prospective cohort study of low-income white
and black Southeastern residents that includes over 12,000 participants age 65 and above with diabetes,
provides a unique opportunity to understand diabetes-related barriers to living at home. By linking survey data
to claims data, this study will examine which factors, including dementia and limited social support, predict
initial use of Medicaid HCBS and nursing home services. Over a fifteen-year period, the study will analyze
whether more generous coverage of Medicaid HCBS benefits is associated with changes in nursing home
entry, inpatient and emergency room use, and treatment for hypoglycemia. To better understand what factors
may prevent older adults from using simpler insulin regimens that may lower their risk for hypoglycemia, the
study will examine whether lower out-of-pocket costs for simpler insulin options are associated with greater use
of these drugs, and whether these associations differ for older adults with dementia or limited social support
who may have more difficulty navigating drug benefits. Finally, the study will assess whether better coverage
of simpler insulin options is associated with lower risk of hospitalizations, emergency room visits, treatment for
hypoglycemia, and nursing home entry. The results will provide novel evidence about how Medicare and
Medicaid policies may be able to address the needs of older adults with diabetes as they age at home and
prevent poor health outcomes, especially for those with dementia or limited social support.

## Key facts

- **NIH application ID:** 10040573
- **Project number:** 1R01AG068606-01
- **Recipient organization:** VANDERBILT UNIVERSITY MEDICAL CENTER
- **Principal Investigator:** Laura Margaret Keohane
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $282,525
- **Award type:** 1
- **Project period:** 2020-09-15 → 2024-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10040573

## Citation

> US National Institutes of Health, RePORTER application 10040573, Diabetes, Dementia, and Aging at Home (1R01AG068606-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10040573. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*