Health Care Provided to Older People with Type 2 Diabetes Mellitus - Term Paper Example

Running heading: LIFESTYLE CHANGES ELDERLY TYPE 2 DIABETES MELLITUS 1 Research Title Different attributes of health care provided to older people with type 2 diabetes mellitus to promoted their behaviours and motivations to self-management Introduction Diabetes mellitus type 2 affects about 80%–90% of elderly people in developed countries and in developing countries. The prevalence of diabetes rises with age, and estimated that 50% of patients with diabetes mellitus are aged 65 years or older. It is important to establish a self-management approach for elderly patients in primary care. Studies identified certain factors that hindered self-management, poor physical condition, financial constraints, and transport problems, long waiting times at clinics, unsupportive healthcare professionals, family support, and long-term intervention. Complications like cognitive and functional impairment is common in patients with diabetes this disability is particularly apparent in the elderly, a number of studies as indicates that deteriorating functional and cognitive ability hinders self-care management. Therefore, the view of the patient is important basis for developing self-care management. (Sinclair & Girling & Bayer 2000) Lifestyle changes of older people experiencing type 2 diabetes mellitus is difficult to management and adhere to. Therefore, they need special attention and constant motivations to manage their lives. Therefore, there is a need for more research on how effectively these lifestyle changes have to be integrated in the primary care and the proper application by health professional. And in making decisions the patients should be involved in every step of LIFESTYLE CHANGES ELDERLY TYPE 2 DIABETES MELLITUS 2 making decisions, and their views have to be considered and be integrated in the final decision. (Boult et al 1994) Background information Diabetes self-care requires that patient make many dietary and lifestyle changes simultaneously which, further emphases the need for self-care management support. Therefore, there are a number of studies that will help explain the behaviours required for successful self-care management such as, self-efficacy, locus of control, health belief and health value. Self-efficacy is concerned with the perceptions a person has about is ability to perform a task and can influence the acquisition of new behaviours, while locus of control contends with an individual's perception of whether is action determines an outcome outside of their control. (Hayes & Ross 1987) Rationale or research questions The aim of this study is to explore different lifestyle changes required for self management of diabetes and to identify the best combination for maximum benefits to the patient. Discussion of different strategies and tailor made changes to suit specific individual’s health belief, value, self-efficacy, and locus of control to help illustrate the findings within the context of self management. Limitation of the study Although there is a strong body of evidence emphasizing the health benefits of lifestyle modification for elderly people with type 2 diabetes, far less is known about the effectiveness of primary care based strategies for achieving the physical activity and dietary changes necessary for the general adult population. All these reviews LIFESTYLE CHANGES ELDERLY TYPE 2 DIABETES MELLITUS 3 Acknowledge the difficulty of drawing conclusions from primary care based studies completed to date. (Clark 1997) Many health professionals do not believe in these lifestyle intervention efforts of prevention and management of type 2 diabetes mellitus. There are no concrete studies to indicate whether these behaviour changes are effective and practice challenges and social and environmental barriers experienced with patients facing other chronic diseases reduce the use of these interventions. Literature Review Would bring out the gaps and outstanding arguments in the existing research that supports the need to undertake this proposed research, and how the proposed research will fill those gaps. There is good evidence that nurses and dieticians have a role in counselling and managing patients diag­nosed with type 2 diabetes, in motivating those to take up these lifestyle changes to self manage their daily life’s. (Sadur 1999) There is enough evidence to support resource intensive and individual based lifestyle programs that could improve diet and exercise behaviours. This could successfully reduce the numerous cases of obesity in the elderly with type 2 diabetes mellitus. The literature discusses a number of services, interventions that target change in lifestyle behaviour, investigations on integration and evaluation of such interventions at the primary care level enhance there effectiveness is not understood. In particular how changes in mood and cognition are implicated in the uptake of healthier behaviours. Example how cognitive factors such as knowledge, motivation to change and self-efficacy beliefs implicated in the ability to adopt and maintain healthy lifestyles, it is not clear if behavioural improvement is dependent on LIFESTYLE CHANGES ELDERLY TYPE 2 DIABETES MELLITUS 4 Psychological changes in motivation, knowledge, mood, and self-efficacy uniquely or in combination. (Brodie & Inoue & Shaw 2008) Older patients require a management approach that differs from that for younger adults because of the presence of co-morbidity, age-related changes in functional ability, the threat of and susceptibility to hypoglycaemia and the increased role of informal carers. Risks of hypoglycaemia are higher in patients who are cognitively impaired. As a result these patients often have impaired awareness of the autonomic warning symptoms of hypoglycaemia even when they have been educated about them. (Norris et al 2002) They may also have delayed psychomotor responses to intervene in the correction of hypoglycaemia Hyperglycaemia and hypoglycaemia, microvascular and large vessel complications all adversely affect the quality of life of elderly patients, while placing a heavy demand on limited health care resources. (Sinclair & Barnett 1993) There is a need of health care professionals to educate and motivate the elderly patients to take up and adhere to lifestyle changes that would help them manage the disorder. The Chinese Da Qing Study reported a 42% reduction in progression of IGT to diabetes over 6 years, based on an intensive regimen of exercise and diet therapy. (Pan et al 1997) The Finnish Diabetes Prevention Study further substantiated that lifestyle change reduced overall incidence of type 2 diabetes by 58% during the 3 years of follow up in this study. There was also an emphasis on self-esteem, empowerment, and social support to help participants achieve and maintain the set goals. (Tuomilehto et al 2001) This article provides an overview of best evidence: an expert review of weight loss and a meta-analysis quantifying the effects of exercise in management of diabetes type 2 showed LIFESTYLE CHANGES ELDERLY TYPE 2 DIABETES MELLITUS 5 Diet reduced HbA1c levels primarily in studies using very low caloric diets (VLCDs). The degree of caloric restriction involved in VLCDs appears to improve initial weight loss and a reviewed and quantified the effects of aerobic exercise on HbA1c levels and body mass among patients with type 2 diabetes. The investigators reported that the weighted mean difference in post intervention HbA1c was clinically relevant and supported moderate exercise interventions on their own for diagnosed type 2 diabe­tes mellitus. A typical program recommends three workouts per week, a mean of 53 minutes in duration for 20 weeks, with moderate aerobic intensity exercises that consists of swimming, walking or cycling. Potential harm from physical activity and dietary counselling for diagnosed type 2 patients was not found in studies in any of these reviews. (UK Prospective Study Group 1998) Aims and Objective This study aims to evaluate different lifestyle changes programmes provided to elderly patients with diabetes mellitus type 2. How effective are these intervention methods in the reducing the risks associated with diabetes in the elderly. Whether tailor made behaviour changes are more efficient than generalized lifestyle changes. What is the best method of monitoring the adherence of these changes in the elderly patients with cognitive impairment and how health professionals should apply these lifestyle modifications to achieve maximum benefits for the elderly type 2 diabetes mellitus patients with proper motivation incentives these goals would be achieved. LIFESTYLE CHANGES ELDERLY TYPE 2 DIABETES MELLITUS 6 Data collection The design of this study would be based on qualitative descriptive and exploratory, with an inductive approach as described in grounded theory. According to Strauss and Corbin, the grounded theory approach would be used because little is known about autonomy and self-management of people with type 2 diabetes in a nurse-led, shared-care setting. This method will starts from the experience of the individuals under study, not from theories derived from the literature, what would be the benefit that of these behaviour changes to the participants’ self-management of type 2 diabetes mellitus. Grounded theory provides a way to go beyond experience and to move it from description of what is happening to the understanding of the process by which it is happening (Strauss & Corbin 1990) 200 in-depth interviews will take place for a period of 12 months at an interval of three weeks. All participants will be interviewed at diabetes centres and clinics. The interview guide will consist of open-ended questions; Interviews will be tape-recorded and transcribed verbatim. Field notes will be taken during and after each interview. One interviewer throughout the study will carry out the interviews. Measures The use of semi-structured open-ended questions, derived from an in-depth literature review would be used to collect data. These questions would be divided into three topics: attitudes towards the role of existing primary care services like clinic follow-up and tailor made programme on the self-management of elderly people with diabetes. Secondly, motivation to enrol in the individual-based program for tailor made behaviour LIFESTYLE CHANGES ELDERLY TYPE 2 DIABETES MELLITUS 7 interventions. Thirdly, suggestions for further development of primary care that involves individual-based program for constant support to the elderly diabetic individuals, the discussions would be conducted at the clinic centres, times convenient for the individuals participating in the study, each discussion would last one hour each. Demographics of the participants, including age, sex, educational attainment, medical history of diabetes mellitus type 2, and exercise time per week would be collected. The aim objective of this study is to investigate different lifestyle modifications used by health professionals in motivating the elderly with type 2 diabetes mellitus to adopt new lifestyles for self management. How effectively are these interventional changes applied in individual based counselling to minimize, health complications that arise as a result of diabetes, avoid numerous vital accidents and increase compliance in adhering to these changes that leads to many amputation in the elderly patient. Analytical strategy At the end of the discussion the patient would be assisted to fill questionnaire form. This content would then be used for data analysis because it placed an emphasis on the conceptual meaning of the role of primary care in participants’ own words and expression, which is our aim in this study. Data analysis and individual discussion would concurrently conduct to check the data saturation. The attitudes toward primary care, motivation to join the individual counselling programs, and suggestions on the future development of tailor made primary care for diabetes mellitus from the perspective of elderly participant would be assessed to ascertain their effectiveness. (Catherine & Nicholas 2006) LIFESTYLE CHANGES ELDERLY TYPE 2 DIABETES MELLITUS 8 Analyses The collected data will be analysed by applying constant comparative analysis as recommended in grounded theory. Inductive coding will be used to examine the phenomenon under study. (Strauss & Corbin 1990) Will provide initial opening code for each interview and the field notes, will divide the data into small pieces and group these codes in larger categories and subcategories. Then will contrast and compare the categories and subcategories and formulate concepts. Theoretical coding will be used to develop models that would clarify the relationships between concepts. Put the concepts back together to find processes, patterns and derived theoretical constructs by clarifying the relationships between the concepts. The interviews will continue until there is data saturation. Ethical considerations The participants will be provided detailed information about the research for making an informed written consent prior to the interviews. Participants will be assured that interview data will be dealt with confidentially, anonymity will be guaranteed by coding, and ethical approval will be sort from the clinics. Several distinctive questions will be asked regarding topics related to autonomy and self-management, participants will be encouraged to support their statements with examples and the interviewer asked follow-up questions. The raw data from the interview will be analysed until the theory emerges to provide the scope of the phenomenon under study. The study will concentrate on the aspects of the interviews and field notes with most relevant information under study and focuses on them in detail by reading, analysed, theorized, LIFESTYLE CHANGES ELDERLY TYPE 2 DIABETES MELLITUS 9 and revise the concepts until the findings provide persistent observation. Throughout the study, will hold regular meetings with research guide to review and explore scientific and organizational aspects of the study. Will guaranteed transferability of information by providing descriptive data of the study context on request to enable readers to evaluate whether the findings are transferable to other cares to ensure conformability and dependability of the study findings. The guide will check whether the analysis of data is in line with accepted standards and examine the analysis process and records for accuracy. (Guba & Lincoln 1985) Conclusion The objective of the study is to analyse available literature, regarding self management of type 2 diabetes mellitus, in the elderly population. How effectively should these behavioural interventions be conducted to have a maximum benefits to the patients, at the sometime to address concerns relating to adherence and motivations that has to be given to these category of patients in order to encourage them to follow through these lifestyle changes to self manage their conditions. The study is expected to address the following concerns; whether group or individual intervention methods is effective, random or tailor made behavioural intervention is convenient to patients and what method is to be followed in the follow up, that is either by telephone, mail or regular visit to the clinic centres. LIFESTYLE CHANGES ELDERLY TYPE 2 DIABETES MELLITUS 10 Reference list Artinian B. M, (1998) Value for nursing grounded theory, Nurs Sci Q, 11, 5-6. Boult C, Louis T. Boult L, McCaffrey D, Kane L, (1994) Functional limitation in the elderly with chronic conditions. J Gerontology, 49(1), 28–36. Brodie A, Inoue A, Shaw D. (2008) Motivational in the change quality of life for people with chronic heart failure. Int J Nurs Stud 45, 489–500. Catherine P & Nicholas M. (2006) Qualitative Research in self management. (3rd ed) Blackwell Publishing. Clark O. D, (1997) Effectiveness of physical activity efficacy among older adults. Diabetes Care 20(7), 1176-1182. Guba E. G, Lincoln Y. S. (1985) Natural Inquiry Sage. Hayes D. & Ross C. (1987) Health beliefs, and eating habits. J Health Soc Behav 28(2), 120-130. Norris S L, Smith S, Schmid C. H, Lau J, Engelgau M. M, (2002) a meta-analysis of the effect on glycemic control self-management for adults with type 2 diabetes mellitus. J Diabetes Care, 25(7), 1159-1171. Pan X R, Yang W. Y, Li W, Hu Y. H, Wang J, (1997) Effects of diet and exercise in with impaired glucose tolerance. J Diabetes Care 20(4), 537-544. Sadur N, Moline N, Costa M, Michalik D, Mendlowitz D, Roller S. (1999) Diabetes and Efficacy of care man­agement using cluster visits. J Diabetes Care 22(12), 2011-2017. LIFESTYLE CHANGES ELDERLY TYPE 2 DIABETES MELLITUS 11 Sinclair J, & Barnett A. (1993) Special needs for self management of elderly diabetic patients. Br Med J 306, 1142-1143. Sinclair A, Girling A, Bayer J. (2000) Impact on diabetes self-management and use of care services in cognitive dysfunction in older patient. J Diabetes, 50(3) 203–212. Strauss A. & Corbin J. (1990) grounded theory procedures and techniques. Sage. Tuomilehto J, Eriksson J. G, Hamalainen H, Ilanne-Parikka P. Lindstrom J, (2001) in lifestyle changes among subjects with impaired glucose tolerance. J Med 344(18), 1343-50. UK Prospective Group. (1998) tight blood pressure control and risk of macro­vascular and microvascular complications in type 2 diabetes. BioMed. J 317(7160), 703-13. Read More