Medication Management and Type 2 Diabetes in the Elderly - Research Proposal Example

Medication Management and Type 2 Diabetes in Elderly Introduction The number of older persons with diabetes is fast rising globally because of the increased life span as well as a high incidence of diabetes in the elderly. In numerous countries, the incidence of diabetes is increasing as a function of age. Type 2 diabetes is mainly more prevalent in ageing populations and this causes a major public health burden (Kim, 2012). Elderly people are at higher risk of developing diabetes-related complications (Grossman, 2011). This population is at higher risk of diabetes comorbidities such as lower extremity complications as well as complications such as impaired vision, risk of falls and depression and this can result to treatment apathy and decreased medication efficacy. Additionally, studies have shown that medication adherence in this population is poor (Grossman, 2011). Moreover, the elderly might not have the ability to read their medication instructions or even comprehend how they are supposed to take medications and this can not only negatively impact their diabetes management but can also have fatal outcomes. For instance, taking multiple drugs numerous times a day can result to medication errors, adverse events, decreased medication effectiveness, elevated costs as well as poor treatment adherence (Grossman, 2011). Still polypharmacy is very common since this population has a tendency of keeping medications that were prescribed a long time ago and might keep drugs that were changed to another medication in the same drug class following a hospitalization (Grossman, 2011). Therefore, this justifies this study in order to find out measures and interventions that can address these issues to increase medication regiment adherence, reduce adverse events and also increase medication efficacy. Significance of the Study The information from this study will be important to all stakeholders in healthcare sector because the information will be useful in informing about the most effective strategies in regard to intensive medication management for elderly persons with type 2 diabetes. Academically, the proposed study is expected to contribute to the existing knowledge and literature in the field of medication management for the elderly persons with diabetes. Moreover, this study will be a basis for further research in the field. Statement of the Problem There are few studies and data that specifically address optimal glycemic goals in older persons with diabetes. Glycemic control goals are supposed to be based on a person’s overall health and estimated duration of survival because the risk of complications depends on duration. Studies also show that medications used in managing diabetes have various side effects on elderly persons with diabetes (Hemmingsen et al, 2011). For instance, the risk of severe hypoglycemia allied to insulin increased with ageing. Moreover, evidence shows that that the elderly have poor adherence to medication and hence it is important to implement measures to ensure that they adhere with treatment regimen (Patel et al 2010). Similarly, literature shows that the elderly are likely to experience problems in insulin administration due to comorbities such as poor vision and reduced physical health (McCulloch & Munshi, 2015). Other health complications such as depression and cognitive impairment and factors like polypharmacy also make it difficult for the elderly to adhere to the correct medication regimen. Furthermore, medications used in treating diabetes have side effects in the elderly and most notably hypoglycemia and this can cause poor outcomes like distressing falls and worsening of comorbid conditions (Bennett et al, 2011). Literature Review Several changes that come with ageing have an impact on the clinical presentation of diabetes. Research of elderly persons without diabetes has demonstrated that glucose counter-regulation concerning glucagon, epinephrine and growth hormone responses to hypoglycemia are reduced and this might contribute to decrease in autonomic warning symptoms. Other complications allied to the physiology of ageing consist of changes within the pharmacokinetics of insulin as well as oral drugs (Lahiri, 2012). McCulloch & Munshi (2015) explain that changes in absorption, distribution, metabolism as well as clearance of medications should be taken into account when treating diabetes in elderly persons. This is because these changes impact individual drug choices as well as dosing decisions (McCulloch & Munshi, 2015). Kim et al (2012) takes a different argument and argues that progressive cognitive decline and dementia in elderly persons with diabetes are common and these are some of the factors that contribute to medication problems in the elderly persons with diabetes. Recent meta-analysis studies aggregate relative risk of Alzheimer’s disease for elderly persons with diabetes as 2.5 and compared to people without diabetes which is 1.5 (Patel et al, 2010). Cognitive impairment in elderly persons with diabetes has been show to impact diabetes self-management. Lahiri (2012) concurs with this ad explains that this population has a higher likelihood of experiencing treatment related complications. Grossman (2011) further stresses that elderly patients with diabetes along with cognitive impairment are at a higher risk of major cardiovascular events and death. According to Grossman (2011) depression is highly prevalent in elderly persons with diabetes. The coexistence of diabetes and depression is allied to elevated healthcare use, elevated healthcare costs as well as adverse health outcomes for persons with diabetes especially the elderly. Additionally, depression is allied to hyperglycemia and an elevated risk for diabetic complications. For this reason, Patel et al (2010) emphasizes that health care professionals ought to be aware of the frequent coexistence of mental conditions like depression in elderly persons with diabetes. This is because as Grossman (2011) explains, psychiatric conditions such as depression can result to treatment apathy and reduced medication efficacy. Good diabetes control through effective medication management in the elderly can not only manage the condition successfully but can also decrease mental health complications (Kim, 2012). As Patel et al (2010) puts it, in elderly persons with diabetes, the choice for medications should consider both drug’s efficacy and drug safety. This is because this population is at a higher risk for adverse events from comorbid conditions and polypharmacy (Lahiri, 2012). Evidence shows that the medication should be used carefully in elderly patients with diabetes because it causes serious side effects such as diarrhea, nausea, vomiting, loss of appetite and such (Bennett et al, 2011). For example, as Bennett et al (2011) explain, insulin is very effective in lowering blood glucose. Owing to insulin’s progressive reduction of β-cell function with age increase, insulin replacement treatment is often needed in elderly patients with type 2 diabetes with long disease duration. Nonetheless, as evidence shows, there are several hindrances to suitable insulin use within elderly persons with type 2 diabetes. Bourdel-Marchasson et al (2011) support this argument and explain that the most common barriers include concerns regarding hypoglycemia and intricate nature of administering insulin administration. Numerous comorbid conditions in elderly patients with diabetes such as poor vision, reduced physical function, and/or cognitive impairment, make it hard for this population to do self-injection of insulin as well as self-glucose monitoring (Bourdel-Marchasson, 2011). Research Question What are strategies used in management of medications in elderly persons with type 2 diabetes? General Objective 1. To investigate the most effective strategies in managing medications in elderly patients with type 2 diabetes Specific Objectives 1. To find out the most suitable medications for elderly persons with type 2 diabetes 2. To find out ways of increasing medication adherence on elderly persons with type 2 diabetes 3. To find out comorbidities that impact medication adherence in elderly persons with type 2 diabetes Research Methodology Study Design The study will use an exploratory cross-sectional design because it will investigate medication management in elderly people with diabetes. The exploratory element will be extremely instrumental in collection of statistical information on how medications for this population are managed in healthcare institutions. This research design is suitable since the study deals with several members in a population and it is impossible to study the whole population and thus sampling will be done to come up with generalizations and inferences on the whole population (Kloman, 2010). Study Population The population of this study will be drawn from various health homecare settings in Australia. Sampling Sampling will be done through convenient sampling and it will consist of 25 homecare facilities in Australia. The 25 facilities will be selected from a sampling frame of all homecare institutions in Australia. This sample will be adequate to represent the population since it represents a significant percentage of homecare facilities in Australia. Data Collection Methods and Instruments Collection of the primary data will done using semi-structured questionnaires. The rationale of using semi-structured questionnaires is that there will be open ended question meant to obtain qualitative responses regarding the views of respondents while closed ended questions will obtain quantitative data for statistical analysis (Kloman, 2010). The questionnaires will be dropped in the respective homecare institutions and picked later for analysis. Data Analysis Methods SPSS (Statistical Package for Social Scientists) will be utilized in data entry as well as statistical analysis. MS Excel will be utilized in determining descriptive statistics of the study. Descriptive statistics as well as inferential statistics will be used in analyzing the results. Lastly, chi-square and Pearson’s correlation test which will be utilized in measuring the strength of the association and relationship between the variables. Ethical Issues Informed consent will be sought from the management and other study participants before conducting the research. Additionally, permission will be sought from the relevant authority before carrying out the research. Lastly, for confidentiality purposes, a password will be created so that only individuals doing the research can access the data. References Bennett WL, Maruthur NM, Singh S, et al (2011). Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations. Ann Intern Med. 154(9):602–13. Bourdel-Marchasson I, Schweizer A, Dejager S. (2011). Incretin therapies in the management of elderly patients with type 2 diabetes mellitus. Hosp Pract (Minneap). 39:7–21. Cheng G, Huang C, Deng H, Wang H. (2012). Diabetes as a risk factor for dementia and mild cognitive impairment: a meta-analysis of longitudinal studies. Intern Med J.  42:484–491. Grossman S. (2011). Management of type 2 diabetes mellitus in the elderly: role of the pharmacist in a multidisciplinary health care team. Journal of Multidisciplinary Healthcare. 4(1). Hemmingsen B, Lund SS, Gluud C, et al (2011). Intensive glycaemic control for patients with type 2 diabetes: systematic review with meta-analysis and trial sequential analysis of randomised clinical trials. BMJ. 343:d6898. Kim K, Sung K, Cho Y & Park S. (2012). Management of Type 2 Diabetes Mellitus in Older Adults. Diabetes Metab J. 36(5): 336–344. Kloman, F. (2010). The use of qualitative context analysis in case study research, Qualitative. Social Research. Vol. 7, No. 1. Lahiri S. (2012). Management of Type 2 Diabetes: What Is the Next Step After Metformin? Clinical Diabetes. 30 ( 2): 72-7. McCulloch, D & Munshi M. (2015). Treatment of type 2 diabetes mellitus in the older patient. Diabetes Care, 31:391. Patel I, Chang J, Shenolikar R & Balkrishnan R. (2010). Medication adherence in low income elderly type-2 diabetes patients: A retrospective cohort study. International Journal of Diabetes Mellitus. 2(2):122–124. Sinclair, A, Dunning, T & Colagiuri, S. (2013). Managing Older People with Type 2 Diabetes. Belgium: International Diabetes Federation. Read More