Understanding how older adults include sets of complementary therapies in their health self-management is important for improving their health care resources, expectations, awareness, and priorities.

OBJECTIVES To examine the association between glycemic control and the executive functioning domain of cognition, and to identify risk factors for inadequate glycemic control that may explain this relation. DESIGN Cross-sectional study. SETTING In-person interviews conducted in participants’ homes. PARTICIPANTS Ninety-five rural older adults with diabetes that included African Americans, American Indians, and whites from three counties in south central North Carolina. MEASUREMENTS Participants underwent uniform evaluations. Glycemic control was assessed using a validated method, and executive function was assessed using a previously established set of measures and scoring procedure. Information pertaining to medication for diabetes treatment, knowledge of diabetes, and diabetes self-care behaviors were obtained. RESULTS In linear regression models adjusting for gender, age, education, ethnicity, duration of diabetes, and depressive symptoms, executive function was significantly associated with glycemic control. A 1-point higher executive function score was associated with a 0.47 lower A1C value (p < 0.01). The association of glycemic control with executive function became marginally significant (p-value = 0.08) when controlling for several glycemic control risk factors, including use of diabetes medication and diabetes knowledge. CONCLUSIONS These results suggest that poor glycemic control is associated with impairments in performance on composite measures of executive function, and that this relation may be explained by modifiable risk factors for glycemic control such as use of diabetes medication and diabetes knowledge.

No abstract

Objective Investigate the importance of viewing belief systems about health maintenance holistically. Methods Qualitative (N=74) and quantitative data (N=95) were obtained from multi-ethnic rural-dwelling older adults with diabetes to characterize their Common Sense Models (CSMs) of diabetes. Results There is a discrete number of CSMs held by older adults, each characterized by unique clusters of diabetes-related knowledge and beliefs. Individuals whose CSM was shaped by biomedical knowledge were better able to achieve glycemic control. Conclusions Viewing individuals’ health beliefs incrementally or in a piece-meal strategy may be less effective for health behavior change than focusing on beliefs holistically.

This study examines older adults’ fears of diabetes complications and their effects on self-management practices. Existing models of diabetes self-management posit that patients’ actions are grounded in disease beliefs and experience, but there is little supporting evidence. In-depth qualitative interviews were conducted with a community-based sample of 74 African American, American Indian, and white older adults with diabetes. Analysis uses Leventhal’s Common Sense Model of Diabetes to link fears to early experience and current self-management. Sixty-three identified fears focused on complications that could limit carrying out normal activities: amputation, blindness, low blood glucose and coma, and disease progression to insulin use and dialysis. Most focused self-management on actions to prevent specific complications, rather than on managing the disease as a whole. Early experiences focused attention on the inevitability of complications and the limited ability of patients to prevent them. Addressing older adults’ fears about diabetes may improve their diabetes self-management practices.