Older Adults' Perceived Challenges With Health Care Providers Treating Their Type 2 Diabetes and Comorbid Conditions

Beverly, Elizabeth A.; Wray, Linda A.; Chiu, Ching Ju; Lacoe, Cynthia L.

doi:10.2337/diaclin.32.1.12

Cited by 22 publications

(29 citation statements)

References 32 publications

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“…Beverly et al found that people with diabetes felt providers did not understand or appreciate the difficulties of living with diabetes or its' complications and many noted that that their care was not individualized. [3] This may be partially related to lack of knowledge about diabetes care among health care practitioners. [4] Griffis et al discovered that acute care nurses had large gaps in their knowledge of diabetes specifically in the areas of therapies and medications.…”

Section: Introductionmentioning

confidence: 99%

Using experiential learning to enhance nursing student knowledge and attitudes about diabetes self-care

Fenske¹,

Freeland

Price

et al. 2015

JNEP

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Diabetes is a significant health care issue that requires healthcare providers to be both knowledgeable about the disease and have positive attitudes toward diabetes self-care issues. Nursing students receive a tremendous amount of information about diabetes in their undergraduate education but it is often presented without an opportunity for application. The purpose of this project was to evaluate the effectiveness of an experiential learning innovation with junior level baccalaureate nursing students enrolled in a medical-surgical nursing class. In addition to the traditional classroom presentations, students were randomly assigned to "live with diabetes" (LWD) (n = 106) or a control group (n = 109). The intervention group students took on one of five diabetic personnas representing the most common treatment regimens for Type I and Type II diabetes. The intervention group reflectively journaled daily about their experiences, observations and thoughts about living with diabetes. The Brief Diabetes Knowledge Test (BDKT) and the Diabetes Attitude Scale (DAS-3) were administered in a pre and posttest fashion at the beginning and end of the diabetes unit of the course. Significant improvement occurred for all students in both knowledge and attitude (p ≤ .005). Although the additional effort of providing the LWD experience may enhance the improvements, simply calling attention to the chronicity and demands of diabetes self-care through various experiential learning opportunities may promote student learning and understanding.

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Section: Introductionmentioning

confidence: 99%

Using experiential learning to enhance nursing student knowledge and attitudes about diabetes self-care

Fenske¹,

Freeland

Price

et al. 2015

JNEP

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“…25,28,30,37,39,42,43,45,[57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73] These comprised 79 research papers and 10 guidelines or discussion pieces. Other papers cited in this chapter are for background information and did not undergo full data extraction.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…A key element of achieving a person-centred or partnership approach to care is building a long-term trusting relationship with the people living with dementia and diabetes and their family 69,70,72,73,79,102,125,142 that involves listening and valuing the patient's subjective health experiences:…”

Section: Trusting Relationshipsmentioning

confidence: 99%

“…In a qualitative study with older adults with diabetes and other comorbidities (not dementia), participants reported that they felt overwhelmed when dealing with their diabetes and other conditions and that they felt that their HCPs did not understand the difficulties they experienced with balancing their comorbidities so that they could achieve a reasonable quality of life. 70 The following quotation from a GP highlights how ideas about assessing a patient's abilities to cope with treatment plans are not yet part of routine care. The GP is referring to the 'choosing wisely' initiative from the American Board of Internal Medicine Foundation, 160 which aims to promote conversations between clinicians and patients to prevent the use of unnecessary tests and procedures:…”

Section: Developing Appropriate Skillsmentioning

confidence: 99%

“…The results of the RCT 103 and accompanying process evaluation 104 and qualitative study 60 suggest that SM support did not fit with a biomedically focused ethos and, as a result, practices did not give it the priority needed to embed it in the day-to-day work of primary care. A qualitative study conducted in the USA also found that an overemphasis on biometrics and medicalisation by HCPs was a Several studies 70,98,134 suggested that there is 'goal divergence' between patients, carers and HCPs, particularly when there is medical uncertainty, as is generally the case with the dynamic nature of living with multiple conditions. In a realist synthesis, Yardley et al 134 suggested that, to reconcile discrepancies between the goals of patients, carers and HCPs, there is a need for less emphasis on a 'diagnostic-cure model'.…”

Section: Developing Appropriate Skillsmentioning

confidence: 99%

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Managing diabetes in people with dementia: a realist review

Bunn

Goodman

Jones

et al. 2017

Health Technol Assess

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BackgroundDementia and diabetes mellitus are common long-term conditions that coexist in a large number of older people. People living with dementia and diabetes may be at increased risk of complications such as hypoglycaemic episodes because they are less able to manage their diabetes.ObjectivesTo identify the key features or mechanisms of programmes that aim to improve the management of diabetes in people with dementia and to identify areas needing further research.DesignRealist review, using an iterative, stakeholder-driven, four-stage approach. This involved scoping the literature and conducting stakeholder interviews to develop initial programme theories, systematic searches of the evidence to test and develop the theories, and the validation of programme theories with a purposive sample of stakeholders.ParticipantsTwenty-six stakeholders (user/patient representatives, dementia care providers, clinicians specialising in dementia or diabetes and researchers) took part in interviews and 24 participated in a consensus conference.Data sourcesThe following databases were searched from 1990 to March 2016: MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Scopus, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Database of Abstracts of Reviews of Effects, the Health Technology Assessment (HTA) database, NHS Economic Evaluation Database, AgeInfo (Centre for Policy on Ageing – UK), Social Care Online, the National Institute for Health Research (NIHR) portfolio database, NHS Evidence, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (Google Inc., Mountain View, CA, USA).ResultsWe included 89 papers. Ten papers focused directly on people living with dementia and diabetes, and the rest related to people with dementia or diabetes or other long-term conditions. We identified six context–mechanism–outcome (CMO) configurations that provide an explanatory account of how interventions might work to improve the management of diabetes in people living with dementia. This includes embedding positive attitudes towards people living with dementia, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. A general metamechanism that emerges concerns the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. A flexible service model for people with dementia and diabetes would enable this synergy in a way that would lead to the improved management of diabetes in people living with dementia.LimitationsThere is little evidence relating to the management of diabetes in people living with dementia, although including a wider literature provided opportunities for transferable learning. The outcomes in our CMOs are largely experiential rather than clinical. This reflects the evidence available. Outcomes such as increased engagement in self-management are potential surrogates for better clinical management of diabetes, but this is not proven.ConclusionsThis review suggests that there is a need to prioritise quality of life, independence and patient and carer priorities over a more biomedical, target-driven approach. Much current research, particularly that specific to people living with dementia and diabetes, identifies deficiencies in, and problems with, current systems. Although we have highlighted the need for personalised care, continuity and family-centred approaches, there is much evidence to suggest that this is not currently happening. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to the needs of people living with dementia and diabetes.Study registrationThis study is registered as PROSPERO CRD42015020625.FundingThe NIHR HTA programme.

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The Psychosocial Challenges and Care of Older Adults with Diabetes: “Can’t Do What I Used To Do; Can’t Be Who I Once Was”

et al. 2016

Self Cite

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The prevalence of diabetes is increasing in older populations worldwide. Older adults with diabetes have unique psychosocial challenges that impact self-care and glycemic control. These challenges may include psychological factors such as depression or anxiety; social factors such loss of independence and removal from home environment/placement in a facility; and medical factors such as multiple comorbidities and polypharmacy. Importantly, these challenges interact and complicate the everyday life of the older adult with diabetes. Thus, timely identification and interventions for psychosocial challenges are a necessary component of diabetes care. This review summarizes the current literature, research findings, and clinical recommendations for psychosocial care in older adults with diabetes.

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Older Adults' Perceived Challenges With Health Care Providers Treating Their Type 2 Diabetes and Comorbid Conditions

Cited by 22 publications

References 32 publications

Using experiential learning to enhance nursing student knowledge and attitudes about diabetes self-care

Using experiential learning to enhance nursing student knowledge and attitudes about diabetes self-care

Managing diabetes in people with dementia: a realist review

The Psychosocial Challenges and Care of Older Adults with Diabetes: “Can’t Do What I Used To Do; Can’t Be Who I Once Was”

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