The Aging, Community and Health Research Unit—Community Partnership Program for older adults with type 2 diabetes and multiple chronic conditions: a feasibility study

Abstract

BackgroundFew studies have examined the effectiveness of community-based self-management interventions in older adults with type 2 diabetes mellitus (T2DM) and multiple chronic conditions (MCC). The objectives of this study were to examine the feasibility of implementation in practice (primary) and the feasibility of study methods and potential effectiveness (secondary) of the Aging, Community and Health—Community Partnership Program, a new 6-month interprofessional, nurse-led program to promote diabetes self-management in older adults (>65 years) with T2DM and MCC.MethodsThis study used a prospective one-group pre-test/post-test design. Participants were recruited from a specialized diabetes clinic. They received a median of three in-home/clinic visits by certified diabetes educators (CDEs) and attended a median of three group wellness sessions provided by the CDEs in partnership with a community-based seniors’ association. The primary outcome was the feasibility of the program (acceptability, fidelity, implementation barriers/facilitators). Secondary outcomes included the feasibility of the study methods (recruitment/retention rates and procedures, eligibility criteria, data collection and analysis methods) and potential effectiveness of the program based on 6-month changes in self-reported outcomes including self-management behavior (diet, exercise, self-monitoring), health status (quality of life, mental health), and costs of service use. Analysis of feasibility outcomes was primarily based on descriptive statistics. The potential effectiveness of the program was explored using different tests, with the results expressed using descriptive statistics and effect estimates (95 % confidence intervals).ResultsIn total, 45 (88 %) of 51 eligible persons consented to participate. Of these, 37 (82 %) completed the 6-month follow-up. Participants and providers viewed the program as acceptable and feasible. Participants had a higher SF-12 physical component summary score at 6 months compared with baseline (mean score difference 3.0, 95 % CI 0.2–5.8). Median costs for diabetes care increased over 6 months (reflecting inclusion of program costs), while other service costs either decreased or remained unchanged.ConclusionsThis study offers preliminary evidence that the program was feasible to deliver and acceptable to participants and providers. Initial results suggest that the program may improve physical functioning. A randomized controlled trial is feasible, with some adaptations to the program and study methods that were identified from this feasibility study.Trial registrationClinicaltrials.gov identifier: NCT01880476 Electronic supplementary materialThe online version of this article (doi:10.1186/s40814-016-0063-1) contains supplementary material, which is available to authorized users.

Community Program Improves Quality of Life and Self‐Management in Older Adults with Diabetes Mellitus and Comorbidity

“…The high prevalence of comorbidity in older adults is widely recognized, and our related work shows that comorbidity in T2DM clients is an important driver of health service use and costs . Provider training on MCCs (including depression) was provided in this RCT, in response to requests from providers in our pilot study and their recognition that comorbidity is critical in shaping self‐management . Dementia is a comorbidity requiring further study in relation to our program, given that our study participants were cognitively intact.…”

Integrative review of the social determinants of health in older adults with multimorbidity

“…Broadening the research teams to include different disciplinary views could lead to different findings (Hankivsky & Cormier, ). This finding may be a function of semantics as nursing researchers tend to use the term multiple chronic conditions instead of MM (Markle‐Reid et al., ). If so, this language barrier to collaborative research needs to be identified and addressed.…”

What works for whom in the management of diabetes in people living with dementia: a realist review

“…Embedding positive attitudes towards PLWD If health and social care delivery systems propagate and reinforce positive attitudes towards people living with dementia and diabetes (PLWDD) and their families, through tailored self-management support Then this fosters a belief in staff that PLWDD have the potential to be involved in self-management (SM) and the right to access diabetes-related services (even when the trajectory is one of deterioration) (M) prompting treatment confidence in PLWDD (M), which leads to engagement in SM practices by PLWDD and their carers (O) [ 11 , 12 , 28 , 37 , 39 – 41 , 53 – 55 , 62 , 67 – 70 , 73 , 74 , 80 , 81 , 88 , 99 , 100 , 102 , 104 , 110 ] 2. Person-centred approaches to care planning If delivery systems promote a person-centred and partnership approach to care, allowing healthcare professionals (HCPs) to understand the individual needs and abilities of PLWDD and their family Then (1) HCPs feel confident that they are acting in the best interests of PLWDD and family (M), and this (2) generates trust between HCP and PLWDD/family (M), leading to better fit between care planning and patient and carer needs and (potentially) a lessening of the burden of medicalisation experienced by PLWDD and their families (O) [ 26 , 27 , 31 , 35 , 37 , 42 , 43 , 52 – 54 , 58 , 60 , 62 , 64 , 65 , 72 , 75 , 79 , 82 , 84 , 89 , …”

“…Family engagement If family carers are routinely involved in care planning and information sharing and are given the support they need to take on the tasks associated with managing diabetes in PLWD (e.g. medication management, recognition of hypoglycaemia) Then family carers will feel supported and believe their contribution is recognised and appreciated (M), leading to the development of effective self-management strategies on the part of the family carers (O) [ 11 , 25 , 26 , 31 , 33 , 46 , 47 , 53 , 64 , 71 , 72 , 81 , 92 , 98 , 110 ] 6. Usability of assistive devices As the dementia trajectory progresses, assistive technology needs to be tailored and adapted to the needs and requirements of PLWDD and family (includes social, environmental and cultural needs) with the focus on maintaining autonomy for the PLWDD This leads to PLWDD and family gaining awareness of the usefulness of assistive technology in their management of diabetes and dementia (M), leading to more effective and sustained use of assistive technology to maintain autonomy and diabetes self-management strategies (O) [ 11 , 25 , 34 , 37 , 48 , 49 , 51 , 56 , 59 , 63 , 69 , 76 , 77 , 87 , 95 , 101 , 103 ] …”