Diabetes self-care activities in older adults and the ability of a nutrition and diabetes edcucation program to effect change
Redmond, Elizabeth H
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This study was designed to test several hypotheses related to diabetes translation in elders participating in Georgia’s Older Americans Nutrition Program (OANP). OANP populations are at high risk for diabetes because of advanced age, low income, and minority group status ( ASA, 2003; Boyle et al., 2002; Ponza et al., 1996). This study evaluates four primary hypotheses for OANP participants with diabetes : 1) higher frequencies of diabetes self-care practices, positive health beliefs, and certain demographic variables would be associated with lower blood A1C at baseline in OANP participants with diabetes; 2) a nutrition and diabetes education program delivered at senior centers would increase the frequency of diabetes self-care activities; 3) improvements in diabetes self-care practices would be associated with decreases in blood A1C following an educational intervention; and 4) healthcare providers would report patients’ lack of ability to follow self-care behaviors, as well as their lack of confidence in facilitating change, as a barrier.Older adult participants with diabetes were a convenience sample (n = 105) of OANP participants with a mean age 73 years (58% Caucasian, 42% African American, 70% women, and 29% with < 8 years of education). Twenty-five percent of participants had an A1C blood value > 8% (poor control). In regard to diabetes self-care activities, participants were most likely to be compliant (> 5 days per week) with medication use (97%); moderately compliant with diet, glucose testing, and daily foot checks (49% to 65%); and least compliant with exercise and foot wear inspections (37% to 39%). More than half of the participants (60%) agreed that their lack of understanding of the diabetes diet was a barrier to them. Following the intervention, compliance (> 5 days/week) substantially increased from baseline for participants following a healthful diet, following an eating plan, avoiding high fat foods, spacing carbohydrates, testing blood sugar as recommended by their health care provider and inspecting shoes (p < .05). Decreases in A1C among those with an initial A1C > 7% were correlated with post-intervention self-care activities and/or increases in self-care activities related to consuming 5 servings of fruits and vegetables a day, spacing carbohydrates, physical activity, and checking shoes and feet (p < .05). Healthcare providers rated their older adult patients’ ability to undertake specific diabetes related activities as a barrier to care. Overall, providers were much more confident in their own ability to give instructions or examinations than in facilitating actual change.