Advertisement
Group Education & Older Diabetics

Group Education & Older Diabetics

Studies suggest that group-based diabetes education efforts can improve short- and long-term disease control among younger patients, but few analyses have explored the effect of these programs on older adults. Unfortunately, older adults are often underrepresented in diabetes edu­cation interventions because subtle changes in functional, cognitive, and psychosocial status can affect diabetes self-care. Many clinicians are reluctant to refer older patients to group education because they believe they may require more individual attention. In a secondary analysis study published in Diabetes Care, we examined whether community-dwelling older adults aged 60 to 75 with type 1 or type 2 diabetes would benefit from self-management interventions similarly to younger and middle-aged adults. We also tested if older adults benefited from group versus individual self-management interventions. Comparing Benefits of Diabetes Intervention In our analysis, patients were randomly assigned to one of three self-management interventions from diabetes educators that were delivered separately to those with type 1 or type 2 disease: 1. Highly structured group: Five group sessions were conducted over 6 weeks. Patients were taught how food, medication, and exercise affected A1C and actions they could take when levels were out of range. Between classes, patients set daily goals and practiced problem solving 2. Attention control group: Five group sessions were conducted over 6 weeks, but the sessions followed a manual-based standard diabetes education program. 3. Control group: One-on-one sessions were delivered for 6 months. During sessions, patients could receive any type of information they requested. According to our results, A1C levels improved equally in the older and younger groups at 3, 6, and 12 months with all interventions and for those...
The Impact of Poor Health Literacy in Patients with COPD

The Impact of Poor Health Literacy in Patients with COPD

Health literacy has been defined as the ability to obtain, process, and understand the basic health information that is needed to make appropriate healthcare decisions. Studies have shown that many adults in the United States have limited health literacy. This can lead to underuse of preventative services, worse self-management skills, and poor outcomes among patients with chronic diseases. “The role of health literacy in COPD and its effect on health status and outcomes have received relatively little attention in clinical studies,” says Theodore A. Omachi, MD, MBA. “Understanding the role of health literacy in COPD outcomes is critical to informing communication strategies in clinical settings and developing appropriate self-management support approaches.” Poor Health Literacy and COPD Outcomes In the Journal of General Internal Medicine, Dr. Omachi and colleagues had a study published that explored the links between poor health literacy and COPD-related health and outcomes in 277 patients with the disease. The analysis measured health literacy with a validated three-item questionnaire that can be incorporated readily into routine clinical practice: “How often do you have someone like a family member, friend, hospital or clinic worker, or caregiver help you read hospital materials?” “How often do you have problems learning about your medical condition because of difficulty understanding written information?” “How confident are you filling out medical forms by yourself?” Scores on the questionnaire were then tabulated to measure health literacy on a point scale ranging from 3 to 15. “It’s becoming increasingly clear that improving self-management is key to preventing poor outcomes in chronic diseases.” According to the study, lower health literacy scores were associated with worse outcomes, including...

Managing Cognitive Decline in Older Adults With Diabetes

This Physician’s Weekly feature on managing cognitive decline in older adults with diabetes was completed in cooperation with the experts at the American Diabetes Association. More than 25% of Ameri­cans aged 65 and older has diabetes, and the aging of the overall population has been identified as a significant driver of the diabetes epidemic. “Diabetes in older adults is associated with higher mortality, reduced cogni­tive and functional status, and increased risk of institutionaliza­tion,” explains Hermes Florez, MD, PhD, MPH. “Importantly, diabetes has been linked to sig­nificantly higher risks of cogni­tive impairment, a greater rate of cognitive decline, and increased risk of dementia.” While various complications of diabetes are well known and well researched, the effect diabetes has on the brain has historically received relatively little attention. “The risk of both diabetes and cognitive impairment increases with age,” Dr. Florez says. “The presentation of cognitive impairment in people with diabetes can vary, ranging from subtle executive dysfunction to overt dementia and memory loss. We’re starting to see links between diabetes and dementia and Alzheimer’s disease, but researchers are still conducting analyses to further increase our knowledge on these associations.”  Consensus Report on Diabetes in Older Adults In the December 2012 issue of Diabetes Care, the American Diabetes Association released a consensus report on diabetes and older adults. Dr. Florez, who was on the writing group that developed the report, says that an important component to managing older adults with diabetes is the role of cognitive impairment. “For older patients with diabetes, treatments will need to be simplified whenever possible, and caregivers should be involved during consultations. The presence of cognitive...

Addressing Treatment Burden in Diabetes

The practice of evidence-based medicine can be especially challenging when managing patients with diabetes. Patients’ care needs are frequently discussed in routine clinical encounters, but little is known about how patients feel about their burden of treatment (BOT) or if conversations on this topic occur with regularity. In addition, BOT can be interpreted differently by healthcare providers and patients. Issues with BOT may lead providers to intensifying treatments for patients so that they achieve therapeutic targets. Patients, on the other hand, may view BOT more in the context of problems with access to care, side effects, or daily self-care demands. Intriguing New Data on Diabetes Treatment Burden In the January 2012 issue of Diabetes Care, my colleagues and I analyzed videos of primary care encounters between patients with type 2 diabetes and clinicians. Our objective was to see if patients with type 2 diabetes and their clinicians discussed BOT, the characteristics of these discussions, and attempts to address and reduce BOT during visits. Two coders independently reviewed videos of primary care visits from patients with type 2 diabetes. Verbalizations concerning BOT were identified and then classified by topic and by whether BOT was addressed. Of the 46 visits analyzed, 43 (93.5%) contained BOT discussions. BOT was explicitly addressed only 30% of the time by clinicians, even though patients initiated 55% of the BOT discussions observed in the analysis. Our results suggest that patients with diabetes routinely discuss BOT with clinicians, but often with no effect. Access to care was prevalently addressed, but administration and monitoring were largely unaddressed. This finding suggests that there may be concern among patients about...

Strategies for Improving Diabetes Care

This Physician’s Weekly feature was completed in cooperation with the experts at the American Diabetes Association. Over the last decade, healthcare providers in primary care settings and endocrinology practices have seen significant and steady improvements in the number of patients with diabetes who are achieving recommended levels of A1C, blood pressure (BP), and cholesterol. National data show that average A1C levels have declined from 7.82% in 1999-2000 to 7.18% in 2004, based on information collected in the National Health and Nutrition Examination Survey. Improvements in lipids and BP control have accompanied improvements in A1C, which in turn have led to substantial reductions in end-stage microvascular complications in individuals with diabetes. While these improvements are significant, data continue to suggest that there are areas for improvement in diabetes care. “Medications, technology, and enhanced insulin pens and pumps have had an important role in improving the management of diabetes,” says Martha M. Funnell, MS, RN, CDE. “However, some studies have shown that a substantial number of people with diabetes still have A1C, BP, and cholesterol levels that need to improve. Complicating the matter is that the quality of diabetes care varies considerably across providers and practice settings.” Examining Diabetes Intervention Over the years, researchers have implemented numerous interventions to improve adherence to recommended diabetes care standards, but care delivery systems are often fragmented and lack clinical information capabilities. In many cases, care delivery systems are poorly designed to manage this chronic disease. “Ideally, patients with chronic conditions like diabetes should be cared for by collaborative, multidisciplinary teams to facilitate self-management and self-care strategies for patients,” says Funnell. In the American Diabetes Association’s Standards of...
Page 1 of 212
[ HIDE/SHOW ]