Literature Review
By 2030, the elderly population aged over 65 will double to 70 million, resulting in one in five US citizens being in this age category (Dugan-Day, Dollar, & Kaf, 2015). Health promotion is a vital healthcare dimension that must focus on the self-care needs of this population. Functional health literacy is a critical skill that seniors should demonstrate in comprehending information, communicating with health providers, and being able to find reliable sources for health-related advice.
Furthermore, health literacy promotes the engagement of adults in self-care and reduces barriers to accessing care when necessary. Educational interventions play an important role in increasing the knowledge and skills of older adults on self-care topics and increasing self-efficacy skills to empower active participation in personal healthcare decisions (Dugan-Day et al., 2015).
Diabetes is a chronic disease that requires continuous care and patient self-management. Type-2 diabetes encompasses 90% of all diabetes diagnoses in developed countries. For 95% of the patients, it is expected they control diabetes themselves and engage in significant lifestyle changes (Jahromi, Ramezanli, & Taheri, 2015). Education is vital to reduce long-term risk and complications as the silent onset and societal burden of diabetes can become a public health issue to patients, families, and healthcare providers. Patients are expected to make meaningful changes to diet, exercise, and individual monitoring of blood glucose.
However, research demonstrates that patient samples often fail to demonstrate recommended self-care behaviors. In elderly populations especially, this leads to high levels of morbidity and mortality. Evidence suggests that programs focused on self-management of improving glycemic control and managing lifestyle changes are effective at providing patients with tools for enhancing self-care behaviors. Furthermore, these educational programs help lower healthcare costs and improve quality of life (Jahromi et al., 2015).
The Affordable Care Act made the transition of care more common and affordable, allowing for enhanced transitions from inpatient hospital settings to outpatient care, including self-management. However, there are existing barriers to diabetes self-management education. It is critical to establish a trusting relationship between the patient and diabetes educator to overcome any challenges, but such a personalized approach can be expensive and time-consuming. The transition of care is burdened by gaps in care coordination and patient education between inpatient and outpatient settings (Brumm, Theisen, & Falciglia, 2016).
Diabetes education programs lead to greater utilization of statins, antihypertensive, and glucose-lowering medications, as well as more active glucose monitoring and visitations to healthcare specialists such as optometrists (Murray & Shah, 2016).
Therefore, diabetes self-management is evidently a vital component of diabetes outpatient care. Beneficial outcomes can be achieved when a patient works in conjunction with healthcare teams to develop an individualized patient education plan. This can include metabolic stability, learning styles, available resource, level of motivation and readiness for change, and individual treatment approaches. Such programs incorporate physical, psychological, and social management concepts of living with a chronic condition such as diabetes. The educational programs use interventions focusing on behavioral, emotional, and social interventions that enhance the level of diabetes self-management (Murray & Shah, 2016).
It is necessary to design improved models for healthcare delivery to elderly patients. It includes assessment of comorbidities, mental health issues, and polypharmacy that may arise in cases with diabetes. Developing a comprehensive and integrated healthcare management plan that is patient-oriented towards self-care can improve outcomes. It is the best clinical approach to decrease the risk of hypoglycemia and other adverse events in diabetic elderly patients with existing co-morbidities (Shubair, McCrory, Reschny, & Tobin, 2018).
Methodology and Design
The research is meant to study the effect of post-discharge self-management education promotions and techniques for elderly patients with diabetes on health outcomes, including readmission rates and glycemic control levels. The experiment will follow a randomized controlled trial design. Participants will be split into two groups. The control group will not receive any intervention and follow standard discharge procedures. The intervention group will receive individualized post-discharge education that will consist of several sessions addressing aspects of lifestyle changes such as diet, exercise, and glycemic control.
Over the period of three months, the intervention group will receive follow-up visits to reinforce the educational parameters. Data collection will occur at the beginning of the experiment as well as at its end after three months. Data collected will include medical characteristics and quantitative measures such as fasting blood glucose as well as A1C levels. Furthermore, qualitative data will be collected via an interview about lifestyle habits and healthcare behaviors of the seniors. Data will be analyzed and compared to determine the effectiveness of educational interventions on self-management of diabetes in elderly patients post-discharge from the hospital.
Sampling Methodology
The study will follow a simple random sampling strategy. A large urban hospital will be used as the primary setting for finding participants. The inclusion criteria for the study is a patient aged 60 to 80 years old. Furthermore, they must have a confirmed diagnosis of type 2 diabetes. Since the study focuses on lifestyle management and glycemic control, type 2 rather than type 1 diabetes is an important factor due to the difference in symptoms and pathology of the conditions as well as the variance in treatments used for glycemic management. Patients will have to be recently hospitalized or discharged.
Additionally, recent physical and laboratory analyses are a benefit. Exclusion criteria include adverse events, psychological illnesses or challenges, and inability to participate in educational sessions or lifestyle management for any reason. Participants will be informed about the nature of the study and asked to provide voluntary consent for participation as well as the collection of personal data and clinical information.
Tools
The study will require a wide variety of tools for all stages of the experimental design, ranging from sampling to data analysis. A computer will be required to design the study and all necessary materials. Programs such as Microsoft Word and Excel will be vital to provide documentation and serve as tools for data collection. Data will be input into the computer program to be processed. Furthermore, programs will be used to create supporting educational material for the participants.
It will also be necessary to print out the materials for elderly patients as reminders. To collect baseline and final data, it will be necessary to have access to a blood glucose measuring device and potentially laboratory tests. Sound and video recording hardware and software will be helpful during interviews for record-keeping purposes. Data analysis will require the use of specialized computer analytical and statistic programs such as IBM SPSS software.
This would allow running a regression analysis, t-tests, and other standard statistical procedures for a randomized controlled experiment of this type. Supporting tools are necessary to ensure the study’s methodology is functional and can be achieved to fulfill its purpose.
References
Brumm, S., Theisen, K., & Falciglia, M. (2016). Diabetes transition care from an inpatient to outpatient setting in a veteran population. The Diabetes Educator, 42(3), 346-353. Web.
Dugan-Day, M., Dollar, S. C., Kaf, W. A. (2015). Rural older adults and functional health literacy: Testing self-efficacy, knowledge and skills resulting from hands-on health promotion. Contemporary Rural Social Work, 7(2), 100-114. Web.
Jahromi, M. K., Ramezanli, S., & Taheri, L. (2014). Effectiveness of diabetes self-management education on quality of life in diabetic elderly females. Global Journal of Health Science, 7(1), 10-15. Web.
Murray, C. M., & Shah, B. R. (2016). Diabetes self-management education improves medication utilization and retinopathy screening in the elderly. Primary Care Diabetes, 10(3), 179-185. Web.
Shubair, M. M., Mccrory, C., Reschny, J., & Tobin, P. (2018). Elderly men and health service provision for type 2 diabetes management: Synthesis of knowledge gaps and identification of research needs. Journal of Men’s Health, 14(3), 77-83. Web.