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Running head: DIABETES MANAGEMENT IN COMMUNITY HEALTH NURSING

8

Diabetes Management in Community Health Nursing

Date

Diabetes Management in Patients Aged 65 Years and Older

Assessment

The selected aggregate for this paper is patients living with diabetes within the community and the suprasystem includes elderly patients. Further down, the plan of care for the project is directed towards caring for patients who are 65 years and above and who are managing their diabetes at home. There are many personal responsibilities that come along with the management of diabetes among them ensuring complete adherence to medication, observing the right nutrition and checking for any complications such neuropathy leading to diabetic foot ulcers, eye damage, kidney damage and skin conditions. In turn, this has financial implications that requires the patients to get deeper into their pockets especially when they have no insurance. In 2017, Trikkalinou, Papazafiropoulou, & Melidonis mentioned that diabetes has a negative effect on the quality of life (QoL) in terms of physical, social, mental, cognitive, and psychological component. This specific aggregate has been selected because of this high numbers of the baby boomer’s population. They are in high numbers in the nation and within the community and hence the need to have more concentration towards them as they greatly affect the health indicators of the nation and the society.

Elderly and diabetic population for those having 65 years and above is made up of different sociodemographic and health status. According to the American Diabetes Association, people who are 45 years and above are usually at high risk for developing diabetes (American Diabetes Association, 2015). The risk also increases with advancement with age. Gender is also another factor and diabetes affect people of both genders. When it comes to race, there are races that have high prevalence for developing diabetes than others. In a descending order, these include American Indians, Non-Hispanic blacks, Hispanics, Asian American and finally the Non-Hispanic whites (American Diabetes Association, 2015). Different factors further play a role on why some races would have high prevalence than others and just to mention these factors they include living in poor communities of neighborhoods, high insulin resistance rates among some races and also those with high level of obesity have high risk of developing diabetes. It is also likely that patients who have low levels of education and with low income would not manage the diabetes as needed due to lack of resources.

In regard to health status as specific characteristic, there are a number of health issues that affect elderly patients. Just to mention some few, these include mental health problems such as depression, Alzheimer’s diseases and dementia which affects their memory, schizophrenia, hypertension, Parkinson’s disease, cataracts and diseases of the joints such as arthritis. It is also likely to find a patient who has been diagnosed with more than one of these diseases. This affects their quality of life due to physical and psychological changes happening to them.

According to the National Diabetes and Statistics Report of 2020, 34.2 million Americans of all ages already had diabetes in 2018. This is equivalent to 10.5 % of the population. 34.1 million of these were adults. The report also shows that with increase in age, the percentage of adults diagnosed with diabetes also increased. 26.8% of these were aged 65 years and older. Men were also found to be at high risk than women. White, non-Hispanics had more prevalence, followed by Hispanics, Black non-Hispanics and Asian non-Hispanics with the lowest numbers. In the same year, 1.5 million newly diagnosed diabetes cases were reported. The incidence rates were also higher in adults aged 45 to 64 years and those aged 65 years and above. Those aged 18 to 44 years had lower incidences compared to the other two (Centers for Disease Control and Prevention, 2020).

Literature from Giri & Putra (2020) on the perceptions and needs that the diabetic patients have indicate that patients diagnosed with diabetes report fear because they do not know their nutritional needs. They reported lack of knowledge of the food patterns they should take and what to avoid. Some patients do not understand what it means by a food intake with high calories. This, therefore, formed the basis for having the project focus on nutrition and other non-pharmacological approach of exercising. Giri & Putra further stated that nutrition is very important for diabetic patients. Lack of this knowledge turned to be a trigger to their stress levels causing deterioration of their health.

Planning

The need identified for this population is management of diabetes using non-pharmacotherapy interventions. As aforementioned, there is needed to continuously manage diabetes because it is a chronic illness and therefore patients must take the responsibility of caring for themselves with the help of their doctor for a long-term period. Taking the medications helps the body in getting rid of the glucose that is in excess in the blood. The body also used the insulin in a better way. Depending on the patient’s condition, the doctor decides what form of treatment is needed. Some patients may only need to take pills while others take pills and also inject insulin. The non-pharmacological therapy involves observing a healthy diet, going for exercise, and weight loss. Taking a diet with low calories is very crucial. Regular exercising helps in weight loss since obesity only complicates diabetes.

On agreement, the student and the aggregate decided to work towards encouraging adherence to the non-pharmacological approaches. The main goal of the intervention was to compliment the use of medications for the best patient outcomes. Taking the medications without observing the mentioned non-pharmacological approach would not result to full effect. This is why it is important to include this intervention. As agreed, upon by the student and the aggregate, there are three areas of focus. These include coming up with a list of all low calories food and preparing sample meal plans, understanding what exercises are needed for a patient who has diabetes and keeping daily reading record of diabetes at least for three months to help track the management of diabetes following adherence to the interventions mentioned herein. This would help in determining whether the approaches applied currently are effective or there is need to change course of treatment. Setting measurable objectives is important as a way of evaluating the effectiveness of the intervention. Below are the objectives to be achieved with this intervention.

i. Patients prepare different meal plans every week with the right number of calories.

ii. Ensuring that they engage in exercises at least three times per week.

iii. Have daily records of the blood sugar level.

These are measurable objectives because patients can report whether they have been able to do as agreed and provide evidence such as the meal plans and the daily records. In regard to exercising, it is possible to tell whether the patients adhered to it by comparing their weight over time to see if they have lost some pounds. To accomplish these objectives, the aggregate needs to have a good understanding of why they need to do so. The intervention that can help in ensuring that they comply is educating them on the benefits of each of the approaches in their diabetes management journey and the outcomes they should expect. Understanding why that is importance increases compliance. This would be considered a preventive approach because it intends to encourage the patients towards proper management of the disease and hence reduces the prevalence of having poorly controlled diabetes and related complications. Hence, they are proactively prevented.

Intervention

Glazier, Bajcar, Kennie, & Willson (2006) explain that there are different levels of planned interventions that can be applied. These include interventions directed to the health systems, to the health providers or patient-level interventions. Health system intervention focus on changing the policies used in an organization or facility while health providers’ interventions affects the practices of care providers. The patient-level intervention is most applicable here and this is because all the attention is given to the patient with the ultimate goal of helping them become more accountable of their health. When the intervention is designed towards the aggregate, it should be within their level of understanding in terms of the language used.

This intervention was applied with a good number of the aggregate population increasingly remaining active during the period of learning and also when it came to evaluating whether the objectives were met. Findings indicated patients having different meal plans for different weeks, recording of readings everyday using digital applications for diabetes management and weight loss in some of the patients who actively engaged in daily exercises.

Evaluation

The plan implemented for this project towards addressing the need for diabetes management among elderly patients is with no doubt found to be beneficial to them. Following its implementation and completion, there are many positive outcomes to be reported including reduces levels of A1C and lower risk of developing complications. Furthermore, with proper diet and exercising, this does not only improve diabetes management but also the overall health. Looking back, the objectives are undeniably very much measurable in nature and this helps in assessment of the response that the aggregate had on the project. Specific to the project, the aggregate’s evaluated the project in a positive way stating the benefits relating to the whole process of educating them on why they need to comply. It proved to be an appropriate approach and also one that is effective. The recommendations made is to have more programs like this which will eventually transform the health of the community, state and nation at large. Different healthcare facilities can implement the approach within their facilities too. Additionally, a follow-up is needed after the completion to ensure that patients develop a culture of taking care of their health using the taught approach. Community health nursing can result to complete transformation of the health status for different illnesses. The designed used can be generalized for use in communities with high prevalence and burden of diabetes complications not only for this specific aggregate but also for all the other age groups.

References

American Diabetes Association. (2015, January 1). 2. Classification and diagnosis of diabetes. Retrieved from https://care.diabetesjournals.org/content/38/Supplement_1/S8

Centers for Disease Control and Prevention. (2020). National Diabetes Statistics Report. Retrieved from https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

Giri, M. K., & Putra, A. (2020). Perceptions and needs among diabetes patients: A qualitative study. Proceedings of the 3rd International Conference on Innovative Research Across Disciplines (ICIRAD 2019). doi:10.2991/assehr.k.200115.033

Glazier, R. H., Bajcar, J., Kennie, N. R., & Willson, K. (2006). A systematic review of interventions to improve diabetes care in socially disadvantaged populations. Diabetes Care29(7), 1675-1688. doi:10.2337/dc05-1942

Trikkalinou, A., Papazafiropoulou, A. K., & Melidonis, A. (2017). Type 2 diabetes and quality of life. World Journal of Diabetes8(4), 120. doi:10.4239/wjd.v8.i4.120