Self-management for people with types 2 diabetes among elderly in England

Added on - 19 Mar 2021

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1Dissertation on:Self-management for people with types 2 diabetes among elderly in EnglandStudent Name:Student ID:
2ContentsChapter 1: Introduction...............................................................................................................................3Research background..............................................................................................................................3Research rationale...................................................................................................................................4Research limitations................................................................................................................................4Aims and objectives.................................................................................................................................5Chapter 2: Literature review.......................................................................................................................6Chapter 3: Methodology...........................................................................................................................15Research purpose..................................................................................................................................15Research philosophy..............................................................................................................................16Research approach................................................................................................................................16Research design.....................................................................................................................................17Sources of data......................................................................................................................................18Sampling................................................................................................................................................19Ethical considerations............................................................................................................................20Questionnaire........................................................................................................................................20Chapter 4: Data and findings.....................................................................................................................23Chapter 5: Conclusions and recommendations.........................................................................................39Conclusions............................................................................................................................................39Recommendations.................................................................................................................................40References.................................................................................................................................................42Appendix...................................................................................................................................................45
3Chapter 1: IntroductionResearch backgroundDiabetes is a physical condition that occurs when the pancreas inside the body becomesincapable of producing adequate amounts of insulin or the body becomes incapable of properlyusing the insulin to manage blood sugar levels. The result is that blood sugar levels remainunregulated and become either excessive or deficient. Hyperglycemia often results in a highspike in blood sugar that can lead to a range of complications. Type 2 diabetes is the mostcommon type of diabetes and it occurs in most people who have diabetes. It largely results fromoverweight and obesity that causes the person’s body to become bad at regulating the bloodsugar levels due to the malfunctioning of the insulin inside the body.A person with type 2 diabetes is often stated to have insulin resistance in their body. One of thebiggest risk factors or enablers of diabetes is old age. The onset of age is often associated withcontracting the condition. It is a lifelong condition meaning that diabetes patients usually have tocontend with the condition for the remainder of their life. But there are cases of diabetes inchildren and young people, which is often due to genetic factors or as a result of childhoodobesity.As stated already, diabetes is a condition that mainly affects the older population i.e. the elderlypopulation, especially those over the age of 65 years old, are most vulnerable to this conditionand are often found to be most frequently contracting it. As the people within this age group havea weaker body compared to the younger populations, their body may also have several othercomplications due to their age or due to lifelong accumulation of problems and complications.As a result, their health deteriorates and the incidence of diabetes makes their other conditionsworse.Unlike most other conditions or diseases that are severe and impact a lot of people, diabetes is acondition that can be prevented and once contracted, controlled and managed by the patientsthemselves. As stated already, the condition is often caused as a result of bad habits such as dietand inadequate physical activity that result in excessive or obesity that messes the internal bodysystems and affects the body’s insulin in a way that it becomes incapable of managing the sugarlevels in the body. So not only is diabetes very preventable, but it is also manageable throughsteadfast maintenance of own body conditions through the development of healthy habits relatedto diet and lifestyle.
4Because of this, there has been a growing interest in the prospect of self-management and self-care as an effective response to treating or managing diabetes. While diabetes can be managedand maintained with the constant help and support of a healthcare practitioner, it is morepractical and more empowering if the individual suffering from the condition is allowed to takecontrol of their health by making appropriate choices related to health, diet and lifestyle.Practitioners have been emphasising the role and significance of self-management and as aresult, this topic has gained a lot of attention which has resulted in a wealth of research.The purpose of this research project is to address a significant gap that lies in research the area ofself-management of elderly patients with type 2 diabetes. The gap has been left because elderlypatients often have a wide range of issues along with diabetes that also affect their health andthat impacts how their treatment is to be approached. This gap in research literature hasprompted this particular research project which seeks to address this gap by making aninvestigation of this issue on a sample of patients within the target demographic.Research rationaleThe main prompt for this research project is the significant gap in the research literatureregarding the self-management of elderly patients with type 2 diabetes. This is a very criticalissue as the elderly population are the most vulnerable to diabetes complications and aretherefore more deserving of the attention of the researchers on how self-management affects thequality of diabetes care and treatment. The elderly are more likely to have a range ofcomplications, diseases and conditions that are worsened by the onset of diabetes, so that issuemust be understood better. That makes their care much more complicated and at the same timevery necessary as they are more vulnerable to the effects of the condition and associatedconditions. The purpose of this research project is to focus on this area of study and address thisgap in knowledge by making an investigation of a sample of people from this demographic inEngland.Research limitationsThis research will only be done with participants from England. Other countries may have theirspecific issues that will not be represented here, only that of patients from England will berepresented here. Regardless, the findings will still be valuable to anyone regardless of whatcountry they belong to since the study is on a demographic that exists in every country and thatalso experience that same main issue of diabetes. The study also involves quantitative research
5and not qualitative, so the answers will be very simplistic and somewhat of a planned nature witha limited set of outcomes that will be explored. Individual experiences are not being exploredhere, rather the objective understanding of the condition on a general level is being investigatedhere.Aims and objectivesAimThis research project aims to make an investigation on the self-management of type 2 diabetesamong the elderly population in England.ObjectivesThe objectives of this research include:Make a literature review on the self-management practices of type 2 diabetes among theelderlyDevelop appropriate research tools to make the required investigation on self-management of type 2 diabetes for elderly patients in EnglandMake the required research using the appropriate sampling techniquesDevelop recommendations for further research and development in the research literatureon type 2 diabetes self-management for the elderly population in England
6Chapter 2: Literature reviewDiabetes self-management education has assumed a very important role in the treatment ofdiabetes. It has found through various studies that any care that involves self-care routines aremore likely to be effective than any program that does not involve self-care procedures. So thegoal of DSME is to empower the patients to handle their care, and that requires proper educationand training for managing self-care (Suhl and Bonsignore, 2006). Studies on self-managementinterventions even show them to be more effective to the point that in one study, patients thatnever experienced DSME were 4 times more at risk from increasing complications than thosethat had experienced DSME treatment. More than 20% of all diabetic patients are above the ageof 60. This age group are heavily under-represented in DSME research as older adults have a lotof issues that make their treatment much more complicated than their younger counterparts.Diabetes Self-Management Education (DSME) for older adults who are diabetic can be verysophisticated because people within this age tend to suffer from many different types ofcomorbidities and conditions other than just diabetes. The complexity of their conditions and thefact that every single individual suffers from a different set of conditions make it very difficult topropose a general, all-purpose, all-encompassing solution for this age range. That is why theDSME treatment must be individualized so that they are tailor-made for dealing with individualconditions. It is also necessary to involve multiple disciplines since the conditions they suffer areusually more than one just one. And if the patients are incapable of handling their care, then careworkers have to be involved in their treatment.Diabetes is a condition that mainly manifests as a case of hyperglycemia that occurs as a result ofinsulin hormone deficiency. The WHO has stated that 346 million people globally have type 2diabetes, which is likely to double by the year 2030 (Shrivastava, Shrivastava and Ramasamy,2013). Managing diabetes involves more than merely glycemic control, there is also the aim ofreducing the possible complications that can result from it as well as preventing disability and
7ensuring better rehabilitation. Diabetes self-care involves 7 key types of behaviours that includediet control, physical exercise/activity, regulating blood sugar levels, taking appropriatemedications, developing skills for solving problems, coping mechanisms, and risk-reducingactions. The aforementioned 7 actions and behaviours are positively linked to and affect betterglycemic control, reduction of complications and an overall improvement in the quality of life.Engaging in self-care behaviour for patients of type 2 diabetes has been found to have positiveimplications for the diabetic patients themselves, but there is still the issue that many people failto maintain the appropriate self-management guidelines especially on a long-term basis.(Norris et al., 2002) made a review of the literature to determine how effective is self-management education on impacting changes in GHb levels for patients diagnosed with type 2diabetes. The purpose of the study was to determine the impact of self-management education onimproving GHb levels in type 2 diabetes patients. For this literature review, the authors wentthrough numerous literature sources and only included studies that met the following criteria:1. The study is a randomized controlled trial, i.e. it involves a control group and an interventiongroup to compare the results of the intervention.2. The study evaluated the effect of self-management education on adults with type 2 diabetes.3. The study reported results of the intervention in the form of changes in GHb LEVELS as aresult of the applied intervention.In total, the authors reviewed 31 studies. The results of the studies showed that on average, theseinterventions had a significant impact on the GHb levels of the patients, thus resulting insignificant improvement of health outcomes.(Wu, Tai and Sun, 2019) made to analyze the experience of older adults with diabetes mellituswith self-management interventions to deal with the disease. The study involved the use of afocus group to understand the subjective experiences of these patients. 23 patients were includedin the study that involved 2 different focus groups. 4 focus group discussions were held and 3themes were explored in the sessions:1. Understanding diabetes and the challenges of diabetes2. Taking a good look at the physical condition and take note of the physical changes that areobserved3. The key dilemmas involved in self-management treatments
8The authors concluded that healthcare teams must assume a greater role in the self-managementeducation programs as it helps reduce the anxiety of the patients in maintaining self-care and toenable the development of clinical skills that are more patient-oriented and culture-sensitive.Pennbrant, Berg and Fohlin Johansson (2019) made a research on the literature to investigate theexperience of elderly diabetes patients with self-care treatment. To make this research, theauthors investigated literature sources on diabetes, self-care and elderly patients with diabetes.The results showed that elderly patient was only concerned about blood glucose testing, issuesrelating to their diet, information on diabetes, motivation for self-care and moral support. Theauthors argued that nurses undertaking the care of diabetic patients must be given theopportunities to enhance their knowledge and be able to reflect their experience as careproviders.Saunders (2019) understand that diabetes is a very common health condition that comes withincreasing complications as people get older. People over 60 years of age are especiallyvulnerable to these complications and are therefore more likely to be affected more severely. Yetthe literature on this age group is scant compared to younger age groups mainly to the fact that itis difficult to generalize the factors that affect diabetes during this age and the treatments that canbe prescribed. Every individual within this age range deals with some sort of issue due that addsto their list of complications along with type 2 diabetes mellitus. One of the key issues the authorrecognizes as important for studying diabetes for this age group is the experience of the diseasefrom the patient’s point of view as each encounters unique experiences and challenges. Therefore(Saunders, 2019) examined the literature on type 2 diabetes self-management for elderly patientsin which 10 articles were analyzed to find barriers to self-management treatment In the study, 4major themes resulted-1. Gap in knowledge and understanding2.Challenges in implementation of self-management3. Barriers to culture and language4. Barrier of Health care providers to self-managementDiabetes is most commonly prevalent in older adults, most notably the age group of adults overthe age of 65. This age growing is a growing demographic, so the problem continues to grow.
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