Self-care practices of older adults with diabetes mellitus

Abstract

Although great strides have been made in recent years in the field of diabetes mellitus, there is little research on how older persons fare in its self-management. This research study aimed to explore the self-care practices of older people living with diabetes by investigating how they perform in the various domains of self-management. It also explored if, and how, practices vary between those with good and poor glycaemic control. Data for this study was collected from a sample size of 12 older adults; half of whom have poor glycaemic control. Qualitative data collected through in-depth semi-structured interviews was analysed using an Interpretative Social Science (ISS) approach. This data revealed important differences in attitudes towards self-care between participants with good and poor glycaemic control. Older adults with good glycaemic control were characterised by being proactive, focused on prevention, more organised in their self-care routine, and more confident in making choices based on informed decisions. These individuals were more careful to prevent hyper- and hypo-glycaemia. Those with poor control, on the other hand, profoundly lacked basic knowledge on diabetes and self-care principles. They followed advice blindly, but were confused by recommendations given and thus had poor problem-solving skills. These individuals were mainly focused on preventing hyper-glycaemia, and did not manage poor blood glucose readings adequately. Physical activity was low in most participants, who often declined to engage in exercise because of limitations imposed by other co-morbidities. Foot care practices, investigated as an example of risk-reducing behaviour, were also neglected by most participants. Insulin therapy contributes to various challenges with medication management and may affect social engagement, but adherence to medications was sufficient in most participants. This paper concludes that older adults with diabetes mellitus encounter a number of bio-psycho-social barriers as they struggle to self-care their condition. Whilst family support was the main facilitator to diabetes self-care, low levels of motivation and health literacy were considerable barriers. Thus, diabetes education should be offered soon after diagnosis and be followed-up regularly to promote motivation and compliance. Furthermore, health-care provided should adopt a patient-centred approach and be based on holistic assessment and management of problems which arise as the individual ages.