“I Try to Keep That Sugar Down.” Experiences of Homebound Older Adults With Type 2 Diabetes: Barriers to Self-Management

Abstract

With the population of older Americans on the rise, the burden of chronic health conditions, functional decline, and diminished independence place an unprecedented strain on the resources of individuals, family members, caregivers, and healthcare systems. Diabetes Mellitus (DM) affects older adults at higher rates, notably within the most vulnerable subgroups of the population including women, minorities, those in poverty, and the homebound. Following a telephone screening process, in‐depth interviews were conducted at the homes of 31 African American, Hispanic, and non‐Hispanic White seniors who regularly receive home‐delivered meals. This interpretive methodology was developed to systematically assess health and dietary self‐management in older adults who receive home‐delivered meals. The interview guide focused on 5 areas: general health; history and perception; self‐management; program planning; and social support. Thematic analysis shows that participants felt liable for their health status, but attributed their non‐compliance to lack of social and economic assistance. The seniors in this study felt competent, but rarely had the opportunity to take protective measures to manage their DM due to a number of barriers. Key barriers to self‐management include financial hardship, food access, coping mechanisms, and psychological well‐being. These results contribute to better understanding of how to approach, support, and motivate homebound older adults with DM while addressing barriers that offer insight to the development of self‐management interventions. Recommendations include training volunteers as community health workers to help seniors with problem‐solving and better management of DM.

What are the self-management experiences of the elderly with diabetes? A systematic review of qualitative research

“…Another study mentioned that some participants felt helpless without the help of their families[ 29 ] . The study also mentioned that the elderly with diabetes require additional assistance in daily life, particularly in cooking, transportation, cleaning, and finances, because of their decline in physical health[ 29 , 32 , 36 ]. This theme shows moderate confidence according to the CERQual assessment and details are presented in Table 3 below.…”

“…Seven of ten papers mentioned functional decline[ 27 , 30 - 33 , 36 , 37 ], discussing aging-related symptoms, memory loss, joint pain, deterioration of vision, peripheral nerve damage, and weakness, which made self-management challenging for the participants. Owing to memory loss, the participants sometimes forgot to take their prescribed medicines, or were unable to remember whether or not they had taken their prescribed medicines.…”

“…Regular exercise is important to people with diabetes; however, owing to frailty, pain, physical limitations, and less self-discipline, participants lack exercise[ 27 , 31 - 33 , 36 ]. Moreover, trying to maintain physical activity can increase depressive symptoms because of the pain and difficulty associated with their declining health conditions[ 33 ].…”

“…Their discipline was not high enough to restrict the amount of food they ate[ 32 ]. Dietary control is influenced by food cultures[ 36 , 37 ], but some traditional foods are not healthy choices as they contain high levels of saturated fats, sodium, carbohydrates, and sugars. Three of the included studies mentioned weight issues[ 31 , 32 , 35 ].…”

Implementing a Community-Based Initiative to Improve Nutritional Intake among Home-Delivered Meal Recipients

“…Despite the critical importance of nutritional intake among high-risk older adult populations, older adults often lack awareness of how to routinely meet their nutritional needs given their health complexities [ 12 , 13 ]. Among HDM recipients specifically, the meal consumption of as many as 80% of older adults was insufficient for meeting recommended energy and macronutrient intake, further elevating the risk of malnourishment [ 14 ].…”