The unmet needs of the elderly with diabetes in home health care

Unmet needs for social support and diabetes-related distress among people living with type 2 diabetes in Thai Binh, Vietnam: a cross-sectional study

BACKGROUND

Diabetes-related distress (DRD) refers to negative emotional and affective experiences from daily demands of living with diabetes. People who received social support seem less likely to experience DRD. The prevalence of T2D in Vietnam is rapidly increasing. Yet, DRD and its association with social support have not been investigated. This study investigates DRD and how it is associated with unmet needs for social support in people with T2D in Thai Binh Province, Vietnam.

METHODS

A total of 806 people, age ≥ 40 years, treated for T2D at primary hospitals in Thai Binh Province, Vietnam, completed a questionnaire-based cross-sectional survey. DRD was self-reported, based on the Problem Areas In Diabetes scale 5 (PAID5). We assessed 6 types of unmet needs for social support from family/friends/community including: (i) Transport and company when visiting health facilities; (ii) Reminders to take medication; (iii) Purchase and preparation of food; (iv) Reminders to engage in physical exercise; (v) Emotional support; and (vi) Financial support. Multivariable logistic regression was used to model DRD as an outcome of each type of unmet need for social support, and as an outcome of the number of unmet needs for social support, adjusted for three sets of covariates.

RESULTS

In this study, 50.0% of people with T2D experienced DRD. Odds for DRD were higher among those who had any unmet need for social support. After adjustment for household economic status, only unmet needs for emotional and financial support were associated with higher odds ratios of DRD (OR = 2.59, CI95%: 1.19-5.63 and OR = 1.63, CI95%: 1.10-2.40, respectively). People who had ≥2 type of unmet need were not a higher risk of experiencing DRD as compared to those with no unmet need.

CONCLUSIONS

Half of the people with T2D experienced DRD. The results suggest that having enough finances may decrease most needs for social support with the exception of emotional support. Thus, social support to financial and emotional of diabetes aspects may contribute to prevent or reverse DRD.

Diabetes prevalence among older people receiving care at home: associations with symptoms, health status and psychological well-being

AIMS

To determine the prevalence of diabetes among older people receiving care at home, and to explore differences in sociodemographic and clinical characteristics, symptoms, health status, quality of life and psychological well-being between diabetes categories defined as HbA_1c ≥ 48 mmol/mol (6.5%) and/or self-report.

METHODS

A community-based sample of 377 people receiving care at home in Western Norway participated in a cross-sectional survey. Instruments included the MMSE-NR, Symptom Check-List, WHO Quality of Life-BREF (WHOQOL-BREF, global items), EuroQol EQ-5D-5L/EQ-5D-VAS and WHO-Five Well-Being Index (WHO-5). Participants were grouped into four categories: no diabetes, self-report only, HbA_1c ≥ 48 mmol/mol (6.5%) and self-report, and HbA_1c ≥ 48 mmol/mol (6.5%) only.

RESULTS

Median age (IQR) was 86 (81-91) years and 34% of the sample were men. We identified 92 people (24%) with diabetes. Diabetes was more prevalent in men than women (34% vs. 20%, age-adjusted P = 0.005). Among people with diabetes, 14% were unaware of their diagnosis. There were significant differences in symptoms between the diabetes categories, with more symptoms (abnormal thirst, polyuria, genital itching, nausea, excessive hunger, perspiring, cold hands/feet, daytime sleepiness) among the groups with elevated HbA_1c . Significant differences in WHO-5, WHOQOL-BREF and EQ-5D-5L between diabetes categories were identified, with the poorest scores in the group with undiagnosed diabetes.

CONCLUSIONS

A high percentage of people with diabetes receiving care at home are unaware of their diagnosis. Diabetes deserves increased case-finding efforts and allocation of resources towards those receiving care at home to alleviate symptoms and the burden of inadequate diabetes care.

Individualising Chronic Care Management by Analysing Patients' Needs - A Mixed Method Approach

Background

Modern health systems are increasingly faced with the challenge to provide effective, affordable and accessible health care for people with chronic conditions. As evidence on the specific unmet needs and their impact on health outcomes is limited, practical research is needed to tailor chronic care to individual needs of patients with diabetes. Qualitative approaches to describe professional and informal caregiving will support understanding the complexity of chronic care. Results are intended to provide practical recommendations to be used for systematic implementation of sustainable chronic care models.

Method

A mixed method study was conducted. A standardised survey (n = 92) of experts in chronic care using mail responses to open-ended questions was conducted to analyse existing chronic care programs focusing on effective, problematic and missing components. An expert workshop (n = 22) of professionals and scientists of a European funded research project MANAGE CARE was used to define a limited number of unmet needs and priorities of elderly patients with type 2 diabetes mellitus and comorbidities. This list was validated and ranked using a multilingual online survey (n = 650). Participants of the online survey included patients, health care professionals and other stakeholders from 56 countries.

Results

The survey indicated that current care models need to be improved in terms of financial support, case management and the consideration of social care. The expert workshop identified 150 patient needs which were summarised in 13 needs dimensions. The online survey of these pre-defined dimensions revealed that financial issues, education of both patients and professionals, availability of services as well as health promotion are the most important unmet needs for both patients and professionals.

Conclusion

The study uncovered competing demands which are not limited to medical conditions. The findings emphasise that future care models need to focus stronger on individual patient needs and promote their active involvement in co-design and implementation. Future research is needed to develop new chronic care models providing evidence-based and practical implications for the regional care setting.

Diabetes Among Recipients of Home Health Services in the United States

The 2007 National Home and Hospice Care Survey was used to generate representative data on diabetic home health patients in the United States. Approximately 30% of home health patients have diabetes (11% have diabetes as the primary diagnosis), 28% were <65, 62% were women, and diabetic patients were more likely to be non-White. Nearly 75% received services immediately following a hospital or emergency room stay, 32% lived alone and nearly 20% did not have a primary caregiver. More than 40% of these patients needed assistance with ≥4 activities of daily living, 38% needed assistance with medication management and more than two thirds of families of diabetic patients received services from the agency that was serving the patient. The cost of services for home health patients with a primary diagnosis of diabetes is US$17.9 million/day.

Unmet physical activity need in old age

OBJECTIVES

To examine which individual and environmental factors correlate with unmet physical activity need in old age and predict development of unmet physical activity need (the feeling that one's level of physical activity is inadequate and thus distinct from the recommended amount of physical activity) over a 2-year follow-up.

DESIGN

Observational prospective cohort study and cross-sectional analyses.

SETTING

Community and research center.

PARTICIPANTS

A total of 643 community-living ambulatory people aged 75 to 81 took part in face-to-face interviews and examinations at baseline and 314 at the 2-year follow-up.

MEASUREMENTS

Unmet physical activity need and its potential individual and environmental correlates were assessed at baseline. Development of unmet physical activity need was assessed over the 2-year follow-up period.

RESULTS

At baseline, all participants were able to walk at least 500 m outdoors, but 14% perceived unmet physical activity need. Unmet physical activity need was more prevalent in those with musculoskeletal diseases, depressive symptoms, and mobility limitations. Hills in the nearby environment, lack of resting places, and dangerous crossroads correlated with unmet physical activity need at baseline; the association was especially strong in those with walking difficulties. Significant baseline predictors for incident unmet physical activity need (15%) included fear of moving outdoors, hills in the nearby environment, and noisy traffic.

CONCLUSION

Unmet physical activity need is common in ambulatory community-living older people who have health and mobility problems and report negative environmental features in their neighborhood. Solutions to overcome barriers to physical activity need to be developed to promote equal opportunities for physical activity participation.

Rural-urban differences in end-of-life care: implications for practice

Most older adults with advanced illnesses express the wish to die at home. Home-based care from home health and hospice agencies makes this possible, but there are great geographic variations in utilization. Interviews and focus groups with key constituents in home health and hospice agencies across the 8-county region of Western New York State were used to explore how rural-urban location and agency type (home health or hospice) influence variations in end-of-life care. Emergent themes were: Rural-Urban Differences (geographic challenges, market forces, and programming issues) and End-of-life Care Issues (macrosocial, mezzosocial, and microsocial factors). Implications for social work practice are discussed.

In-Home Chronic Disease Management in Diabetes

With the rate of diabetes increasing in the elderly, home health care agencies must creatively approach disease management in this high-risk population. Specialized training programs, standardized policies and procedures, and strategic staffing patterns support agencies to systematically and effectively manage diabetes in the home. Collaboration with endocrinology providers assists agencies to incorporate and appropriately use national standards in diabetes care. Additionally, home health partnership with endocrinology providers will enhance a disease management program with increased provider participation and oversight, improving patient clinical outcomes and serving as a resource for home health agencies managing patients with diabetes.

Community-based tele-health systems for persons with diabetes: development of an outcomes model

The purpose of this study was to obtain information on the perceptions of persons with diabetes regarding participation in a tele-health program. We conducted three focus groups among diabetics who had used a monitoring and messaging device (MMD), a commonly used tele-health care system. Analysis involved open and axial coding to identify major themes and relationships. Results suggest that these systems enhance communication, care-manager relationships, self-discipline, and clinical follow-up. The results suggest mechanisms by which tele-health systems influence the health care system and point to areas for further tele-health development.