Conference Proceedings - School of Nursing & Midwifery - Trinity ...

School of Nursing & Midwifery, Trinity College Dublin: 8 th Annual Interdisciplinary Research Conference
Transforming Healthcare Through Research, Education & Technology: 7 th – 9 th November 2007
Conference Proceedings
adherence with diabetes self-management. Although effective
medications, methods of delivery, and methods for self-monitoring
have improved diabetic clients’ ability to control hyperglycemia,
normal metabolic control remains difficult to achieve for the older
population.
Adherence by the elderly diabetic to dietary therapy, physical
activity, and medication regimes may be compromised by co-
morbid conditions and psychosocial limitations. The principles of
managing diabetes in the elderly are not different from those in
younger patients, but the priorities and therapeutic strategies need
to be individualized. The objectives of treatment are to improve
glycemic control in an approach that involves diet and exercise
combined with insulin. Treatment decisions are influenced by age,
life expectancy, co-morbid conditions, and severity of vascular
complications. Suhl and Bonsignore (2006) reported that risk of
cognitive dysfunction increase with age and evidence suggests the
decline is more significant in older diabetics and is associated with
poor diabetes control.
Individuals with diabetes provide about 95% of their own care
(Anderson, Funnel, Butler, Arnold, Fitzgerald, & Feste, 1995) and
diabetes education is used as a tool towards the development of
self-management education. People with diabetes make many
choices every day that affect their disease. The focus of diabetic
education has been to provide effective education that promoted
behavioral change, which improved choices, better health, and
reduction of complications. This was accomplished with a
pedagogical approach which included lecture content, knowledge
tested for accuracy, and demonstration-return demonstration of the
necessary skills to self-manage (Bradley, 1995; Brown, 1992). This
strategy may not necessarily lead to long-term adherence to
diabetes regimens. Consideration of extemporaneous factors with
clients, who have had diabetes for several years, may show a
different result.
Jack, Liburd, Vinicor, Brody, and McBride-Murry (1999),
determined that diabetic education has not considered the impact of
the patient’s experiences upon their social circumstances and
physical environment. They assert that diabetes education research
needs to examine both traditional psychological measures such as
depression, coping or stress and the environmental context that
influences diabetic patients.
In their study, these authors asserted that in many diabetes
education studies, interventions are inadequately defined; with no
rationale given that supports a particular education methodology.
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