March 12, 2013

Group Education Benefits the Elderly – Part 1

Part 1 of 2 Parts

This is one of the studies I have been searching for and I now have an answer to many of the questions that have been going through my mind as to why the elderly with diabetes are not well thought of in the medical community. From the extract, we have the objective, which states, OBJECTIVE In this secondary analysis, we examined whether older adults with diabetes (aged 60–75 years) could benefit from self-management interventions compared with younger adults. Seventy-one community-dwelling older adults and 151 younger adults were randomized to attend a structured behavioral group, an attention control group, or one-to-one education.”

When looking at the graphs as part of the study, the groups all started with A1c's above 8.5 percent and no group ended up below 8 percent. This does not speak well for the study, as a goal should have been to bring everyone below 7.5 percent. This seems to be the shortcomings of many of the studies involving people over the age of 60. The researchers seem happy with not showing the elderly how to bring their blood glucose levels down significantly.

Within the study, the authors state that there are large numbers of older adults with diabetes, but how to provide diabetes self-management support to this group remains unclear. Older adults, aged 60 years or older, are often under represented in diabetes education interventions because of subtle changes in their functional, cognitive, and psychosocial statuses. This scares researchers away and consequently, evidence-based guidelines for this age group are not well established.

It is somewhat understandable that restrictions for this study were rather strict, but in some areas, I have to wonder if this was for the researchers convenience or to prevent confounding factors entirely. I can understand having the age range of 18 to 75 to help determine if the elderly were capable of improving their overall diabetes management

One statement that seems to sum up how researchers feel about the elderly is this. “Finally, we did not recruit adults aged 76 years and greater because these individuals may present with unique clinical (e.g., comorbidity, complications) and functional (e.g., impairment, disability) challenges that require special attention. For example, older diabetes patients are at greater risk for several geriatric syndromes, including depression, cognitive impairment, injurious falls, neuropathic pain, and urinary incontinence. These syndromes can have a deleterious effect on diabetes self-care, health status, and quality of life. Thus, the value of group versus individual diabetes education needs to be evaluated in the age 76 and up population. Importantly, future diabetes behavioral interventions need to address changes in older adult functional, cognitive, and psychosocial states and how best to assess and address these factors.”

When I wrote this blog, I emphasized, “DSME for those age 60 and older requires, and I mean requires that it be on an individual basis.” Now I must change my opinion to say that group education does work and greatly helps the people over the age of 60. Then I continued my blog in part 2 here and stressed the “importance of diabetes self-management education (DSME).
In the conclusions area, the authors had some rather welcome results, “we examined whether older adults with diabetes could benefit from self-management interventions compared with middle-aged and younger adults. We also examined whether older adults benefited from group versus individual self-management interventions. The data show that compared with the younger adults in this study, the older adults received equal glycemic benefit from participating in self-management interventions, and this finding did not differ by type of diabetes. Moreover, older adults showed the greatest glycemic improvement in the two group interventions, with both groups achieving clinically significant improvements in A1C (greater than or equal to 0.5%). Of note, both older and younger adults in the group conditions maintained their A1C improvements similarly at 12 months post intervention. Finally, the diabetes self-management interventions had a positive impact on older and younger participants’ diabetes self-care and psychosocial outcomes.” Bold is my emphasis.

To me, the best statement is the most encouraging. “Thus, clinicians can safely recommend group diabetes education classes for older patients with poor glycemic control. As the U.S. population ages and develops diabetes at a rapid rate, more high-quality research is needed to understand how normal aging processes influence how older adults learn about and take care of diabetes.” The one weakness is that researchers are not interested in helping many of us in the elderly group to become even more proficient in managing our diabetes. It seems only of you have poor glycemic control and have none of the conditions that will make management more difficult.

All members of our group agree that not enough is being done for people our age in diabetes education and that most doctors are not interested because of time constraints and other limitations. Even the majority of certified diabetes educators (CDEs) could care less about educating elderly people with type 2 diabetes. That is the reason we have called ourselves an informal peer-to-peer group because we work to help each other.

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