The Lived Experience of Older Adults With Type 2 Diabetes Mellitus and Diabetes-Related Distress.

An older, more diverse population and longer lifespans are major contributors to the anticipated tripling of diabetes prevalence by 2050. Diabetes-related distress affects up to 40% of people with diabetes and may be a higher risk for older adults due to greater prevalence of comorbidities. The objective of the current phenomenological study was to describe how diabetes-related distress might be uniquely experienced by older adults (age ≥65) with type 2 diabetes mellitus (T2DM). Interpretive phenomenology guided the research design and analysis. Everyday life experiences of living with T2DM and elevated diabetes distress were investigated with interpretive interviews. The most prevalent lived experiences were strained relationships with health care providers, guilt, fear, loneliness, and forgetfulness. These experiences created challenges in managing diabetes and increased diabetes-related distress. Improving knowledge regarding the lived experience of older adults with diabetes-related distress may allow health care providers to tailor treatment to this population, thus improving outcomes. [Journal of Gerontological Nursing, 46(3), 37-44.].

Symptom Experience of Older Adults With Type 2 Diabetes and Diabetes-Related Distress.

BACKGROUND: An older, more diverse population and longer life spans are major contributors to the anticipated tripling of Type 2 diabetes prevalence by 2050. Diabetes-related distress affects up to 40% of people diagnosed with Type 2 diabetes and may be a greater risk for older adults due to greater prevalence of comorbidities. OBJECTIVE: The objective of this phenomenological study was to describe how diabetes-related distress in older adults (≥65 years) with Type 2 diabetes might be uniquely experienced. METHODS: Participants were recruited using convenience sampling and snowball sampling. Interpretive phenomenology guided the research design and analysis. With interpretive interviews, we investigated the everyday health, symptoms, and life experiences of living with Type 2 diabetes and elevated diabetes distress. RESULTS: Among the older adults in this study, the most prevalent symptoms were fatigue, hypoglycemia, diarrhea, pain, loss of balance, and falling. These diabetes-related symptoms led to substantial loss of independence, decreased quality of life, and constrained social lives due to restricted activities. DISCUSSION: Diabetes-related distress presents with some unique symptoms and responses in older adults. Improving knowledge regarding the symptom experience of older adults with diabetes-related distress may allow healthcare providers to tailor treatment and thus improve outcomes for older adults struggling with diabetes.

Familial Caregiver and Physician Perceptions of the Family-Physician Interactions During Interfacility Transfers.

BACKGROUND AND OBJECTIVES: Children with special health care needs (CSHCN) have frequent hospitalizations and high specialty care utilization. If they initially present to a medical facility not capable of providing their definitive care, these children often experience an interfacility transfer. This transition has potential to impose hardships on familial caregivers. The goal of this study was to explore family-physician interactions during interfacility transfers from the perspectives of referring and accepting physicians and familial caregivers, and then develop a conceptual model for effective patient- and family-centered interfacility transfers that leverages the family-physician interaction. METHODS: This single-center qualitative study used grounded theory methods. Interviews were conducted with referring and accepting physicians and the familial caregivers of CSHCN. Four researchers coded the data. The research team reached consensus on the major categories and developed a conceptual model. RESULTS: Eight referring physicians, 9 accepting physicians, and 8 familial caregivers of 25 CSHCN were interviewed. All participants stated that family-physician interactions during transfers should be improved. Three main categories were developed: shared decision-making, provider awareness of families' resource needs, and communication. The conceptual model showed that 2-way communication allows providers to gain awareness of families' needs, which can facilitate shared decision-making, ultimately enhancing effective coordination and patient- and family-centered transfers. CONCLUSIONS: Shared decision-making, provider awareness of families' resource needs, and communication are perceived as integral aspects of the family-physician interaction during interfacility transfers. Transfer systems should be reengineered to optimize family-physician interactions to make interfacility transfers more patient- and family-centered.

Cultural Adaptation of the Group Lifestyle Balance Program for Chinese Americans.

PURPOSE: The purpose of this pilot study was to develop and evaluate a culturally adapted, language-translated diabetes prevention program for Chinese Americans. METHODS: This pilot study had a single-group repeated-measures design. Participants were 25 first-generation (n = 20) or second-generation (n = 5) Chinese Americans at risk for diabetes because of overweight (using the Asian-specific criterion of body mass index ≥ 23) and either prediabetes or metabolic syndrome. The 16-session program was administered over 6 months in separate Mandarin (n = 9) and English (n = 16) groups. Outcomes were assessed at baseline and at 3 and 6 months. Four participants dropped out. Multilevel regression models were used to examine change in study outcomes over time. RESULTS: Participants lost an average of 5.4% of their body weight across the 6 months of the study. Self-report questionnaires suggested improved dietary intake and increased physical activity. Both total and low-density lipoprotein cholesterol levels improved. There were no statistically significant changes in fasting plasma glucose or A1C levels. Participants reported high satisfaction with and acceptance of the program. CONCLUSION: Results suggest that the culturally adapted Group Lifestyle Balance program for Chinese Americans was both acceptable and effective. The culturally adapted program warrants further examination using scientific approaches for dissemination and implementation.

Interfacility Transfers to General Pediatric Floors: A Qualitative Study Exploring the Role of Communication.

BACKGROUND: Children with special health care needs often require health services that are only provided at subspecialty centers. Such children who present to nonspecialty hospitals might require a hospital-to-hospital transfer. When transitioning between medical settings, communication is an integral aspect that can affect the quality of patient care. The objectives of the study were to identify barriers and facilitators to effective interfacility pediatric transfer communication to general pediatric floors from the perspectives of referring and accepting physicians, and then develop a conceptual model for effective interfacility transfer communication. METHODS: This was a single-center qualitative study using grounded theory methodology. Referring and accepting physicians of children with special health care needs were interviewed. Four researchers coded the data using ATLAS.ti (version 7, Scientific Software Development GMBH, Berlin, Germany), using a 2-step process of open coding, followed by focused coding until no new codes emerged. The research team reached consensus on the final major categories and subsequently developed a conceptual model. RESULTS: Eight referring and 9 accepting physicians were interviewed. Theoretical coding resulted in 3 major categories: streamlined transfer process, quality handoff and 2-way communication, and positive relationships between physicians across facilities. The conceptual model unites these categories and shows how these categories contribute to effective interfacility transfer communication. Proposed interventions involved standardizing the communication process and incorporating technology such as telemedicine during transfers. CONCLUSIONS: Communication is perceived to be an integral component of interfacility transfers. We recommend that transfer systems be re-engineered to make the process more streamlined, to improve the quality of the handoff and 2-way communication, and to facilitate positive relationships between physicians across facilities.