Psychosocial Contexts of Diabetes and Older Adulthood: Reciprocal Effects

The present study was conducted to assess the reciprocal effects between the psychosocial contexts of diabetes and older adulthood. Data were collected from 191 community-dwelling adults over the age of 60 with non-insulin-dependent diabetes mellitus. Results indicate that older adults with diabetes reported higher rates of selected chronic illnesses, lower self-rated physical health, and higher levels of depression than did comparison samples of older adults without diabetes. Compared with younger adults with NIDDM, the present sample of older adults perceived fewer impacts of diabetes, including fewer symptoms of poor metabolic control, less emotional impact, fewer barriers to adherence, and less complex regimens. Overall levels of social support and regimen adherence were high. Older adults in this sample reported wanting minimal help from their family and friends with self-management activities and receiving more help than desired with following a meal plan and taking medications. Implications of the unique context of older adulthood for diabetes self-management are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69058/2/10.1177_014572179101700507.pd

Implications and Impacts of Awareness Sessions in a Work Site Health Promotion Program

The purpose of this study was to evaluate one phase of an extensive worksite health promotion program, developed multidisciplinary health care professionals. A single was conducted using the Cardiac Health Questionnaire. results to card: climate and implemented by group pre-post design T-test and chi-square indicated significant changes in attitude and knowledge related ovascular disease prevention. Perceptions of organizational and employee work place, also have The need for worksite concerns regarding issues of confidentiality in the implications for the development of such programs. health programs and the skills health professionals provide to their successful implementation, provide educational direction to the development of health occupations programs

Progression of Symptoms and Functioning Among Female Cardiac Patients With and Without Diabetes

Objective: To determine if older women with both heart disease and diabetes experience worse physical and psychosocial functioning and higher symptom burden over an 18-month period compared with those with heart disease alone. Methods: Data from older women with heart disease (>=60 years, n = 1008, 18% with diabetes) were used to assess the impact of diabetes on physical functioning (Sickness Impact Profile [SIP]-Physical and Six-Minute Walk test [6MWT]), psychosocial functioning (SIP-Psychosocial and depressive symptoms), and physical symptom burden (cardiac and general) at baseline and 4, 12, and 18 months later. Generalized estimating equation models compared trends in outcomes over time between groups with and without diabetes. Results: Across all four time points, women with heart disease and diabetes had greater functional impairment, as indicated by higher SIP scores, than those without diabetes (43%-71% higher SIP-Physical scores and 32%-65% higher SIP-Pyschosocial scores; all p<=-0.002). 6MWT distance was 17%-30% less in the diabetes group across time points (all p<=-0.002). Depressive symptoms were 27%-39% higher in the diabetes group (all p-<-0.03) except at month 4. Women with diabetes scored 15%-29% higher on a physical symptom index across time points (all p-<-0.05) than those without diabetes; no significant differences were observed in cardiac symptoms until month 18 (diabetes group 29% higher, p = 0.02). Subgroups with and without diabetes in this sample experienced significantly different trends over time in SIP-Physical scores (p = 0.02) and 6MWT distance (p = 0.05), such that the disadvantage of the diabetes group at baseline was greater 18 months later. Conclusions: Women with comorbid diabetes and heart disease are vulnerable to poor health-related quality of life, particularly in terms of physical functioning and symptoms, and require special efforts from clinical care providers to ameliorate a potential downward trend in these outcomes over time.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90452/1/jwh-2E2010-2E2123.pd

Measurement of Health-Related QOL in Diabetes Mellitus

A number of health-related QOL (HR-QOL) measures specifically designed for people with diabetes mellitus have appeared in the literature. This article provides a selective review of 12 measures that address this important construct. For each included study, a description of the measure and its development phase is provided, followed by discussion of sampling, reliability, validity and appropriateness for selected populations. Measures designed to investigate broad and specific conceptualisations of diabetes-specific QOL are included. For research in which a broad conceptualisation of diabetes-specific QOL is appropriate, the following measures are recommended: Diabetes-39, Diabetes Care Profile (DCP), Diabetes Impact Management Scales (DIMS), Diabetes Quality of Life (DQOL) and the Diabetes-Specific Quality of Life Scale (DSQOLS). For investigation of one or more specific aspects of diabetes-specific QOL, other measures may also be appropriate: single-scale questionnaires such as the Appraisal of Diabetes Scale (ADS) [stressful impact], Audit of Diabetes-Dependent Quality of Life (ADDQoL) [life without diabetes] and the Problem Areas in Diabetes scale (PAID) [diabetes-related distress]; the Diabetes Health Profile (DHP) which focuses on diabetes-related distress, activity and eating behaviour; the Questionnaire on Stress in Patients with Diabetes-Revised (QSD-R) which has a primary focus on diabetes-related distress; and the Well-Being Enquiry for Diabetics (WED) which is primarily concerned with the perceptions of patients with diabetes in relation to mental health. Researchers selecting a diabetes-specific QOL measure should also carefully consider the conceptual underpinnings of the available instruments, as there is little uniformity in the definition and conceptualisation of HR-QOL. Based upon participants involved in questionnaire development and validation studies, those questionnaires that appear to be most appropriate for use with a variety of patient populations include the Diabetes-39, DIMS, Diabetes Quality of Life Clinical Trial Questionnaire - Revised (DQLCTQ-R), PAID and the QSD-R. The DCP and DHP appear to be especially relevant measures of HR-QOL for patients with type 2 diabetes, while the DQOL, DSQOLS and WED have clear emphases on concerns of individuals with type 1 diabetes. The length of the DQLCTQ-R may raise concerns about its use among some populations (e.g. older adults). Recommendations for future research include: (i) increasing the diversity of samples used to develop and evaluate existing and new measures in terms of race/ethnicity, age and gender; (ii) examination of the causal relationship between diabetes self-management and QOL using longitudinal designs; (iii) increasing emphasis on the positive aspects of successful chronic illness self-management; and (iv) use of HR-QOL measures to inform empowering relationships between physicians and patients.Diabetes-mellitus, Quality-of-life, Quality-of-life-rating-scales