| Diabetes mellitus is one of the main reasons that affect the health condition,self-care ability and life expectancy of the elderly. The demographic changes of aging result in the high incidence of diabetes, high mortality rate, and high complication rate of the elderly population, and thus are stretching the limits of what countries can afford to offer for better healthcare from their national health systems.In this sense, how to efficiently make full use of community resources in the existing community management model, and actively explore and design suitable methods of diabetes management, to reduce the harm of diabetes and promote healthy aging society, is becoming the critical problem that the current health authorities face with.Objective:Xinjiang is located in the western minority areas of China. The problem of aging with chronic diseases such as diabetes is prominent and serious in this region.In this study, Urumqi, which is the Captical of Xinjiang and has a large aging population and high-level standardized community health services, was selected as an exemplar region, to investigate the prevalence of diabetes and risk factors among residents aged over 60 years in the home-care setting of Urumqi. Specifically, this study investigates the adoption of knowledge-attitude-belief-practice(KAP) and the potentials of social support for elderly diabetic patients in community health centers,figures out the effectiveness and deficiency of the diabetes management mechanism in the city communities, so as to extract non-trivial knowledge to develop efficient intervention strategies of guided care mode for elderly patients with diabetes in their home-care settings, to improve the communities quality of diabetes management,and to provide new methods and strategies for actively medical support via health services delivered at home.Methods:(1) In this study, the prevalence of diabetes in the elderly in Urumqi was investigated by a multi-stage cluster sampling approach. The streets of six administrative districts in Urumqi were numbered, and three streets were randomly selected from each administrative district. Then, one community was randomly selected in each street. As a result, 18 communities were randomly selected, and a total of 1901 diabetic patients over 60 years old were randomly selected from 18 communities. We questionnaire the selected 1901 patients to investigate the prevalence of diabetes and potential risk factors for the elderly in their home-care settings.(2) From the selected 18 surveying communities, this study randomly selected four communities to figure out the current situation of social support in the elderly with diabetes. Accordingly, a total number of 219 elderly patients over 60 years old were selected to enquiry their diabetes knowledge, self-efficacy, self-healthcare management, and social support in a questionnaire manner.(3) In the Guided Care intervention study, the four selected communities were randomly divided into both control and intervention groups(each group has two communities). According to the inclusion and exclusion criteria, 149 patients with diabetes(intervention group 73 and control group 76) were selected. While patients in the control group were managed following the conventional diabetes management mode of community health centers, patients in the intervention group were managed based on the routine management manner in combination with the nursing interventions of the 6-month-long-guided mode. In addition, synchronous interventions were carried out by family caregivers for patients in the intervention group. The knowledge of diabetes,self-efficacy, self-healthcare management, social support and physiologic indicators were also collected before and after intervention,and the knowledge of diabetes and the health behavior questionnaire were collected before and after intervention that was given by the family caregivers.Results:(1) Among the selected 1901 subjects, there were 386 elderly patients with diabetes(20.31%). The differences of age, living situation, the status of occupations,incoming, and sources of income were statistical significant indicators for elderly home prevalence. The scores of body mass index(BMI), waist circumference,abdominal circumference, systolic pressure, and fasting blood glucose of elderly patients with diabetes were higher than those in non-diabetic group with statistically significant difference(P<0.05). The analysis results of binary logistic regression indicate that: the main risk factors that affect elderly patients with diabetes in Urumqi were occupational status, living conditions, income, BMI and waist circumference.(2) The analysis results on the survey data of 219 elderly diabetic patients with chronic disease management in the community health center are as follows:By using the United States Michigan Siegen diabetes knowledge assessment questionnaire(DKT), it disclosed that elderly patients have little diabetic knowledge with the total score 7. 07 ± 2. 92(scoring rate: 30.73%). As well, the analysis results using multiple linear regression showed that education degree, living condition,received treatment level, and BMI are factors that affect the knowledge of elderly patients with diabetes(P<0.05).By using of the diabetic self-efficacy questionnaire designed by Lorig of Stanford University, it showed that the self-efficacy of the elderly was in middle level with scores 14. 50 ± 3. 21(scoring rate: 72. 5%). As well, the analysis results using the multiple linear regression showed that ethnic groups, monthly income,glucose, physical exercise are factors for self-efficacy of elderly patients with diabetes(P<0.05).By using the Summary of Diabetes Self-Care Activities designed by Toobert, it showed that self-management of the elderly in this study has scores 20.21 ± 5. 77(scoring rate: 57, 74%). As well, the analysis results of multiple linear regression showed that care situation, physical exercise level, and standard treatment level are factors for diabetes self-management of elderly patients with diabetes(P<0.05).By using the social support scale in Diabetes Management Rating Scale(DCP),it showed that the social support of the elderly in this study has scores 10.64 ± 1.75(scoring rate: 59, 11%). As well, the analysis results of multiple linear regression showed that care status, the standard treatment level, waist circumference, and BMI are factors for social support of elderly patients with diabetes(P<0.05).The correlation analysis on diabetes knowledge, self-efficacy social support and self-healthcare management showed that diabetes knowledge and self-efficacy were positively correlated(r=0.413 P<0.05), diabetes knowledge and social supportwere positively correlated(r=0.446P<0.05), diabetes knowledge and self-healthcare management were positively correlated(r=0.283P<0.05), self-efficacy was positively correlated with self-healthcare management(r=0.508P<0.05), and self-management was positively correlated with social support(r=0.183 P<0.05).(3) The application of guided nursing for elderly patients with diabetes in the home-care setting and interventions conducted by family caregivers showed that:Knowledge of elderly patients with diabetes: There was no significant difference between the two groups before intervention(P>0.05). The scores of the knowledge of the control group before and after intervention were no significantly different(P>0.05). The scores after intervention of diabetes mellitus knowledge and blood glucose, dietary dimension, complication dimension physical exercise dimension and insulin dimension were significantly higher than before in intervention group(P<0.05). The intervention group scores of diabetes mellitus knowledge and blood glucose, dietary dimension, complication dimension, physical exercise dimension and insulin dimension were significantly higher than those of the control group with statistically significant difference after intervention(P<0.05).Self-efficacy of elderly patients with diabetes: there was no significant difference between the two groups before intervention(P>0.05). In the control group, only the score of exercise self-efficacy after intervention was lower than before and the difference was statistical significance(P<0.05). The total score,dietary regulations,and physical exercise dimension of the intervention group after intervention were significantly higher than those before and the difference was statistical significance(P<0.05), and after intervention,The total score,dietary regulations,physical exercise dimension,blood glucose and disease controlling were higher than those of the control group(P<0.05).Social support of elderly patients with diabetes: there was no significant difference in scores of self-healthcare management between the two groups before intervention(P>0.05), and there was no significant difference in control group before and after intervention(P>0.05). In the intervention group, the total score and the scores of the three dimensions after intervention were higher than before and the difference was statistical significance(P<0.05). After intervention, the total score,the support of elderly patients needing,the support of elderly patients having and the cognizatonin of support in the intervention group were significantly higherthan those in the control group(P<0.05).Self-healthcare management of elderly patients with diabetes: there was no significant difference in body weight and blood glucose between the two groups before intervention(P>0.05). The waist circumference in the control group was significantly higher than that before intervention(P<0.05). There was no significant difference in the other indexes between the two groups after intervention. Compared with the control group, the intervention group showed no significant difference(P>0.05). Systolic blood pressure was lower than that of the control group, and the difference was statistically significant(P<0.05). There were no significant differences among the other indexes(P>0.05).Physical and blood glucose levels of elderly patients with diabetes: the total scores of diabetes knowledge and the score of blood glucose, dietary knowledge,complication knowledge and insulin knowledge of caregivers were significantly higher than those before intervention(P<0.05). The scores of health responsibility,physical exercise, nutrition, interpersonal relationship and stress management dimension were higher than those before intervention(P<0.05).Conclusion:(1) The prevalence rate of diabetes among elderly at home in Urumqi is high,and there are critical risk factors for diabetes. The study shows that the prevalence of elderly patients with diabetes at home in Urumqi increases rapidly and closes to the national level. The prevalence of elderly patients with at home is increasing with age, and the prevalence of elderly people who have not yet retired is higher than that after retirement. The prevalence of empty-nesters living alone or living alone with their spouses is higher than that of non-empty nesters living with their children. The prevalence of low-income elderly is higher than that of high-income elderly, and the proportion of obese people with diabetes is higher than the elderly without diabetes.Therefore, we should actively allocate community healthcare resources to strengthen the early prevention and management of diabetes. According to the physical and mental characteristics, and their living conditions of elderly patients with diabetes at home, targeted diabetes management programs can be carried out to effectively prevent and control the occurrence and development of diabetes in the elderly, so as to reduce the harm to the elderly population.(2) Existing community health institutions carry out poor management ofdiabetes, and the self-healthcare management level of elderly patients with diabetes is not high. The present study shows that patients who are well managed by community health institutions have low levels of knowledge of diabetes, moderate self-efficacy, low level of social support, low level of self-healthcare management,and the above factors are affected with each other. Therefore, it is necessary to actively explore and improve the existing management mechanisms and measures in view of the current status of community management of diabetes, not only to continuously strengthen the management of knowledge and behavior of elderly patients with diabetes, but also pay attention to the social support system for elderly patients with synergistic effects.(3) Guided care model can effectively improve the quality of diabetes knowledge learning, self-efficacy, social support, self-healthcare management, and health behaviors of family caregivers. Therefore, we can draw lessons from the beneficial experiences of guiding care model, to construct a targeted diabetes management model in which the community health care workers, patients and family caregivers participate together in the existing chronic disease management model of communities. Ultimately, the quality of health services delivered by community health institutions will be improved continuously. |
PDF Full Text Request