| The prevalence of type 2 diabetes, coupled with the life-altering and potentially life-threatening secondary outcomes of disease progression, support the need to better understand how older adults live with and manage diabetes. Most clinical care guidelines for older adults are disease-focused and do not provide guidance for prioritizing multiple health conditions that are common in older adults. Nor do most guidelines make explicit provision for addressing older adults' values and preferences for care when they differ from guideline recommendations. Considering the rapidly increasing number of older adults with diabetes and the enormous public health burden of diabetes, the development and implementation of more appropriate guidelines are critical needs. Toward this goal, the purpose of this research was to illuminate the context of type 2 diabetes in the older population, in particular, how older adults prioritize attention to their comorbidity, values and preferences.;The present research integrated a multi-method approach (focus groups, Q-sorting techniques) to explore the influence of comorbidities as well as values and preferences for diabetes care in older adults living with type 2 diabetes. The first study employed focus group methods to assess the perceived challenges to diabetes self-management in older adults living with multiple concurrent chronic conditions. The most common challenges to clinical management included Healthcare, Medical costs and insurance, and Conflicting treatment regimens. Complications, Physical disability and limitations, Acute illness, and Stress were the most frequently cited challenges to active self-management. The second study employed focus group methods and Q-sorting techniques to define, identify, and rank the values and preferences older adults express for their diabetes care. Findings revealed that older adults expressed Individual and Shared values for care in addition to diverse Treatment, Interpersonal and Practice preferences for care. In sum, contemporary issues, such as clinical heterogeneity and diverse values and preferences, challenge the health community to provide comprehensive care to older adults living with diabetes. The findings of this research support the need to assess the impact of comorbidity in diabetes self-management with respect to clinical outcomes. Moreover, the findings underscore the importance of understanding the diverse values and preferences older adults express in their diabetes care. As the prevalence of diabetes burgeons in our aging population, a concerted effort to address comorbidity and values and preferences for care is vital to maximize successful management and, ultimately, to improve both the length and quality of life experienced by older adults. |
