Deborah Willoughby

Insights From Older Adults With Type 2 Diabetes: Making Dietary and Exercise Changes

PURPOSE The purpose of this research was to identify factors that affect the nutrition and exercise behaviors of persons over the age of 55 with type 2 diabetes. METHODS Focus groups were conducted using a validated focus group interview guide to determine primary health concerns and health behaviors, favored learning modalities, barriers to learning, food preferences, and exercise preferences. RESULTS The following major themes and subthemes were identified: some risk factors for diabetes and heart disease seem more salient than others; perceived susceptibility for serious outcomes of diabetes can occur through vicarious learning; willpower, often obtained through a belief in God, is necessary for successful behavior change; effective modification of behavior and building self-efficacy starts with small steps; and intrinsic reinforcement is necessary for behavior change. CONCLUSIONS These data were used to identify strategies and messages to enhance adherence to nutrition and activity recommendations for persons with type 2 diabetes and accompanying cardiovascular risk factors.

Preventing type 2 diabetes after gestational diabetes.

Purpose The purposes of this article are to examine the epidemiology of gestational diabetes mellitus (GDM) and subsequent type 2 diabetes, identify risk factors for the development of GDM and subsequent type 2 diabetes, discuss protocols for postpartum screening, and recommend evidence-based interventions to delay or prevent type 2 diabetes after GDM. Methods A review of the research literature from 1995 to 2005 concerning gestational diabetes was done using MEDLINE, CINAHL, National Institutes of Health, and American Diabetes Association internet resources. The criteria set for selection included the following: the research explored risk factors for and epidemiology of gestational diabetes, the relationship of gestational diabetes and the subsequent development of type 2 diabetes, and/or the prevention of type 2 diabetes after GDM. Results Women with pregnancies complicated by GDM are at increased risk for subsequent development of type 2 diabetes. Research suggests that modification of lifestyle-based risk factors including obesity, poor nutrition, and lack of exercise can delay or prevent the onset of type 2 diabetes in these women. However, there is evidence that recommended postpartum screening protocols for women with GDM are not being followed; hence, those women at high risk for type 2 diabetes are not identified, and no intervention is undertaken to reduce their risks. Conclusions Diabetes educators must play an integral role in increasing awareness of the need for postpartum screening and intervention for women with gestational diabetes. Only with early identification and intensive intervention can the devastating toll of diabetes be averted for many of these women.

Advice from Rural Elders: What It Takes to Age in Place.

Older adults prefer to age in place (AIP), and there are psychological, physiological, and economic benefits in doing so. However, it is especially challenging to AIP in rural communities. AIP models have been tested in urban settings and age-segregated communities, but they are not appropriate for rural communities. This paper presents rural AIP variables identified in the literature as well as those described by 39 older adults in five focus groups.

Coping and Psychosocial Adjustment of Women With Diabetes

PURPOSE The purpose of this study was to investigate relationships between coping styles and psychosocial adjustment for women with diabetes. METHODS The sample consisted of 115 community-residing women with diabetes. Coping was measured by the Revised Jalowiec Coping Scale and psychosocial adjustment by the Psychosocial Adjustment to Illness Scale. Pearsons product moment correlation was used to assess relationships between coping and adjustment. RESULTS The most frequently and effectively used coping styles were optimistic, confrontive, self-reliant, and supportant. The psychological, social, and health care domains showed the most problems; the fewest were in the extended family, sexual, and vocational domains. Relationships were found between womens coping styles and psychosocial adjustment, with better adjustment associated with effective use of confrontive, supportant, optimistic, self-reliant, and palliative coping styles. CONCLUSIONS Important relationships exist between the ways women cope with diabetes and their level of psychosocial adjustment to the illness. Knowledge of these relationships can help diabetes educators assist clients in making lifestyle changes.

Examining the benefit of vaccinating adults against pertussis

Purpose: To examine recent evidence concerning the health benefits and cost effectiveness of replacing a single dose of adult tetanus/diphtheria vaccine with a single dose of tetanus/diphtheria/pertussis (TDaP). Methods: A review of the literature was conducted utilizing the databases CINAHL and Medline with the keywords pertussis, adult immunization, vaccination, TDaP, DTaP, and healthcare workers. Conclusions: Recent outbreaks of pertussis have shown that preventing such outbreaks through immunization of adults with a single TDaP vaccine is a cost‐effective measure. These studies focused on hospitals and universities where air‐borne diseases are easily spread. Four hospital studies that examined the financial cost of investigating and treating a pertussis outbreak were reviewed. Results presented offer strong evidence to support vaccinating adults with TDaP at their next scheduled immunization or sooner if they are frequently exposed to populations vulnerable to pertussis. Implications for practice: Financially, investigating a single case of pertussis can cost hospitals hundreds of thousands of dollars. This is related to the time and expense of determining who was exposed and the provision of preventive treatment for those exposed. Preventing unnecessary illness and potential mortality, especially among not yet immunized infants, provides a strong argument for administration of the TDaP vaccine. Healthcare providers should educate adults about the availability and advantages of TDaP immunization and encourage them to be immunized with TDaP.

Breastfeeding and Growth of Children in the Peri/postnatal Epigenetic Twins Study (PETS) Theoretical Epigenetic Mechanisms

Background: The prevalence of overweight infants and toddlers has increased by 60% in the past 30 years and is a significant contributor to diabetes, cardiovascular disease, and early morbidity and mortality. The World Health Organization’s updated meta-analysis in 2013 observed an association between breastfeeding and a lower prevalence of obesity later in life. The purpose of this study was to assess the growth of children in a cohort of Australian twins to examine associations between duration of breastfeeding and growth at 18 months of age. Our hypothesis is that the anthropometric measurements of the participants will be greater with shorter duration of breastfeeding. Methods: Methods include using cross-sectional data from a cohort at the 18-month visit (n = 179) in the Peri/postnatal Epigenetics Twins Study (PETS) to assess the relationship between duration of breastfeeding and infant size at 18 months of age. Inclusion criteria were birth weight of more than 2000 grams and breastfed for less than 1 month, 1 to 3 months, or 4 to 6 months. Results: The analysis suggested that infants breastfed for 1 to 3 months were significantly larger than infants breastfed for 4 to 6 months in terms of mean body mass index (BMI) (0.61 kg/m2; P = .02; 95% confidence interval [CI], 0.17-1.05), arm circumference (0.66 cm; P = .006; 95% CI, 0.26-1.06), and abdominal circumference (1.16 cm; P = .03; 95% CI, 0.26-2.06). The analysis also suggested that infants breastfed for less than 1 month were significantly larger than infants breastfed for 4 to 6 months in terms of mean arm circumference (0.72 cm; P = .009; 95% CI, 0.26-1.17). Conclusion: Results suggest that supplementing with non–breast milk before 4 months of age was associated with an increased BMI, arm circumference, and abdominal circumference at 18 months of age. The mean BMI decreased from 85% to 65% when infants were breastfeeding for 4 to 6 months as compared to breastfeeding for 1 to 3 months. Breastfeeding for 4 to 6 months appeared to protect against the risk of obesity for the children in the PETS.

A CNS-managed diabetes foot-care clinic: a descriptive survey of characteristics and foot-care behaviors of the patient population.

Lower extremity lesions are the primary cause of hospitalization for people with diabetes, resulting in enormous personal and financial costs. This study used a survey designed to describe the characteristics and foot-care behaviors of people with diabetes who attended a clinical nurse specialist managed foot-care clinic. Forty-eight patients who received care at the participating foot-care clinic completed a 21-item multiple-choice questionnaire designed to determine the presence of foot pathology and foot-care behaviors. Most of the patients were between 65 and 74 years of age, had concurrent illnesses, and had four or more primary care visits per year. Although 69% had existing foot pathology, only 44% reported inspecting their feet daily and only 54% reported that their primary care provider examined their feet on each visit. Twenty-five percent reported going barefoot sometimes and eight percent would either treat a foot lesion themselves or wait for it to get better.

Protecting the kidneys of patients with diabetes.

Diabetes is the most common cause of end-stage renal disease; however, there is evidence that diabetes-related renal disease can be prevented with interventions currently available. The purposes of this article are to describe current screening and intervention guidelines for renal complications in patients with diabetes and to provide clinical nurse specialists with tools to facilitate the education and expert guidance needed by patients with diabetes to preserve their kidney function. This article includes (1) a review of the pathology of diabetic nephropathy, (2) a summary of screening guidelines, (3) current treatment recommendations to prevent or delay nephropathy, and (3) nursing strategies and tools framed within the education, expert coaching, and guidance roles of the clinical nurse specialist practice model.

Improving Chronic Disease Self-Management by Older Home Health Patients through Community Health Coaching

The purpose of the study was to pilot test a model to reduce hospital readmissions and emergency department use of rural, older adults with chronic diseases discharged from home health services (HHS) through the use of volunteers. The study’s priority population consistently experiences poorer health outcomes than their urban counterparts due in part to lower socioeconomic status, reduced access to health services, and incidence of chronic diseases. When they are hospitalized for complications due to poorly managed chronic diseases, they are frequently readmitted for the same conditions. This pilot study examines the use of volunteer community members who were trained as Health Coaches to mentor discharged HHS patients in following the self-care plan developed by their HHS RN; improving chronic disease self-management behaviors; reducing risk of falls, pneumonia, and flu; and accessing community resources. Program participants increased their ability to monitor and track their chronic health conditions, make positive lifestyle changes, and reduce incidents of falls, pneumonia and flu. Although differences in the ED and hospital admission rates after discharge from HHS between the treatment and comparison group (matched for gender, age, and chronic condition) were not statistically significant, the treatment group’s rate was less than the comparison group thus suggesting a promising impact of the HC program (90 day: 263 comparison vs. 129 treatment; p = 0.65; 180 day 666.67 vs. 290.32; p = 0.19). The community health coach model offers a potential approach for improving the ability of discharged older home health patients to manage chronic conditions and ultimately reduce emergent care.