Self-Reported Goals of Older Patients with Type 2 Diabetes Mellitus

Authors


  • Presented in part at the Society of General Internal Medicine Annual Meeting, May 2, 2003, Vancouver, Canada, and the Midwest Society of General Internal Medicine Annual Meeting, September 19, 2003, Chicago, Illinois. This study was supported by a Hartford Center of Excellence Pilot Grant (Dr. Huang, Grant 695147), a National Institute on Aging Geriatric Academic Program Award (Dr. Huang, K12 AG00488-10), a National Institute on Aging Career Development Award (Dr. Huang, K23 AG21963–01A1), a NIDDK Diabetes Research and Training Center (Drs. Huang, Gorawara-Bhat, and Chin, P60 DK20595), and a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar Award (Dr. Chin).

Elbert S. Huang, MD, MPH, The University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL 60637. E-mail: ehuang@medicine.bsd.uchicago.edu

Abstract

Objectives: New diabetes mellitus guidelines from the American Geriatrics Society promote the individualization of treatment goals and plans for patients aged 65 and older. Communicating with older patients about such complex medical decisions presents new challenges for providers. The self-reported healthcare goals, factors influencing these goals, and self-care practices of older patients with diabetes mellitus were explored.

Design: Exploratory study involving semistructured interviews.

Setting: Four clinics of a midwestern, urban academic medical center.

Participants: Patients aged 65 and older with type II diabetes mellitus (N=28).

Measurements: Semistructured, one-on-one interviews were conducted. Interviews were audiotaped, transcribed, and evaluated for recurring themes using a grounded theory approach.

Results: The majority of patients expressed their healthcare goals in a social and functional language, in contrast to the biomedical language of risk factor control and complication prevention, even when specifically asked about goals for diabetes mellitus care. Patient's predominant healthcare goals centered on maintaining their independence and their activities of daily living (71%). Medical experiences of friends and family (50%), social comparison with peers (7%), and medical professionals (43%) shaped patients' goals. Self-reported medication adherence and glucose monitoring was high, but more than one-quarter of patients failed to adhere to any dietary recommendations, and one-third failed to adhere to their exercise regimens.

Conclusion: As diabetes mellitus care recommendations for older patients grow more complex, providers could enhance their communication about such medical decisions by exploring patients' specific circumstances and reframing diabetes mellitus treatment goals in patients' own language. These may be crucial steps to developing successful individualized care plans.

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