Iran Journal of Nursing

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Epakchipoor F, Bastani F, Pashaei Sabet F. Self-management and Medication Adherence in Older Adults with Type II Diabetes Referring to the Endocrinology Clinics of the Teaching Hospital Affiliated to Iran University of Medical Sciences (2019). IJN 2021; 34 (129) :1-14
URL: http://ijn.iums.ac.ir/article-1-3362-en.html

Background & Aims: The world's population is ageing, and the elderly constitute large number of the world's population. With ageing, the health status undergoes certain changes, and the risk of developing chronic diseases and disabilities increases in the final years of life. Given the increased index of life expectancy and the subsequent increase in the number of the elderlies in the world, the number of diabetic patients in this population also increases. Diabetes is an important health issue and a common physical illness, which causes numerous complications in old age. Type II diabetes has no definite diagnosis and requires long-term care and proper self-management. Since diabetes has no definite treatment, the early identification of the suspected cases could prevent and delay the associated complications through proper self-management. The self-management of diabetes is complex and may go beyond blood sugar control, requiring the balancing of multiple metabolic and lifestyle factors and helping the patients to discover and exploit their capabilities in this regard. If patients with chronic diseases refrain from self-management and do not actively partake in self-care, positive clinical outcomes will be hard or impossible to achieve. Self-management is a rehabilitative method in which the care activities mainly depend on the patient, and the aim is to attain maximum independence, decision-making, and health improvement based on the abilities and lifestyle of the patient. Therefore, self-management must be evaluated in vulnerable and targeted populations, such as the elderly. Due to the chronic nature of diabetes, the patient must follow a special, long-term medication regimen that is prescribed by the treatment team, which is only possible with the active participation of the patient in the treatment and implementation of the recommendations of the treatment team members; this is referred to as treatment adherence. One of the main concerns and clinical problems that is frequently faced by healthcare providers is the problems associated with the lack of adherence to the prescribed treatment, particularly in the patients with chronic diseases that require long-term treatment. In the absence of proper self-management and medication adherence in elderly patients, heavy costs of the treatment of the disease and its complications will be imposed on the patients, their family, the community, and the health system. In addition, the subsequent psychological and social costs should be considered in this regard, and special attention has to be paid to this issue. Several studies have shown the unsatisfactory state of self-management and medication adherence in elderly diabetic patients, emphasizing on the periodical and frequent assessment of this issue. Given the necessity of healthy, active, and successful aging, the present study aimed to evaluate self-management in the elderly with type II diabetes in the teaching hospitals affiliated to Iran University of Medical Sciences.
Materials & Methods: This descriptive, cross-sectional study was conducted on the elderly patients with type II diabetes referring to the endocrine clinics of the teaching hospitals affiliated to Iran University of Medical Sciences. The patients were selected via continuous sampling during January-May 2020. For the evaluation of self-management and treatment adherence in the patients, the minimum sample size was estimated at 280 patients at the confidence level of 95%, accuracy of d=0.2, and standard deviation of 1.7. The inclusion criteria of the study were age of more than 60 years and less than 75 years, at least one year since the definitive diagnosis of diabetes by a physician, treatment with antihypertensive drugs for a minimum of six months, and no cognitive impairment with the score of ≥7 in the abbreviated mental test (AMT). Data were collected using the short-form AMT, a demographic form, diabetes self-management questionnaire (DSMQ), and drug adherence questionnaire (MMAS). After the completion of the questionnaires by the researcher, the data were coded, and the analysis of the raw data was performed using descriptive statistics (adjusting frequency distribution tables, calculating frequency indices, and frequency numerical indices) for the qualitative variables. In addition, the minimum, maximum, mean, and standard deviation were determined using inferential statistics and Chi-square, independent t-test, analysis of variance (ANOVA), Pearson' correlation-coefficient, Scheffe post-hoc test, and regression analysis at the significance level of P≤0.05.
Results: The mean age of the patients was 66.64 years, and the majority were married (6%). Based on the questionnaire data, 77.1% of the elderly patients had at least one underlying diseases, and patients with cardiac diseases constituted the majority in this regard (50.4%). In addition, the duration of the disease was more than five years in most of the patients (70.4%) (Table 1). On a scale of 0-10, the mean score of self-management in the elderlies was 6.55, and 63.2% of the research units obtained a higher score than eight in drug adherence, which indicated favorable self-management and drug adherence. According to the data obtained by the multivariate analysis and among the regression factors, the variables of education level (P=0.017), housing status (P<0.001), and income adequacy (P=0.01) were significantly correlated with self-management. Furthermore, self-management in the domain of physical activity (mean score: 7.07) had the highest mean score, while the domain of diet control (mean score: 6.05) had the lowest mean score compared to the other domains. Self-management had a significant correlation with education level (P=0.017) and income adequacy (P=0.01). The results of independent t-test also showed that self-management was significantly lower in the unmarried patients (single/widowed/divorced) compared to the married elderlies (P=0.003). Drug adherence was significantly lower in men compared to women (P=0.015) and had significant correlations with education level (P=0.001), employment status (P=0.013), and income adequacy (P=0.019).
Conclusion: According to the results, self-management and drug adherence were generally satisfactory in the elderly patients with type II diabetes. However, self-management was significantly lower in the patients who were illiterate, unmarried (single/widowed/divorced), and had an insufficient income, regarded as the vulnerable segment of the society. Therefore, this group of elderlies needs more attention from the health system and healthcare planners, as well as educational-counseling interventions based on the empowerment of vulnerable elderlies in order to promote self-management behaviors, minimize the complications of diabetes, and experience a healthy, active, and successful aging.