Correlates of Quality of Life in Older Adults, Coursework Example

Introduction

Health disparities are common among some population groups, based upon their specific needs, expectations, and limitations that impact their health and wellbeing. For example, older adults often experience many different types of disparities as a result of age, lack of or affordability of insurance coverage, transportation barriers, quality of life issues, and other complications. For this group, it may be difficult to obtain and/or manage treatment requirements in the home environment; therefore, patients may experience difficulties that must be addressed as early as possible in order to minimize additional physical and psychological damage. The impact of health disparities on older adults is significant; therefore, they require a high degree of support and guidance in order to prevent additional complications and other challenges that will have a lasting impact on health outcomes. The following discussion will address the health disparities of older adults, and in particular, diabetes care and treatment within this population, including pharmacological treatments that are available, quality of life concerns, socioeconomic status, cultural beliefs and values, and other practices and behaviors that impact this population. These concerns will be addressed in order to effectively convey the importance of community-based interventions and alternatives that are available to support older adults with diabetes and how to have a lasting impact on this population at the desired level.

Body

The older adult population possesses specific needs that must be addressed in a timely manner in order to reduce the impact on quality of life and overall wellbeing. This process requires nurses to be involved in the care and treatment of this population in many ways in order to ensure that any health problems that exist are properly addressed and diagnosed in order to prevent additional risks. The burden of diabetes, for example, in older adults is significant, as it impacts over 25 percent of this population (Kirkman et.al, 2012). It is known that “Older adults with diabetes have the highest rates of major lower-extremity amputation, myocardial infarction (MI), visual impairment, and end-stage renal disease of any age-group” (Kirkman et.al, 2012, p. 2650). Under these conditions, therefore, it is necessary to demonstrate the value of nursing practice in the proper diagnosis of patients and in supporting a framework that will have a lasting impact on patient care outcomes, based upon the symptoms that are often experienced within this population (Kirkman et.al, 2012). It is important to provide a level of care and treatment that meets quality standards and to be proactive in meeting patient care needs without delays so that quality of life is not compromised (Kirkman et.al, 2012). The natural aging process places a high level of stress on the human body; therefore, diabetes risk tends to increase for older adults and requires nurses to be proactive in developing strategies to support patients at this stage (Kirkman et.al, 2011).

Diabetes treatments for older adults typically involve a number of different pharmacologic treatments, including oral medications and insulin. These alternatives are prescribed based upon individual needs and how patients might respond to these medications, as well as any other medications that could interfere with their action. Typically, patients conduct routine blood glucose testing at home or in a clinic or physician office in order to monitor these levels and to determine if additional medications or a change in existing treatment is required (American Diabetes Association, 2015). In regards to medication administration, insulin is often prescribed for patients who possess a lack of control over their blood glucose levels due to insulin deficiencies, and since there are over 20 different types of insulin available to patients, the appropriate type must be determined by the physician to promote effectiveness (American Diabetes Association, 2015).

In addition, some patients are prescribed different types of oral medications that aim to reduce blood glucose levels in a desirable manner, in conjunction with a diet and exercise plan (American Diabetes Association, 2015). Common oral medications include sulfonylureas such as glipizide (Glucotrol), Biguanides such as metformin (Glucophage), Meglitinides such as repaglinide (Prandin), Thiazolidinediones such as rosiglitazone (Avandia) and pioglitazone (ACTOS), DPP-4 Inhibitors such as canagliflozin (Invokana), Alpha-glucosidase inhibitors such as acarbose (Precose), and bile acid sequestrants such as colesevelam (Welchol) (American Diabetes Association, 2015). Most importantly, patients must be treated with the appropriate medication or a combination thereof in order to improve blood glucose management and to be proactive in meeting the treatment goals and objectives to minimize the symptoms and damage associated with diabetes.

Patients must receive the highest possible level of attention and focus in order to prevent lasting complications and other concerns that could impact their care. It is the responsibility of nurses to monitor patients in order to prevent possible complications and too be effective in addressing complications or side effects as they occur to prevent any type of permanent damage. This is an important step towards the discovery of new ideas and approaches to improve patient care quality and to be proactive in meeting their needs without significant risk or harm beyond what has already occurred. The proper treatment protocol is essential to a patient’s wellbeing and to minimize possible long-term damage as a result of diabetes-related complications that impact quality of life in different ways. This protocol will also aim to support healthier outcomes for patients and to be proactive in meeting the needs of the patient population in a consistent manner that will impact care and treatment.

Diabetes within the older adult population contributes to the evidence that supports a lack of attention and focus on many people within this group and a subsequent level of disparity that requires further consideration. Quality of life is a serious concern for older adults with diabetes, particularly as they succumb to various complications and other concerns that influence their daily routine (Laiteerapong et.al, 2011). At this stage, care and treatment becomes more complicated and requires a higher level of attention and focus in order to ensure that patients receive the level of care that promotes desirable outcomes (Laiteerapong et.al, 2011). In this context, quality of life must be a critical priority for patients and for nurses and requires a high level of collaboration in order to reduce the long-term risks (Laiteerapong et.al, 2011). Most importantly, patients must receive regular treatment and guidance in order to prevent long-term complications, but this is often very difficult to achieve when barriers get in the way, such as lack of insurance or funding to pay for treatment, transportation issues, and other concerns; therefore, patients must be able to access routine care and treatment to ensure that their needs are met without further risk or harm (Laiteerapong et.al, 2011). This practice also supports a greater understanding of the different needs of older adults and how to balance these with the resources that are available within the healthcare community to provide support and to intervene as necessary (Laiteerapong et.al, 2011).

Diabetes self-management education is an area that requires further consideration, as there appears to be a number of weaknesses in current strategies and a lack of knowledge that is transferred to patients in order to improve their quality of life (Haas et.al, 2013). This process requires nurses to be proactive in working with older adults with diabetes in order to communicate the expectations of self-care and how they will have a lasting impact on overall health and wellbeing (Haas et.al, 2013). This process also requires nurses to express the urgency of self-care and treatment in order to minimize long-term complications, such as adherence to medication schedules and other important needs (Haas et.al, 2013). Therefore, the following is of critical importance to healthcare providers who treat older adults with diabetes: “The National Standards for Diabetes Self-Management Education are designed to define quality DSME and support and to assist diabetes educators in providing evidence-based education and self-management support” (Haas et.al, 2013). In this context, patients must be educated at a level that will translate into improved self-management in the home environment in order to minimize symptoms and improve quality of life (Haas et.al, 2013). In this context, nurses play a critical role in advancing patient outcomes and in providing the level of education that is necessary to have a lasting impact on their care and treatment (Haas et.al, 2013).

One of the primary concerns for older adults with diabetes from community-based perspective is the lack of literacy regarding the disease and how this may impact quality of care and the level of treatment and attention that are received. This process requires nurses to effectively evaluate patients within the community in order to determine how to best approach patients’ level of health literacy and whether or not this impacts their diabetes risk and symptoms (Bostock & Steptoe, 2012). To be specific, “lower health literacy is associated with less knowledge of chronic disease processes, poorer mental and physical health, limited use of preventive services, and higher rates of hospital admissions… Low health literacy is predicted by older age, lower income, fewer education qualifications, and being from an ethnic minority group, yet the relation between health literacy and health is reported to persist after accounting for education and other socioeconomic indicators” (Bostock & Steptoe, 2012). In this context, nurses must be prepared to recognize where low health literacy within the older adult population exists in order to demonstrate how an increase in health literacy may have a positive and lasting impact on their health (Bostock & Steptoe, 2012). This impact may be significant, particularly when there is a greater focus on how patients use the education that they receive and translate it into minimizing disparities and taking advantage of the care and treatment opportunities that are available (Bostock & Steptoe, 2012).  When health literacy is maximized, patients will reap the benefits of these tools in their daily lives and will support a higher level of self-care that will be effective in minimizing long-term risks that could influence their quality of life (Bostock & Steptoe, 2012).

Conclusion

Older adults with diabetes face a number of challenging risks that require continuous attention and monitoring in order to prevent lasting complications. This process requires nurses to share their knowledge and insight with patients so that they are able to effectively contribute to the overall direction of their own care and treatment in the home environment. At the same time, this practice expands health literacy and provides a higher level of support and guidance in order to prevent patients from experiencing additional risks that could compromise their health. This practice also encourages patients to be proactive in meeting patient care needs and in supporting a framework that has a lasting impact on outcomes over time. Nurses who provide community-based education to patients to improve health literacy will facilitate effective outcomes and encourage new ideas to reach out to older adults with diabetes to improve care and treatment as best as possible. It is necessary to evaluate these conditions on a regular basis and to be proactive in meeting patient care needs without complications in order to prevent risks that may contribute to increased mortality rates for some patients. Nurses must play an active role in this process in order to prevent irreversible harm to this population group.

References

American Diabetes Association (2015). What are my options? Retrieved from http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/oral-medications/what-are-my-options.html

Bostock, S., & Steptoe, A. (2012). Association between low functional health literacy and mortality in older adults: longitudinal cohort study. Bmj, 344, e1602.

Haas, L., Maryniuk, M., Beck, J., Cox, C. E., Duker, P., Edwards, L., … & Youssef, G. (2013). National standards for diabetes self-management education and support. Diabetes care, 36(Supplement 1), S100-S108.

Kirkman, M. S., Briscoe, V. J., Clark, N., Florez, H., Haas, L. B., Halter, J. B., … & Swift, C. S. (2012). Diabetes in older adults. Diabetes care, 35(12), 2650-2664.

Laiteerapong, N., Karter, A. J., Liu, J. Y., Moffet, H. H., Sudore, R., Schillinger, D., … & Huang, S. (2011). Correlates of Quality of Life in Older Adults With Diabetes The Diabetes & Aging Study. Diabetes Care, 34(8), 1749-1753.