Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
BMC Prim Care. 2024 May 22;25(1):180. doi: 10.1186/s12875-024-02318-3.
There is a rising prevalence of type 2 diabetes among older people. This population also suffers from co-morbidity and a greater number of diabetes related complications, such as visual and cognitive impairment, which can potentially affect their ability to manage insulin regimens. Understanding the experiences of older people when they transition to insulin will help the development of healthcare interventions to enhance their diabetes outcomes, overall health and quality of life.
The aims of this exploratory study were to (1) understand the experiences of older people with type 2 diabetes in relation to insulin treatment initiation and management and (2) use this understanding to consider how the insulin management support provided to older people by healthcare providers could be more tailored to their needs.
A qualitative study using semi structured (remote) interviews with older people with diabetes (n = 10) and caregivers (n = 4) from the UK. Interviews were audio recorded and transcribed, and framework analysis was used to analyse the data.
Three main themes, along with six subthemes, were generated from the study data. Participants generally felt at ease with insulin administration following training, yet some reported feelings of failure at transitioning to insulin use. Participants were also frustrated at what they perceived were insufficient resources for effective self-management, coupled with a lack of professional interest in optimising their health as older people. Some also expressed dissatisfaction regarding the brevity of their consultations, inconsistent information from different healthcare professionals and poor treatment coordination between primary and secondary care.
Overall, the study emphasised that older people need better support, education and resources to help manage their insulin use. Healthcare professionals should be encouraged to adopt a more individualised approach to supporting older people that acknowledges their prior knowledge, physical and psychological capabilities and motivation for diabetes self-management. In addition, better communication between different services and greater access to specialist support is clearly needed for this older population.
An integrated care pathway for insulin use in older people could be considered. This would include an assessment of the older person's needs and capacity on their initiation to insulin; targeted education and training in self-management; timely access to appropriate emotional and peer support resources; care plans developed collaboratively with patients; and individualised glucose targets that recognise the needs and preferences of the older person.
2 型糖尿病在老年人中的发病率不断上升。这一人群还患有合并症和更多与糖尿病相关的并发症，如视力和认知障碍，这可能会影响他们管理胰岛素方案的能力。了解老年人在过渡到胰岛素治疗时的体验将有助于制定医疗保健干预措施，以改善他们的糖尿病结局、整体健康和生活质量。
本探索性研究的目的是：（1）了解 2 型糖尿病老年人在开始和管理胰岛素治疗方面的体验；（2）利用这一理解，考虑如何更根据老年人的需求调整医疗保健提供者为他们提供的胰岛素管理支持。
采用半结构式（远程）访谈法，对来自英国的 10 名糖尿病老年患者和 4 名护理人员进行了定性研究。访谈进行了录音和转录，并使用框架分析对数据进行了分析。
从研究数据中产生了三个主要主题，以及六个子主题。经过培训，参与者通常对胰岛素给药感到轻松，但有些人报告说在过渡到胰岛素使用时感到失败。参与者还对他们认为自我管理的资源不足感到沮丧，加上专业人员对老年人优化健康的兴趣不足。一些人还对他们的咨询时间过短、来自不同医疗保健专业人员的信息不一致以及初级保健和二级保健之间的治疗协调不佳表示不满。
总的来说，该研究强调老年人需要更好的支持、教育和资源来帮助他们管理胰岛素的使用。应鼓励医疗保健专业人员采取更个体化的方法来支持老年人，承认他们的先前知识、身体和心理能力以及对糖尿病自我管理的动力。此外，显然需要为这一年龄段的人群提供更好的服务之间的沟通和更多获得专业支持的机会。
可以考虑为老年人使用胰岛素制定综合护理途径。这将包括在开始使用胰岛素时对老年人的需求和能力进行评估；有针对性的自我管理教育和培训；及时获得适当的情感和同伴支持资源；与患者合作制定护理计划；以及制定个体化的血糖目标，以满足老年人的需求和偏好。
