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Project Summary
Very little research has been conducted in the area of Type 2 Diabetes (DM2) among frail, community-dwelling older adults with comorbid chronic conditions. These older adults are particularly vulnerable to suboptimal diabetes care and its adverse outcomes because of issues such as decreased cognition, physical and functional limitations, depression, financial limitations, minimal transportation services, increased risk of falling, lack of social support, and reduced access to health and community services. To date, research has focused on collaborative, interprofessional DM2 management interventions targeting older adults in primary healthcare settings however, optimal management of DM2 in the context of other comorbidities is not currently known. Furthermore, because most clinical guidelines are disease-specific, best practice for providing care to this population is also underdetermined. Best practice guidelines might conflict with each other and might not be appropriately applied to frail older adults with complex chronic conditions or take into account clients' goals and preferences for healthcare. There is a need to establish a knowledge base about the needs, gaps, challenges, and opportunities for enhancing the quality of diabetes care among this vulnerable group. In particular, new and innovative approaches to the prevention and management of DM2 need to be developed and tested as a means for improving the health-related quality of life of this population, and reduce demand for costly health services. The overall purpose of the project is to develop an acceptable and feasible evidence-based model of community-based diabetes care for frail older adults with comorbid chronic conditions that will form the basis of a CIHR Operating Grant application.
The project will be conducted in two stages using both quantitative and qualitative methods. In Stage One, we will systematically evaluate and synthesize the literature and conduct an analysis of current practice to: (1) increase the team's understanding of the nature of the problem of DM2 among frail community-dwelling older adults with comorbid conditions, from both objective and subjective points of view, (2) increase the team's understanding of the needs, gaps and opportunities for enhancing the quality of diabetes care in this population, and (3) define the goals and key features of a new and innovative community-based diabetes intervention for frail older adults with comorbid chronic conditions. In Stage Two, we will: (1) develop an understanding of the attitudes, knowledge, and practices of service providers, managers/directors of a primary health care and community senior centre intervention site related to management of DM2 among frail older adults with comorbid conditions, (2) assess the feasibility, acceptability, and importance of the proposed community-based diabetes intervention from the perspective of health care providers, administrators, seniors, and their family caregivers, (3) identify perceived barriers and facilitators related to the readiness of primary healthcare and community senior centre intervention sites to implement the proposed community-based diabetes intervention, and (4) engage primary health care and community senior intervention sites in the development of strategies to facilitate implementation of the intervention through participatory activities.
March 2011 - September 2012, funded by:
Elizabeth Bruyère Research Institute (on behalf of the Ontario Research Coalition)
Principal Investigator:
Dr. Maureen Markle-Reid, RN, MScN, PhD
Associate Professor and Acting Assistant Dean (Research), School of Nursing
Associate Member, Department of Clinical Epidemiology and Biostatistics
McMaster University
1200 Main Street West, HSC 3N28H
Hamilton, Ontario L8N 3Z5
Telephone: (905) 525-9140, ext. 22306
Fax: (905) 521-8834
E-mail: mreid@mcmaster.ca
