Saturday, 15 January 2005 - 8:00 AM

This presentation is part of: Health-Related Services for Older Adults

Empowering Elders Living With Diabetes: The Health Investment Club for Diabetes Intervention

Purpose In the United States, approximately 40% of elders have diabetes or pre-diabetes, a serious challenge to health and well-being placing them at greater risk for cardiovascular disease, blindness, end-stage renal disease, depression, and nursing home placements. Experts emphasize diabetes education as a principal intervention, yet few elders receive such training. Furthermore, research demonstrates the failure of traditional diabetes programs, noting their aging insensitivity, excessive use of didactic methods, a-theoretical basis, and failure to promote life-style changes. The purpose of this research was to pilot-test a community based intervention to empower elders through the establishment of an ongoing, peer-lead, self-help group dedicated to diabetes management - Health Investment Club for Diabetes.

Methods This twelve month non-experimental study used an aggregating single subject design: Ss1 A - B - C + Ss2 A - B - C + Ssi A - B - C where “Ss” indicates participant, “A” non-intervention phase (baseline), “B” diabetes club development phase, and "C" diabetes club independent functioning phase. Following approval from the Institutional Review Board, a convenience sample of elders was solicited from an urban senior activity center. Project participants were 65 years of age or older (x = 74), diagnosed with type 1 or type 2 diabetes for a duration of at least 6-months, in good cognitive and mental health. Facilitated by clinical social workers, this intervention was formulated upon the empowerment perspective, adapting existing empirically supported methods: diabetes self-management behavioral recording (Bielamowicz et. al., 1995); problem solving & a self-efficacy focused educational model (Glasgow et al., 1992); systematic individual and group follow-ups on progress (Hendricks & Hendricks, 2000); computer-generated personalized goal materials to participants and primary care providers (Levetan et al., 2002); and facilitated peer support in the diabetes club (Shalom, 1991; Warren-Boulton, et al., 1981). A battery of standardized measures (self-care behaviors, efficacy, well-being) and glycemic control outcomes (glycosolated hemoglobin, weight) assessed effectiveness, administered prior to the intervention and 3-month intervals.

Results A convenience sample of 16 elders participate in the Health Investment Club, with weekly participation varying from 9-12. Initial findings at three and six months, in this 12-month project, indicate positive responses by participants. Data showed significant increases in efficacy and well-being at 3 and 6-months since club inception, p. < .05 and p. < .01. Although weight and glycosolated hemoglobin increased at 3-months, typical response for Winter holiday season, 6-month findings showed declines in weight (3-10 pounds) and A1C levels (.2 - 1.5%).

Implications This ongoing pilot project demonstrates the effectiveness of a social work facilitated empowerment based intervention held in a senior activity center for elders with diabetes. Findings illustrate the linkage between empowerment, health behaviors, and physical outcomes for a prevalent chronic disease. This presentation will detail the intervention and measurement protocols and procedures, challenges investigators faced, and future direction for this and similar projects.

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