In the United States, approximately forty percent of elders have diabetes or pre-diabetes. African American elders are twice as likely to have diabetes, two-to-three times more likely to experience complications, and twice as likely to die from diabetes as similar White elders. Research demonstrates the failure of traditional diabetes education, noting their aging insensitivity, excessive use of didactic methods, a-theoretical basis, and failure to promote life-style changes. To address these deficits, this study developed and tested a theoretical model to explain the biopsychosocial adjustment process of older adults living with diabetes. Modifying Devin's (1984) Illness Intrusiveness Model, the authors constructed a three-tier recursive model of adaptation to chronic illness, predicting that a disease's psychosocial impact upon a person is the function of an interaction of biopsychosocial factors mediated by personal control and perceived illness intrusiveness.

Using a cross-sectional design, the researchers collected data from 145 older adults in urban and rural settings in a Mid-South state. Participants completed a battery of 14 standardized instruments, measuring items such as diabetes knowledge and self-care behaviors, core self-evaluations, disease severity, comorbid conditions, diabetes self-efficacy, outcome expectations, intrusiveness, and basic demographic information. Diabetes outcomes included glycosolated hemoglobin (A1C), self-care behaviors, and well-being. Instruments were group and individually administered, the later for visually impaired or reading challenged elders. As an incentive, members received a $50 dollar gift certificate after completing the battery of instruments. The researchers conducted descriptive and graphical analyses; the illness intrusiveness path model was analyzed using structural equation modeling (SEM, LISREL 8, Jreskog & Srbom, 1993).

Findings supported the hypotheses and demonstrated the strength of the proposed theoretical model. Although limited in generalizability, this study offers one of the first comprehensive empirically validated explanations for older African American adult adjustment to a chronic disease like diabetes. Furthermore, it offers a theoretical framework for future interventions, empirically denoting targets for interventions with older adults with diabetes. The presentation details additional policy and practice implications and the researchers' planned community, participatory, evidence based intervention framed from this model and empirical findings. From a public health perspective, they emphasize the potential and future roles of social work in diabetes.