Community Program Improves Quality of Life and Self-Management in Older Adults with Diabetes Mellitus and Comorbidity

Maureen Markle-Reid; Jenny Ploeg; Kimberly D Fraser; Kathryn A Fisher; Amy Bartholomew; Lauren E Griffith; John Miklavcic; Amiram Gafni; Lehana Thabane; Ross Upshur

doi:10.1111/jgs.15173

Community Program Improves Quality of Life and Self-Management in Older Adults with Diabetes Mellitus and Comorbidity

J Am Geriatr Soc. 2018 Feb;66(2):263-273. doi: 10.1111/jgs.15173. Epub 2017 Nov 27.

Authors

Maureen Markle-Reid^{1

2}, Jenny Ploeg^{1

3}, Kimberly D Fraser⁴, Kathryn A Fisher¹, Amy Bartholomew¹, Lauren E Griffith², John Miklavcic⁴, Amiram Gafni^{2

5}, Lehana Thabane², Ross Upshur⁶

Affiliations

¹ Aging Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
³ Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada.
⁴ Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
⁵ Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.
⁶ Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

Abstract

Objectives: To compare the effect of a 6-month community-based intervention with that of usual care on quality of life, depressive symptoms, anxiety, self-efficacy, self-management, and healthcare costs in older adults with type 2 diabetes mellitus (T2DM) and 2 or more comorbidities.

Design: Multisite, single-blind, parallel, pragmatic, randomized controlled trial.

Setting: Four communities in Ontario, Canada.

Participants: Community-dwelling older adults (≥65) with T2DM and 2 or more comorbidities randomized into intervention (n = 80) and control (n = 79) groups (N = 159).

Intervention: Client-driven, customized self-management program with up to 3 in-home visits from a registered nurse or registered dietitian, a monthly group wellness program, monthly provider team case conferences, and care coordination and system navigation.

Measurements: Quality-of-life measures included the Physical Component Summary (PCS, primary outcome) and Mental Component Summary (MCS, secondary outcome) scores of the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12). Other secondary outcome measures were the Generalized Anxiety Disorder Scale, Center for Epidemiologic Studies Depression Scale (CES-D-10), Summary of Diabetes Self-Care Activities (SDSCA), Self-Efficacy for Managing Chronic Disease, and healthcare costs.

Results: Morbidity burden was high (average of eight comorbidities). Intention-to-treat analyses using analysis of covariance showed a group difference favoring the intervention for the MCS (mean difference = 2.68, 95% confidence interval (CI) = 0.28-5.09, P = .03), SDSCA (mean difference = 3.79, 95% CI = 1.02-6.56, P = .01), and CES-D-10 (mean difference = -1.45, 95% CI = -0.13 to -2.76, P = .03). No group differences were seen in PCS score, anxiety, self-efficacy, or total healthcare costs.

Conclusion: Participation in a 6-month community-based intervention improved quality of life and self-management and reduced depressive symptoms in older adults with T2DM and comorbidity without increasing total healthcare costs.

Keywords: community-based program; comorbidity; older adults; self-management; type 2 diabetes mellitus.

Publication types

Pragmatic Clinical Trial
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Comorbidity*
Diabetes Mellitus, Type 2 / psychology
Diabetes Mellitus, Type 2 / therapy*
Female
Health Care Costs
Humans
Male
Ontario
Quality of Life*
Self-Management / methods*
Single-Blind Method