Elderly with type 2 diabetes struggle with self-care and medication adherence

By Dr. Liji Thomas, MDReviewed by Lily Ramsey, LLMAug 21 2024

As the world’s population ages rapidly, the risk of chronic diseases is rising.

A recent in Scientific Reports discusses how self-care, adherence to medication plans, and other health practices affect treatment outcomes among elderly patients with diabetes.

Study: Self-care behaviors, medication adherence status, and associated factors among elderly individuals with type 2 diabetes. Image Credit: Halfpoint/Shuterstock.com

Aging and diabetes mellitus

Currently, 12% of the population is elderly, and this proportion is expected to double by 2050. Aging is a significant risk factor for chronic diseases, including type 2 diabetes mellitus (T2DM). In Iran, at least 14% of older adults are affected by T2DM.

Type 2 diabetes mellitus (T2DM) is one of the most common chronic conditions today. Its growing prevalence is linked to longer lifespans, increasing urbanization, higher obesity rates, and changing lifestyles.

By 2045, it is predicted that T2DM will affect 625 million people worldwide, with prevalence rates ranging from 14% to 34% depending on the region.

In the elderly, diabetes impacts mental, physical, and social functions and contributes to death in 88% of cases.

Effective diabetes management focuses on normalizing blood glucose levels and reducing complications. This often requires significant patient involvement in managing their own health, with less emphasis on physician intervention.

Medication adherence is crucial for effective treatment. Studies show that adherence rates in elderly people with diabetes range from 80% to 85% in Africa and the UAE but can be as low as 40% to 50% in Switzerland and Botswana.

Low adherence is associated with treatment failure, prolonged treatment, higher costs, and increased complications.

Elderly patients with diabetes often struggle with both medication adherence and self-care practices, such as monitoring blood glucose, following prescribed diets, and maintaining overall quality of life. Self-care is essential for preventing complications.

The current study aims to explore these issues among elderly individuals with diabetes.

About the study

A systematic random sampling method was used to select participants from among all elderly diabetic patients who attended one of two teaching hospitals. The study included 412 patients. The mean participant age was 68 years.

Participants were evaluated using a questionnaire and a follow-up interview. The questionnaire assessed five domains of self-care: diet, exercise, blood glucose testing, foot care, and smoking-related questions.

It also examined adherence to medication using the Morisky medication adherence scale (MMAS).

Self-care was best reflected in adherence to the physician-recommended diet, with a mean score of 3.16. With advancing age, participants were more likely to follow their diet strictly, especially those who had a family history of diabetes.

About 81% had fatty foods three or more times a week, with a higher proportion of those who had higher education. About 72% had high-carbohydrate foods three or more times a week.

The lowest self-care scores related to daily checking of the feet and inside the shoes for potential injury and sources of damage. The mean score for checking the feet and inside the shoes was 0.31 and 0.17, respectively. Only six patients checked their feet daily, while 94% failed to check inside their shoes.

Smoking was reported by 18% of the sample. About 87% of patients who did not exercise, especially those without a family history of diabetes, were less likely to exercise than those with a positive family history.

Participants with higher education were less likely to self-check their blood sugar. Again, urban dwellers were less likely to perform self-monitoring of blood glucose (SMBG). However, urban dwellers were more likely to check their blood sugar levels frequently than those in rural locations.

The mean medication adherence score was 5.5, which is below average. Poor self-care was reported relating to the level of physical activity, SMBG,

Conclusions

The importance of self-care in managing diabetes and other chronic conditions is undisputed. This relates to medication adherence as well. Self-care promotes individual agency in coping with and improving one’s health.

In this study, most patients displayed a lack of self-care in almost all areas. This corroborates earlier studies in Asia and Africa, indicating the need for “comprehensive, effective, and efficient health interventions.”

The inadequacy of self-care may account for the high level of public health threat posed by diabetes in much of the world. Physical exercise may be challenging for elderly patients with diabetes for many reasons. These include lack of mobility, comorbidities, and physical issues.

The lower levels of SMBG with increasing education in this study were unexpected, as most research indicates the opposite trend. The abysmally low levels of foot care observed here underline the need for awareness campaigns of its importance in this group.

Finally, the low medication adherence in this study also confirms earlier observations. Further research will be necessary to validate these results and identify the underlying reasons.

Meanwhile, “health authorities must develop a comprehensive operational plan to improve these patients' health, strengthen their self-care behaviors, and pay more attention to this issue.”