scholarly journals Qualitative analysis of reasons for hospitalization for severe hypoglycemia among older adults with diabetes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Weronika E. Pasciak ◽  
David N. Berg ◽  
Emily Cherlin ◽  
Terri Fried ◽  
Kasia J. Lipska
Keyword(s):  
Older Adults ◽  
Diabetes Management ◽  
Hospital Admissions ◽  
Comparative Method ◽  
Severe Hypoglycemia ◽  
Medical Intervention ◽  
Older Individuals ◽  
Structured Interviews ◽  
Tertiary Referral Hospital ◽  
Patient Capacity

Abstract Background Hospital admissions for severe hypoglycemia are associated with significant healthcare costs, decreased quality of life, and increased morbidity and mortality, especially for older adults with diabetes. Understanding the reasons for hypoglycemia hospitalization is essential for the development of effective interventions; yet, the causes and precipitants of hypoglycemia are not well understood. Methods We conducted a qualitative study of non-nursing home patients aged 65 years or older without cognitive dysfunction admitted to a single tertiary-referral hospital with diabetes-related hypoglycemia. During the hospitalization, we conducted one-on-one, in-depth, semi-structured interviews to explore: (1) experiences with diabetes management among patients hospitalized for severe hypoglycemia; and (2) factors contributing and leading to the hypoglycemic event. Major themes and sub-themes were extracted using the constant comparative method by 3 study authors. Results Among the 17 participants interviewed, the mean age was 78.9 years of age, 76.5% were female, 64.7% African American, 64.7% on insulin, and patients had an average of 13 chronic conditions. Patients reported: (1) surprise at hypoglycemia despite living with diabetes for many years; (2) adequate support, knowledge, and preparedness for hypoglycemia; (3) challenges balancing a diet that minimizes hyperglycemia and prevents hypoglycemia; (4) the belief that hyperglycemia necessitates medical intervention, but hypoglycemia does not; and (5) tension between clinician-prescribed treatment plans and self-management based on patients’ experience. Notably, participants did not report the previously cited reasons for hypoglycemia, such as food insecurity, lack of support or knowledge, or treatment errors. Conclusions Our findings suggest that some hypoglycemic events may not be preventable, but in order to reduce the risk of hypoglycemia in older individuals at risk: (1) healthcare systems need to shift from their general emphasis on the avoidance of hyperglycemia towards the prevention of hypoglycemia; and (2) clinicians and patients need to work together to design treatment regimens that fit within patient capacity and are flexible enough to accommodate life’s demands.

scholarly journals Meanings of Care Convoys: The Structure, Function, and Adequacy of Care Networks Among Frail, Community-Dwelling Older Adults

2019 ◽  
Vol 30 (4) ◽  
pp. 583-597
Author(s):  
Deborah Lambotte ◽  
An-Sofie Smetcoren ◽  
G. A. Rixt Zijlstra ◽  
Jan De Lepeleire ◽  
Liesbeth De Donder ◽  
...  
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Community Dwelling ◽  
Older Individuals ◽  
Structured Interviews ◽  
Wide Range ◽  
Relational Aspect ◽  
Health Care Monitoring ◽  
Community Dwelling Older Adults

Researchers propose that the convoy of care model should be used to study care networks of frail, older individuals. Care convoys are defined as the evolving collection of individuals who may or may not have close personal connections to the recipient or to one another, but who provide care, including help with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), socio-emotional care, skilled health care, monitoring, and advocacy. This study reports on community-dwelling older adults’ experiences of their care convoy, how care convoys change over time, and perceived (positive) outcomes. A qualitative analysis among 65 semi-structured interviews with frail, community-dwelling older adults demonstrates a great variety in the composition of care convoys. Participants were often actively involved in their care convoy and valued the social/relational aspect of care. Care and support covered a wide range of activities, with some activities being provided by specific types of caregivers. Participants expressed the adequacy of their care convoy in terms of satisfaction and sufficiency. Noteworthy, participants who were satisfied with their care convoy did not necessarily receive sufficient help. Policies and practice should recognize the relational aspect of care, the complex interplay between all actors, and the dynamic character of care convoys.

scholarly journals Severe Hypoglycemia, Cardiac Structure and Function, and Risk of Cardiovascular Events among Older Adults with Diabetes

2020 ◽  
Author(s):  
Justin B. Echouffo-Tcheugui ◽  
Natalie Daya ◽  
Alexandra K Lee ◽  
Olive Tang ◽  
Chiadi E. Ndumele ◽  
...  
Keyword(s):  
Older Adults ◽  
Negative Binomial ◽  
Cox Regression ◽  
Severe Hypoglycemia ◽  
Left Ventricular ◽  
Community Dwelling ◽  
Emergency Department Visits ◽  
Cardiac Structure ◽  
Older Individuals ◽  
All Cause Mortality

<b>Objective: </b>To assess the association of severe hypoglycemia measured at baseline with cardiovascular disease (CVD) among community-dwelling older individuals with diabetes, a group particularly susceptible to hypoglycemia. <p><b>Methods: </b>We included older adults with diabetes from the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 5 (2011–2013, baseline). Severe hypoglycemia at baseline was defined using first position ICD-9 codes, from hospitalizations, emergency department visits, and ambulance calls. We examined cross-sectional associations of severe hypoglycemia with echocardiographic indices of cardiac structure-function. We prospectively evaluated the risks of incident or recurrent CVD (coronary heart disease, stroke or heart failure) and all-cause mortality, from baseline to 31 December 2018, using negative binomial and Cox regression models. </p> <p><b>Results: </b>Among 2,193 participants (mean age: 76 years [SD: 5], 57% female, 32% blacks), 79 had a history of severe hypoglycemia at baseline. Severe hypoglycemia was associated with a lower left ventricular (LV) ejection fraction (adjusted beta coefficient: -3.7 % [95% CI: -5.5, -1.7]), higher LV end diastolic volume (14.8 ml [95% CI: 8.8, 20.8]), higher E/A ratio (0.11 [95% CI: 0.03, 0.18]), and higher septal E/e’ (2.48 [95%CI: 1.13, 3.82]). In adjusted models, severe hypoglycemia was associated with incident or recurrent CVD (incidence rate ratio [IRR]: 2.49 (95% CI 1.4, 4.39]) and all-cause mortality (HR 1.70 [95% CI 1.10, 2.67]) among those without prevalent CVD. </p> <p><b>Conclusions:</b> Our findings suggest that a history severe hypoglycemia is associated with alterations in cardiac function and is an important marker of future cardiovascular risk in older adults.<br> </p>

scholarly journals Severe Hypoglycemia, Cardiac Structure and Function, and Risk of Cardiovascular Events among Older Adults with Diabetes

2020 ◽  
Author(s):  
Justin B. Echouffo-Tcheugui ◽  
Natalie Daya ◽  
Alexandra K Lee ◽  
Olive Tang ◽  
Chiadi E. Ndumele ◽  
...  
Keyword(s):  
Older Adults ◽  
Negative Binomial ◽  
Cox Regression ◽  
Severe Hypoglycemia ◽  
Left Ventricular ◽  
Community Dwelling ◽  
Emergency Department Visits ◽  
Cardiac Structure ◽  
Older Individuals ◽  
All Cause Mortality

<b>Objective: </b>To assess the association of severe hypoglycemia measured at baseline with cardiovascular disease (CVD) among community-dwelling older individuals with diabetes, a group particularly susceptible to hypoglycemia. <p><b>Methods: </b>We included older adults with diabetes from the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 5 (2011–2013, baseline). Severe hypoglycemia at baseline was defined using first position ICD-9 codes, from hospitalizations, emergency department visits, and ambulance calls. We examined cross-sectional associations of severe hypoglycemia with echocardiographic indices of cardiac structure-function. We prospectively evaluated the risks of incident or recurrent CVD (coronary heart disease, stroke or heart failure) and all-cause mortality, from baseline to 31 December 2018, using negative binomial and Cox regression models. </p> <p><b>Results: </b>Among 2,193 participants (mean age: 76 years [SD: 5], 57% female, 32% blacks), 79 had a history of severe hypoglycemia at baseline. Severe hypoglycemia was associated with a lower left ventricular (LV) ejection fraction (adjusted beta coefficient: -3.7 % [95% CI: -5.5, -1.7]), higher LV end diastolic volume (14.8 ml [95% CI: 8.8, 20.8]), higher E/A ratio (0.11 [95% CI: 0.03, 0.18]), and higher septal E/e’ (2.48 [95%CI: 1.13, 3.82]). In adjusted models, severe hypoglycemia was associated with incident or recurrent CVD (incidence rate ratio [IRR]: 2.49 (95% CI 1.4, 4.39]) and all-cause mortality (HR 1.70 [95% CI 1.10, 2.67]) among those without prevalent CVD. </p> <p><b>Conclusions:</b> Our findings suggest that a history severe hypoglycemia is associated with alterations in cardiac function and is an important marker of future cardiovascular risk in older adults.<br> </p>

Association of Type 1 Diabetes and Hypoglycemic and Hyperglycemic Events and Risk of Dementia

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012243
Author(s):  
Rachel A. Whitmer ◽  
Paola Gilsanz ◽  
Charles P. Quesenberry ◽  
Andrew J. Karter ◽  
Mary E. Lacy
Keyword(s):  
Older Adults ◽  
Type 1 Diabetes ◽  
Healthcare Delivery ◽  
Severe Hypoglycemia ◽  
Older Individuals ◽  
Healthcare Delivery System ◽  
Dementia Risk ◽  
History Of ◽  
Cox Proportional Hazard Models

Objective:To determine whether severe hypoglycemic and hyperglycemic events are associated with longitudinal dementia risk in older adults with type 1 diabetes.Methods:A longitudinal cohort study followed 2,821 members of an integrated healthcare delivery system with type 1 diabetes from 1997-2015. Hypoglycemic and hyperglycemic events requiring emergency room or hospitalization were abstracted from medical records beginning 1/1/1996 through cohort entry. Participants were followed for dementia diagnosis through 9/30/2015. Dementia risk was examined using Cox proportional hazard models adjusted for age (as timescale), sex, race/ethnicity, HbA1c, depression, stroke, and nephropathy.Results:Among 2,821 older adults (mean age 56) with type 1 diabetes, 398 (14%) had a history of severe hypoglycemia, 335 (12%) severe hyperglycemia and 87 (3%) both. Over a mean 6.9 years of follow-up, 153 individuals (5.4%) developed dementia. In fully adjusted models, individuals with hypoglycemic events had 66% greater risk of dementia than those without a hypoglycemic event (HR=1.66; 95% CI: 1.09, 2.53), while those with hyperglycemic events had >2 times the risk (HR=2.11; 95% CI: 1.24, 3.59) than those without a hyperglycemic event. There was a 6-fold greater risk of dementia in individuals with both severe hypoglycemia and hyperglycemia versus those with neither (HR=6.20; 95% CI: 3.02, 12.70).Conclusions:For older individuals with type 1 diabetes, severe hypoglycemic and hyperglycemic events are associated with increased future risk of dementia.

Timing of onset and self-management of multiple chronic conditions: A qualitative examination taking a lifespan perspective

2018 ◽  
Vol 16 (3) ◽  
pp. 173-189 ◽  
Author(s):  
Allison R Heid ◽  
Andrew R Gerber ◽  
David S Kim ◽  
Stefan Gillen ◽  
Seran Schug ◽  
...  
Keyword(s):  
Older Adults ◽  
Social Life ◽  
Chronic Conditions ◽  
Self Management ◽  
Multiple Chronic Conditions ◽  
Older Individuals ◽  
Structured Interviews ◽  
Targeted Interventions ◽  
Timing Of Onset ◽  
Management Behaviors

Objectives Over two-thirds of older individuals live with multiple chronic conditions, yet chronic diseases are often studied in silos. Taking a lifespan approach to understanding the development of multiple chronic conditions in the older population helps to further elucidate opportunities for targeted interventions that address the complexities of multiple chronic conditions. Methods Semi-structured interviews were conducted with 38 older adults (age 64+) diagnosed with at least two chronic health conditions. Content analysis was used to build understanding of how older adults discuss the timing of diagnoses and subsequent self-management of multiple chronic conditions. Results Findings highlight the complex process by which illnesses unfold in the context of individuals’ lives and the subsequent engagement and/or disengagement in self-management behaviors. Two primary themes were evident regarding timing of illnesses: illnesses were experienced within the context of social life events and/or health events, and illnesses were not predominantly seen as connected to one another by patients. Self-management behaviors were described in response to onset of each illness. Discussion Findings provide insight into how older adults understand their experience of multiple chronic conditions and change in self-management behaviors over time. In order for practitioners to ignite behavioral changes, a person’s history and life experiences must be considered.

scholarly journals A Qualitative Analysis of the Relationship Between Older Adults’ Daily Lives and Life Outlook

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 608-608
Author(s):  
Isabella Bouklas ◽  
Giancarlo Pasquini ◽  
Renee Gilbert ◽  
Cindy Bergeman ◽  
Stacey Scott
Keyword(s):  
Older Adults ◽  
Adult Development ◽  
Daily Life ◽  
Comparative Method ◽  
Well Being ◽  
Structured Interviews ◽  
Daily Lives ◽  
Use Of Time ◽  
Age Related ◽  
Dialectical Relationship

Abstract Leading theories of adult development suggest age-related changes in one’s life perspective and changes in one’s priorities are reflected in daily behavior. The present study explored how older adults understand their current lives through a qualitative study of midwestern Americans. Twenty-four participants (Mage= 69.53 years; age range=63-78 years) from the Notre Dame Study of Health & Well-Being (Whitehead & Bergeman, 2014) completed semi-structured interviews in which they were asked about turning points across their lives. Inductive analysis using the constant comparative method (Maykut & Morehouse, 1994) resulted in 10 life-domains based on common descriptions across participants. These domains represented the ways in which participants understood their identities over the course of their lives, as well as their organization and use of time and space in daily life. Participants’ descriptions of both general life outlook and daily life informed one another, revealing the dialectical relationship between micro-level behaviors and macro-level attitudes.

scholarly journals Severe Hypoglycemia, Cardiac Structure and Function, and Risk of Cardiovascular Events among Older Adults with Diabetes

2020 ◽  
Author(s):  
Justin B. Echouffo-Tcheugui ◽  
Natalie Daya ◽  
Alexandra K Lee ◽  
Olive Tang ◽  
Chiadi E. Ndumele ◽  
...  
Keyword(s):  
Older Adults ◽  
Negative Binomial ◽  
Cox Regression ◽  
Severe Hypoglycemia ◽  
Left Ventricular ◽  
Community Dwelling ◽  
Emergency Department Visits ◽  
Cardiac Structure ◽  
Older Individuals ◽  
All Cause Mortality

<b>Objective: </b>To assess the association of severe hypoglycemia measured at baseline with cardiovascular disease (CVD) among community-dwelling older individuals with diabetes, a group particularly susceptible to hypoglycemia. <p><b>Methods: </b>We included older adults with diabetes from the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 5 (2011–2013, baseline). Severe hypoglycemia at baseline was defined using first position ICD-9 codes, from hospitalizations, emergency department visits, and ambulance calls. We examined cross-sectional associations of severe hypoglycemia with echocardiographic indices of cardiac structure-function. We prospectively evaluated the risks of incident or recurrent CVD (coronary heart disease, stroke or heart failure) and all-cause mortality, from baseline to 31 December 2018, using negative binomial and Cox regression models. </p> <p><b>Results: </b>Among 2,193 participants (mean age: 76 years [SD: 5], 57% female, 32% blacks), 79 had a history of severe hypoglycemia at baseline. Severe hypoglycemia was associated with a lower left ventricular (LV) ejection fraction (adjusted beta coefficient: -3.7 % [95% CI: -5.5, -1.7]), higher LV end diastolic volume (14.8 ml [95% CI: 8.8, 20.8]), higher E/A ratio (0.11 [95% CI: 0.03, 0.18]), and higher septal E/e’ (2.48 [95%CI: 1.13, 3.82]). In adjusted models, severe hypoglycemia was associated with incident or recurrent CVD (incidence rate ratio [IRR]: 2.49 (95% CI 1.4, 4.39]) and all-cause mortality (HR 1.70 [95% CI 1.10, 2.67]) among those without prevalent CVD. </p> <p><b>Conclusions:</b> Our findings suggest that a history severe hypoglycemia is associated with alterations in cardiac function and is an important marker of future cardiovascular risk in older adults.<br> </p>

Masters of Adaptation: Learning in Late Life Adjustments

2005 ◽  
Vol 61 (4) ◽  
pp. 265-291 ◽  
Author(s):  
Donald N. Roberson
Keyword(s):  
Older Adults ◽  
Comparative Method ◽  
Late Life ◽  
Structured Interviews ◽  
Self Directed Learning ◽  
Personal Learning ◽  
Directed Learning ◽  
Education And Employment ◽  
Time Changes ◽  
The Individual

The purpose of this research is to understand the relationship between human development in older adults and personal learning. Personal or self-directed learning (SDL) refers to a style of learning where the individual directs, controls, and evaluates what is learned. It may occur with formal classes, but most often takes place in non-formal situations. This study employed a descriptive qualitative design incorporating in-depth, semi-structured interviews for data collection. The sample of 10 purposefully selected older adults from a rural area reflected diversity in gender, race, education, and employment. Data analysis was guided by the constant comparative method. The primary late life adjustments of these older adults were in response to having extra time, changes in family, and social and physical loss. This research also indicated that late life adjustments are a primary incentive for self-directed learning. The results of this study indicated that older adults become masters of adaptation through the use of self-directed learning activities.

Perceived Voice Disorders in Older Adults and Impact on Social Interactions

2021 ◽  
pp. 1-8
Author(s):  
Connie K. Porcaro ◽  
Clare Singer ◽  
Boris Djokic ◽  
Ali A. Danesh ◽  
Ruth Tappen ◽  
...  
Keyword(s):  
Older Adults ◽  
Social Interactions ◽  
Social Engagement ◽  
Leisure Activities ◽  
Treatment Strategies ◽  
Voice Disorders ◽  
Community Dwelling ◽  
Vocal Performance ◽  
Older Individuals ◽  
Cross Sectional

Purpose Many aging individuals, even those who are healthy, report voice changes that can impact their ability to communicate as they once did. While this is commonly reported, most do not seek evaluation or management for this issue. The purpose of this study was to investigate the prevalence and differences in voice disorders in older adults, along with the effect of fatigue on their social interactions. Method This is a cross-sectional investigation of a community-dwelling sample of individuals aged 60 years or older. Participants completed the Questionnaire on Vocal Performance, the Social Engagement Index subset “Engagement in Social or Leisure Activities,” and the Fatigue Severity Scale. Results Results indicated 32.5% of the 332 participants reported symptoms of voice problems with no difference found between male and female respondents. A slight increase in report of voice problems was noted with each year of age. Participants who self-reported voice problems indicated less interaction in social activities involving communication than those who did not. Finally, as severity of self-reported voice problems increased, an increase was reported by the same individuals for signs of fatigue. Conclusions Voice problems and resulting decreased social interaction are commonly experienced by older individuals. Voice symptoms in older adults have been found to benefit from evidence-based treatment strategies. It is critical to provide education to encourage older individuals to seek appropriate evaluation and management for voice issues through a speech-language pathologist or medical professional.

Age Advantages of Emotional Experience during the COVID-19 Pandemic are Robust, but Diminished Compared to Pre-pandemic Conditions

2020 ◽  
Author(s):  
Rui Sun ◽  
Disa Sauter
Keyword(s):  
Older Adults ◽  
Large Scale ◽  
Negative Emotion ◽  
Emotional Experience ◽  
Negative Emotions ◽  
Older Individuals ◽  
Selection Strategies ◽  
Scale Test ◽  
Prolonged Stress

Getting old is generally seen as unappealing, yet aging confers considerable advantages in several psychological domains (North &amp; Fiske, 2015). In particular, older adults are better off emotionally than younger adults, with aging associated with the so-called “age advantages,” that is, more positive and less negative emotional experiences (Carstensen et al., 2011). Although the age advantages are well established, it is less clear whether they occur under conditions of prolonged stress. In a recent study, Carstensen et al (2020) demonstrated that the age advantages persist during the COVID-19 pandemic, suggesting that older adults are able to utilise cognitive and behavioural strategies to ameliorate even sustained stress. Here, we build on Carstensen and colleagues’ work with two studies. In Study 1, we provide a large-scale test of the robustness of Carstensen and colleagues’ finding that older individuals experience more positive and less negative emotions during the COVID-19 pandemic. We measured positive and negative emotions along with age information in 23,629 participants in 63 countries in April-May 2020. In Study 2, we provide a comparison of the age advantages using representative samples collected before and during the COVID-19 pandemic. We demonstrate that older people experience less negative emotion than younger people during the prolonged stress of the COVID-19 pandemic. However, the advantage of older adults was diminished during the pandemic, pointing to a likely role of older adults use of situation selection strategies (Charles, 2010).

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