Racial and ethnic disparities in diabetes and subsequent complications are often attributed to culture; however, previous diabetes disparities research is restricted to in-depth ethnic-specific samples or to comparative study designs with limited belief assessment. The goal of this study is to improve understanding of the cultural basis for variation in diabetes beliefs.
Rural North Carolina
Older adults (aged 60+) with diabetes, equally divided by ethnicity (White, African American, American Indian) and gender (N=593).
Guided by Explanatory Models of Illness and Cultural Consensus research traditions, trained interviewers collected data using 38 items in four diabetes belief domains: causes, symptoms, consequences, and medical management. Items were obtained from the Common Sense Model of Diabetes Inventory (CSMDI).
Beliefs about diabetes. Response options for each diabetes belief item were “agree,” “disagree” and “don’t know”. Collected data were analyzed using Anthropac (version 4.98) and Latent Gold (version 4.5) programs.
There is substantial similarity in diabetes beliefs among African Americans, American Indians, and Whites. Diabetes beliefs were most similar in the “symptoms” and “consequences” domains compared to beliefs pertaining to “causes” and “medical management.” Although some discrete beliefs differed by ethnicity, systematic differences by ethnicity were observed for specific educational groups.
Socioeconomic conditions influence diabetes beliefs rather than “ethnicity” per se.
Diabetes Beliefs; Explanatory Models of Illness; Cultural Consensus; Ethnic Differences; Health Disparities
There is growing recognition that policymakers can promote access to healthy, affordable foods within neighborhoods, schools, childcare centers, and workplaces. Despite the disproportionate risk of obesity and type 2 diabetes among American Indian children and adults, comparatively little attention has been focused on the opportunities tribal policymakers have to implement policies or resolutions to promote access to healthy, affordable foods. This paper presents an approach for integrating formative research into an action-oriented strategy of developing and disseminating tribally led environmental and policy strategies to promote access to and consumption of healthy, affordable foods. This paper explains how the American Indian Healthy Eating Project evolved through five phases and discusses each phase’s essential steps involved, outcomes derived, and lessons learned.
Using community-based participatory research and informed by the Social Cognitve Theory and ecologic frameworks, the American Indian Healthy Eating Project was started in fall 2008 and has evolved through five phases: (1) starting the conversation; (2) conducting multidisciplinary formative research; (3) strengthening partnerships and tailoring policy options; (4) disseminating community-generated ideas; and (5) accelerating action while fostering sustainability. Collectively, these phases helped develop and disseminate Tools for Healthy Tribes—a toolkit used to raise awareness among participating tribal policymakers of their opportunities to improve access to healthy, affordable foods. Formal and informal strategies can engage tribal leaders in the development of culturally appropriate and tribe-specific sustainable strategies to improve such access, as well as empower tribal leaders to leverage their authority toward raising a healthier generation of American Indian children.
Cognitive impairment is common in older adults with diabetes, yet it is unclear to what extent cognitive function is associated with health literacy. We hypothesized that cognitive function, independent of education, is associated with health literacy.
The sample included 537 African American, American Indian, and White men and women 60 years or older. Measures of cognitive function included the Mini-Mental State Examination (MMSE), Verbal Fluency, Brief Attention, and Digit Span Backward tests. Health literacy was assessed using the S-TOFHLA.
Cognitive function was associated with health literacy, independent of education and other important confounders. Every unit increase in the MMSE, Digit Span Backward, Verbal Fluency or Brief Attention was associated with a 20% (p<.001), 34% (p<.001), 5% (p<.01), and 16% (p<.01) increase in the odds of having adequate health literacy, respectively.
These results suggest that cognitive function is associated with health literacy in older adults with diabetes. Because poor cognitive function may undermine health literacy, efforts to target older adults on improving health literacy should consider cognitive function as a risk factor.
cognition; health literacy; diabetes
To describe older adults' use of complementary therapies, self-care practices, and medical care to treat daily symptoms and to delineate gender, ethnic, age, and education differences.
A total of 200 African American and White participants (age 65+) selected using a site-based procedure complete a baseline interview and up to six sets of three daily follow-up interviews at monthly intervals. The percent of older adults using a therapy and the frequency with which therapies are used are considered.
The use of complementary therapies to treat daily symptoms, though important, is substantially less than the use of self-care practices and medical care. Participants differed by age, ethnicity, and education in the use of therapies.
In considering the percentage of individuals who use a therapy and the frequency with which therapies are used, this analysis adds a new dimension to understanding how older adults manage daily symptoms. Older adults are selective in their use of health self-management.
health self-management; complementary therapies; rural aging
This analysis delineates the predisposing, need, and enabling factors that are significantly associated with regular and recent dental care in a multi-ethnic sample of rural older adults.
A cross-sectional comprehensive oral health survey conducted with a random, multi-ethnic (African American, American Indian, white) sample of 635 community-dwelling adults aged 60 years and older was completed in two rural southern counties.
Almost no edentulous rural older adults received dental care. Slightly more than one-quarter (27.1%) of dentate rural older adults received regular dental care and slightly more than one-third (36.7%) received recent dental care. Predisposing (education) and enabling (regular place for dental care) factors associated with receiving regular and recent dental care among dentate participants point to greater resources being the driving force in receiving dental care. Contrary to expectations of the Behavioral Model of Health Services, those with the least need (e.g., better self-rated oral health) received regular dental care; this has been referred to as the Paradox of Dental Need.
Regular and recent dental care are infrequent among rural older adults. Those not receiving dental care are those who most need care. Community access to dental care and the ability of older adults to pay for dental care must be addressed by public health policy to improve the health and quality of life of older adults in rural communities.
dental care utilization; aging; gerontology; rural health; minority health; public health policy
To examine the association of cognitive function with use of non-prescribed therapies for managing acute and chronic conditions, and to determine whether use of non-prescribed therapies changes over time in relation to baseline cognitive function.
200 community-dwelling adults aged 65 and older were recruited from three counties in south central North Carolina. Repeated measures of daily symptoms and treatment were collected on three consecutive days at intervals of at least one month. The Mini-Mental State Examination (MMSE), the primary cognitive measure, was collected as part of the baseline survey. Data were collected on the daily use of common non-prescribed therapies (use of prayer, ignore symptoms, over-the-counter remedies, food and beverage therapies, home remedies, and vitamin, herb, or supplements) on each of the three days of the follow-up interviews for up to six consecutive months.
Older adults with poorer cognitive function were more likely to pray and ignore symptoms on days that they experienced acute symptoms. Poorer cognitive function was associated with increased use of home remedies for treating symptoms related to existing chronic conditions.
Cognitive function may play a role in why older patients use some non-prescribed therapies in response to acute and chronic conditions.
cognitive function; self health management; health services
Evaluate similarities and differences in the self-care domain of health lifestyle among older, rural dwelling women and men.
Qualitative analysis of in-depth interview data from 62 community-dwelling older (M = 74.3 years) African and European American women and men.
Both older women and men rely heavily on over-the-counter (OTC) medications and home remedies self-care; professional health care is typically sought when self-care is not effective. However, relative to men, women were more knowledgeable about different approaches to self-care, especially home remedies, they used a wider range of self-care activities, and they placed greater priority on self-care over professional health care.
The structure of older women’s and men’s self-care domain of health lifestyle is similar. However, there are subtle differences in health lifestyle that are likely embedded in gendered role behavior and may contribute to women’s greater health complaints.
This analysis examines the associations of oral health with social integration among ethnically diverse (African American, American Indian, white) rural older adults. Data are from a cross-sectional survey of 635 randomly selected community-dwelling adults aged 60+. Measures include self-rated oral health, number of teeth, number of oral health problems, social engagement, and social network size. Minority elders have poorer oral health than do white older adults. Most rural elders have substantial social engagement and social networks. Better oral health (greater number of teeth) is directly associated with social engagement, while the relationship of oral health to social network size is complex. The association of oral health with social engagement does not differ by ethnicity. Poorer oral health is associated with less social integration among African American, American Indian and white elders. More research on the ways oral health affects the lives of older adults is warranted.
Oral health disparities; social engagement; social network; rural aging
This paper describes research designed to specify complementary therapies used among older adults by obtaining daily use data and the specific purposes for use.
Two-hundred African American and white participants completed a baseline interview and up to six sets of three daily-diary interviews at monthly intervals.
Participants provided retrospective information on complementary therapy use, and information on the use of therapies for specific symptoms experienced across 3,070 person days. Retrospective information indicated that most participants used complementary therapies (e.g., 85.0% used home remedies in the past year). The use of complementary or other therapies and the number of days the therapies were used varied for specific symptoms. For example, home remedies were used on 86 (9.1%) of the 944 person days for which joint pain was reported.
The daily-diary design provides detailed information for delineating how elders include complementary and other therapies in their health self-management.
Health self-management; complementary therapies; rural aging
This analysis describes the association of health and functional status with private and public religious practice among ethnically diverse (African American, Native American, white) rural older adults with diabetes.
Data were collected using a population-based, cross-sectional, stratified, random sample survey of 701 community-dwelling elders with diabetes in two rural North Carolina counties. Outcome measures were private religious practice, church attendance, religious support provided, and religious support received. Correlates included religiosity, health and functional status, and personal characteristics. Statistical significance was assessed using multiple linear regression and logistic regression models.
These rural elders had high levels of religious belief, and private and public religious practice. Religiosity was associated with private and public religious practice. Health and functional status were not associated with private religious practice, but they were associated with public religious practice, such that those with limited functional status participated less in public religious practice. Ethnicity was associated with private religious practice: African Americans had higher levels of private religious practice than Native Americans or whites, while Native Americans had higher levels than whites.
Variation in private religious practice among rural older adults is related to personal characteristics and religiosity, while public religious practice is related to physical health, functional status and religiosity. Declining health may affect the social integration of rural older adults by limiting their ability to participate in a dominant social institution.
rural aging; minority aging; chronic disease; diabetes; religious participation; religiosity; social integration
Knowing a patient’s health literacy can help clinicians and researchers anticipate a patient’s ability to understand complex health regimens and deliver better patient-centered instructions and information. Poor health literacy has been linked with lower ability to function adequately in health care systems.
We evaluated and compared three measures of health literacy and performance among older patients with diabetes.
Cross-sectional study utilizing in-person interviews conducted in participants’ homes.
A tri-ethnic sample (n = 563) of African American, American Indian, and white older adults with diabetes from eight counties in south-central North Carolina.
Participants completed interviews and health literacy assessments using the Short-Form Test of Functional Health Literacy in Adults (S-TOFHLA), the Rapid Estimates of Adult Literacy in Medicine Short-Form (REALM-SF), or the Newest Vital Signs (NVS). Scores for reading comprehension and numeracy were calculated.
Over 90% completed the S-TOFHLA numeracy and approximately 85% completed the S-TOFHLA reading and REALM-SF. Only 73% completed the NVS. The correlation of S-TOFHLA total scores with REALM-SF and NVS were 0.48 and 0.54, respectively. Age, gender, ethnic, educational and income differences in health literacy emerged for several instruments, but the pattern of results across the instruments was highly variable.
A large segment of older adults is unable to complete short-form assessments of health literacy. Among those who were able to complete assessments, the REALM-SF and NVS performed comparably, but their relatively low convergence with the S-TOFHLA raises questions about instrument selection when studying health literacy of older adults.
health literacy; older adults; diabetes
To describe diabetes management behaviors and social integration among older adults, and delineate the associations of social integration with diabetes management behaviors.
Interview data from 563 African American, American Indian and white participants (age 60+) from eight south central North Carolina counties selected using a site-based procedure. Statistical analysis comprises descriptive statistics, bivariate analysis, and multivariate analysis.
Participants had high levels of social integration and largely adhered to diabetes management behaviors (glucose monitoring, checking feet, maintaining diet, formal exercise program, health provider monitoring A1C and examining feet). Social integration was associated with several behaviors; social network size, particularly other relatives seen and spoken with on the telephone, was associated with provider A1C monitoring and foot examinations.
Social integration had small but significant associations with diabetes management behaviors. This analysis suggests specific mechanisms for how social integration influences the effect of disease on disability.
Diabetes management; social integration; social engagement; social network; disablement process
The Complementary and Alternative Medicine Beliefs Inventory (CAMBI) was developed to provide a comprehensive measure of beliefs believed to differentiate complementary therapy (CT) users from nonusers. The initial evaluation of the CAMBI was based on a relatively homogeneous sample of CT users, which raises questions about its applicability in more generalized samples. This study uses data from a community-based sample of older adults (N=200) to evaluate the utility of the CAMBI in more diverse samples. Results indicated substantial variation in responses to items with each of a-priori belief domains (i.e., perceived value of natural treatments, preference for participation in treatments, and orientation toward holistic health) and modest inter-correlation among items within each belief domain. Confirmatory factor analysis results indicated the a-priori measurement structure provided a poor fit to obtained data. Post-hoc analyses indicated that African Americans and those with less education had less consistent responses to items within each belief domain. Revision and additional development of the CAMBI is needed to enable its use in more diverse research samples.
Among individuals with diabetes, a comparison of HbA1c (A1C) levels between African Americans and non-Hispanic whites was evaluated. Data sources included PubMed, Web of Science, the Cumulative Index to Nursing and Allied Health, the Cochrane Library, the Combined Health Information Database, and the Education Resources Information Center.
RESEARCH DESIGN AND METHODS
We executed a search for articles published between 1993 and 2005. Data on sample size, age, sex, A1C, geographical location, and study design were extracted. Cross-sectional data and baseline data from clinical trials and cohort studies for African Americans and non-Hispanic whites with diabetes were included. Diabetic subjects aged <18 years and those with pre-diabetes or gestational diabetes were excluded. We conducted a meta-analysis to estimate the difference in the mean values of A1C for African Americans and non-Hispanic whites.
A total of 391 studies were reviewed, of which 78 contained A1C data. Eleven had data on A1C for African Americans and non-Hispanic whites and met selection criteria. A meta-analysis revealed the standard effect to be 0.31 (95% CI 0.39–0.25). This standard effect correlates to an A1C difference between groups of ~0.65%, indicating a higher A1C across studies for African Americans. Grouping studies by study type (cross-sectional or cohort), method of data collection for A1C (chart review or blood draw), and insurance status (managed care or nonmanaged care) showed similar results.
The higher A1C observed in this meta-analysis among African Americans compared with non-Hispanic whites may contribute to disparity in diabetes morbidity and mortality in this population.
This study categorizes older adults living in rural areas by denture status, assesses the frequency of wearing dentures during meals, and determines whether denture status or use is associated with dietary quality or the number of foods avoided. A multi-ethnic population-based sample of adults ≥60 years (N=635) in the rural US was interviewed. Survey included denture use, removing dentures before eating, and foods avoided due to oral health problems. Dietary intakes were converted into Healthy Eating Index-2005 scores. Sixty percent wore removable dentures of some type; 55% never, 27% sometimes, and 18% always removed dentures when eating. More frequent removal was associated with lower dietary quality and more foods avoided. Those with severe tooth loss had the lowest dietary quality and avoided the most foods. Many rural older adults wear dentures. Learning how they adapt to denture use will offer insight into their nutritional self-management and help explain differences in dietary quality.
To determine the degree to which rural older adults are able to complete a measure of dental anxiety and to assess the prevalence, as well as the demographic and oral health characteristics, of individuals reporting high dental anxiety.
A population-based sample of 635 African American, American Indian and white older adults (age ≥60 years) completed an in-home survey, and 362 dentate participants completed an oral examination. Dental anxiety was measured using the 4-item Corah's Dental Anxiety Scale (DAS). Gender, ethnicity, age, education and oral health outcomes were compared between those who completed all four DAS questions (completers) and those who did not (non-completers) as well as, among completers, those with high versus low DAS scores.
There were 94 (14.8%) non-completers. Non-completion was associated with older age, lower education, being edentulous, and having gingival recession. 12.4% of DAS completers had high DAS scores, which was more common among those aged 60-70 years, women, and those with oral pain and sore or bleeding gums. In logistic regression analysis, only sore and bleeding gums had a significant association with a high DAS score (OR = 2.40, 95% CI 1.09-5.26).
About one in eight rural older adults have high dental anxiety, which is associated with poor oral health outcomes. Identifying new approaches to measure dental anxiety among a population with limited interaction with dental care providers is needed.
Dental Anxiety; Oral Health Outcomes; Rural Older Adults; African Americans; American Indians
Young children have an unacceptably high prevalence of diabetic ketoacidosis (DKA) at the clinical diagnosis of type 1 diabetes. The aim of this study was to determine whether knowledge of genetic risk and close follow-up for development of islet autoantibodies through participation in The Environmental Determinants of Diabetes in the Young (TEDDY) study results in lower prevalence of DKA at diabetes onset in children aged <2 and <5 years compared with population-based incidence studies and registries.
RESEARCH DESIGN AND METHODS
Symptoms and laboratory data collected on TEDDY participants diagnosed with type 1 diabetes between 2004 and 2010 were compared with data collected during the similar periods from studies and registries in all TEDDY-participating countries (U.S., SEARCH for Diabetes in Youth Study; Sweden, Swediabkids; Finland, Finnish Pediatric Diabetes Register; and Germany, Diabetes Patienten Verlaufsdokumenation [DPV] Register).
A total of 40 children younger than age 2 years and 79 children younger than age 5 years were diagnosed with type 1 diabetes in TEDDY as of December 2010. In children <2 years of age at onset, DKA prevalence in TEDDY participants was significantly lower than in all comparative registries (German DPV Register, P < 0.0001; Swediabkids, P = 0.02; SEARCH, P < 0.0001; Finnish Register, P < 0.0001). The prevalence of DKA in TEDDY children diagnosed at <5 years of age (13.1%) was significantly lower compared with SEARCH (36.4%) (P < 0.0001) and the German DPV Register (32.2%) (P < 0.0001) but not compared with Swediabkids or the Finnish Register.
Participation in the TEDDY study is associated with reduced risk of DKA at diagnosis of type 1 diabetes in young children.
To estimate the prevalence of asthma among youth with types 1 and 2 diabetes and examine associations between asthma and glycemic control.
This was a cross-sectional analysis of data from the SEARCH for Diabetes in Youth study, which included youth diagnosed with type 1 (n = 1683) and type 2 (n = 311) diabetes from 2002 through 2005. Asthma status and medications were ascertained from medical records and self-administered questionnaires, and glycemic control was assessed from hemoglobin A1c measured at the study visit.
Prevalence of asthma among all youth with diabetes was 10.9% (95% confidence interval [CI]: 9.6%–12.3%). The prevalence was 10.0% (95% CI: 8.6%–11.4%) among youth with type 1 and 16.1% (95% CI: 12.0%–20.2%) among youth with type 2 diabetes and differed according to race/ethnicity. Among youth with type 1 diabetes, those with asthma had higher mean A1c levels than those without asthma, after adjustment for age, gender, race/ethnicity, and BMI (7.77% vs 7.49%; P = .034). Youth with asthma were more likely to have poor glycemic control, particularly those with type 1 diabetes whose asthma was not treated with pharmacotherapy, although this association was attenuated by adjustment for race/ethnicity.
Prevalence of asthma may be elevated among youth with diabetes relative to the general US population. Among youth with type 1 diabetes, asthma is associated with poor glycemic control, especially if asthma is untreated. Specific asthma medications may decrease systemic inflammation, which underlies the complex relationship between pulmonary function, BMI, and glycemic control among youth with diabetes.
asthma; diabetes mellitus; diabetes type 1; diabetes type 2; obesity
To describe demographic and clinical characteristics associated with self-reported receipt of tests and measurements recommended by the American Diabetes Association (ADA) for children and youths with diabetes.
The study included 1514 SEARCH for Diabetes in Youth study participants who completed a survey about diabetes care received. Quality-of-care measures were based on ADA guidelines for eye examinations and glycohemoglobin (hemoglobin A1c [HbA1c]), lipid level, microalbuminuria, and blood pressure measurements, and a composite variable of these 5 indicators was created. Multivariate logistic regression models were used to assess the association of selected demographic and clinical characteristics with the reported receipt of all recommended tests and measurements according to age and diabetes type subgroups.
Overall, 95% of the participants reported having their blood pressure checked at all or most visits, 88% had lipid levels measured, 83% had kidney function tested, 68% underwent HbA1c testing, and 66% underwent an eye examination, in accordance with ADA recommendations. Participants aged 18 years or older, particularly those with type 2 diabetes, tended to have fewer tests of all kinds performed. Age and family income emerged as important correlates of overall quality of care in multivariate models; older age and lower income were associated with not meeting guidelines.
Although there was relatively good adherence to ADA-recommended guidelines for most indicators, efforts are needed to improve rates of HbA1c testing and eye examinations, particularly among older youths.
quality of care; children and youths; diabetes mellitus
To compare oral health status by ethnicity and socioeconomic status among African American (AA), American Indian (AI), and white dentate and edentulous community-dwelling older adults.
Cross-sectional study; data from self-reports and oral examinations.
A multi-stage cluster sampling design was used to recruit 635 participants aged 60+ from rural North Carolina counties with substantial AA and AI populations.
Participants completed in-home interviews and oral examinations. Self-reported data included socio-demographic indicators, self-rated oral health status, and presence/absence of periodontal disease, bleeding gums, oral pain, dry mouth, and fit of prostheses. Oral examination data included number of teeth and numbers of anterior and posterior functional occlusal units.
Compared to whites, AAs and AIs had significantly lower incomes and educational attainment. Self-rated oral health was significantly higher in whites, compared to both AAs and AIs. Prevalence of self-reported periodontal disease and bleeding gums was lower in whites. Among dentate participants, AAs were significantly more likely than whites to have moderately reduced numbers of teeth (11–20 teeth) and posterior occlusal contacts. Oral health deficits remained associated with ethnicity when adjusted for socioeconomic variables.
Oral health disparities in older adults in a multi-ethnic rural area are largely associated with ethnicity and not socioeconomic status. Clinicians should be aware of these health disparities in oral health status and their possible role in disparities in chronic disease. Further research is necessary to understand whether these oral health disparities reflect current or lifetime access to care, diet, or attitudes toward oral health care.
Investigate the importance of viewing belief systems about health maintenance holistically.
Qualitative (N=74) and quantitative data (N=95) were obtained from multi-ethnic rural-dwelling older adults with diabetes to characterize their Common Sense Models (CSMs) of diabetes.
There is a discrete number of CSMs held by older adults, each characterized by unique clusters of diabetes-related knowledge and beliefs. Individuals whose CSM was shaped by biomedical knowledge were better able to achieve glycemic control.
Viewing individuals’ health beliefs incrementally or in a piece-meal strategy may be less effective for health behavior change than focusing on beliefs holistically.
Diabetes; common sense model; health beliefs; glycemic control; health behavior change
There are widespread assumptions that a large proportion of American adults use a variety of complementary and alternative medicine (CAM) therapies. The goal of this study is to explore the clustering or linkages among CAM categories in the general population. Linkset analysis and data from the 2002 National Health Interview Survey (NHIS) were used to address two specific aims. First, the dominant linkages of CAM categories used by the same individual were delineated, and population estimates were generated of the percentage of American adults using different linksets of CAM categories. Second, it was determined whether dominant linkages of CAM modalities differ by age, gender, ethnicity, and education.
Linkset analysis, a method of estimating co-occurrence beyond chance, was used on data from the 2002 NHIS (N = 29,862) to identify possible sets of CAM use.
Most adults use CAM therapies from a single category. Approximately 20% of adults combined two CAM categories, with the combination of mind–body therapies and biologically based therapies estimated to be most common. Only 5% of adults use therapies representing three or more CAM categories. Combining therapies across multiple CAM categories was more common among those 46–64, women, whites, and those with a college education.
The results of this study allow researchers to refine descriptions of CAM use in the adult population. Most adults do not use a wide assortment of CAM; most use therapies within a single CAM category. Sets of CAM use were found to differ by age, gender, ethnicity, and education in ways consistent with previous research.
To quantify: (1) prevalence of dry mouth; (2) association of dry mouth with beverage intake and dietary quality; and (3) association of dry mouth with self-reported dietary accommodations to oral health deficits.
Cross-sectional study; data from self-reports.
A multi-stage cluster sampling design was used to recruit 622 participants aged 60+ from rural North Carolina counties with substantial African American and American Indian populations.
Data included the 11-item Xerostomia Inventory (XI); higher scores connote greater impact from dry mouth; a food frequency questionnaire (converted into Health Eating Index-2005 scores); and survey items on foods modified before consumption or avoided due to oral health problems.
Dry mouth was associated with being female, lower education, and income below the poverty level. Although overall beverage consumption did not vary with dry mouth, consumption of certain sugar-sweetened beverages was positively associated with dry mouth. Overall dietary quality did not differ with dry mouth, but more severe dry mouth was associated with lower intake of whole grains and higher intakes of total fruits. Dry mouth was strongly associated with self-reported modification and avoidance of foods. Those in the highest tertile of dry mouth were more likely to modify several foods compared to the lowest tertile, and were more likely to avoid three or more foods.
Older adults appear to modify foods or selectively avoid foods in response to perceived dry mouth. Despite these behaviors, dry mouth does not result in reduced dietary quality.
xerostomia; rural; nutrition; oral health
Purpose of the Study: This study identified approaches to diabetes self-management that differentiate persons with well-controlled from poorly controlled diabetes. Previous research has focused largely on persons participating in self-management interventions. Design and Methods: In-depth qualitative interviews were conducted with 48 adults, drawn from a population-based sample aged 65 years or older with diabetes. The sample was stratified by sex and ethnic group (African American, American Indian, and White) from the low (A1C <6%) and high (A1C >8%) extremes of the glycemic control distribution. Case-based text analysis was guided by a model, including six self-management domains and four resource types (self-care, informal support, formal services, and medical care). Results: A “structured” approach to self-management differentiated respondents in good glycemic control from those in poor glycemic control. Those in good glycemic control were more likely to practice specific food behaviors to limit food consumption and practice regular blood glucose monitoring with specific target values. This approach was facilitated by a greater use of home aides to assist with diabetes care. Respondents in poor glycemic control demonstrated less structure, naming general food categories and checking blood glucose in reaction to symptoms. Implications: Results provide evidence that degree of structure differentiates self-management approaches of persons with good and poor glycemic control. Findings should provide a foundation for further research to develop effective self-management programs for older adults with diabetes.
Self-management of chronic disease; African American; American Indian; Diabetes; Qualitative methods