Self-reported goals of older patients with type 2 diabetes mellitus.
OBJECTIVE
New diabetes mellitus guidelines from the American Geriatrics Society promote the individualization of treatment goals and plans for patients aged 65 and older. Communicating with older patients about such complex medical decisions presents new challenges for providers. The self-reported healthcare goals, factors influencing these goals, and self-care practices of older patients with diabetes mellitus were explored.


METHODS
Exploratory study involving semistructured interviews.


METHODS
Four clinics of a midwestern, urban academic medical center.


METHODS
Patients aged 65 and older with type II diabetes mellitus (N=28).


METHODS
Semistructured, one-on-one interviews were conducted. Interviews were audiotaped, transcribed, and evaluated for recurring themes using a grounded theory approach.


RESULTS
The majority of patients expressed their healthcare goals in a social and functional language, in contrast to the biomedical language of risk factor control and complication prevention, even when specifically asked about goals for diabetes mellitus care. Patient's predominant healthcare goals centered on maintaining their independence and their activities of daily living (71%). Medical experiences of friends and family (50%), social comparison with peers (7%), and medical professionals (43%) shaped patients' goals. Self-reported medication adherence and glucose monitoring was high, but more than one-quarter of patients failed to adhere to any dietary recommendations, and one-third failed to adhere to their exercise regimens.


CONCLUSIONS
As diabetes mellitus care recommendations for older patients grow more complex, providers could enhance their communication about such medical decisions by exploring patients' specific circumstances and reframing diabetes mellitus treatment goals in patients' own language. These may be crucial steps to developing successful individualized care plans.
Huang
Elbert S
ES
Section of General Internal Medicine, University of Chicago, Chicago, Illinois 60637, USA. ehuang@medicine.bsd.uchicago.edu <ehuang@medicine.bsd.uchicago.edu>
Gorawara-Bhat
Rita
R
Chin
Marshall H
MH
D000203:Activities of Daily Living; D000368:Aged / Q000523:psychology*; D000369:Aged, 80 and over; D003695:Delivery of Health Care; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006040:Goals; D015438:Health Behavior; D006801:Humans; D008016:Life Change Events; D008297:Male; D012648:Self Care / Q000523:psychology; D012647:Self-Assessment