title: "Everyone else gets ice cream here more often than I do--It burns me up"--Perspectives on Diabetes Care from Nursing Home Residents and their Doctors.
abstract: BACKGROUND
  To explore the perspectives of nursing home (NH) residents with diabetes and their doctors regarding the burdens of living with diabetes and diabetes treatments.
  
  
  METHODS
  Qualitative study of nursing home residents aged 65 and older with diabetes (n = 14) and nursing home physicians (n = 9) at a Department of Veterans Affairs nursing home (known as the Community Living Center). A semi-structured interview was used to elicit nursing home residents' and physicians' perspectives on the burden of diabetes and diabetes treatments. Transcripts were analyzed using constant comparative methods.
  
  
  RESULTS
  The mean age of the nursing home residents was 74; Most (93%) were male and 50% self-identified themselves as white. The mean age of nursing home physicians was 39 and 55% were geriatricians. Dietary restrictions, loss of independence and fingersticks/insulin were noted to be the most burdensome aspects of diabetes. Nursing home residents with a more positive outlook were generally more engaged in their care, while nursing home residents with a more pessimistic outlook were less engaged, allowing their physicians to assume complete control of their care. While physicians noted the potential negative impact of dietary restrictions, nursing home residents' comments suggest that physicians underestimate the burden of dietary restrictions.
  
  
  CONCLUSIONS
  Veterans Affairs nursing home residents were substantially burdened by their diabetes treatments, especially dietary restrictions and fingerstick monitoring. Since there is little evidence that dietary restrictions improve outcomes, fewer dietary restrictions may be appropriate and lead to lower treatment burdens for nursing home residents with diabetes.
authors.affiliation: University of California, San Francisco, CA, USA. Cbarnhart051@gmail.com.|San Francisco VA Medical Center, Division of Geriatrics, University of California San Francisco, 4150 Clement St, Bldg 1, Room 220 F, San Francisco, CA, 94121, USA. Cbarnhart051@gmail.com.
authors.forename: Caroline
authors.initials: C
authors.lastname: Barnhart
authors.affiliation: University of California, San Francisco, CA, USA. Keelan_w27@hotmail.com.|San Francisco VA Medical Center, Division of Geriatrics, University of California San Francisco, 4150 Clement St, Bldg 1, Room 220 F, San Francisco, CA, 94121, USA. Keelan_w27@hotmail.com.
authors.forename: Keelan
authors.initials: K
authors.lastname: McClymont
authors.affiliation: University of California, San Francisco, CA, USA. Aksmith@ucsf.edu.|San Francisco VA Medical Center, Division of Geriatrics, University of California San Francisco, 4150 Clement St, Bldg 1, Room 220 F, San Francisco, CA, 94121, USA. Aksmith@ucsf.edu.
authors.forename: Alex K
authors.initials: AK
authors.lastname: Smith
authors.affiliation: University of California, San Francisco, CA, USA. Alvin.Au-Yeung@ucsf.edu.|San Francisco VA Medical Center, Division of Geriatrics, University of California San Francisco, 4150 Clement St, Bldg 1, Room 220 F, San Francisco, CA, 94121, USA. Alvin.Au-Yeung@ucsf.edu.
authors.forename: Alvin
authors.initials: A
authors.lastname: Au-Yeung
authors.affiliation: University of California, San Francisco, CA, USA. sei.lee@ucsf.edu.|San Francisco VA Medical Center, Division of Geriatrics, University of California San Francisco, 4150 Clement St, Bldg 1, Room 220 F, San Francisco, CA, 94121, USA. sei.lee@ucsf.edu.
authors.forename: Sei J
authors.initials: SJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001786:Blood Glucose / Q000032:analysis; D017281:Cost of Illness; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000178:diet therapy / Q000523:psychology; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data; D036301:Qualitative Research; D011788:Quality of Life; D064167:Recommended Dietary Allowances; D014481:United States
chemical_list: D001786:Blood Glucose
references.citation: Health Psychol. 2008 Jan;27(1S):S73-82
references.pmid: 18248108
references.citation: Diabet Med. 2012 Jan;29(1):132-5
references.pmid: 21790774
references.citation: Diabetes Care. 2015 Jan;38 Suppl:S4
references.pmid: 25537706
references.citation: Appetite. 2005 Oct;45(2):169-76
references.pmid: 16009454
references.citation: J Am Geriatr Soc. 2008 Jul;56(7):1183-90
references.pmid: 18492034
references.citation: Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004097
references.pmid: 17636747
references.citation: JAMA Intern Med. 2014 Aug;174(8):1227-34
references.pmid: 24979148
references.citation: Diabetes Care. 2004 May;27 Suppl 2:B10-21
references.pmid: 15113777
references.citation: BMC Geriatr. 2014 Nov 28;14:126
references.pmid: 25432268
references.citation: Patient Educ Couns. 2008 Sep;72(3):418-23
references.pmid: 18621501
references.citation: Health Educ Behav. 2011 Apr;38(2):150-8
references.pmid: 21368240
references.citation: J Am Geriatr Soc. 2005 Feb;53(2):306-11
references.pmid: 15673357
references.citation: J Clin Nurs. 2009 Dec;18(23):3308-15
references.pmid: 19930088
references.citation: Health Psychol. 2014 Jul;33(7):686-9
references.pmid: 24245846
references.citation: Diabetes Educ. 2011 Mar-Apr;37(2):167-87
references.pmid: 21421990
references.citation: Diabetes Care. 2009 Dec;32(12):2225-9
references.pmid: 19940225
references.citation: Am J Geriatr Pharmacother. 2011 Aug;9(4):212-23
references.pmid: 21659006