Meeting the Challenge of Diabetes in Ageing and Diverse Populations: A Review of the Literature from the UK.
The impact of type 2 diabetes on ageing societies is great and populations across the globe are becoming more diverse. Complications of diabetes unequally affect particular groups in the UK older people, and people with a South Asian background are two population groups with increased risk whose numbers will grow in the future. We explored the evidence about diabetes care for older people with South Asian ethnicity to understand the contexts and mechanisms behind interventions to reduce inequalities. We used a realist approach to review the literature, mapped the main areas where relevant evidence exists, and explored the concepts and mechanisms which underpinned interventions. From this we constructed a theoretical framework for a programme of research and put forward suggestions for what our analysis might mean to providers, researchers, and policy makers. Broad themes of cultural competency; comorbidities and stratification; and access emerged as mid-level mechanisms which have individualised, culturally intelligent, and ethical care at their heart and through which inequalities can be addressed. These provide a theoretical framework for future research to advance knowledge about concordance; culturally meaningful measures of depression and cognitive impairment; and care planning in different contexts which support effective diabetes care for aging and diverse populations.
Institute for Health Research, University of Bedfordshire, Luton, UK.
Emma
E
Wilkinson
Institute for Health Research, University of Bedfordshire, Luton, UK.
Muhammad
M
Waqar
Foundation for Diabetes Research in Older People, Diabetes Frail, Droitwich, UK.
Alan
A
Sinclair
Institute for Health Research, University of Bedfordshire, Luton, UK.
Gurch
0000-0002-2289-5859
G
Randhawa
D000368:Aged; D000369:Aged, 80 and over; D001211:Asia, Western; D044466:Asian People; D060825:Cognitive Dysfunction; D065246:Culturally Competent Care; D003863:Depression; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D019468:Disease Management; D005006:Ethnicity; D006291:Health Policy; D054624:Health Status Disparities; D006801:Humans; D008875:Middle Aged; D008913:Minority Groups; D018570:Risk Assessment; D006113:United Kingdom; D044465:White People