Factors Predicting Self-Care Behavior among Older Adults with Type 2 Diabetes Mellitus

Abstract

Diabetes is a non-communicable disease that is a major public health problem and affects the quality of life, especially among older adults. Older adults with diabetes will experience changes in the body due to increasing age, further affecting self-care behavior. Understanding the predicting factors of self-care behavior of older adults with type 2 diabetes will be helpful to properly create a nursing care plan in promoting self-care behaviors for older adults with type 2 diabetes mellitus. This descriptive predictive study aimed to investigate the predictability of cognitive function, ability to perform daily activities, perceived self-esteem, and social support to self-care behavior in older adults with type 2 diabetes mellitus. The sample consisted of 141 older adults diagnosed with type 2 diabetes who came to follow-up at the outpatient department of internal medicine specializing in diabetes, thyroid, and hormone clinics at King Chulalongkorn Memorial Hospital. The sample was selected through purposive sampling. The inclusion criteria included older adults who were aged 60 years and older, diagnosed with type 2 diabetes by a doctor at least six months, able to communicate in Thai, and willing to participate by signing a consent form. Data were collected between November 2022 and July 2023 through interviewing with older adults using a demographic questionnaire, the Montreal Cognitive Assessment (MOCA),the Summary of Diabetes Self-care Activities Measure, the Rosenberg’s Self-Esteem Scale, the Social Support Questionnaire, and the Chula Activities of Daily Living Index. Inter-rater reliability of the Montreal Cognitive Assessment (MOCA) was .99. Cronbach’s alpha coefficients of the Summary of Diabetes Self-care Activities Measure, the Rosenberg’s Self-Esteem Scale, the Social Support Questionnaire, and the Chula Activities of Daily Living Index were .75, .87, .87,and .88, respectively. The data were analyzed using descriptive statistics, Pearson’s correlation coefficients, Spearman’s rank correlation coefficient, and hierarchical multiple linear regression analysis.

Findings revealed that participants were aged 60-69 years (51.10%), with 62.40%being female. Most of them were married (61.00%), had a family history of diabetes (69.50%),and the duration of diabetes was 21-30 years (33.30%). Participants had mild cognitive impairment (mean = 21.48, SD = 2.64), a good level of ability to perform daily activities (mean= 8.38, SD = 0.99), a high level of perceived self-esteem (mean = 31.38, SD = 2.99), a high level of social support (mean = 64.06 , SD = 12.01) and a high level of self-care behavior(mean = 95.17 , SD = 13.72). All predictive variables could together explain 15.10% of the variance in self-care behavior (adjusted R2 = .15). Social support was the only variable significantly predicting self-care behavior (β = .38, p < .01). Meanwhile, cognitive function,perceived self-esteem, and ability to perform daily activities did not significantly predict self-care behavior in older adult patients with type 2 diabetes (β = -.01, p > .05; β = .03, p > .05; and β = .15, p > .05, respectively). The results from this study indicated that social support was a crucial predictor of self-care behavior in older adults with type 2 diabetes. Therefore, social support from family members, friends, and healthcare team members should be integrated into the intervention program to promote self-care behavior among older adults with type 2 diabetes,thereby achieving better health outcomes.

Keywords: Ability to perform daily activities, Cognitive function, Diabetes mellitus, Older adults,Self-care behavior