05 Jun Propose a health promotion program using an evidence-based intervention found in your literature search to address the problem in the selected

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Diabetes in Older Adults in Florida

Case Study Part 1

Student name: Jeniffer Martinez

Institution: Florida National University

Course: Integration Advanced Primary Care of Family

Instructor name: Theresa G St. Philippe

Date: May 19, 2025

Diabetes in Older Adults in Florida

Type 2 diabetes is brought on by your body producing insulin but unable to carry out its function, preventing glucose from entering your cells. One in every ten Americans, or thirty-eight million individuals, has been diagnosed with diabetes, while those people diagnosed with type 2 are about ninety to ninety-five percent. The age at which type 2 diabetes is typical is forty-five years and above, but it is also becoming more common among children, teenagers, and young adults. In Miami-Dade, approximately 30% of people 65 and above have diabetes (Khan, 2023). The burden of disease is particularly at the heart of Miami's Hispanic community, where cultural determinants of food and genetics combine with socioeconomic limitations to create a synergy of risk for diabetes (American Diabetes Association, 2022). The planned health promotion program will tackle glycemic control solely with a multi-component strategy.

Unlike generic diabetes education programs, this effort would be specifically tailored to Miami's multicultural elderly, with Spanish, Creole, and English materials accessible to all language groups. Program success will be evaluated based on objective outcomes such as decreases in HbA1c levels (the goal is a 0.8% decrease in participants' HbA1c levels) and shifts in diabetes self-care activities.

Miami's unique demographic profile creates difficulties and possibilities for diabetes prevention. Miami's older adult population includes massive cohorts of first-generation immigrants with varying health literacy levels and beliefs concerning illness and treatment. Miami's low-income older adults also face additional barriers to improved healthcare services through transportation and food deserts where fruits and vegetables are unavailable, but fast foods are readily available.

PICOT Question

In adults over 60 years with Type II diabetes mellitus (P), does an intensive lifestyle intervention program (I) more effectively improve glycemic control (O) in six months (T) compared to usual care (C)?

Vulnerable Population, Literature Review, and Theoretical Framework

Vulnerable Population

The leading vulnerable group being targeted is people aged 60 years and older in Miami, Florida; low-income and ethnic groups are being mainly targeted. Socioeconomic indicators, poor healthcare access, and cultural dietary practices leading to poor glycemic control are some risk factors that define them. In addition, as one age, older adults naturally undergo physiological changes that increase insulin resistance and put them at risk for diabetic complications. The issue is further complicated in the multicultural Miami population by the fact that African American and Hispanic people have a fifty percent chance of developing this kind of diabetes compared to non-Hispanic whites, according to the American Diabetes Association (2021). This group is particularly vulnerable due to SDOH, such as food insecurity and a lack of safe space for physical activity. These determinants must be overcome through focused intervention in order to curtail rates of diabetes and enhance health outcomes. Each of these determinants increases the risk of complication and glycemic deterioration.

Literature Review

There is mounting evidence that lifestyle therapy prevents and manages T2DM in advanced age. In a systematic review of controlled lifestyle interventions, Haw et al. (2021) discovered that lifestyle therapy with diet, exercise, and behavioral counseling alone reduced HbA1c levels by 0.5–1.0% at six months. The effects were consistently similar across settings and populations, showing such interventions' adaptability and efficacy. The review mentioned that the programs needed cultural adaptation for success, especially among Hispanic populations with specific eating habits and health beliefs. Building upon these findings, a longitudinal study by Dietz et al. (2023) investigated the impact of diabetes prevention programs conducted at the community level on the metabolic health of aging adults. The findings indicated that individuals with group education sessions and peer support groups demonstrated improved glycemic control, blood pressure, and lipid profiles over time. The community-based intervention addressed the health need with an empowered community with accountability and sustained lifestyle change.

Theoretical Framework

“Health Belief Model (HBM) provides a robust theoretical basis for understanding and changing the health behavior of elderly patients with T2DM (Wang et al., 2023). Rosenstock's model of HBM is grounded on the postulate that individuals will be more likely to engage in health-protective behavior if they believe they can contract an illness”, view an illness as serious, believe there are prevention benefits, and believe that there is no evident barrier to action. This model is especially suitable for managing diabetes because it targets the cognitive processes in describing individuals' motivation to alter such behaviors as diet and exercise. For older adults, reminding them about the perceived seriousness of diabetes and the hard fact of potential glycemia-associated complications, e.g., blindness, amputation, or kidney disease, can instill a sense of urgency.

Self-efficacy, or belief in one's ability to perform the behaviors necessary to manage an illness, is another fundamental notion of the HBM. In this proposal, self-efficacy strengthening is a case of developing participants through goal-setting meetings, skill development workshops, and continuous encouragement by healthcare workers and peer mentors. Interventions such as interactive cooking class lessons, exercise class lessons with demonstrations, and one-on-one coaching can enlist older adults to be self-efficacious in creating and sustaining change.

References

American Diabetes Association. (2022). Statistics about diabetes. https://diabetes.org/about-diabetes/statistics/about-diabetes

Dietz, C. J., Sherrill, W. W., Ankomah, S., Rennert, L., Parisi, M., & Stancil, M. (2023). Impact of a community-based diabetes self-management support program on adult self-care behaviors.  Health Education Research,  38(1), 1-12. https://link.springer.com/content/pdf/10.1007/s10670-022-00598-8.pdf

Haw, J. S., Shah, M., Turbow, S., Egeolu, M., & Umpierrez, G. (2021). Diabetes complications in racial and ethnic minority populations in the USA.  Current diabetes reports,  21, 1–8. https://pmc.ncbi.nlm.nih.gov/articles/PMC7935471/pdf/nihms-1674152.pdf

Khan, M. M. (2023). Spatial Epidemiology of Prediabetes and Diabetes in Florida. https://trace.tennessee.edu/cgi/viewcontent.cgi?article=9491&context=utk_graddiss

Wang, X., Tian, B., Zhang, S., Li, J., Yang, W., Gu, L., & Zhang, W. (2023). Underlying mechanisms of diabetes knowledge influencing diabetes self-management behaviors among patients with type II diabetes in rural China: Based on health belief model.  Patient Education and Counseling,  117, 107986. https://www.sciencedirect.com/science/article/pii/S073839912300366X

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