الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 148 |  |  |
| | | from | 148 | | |
Abstract
T2DM is a public health problem that is widespread, serious, and growing among elderly people with a major impact on their health and well-being. Poor DM managements could impairs the older adult’s health making them more liable to serious implications such as decreased functional health status, the development of chronic complications and higher morbidity and mortality rate. SOC and resourcefulness are important resources that may empower the person and give a greater capacity to manage different life challenges including the burden of such chronic disease in a health-promoting manner.
Aim of the study:
The present study aimed to determine the relationship between sense of coherence, resourcefulness and functional health status of geriatric patients with diabetes mellitus.
Research tools and method:
Design: descriptive correlational research design
Setting: The study was conducted in five outpatient clinics at The Main University Hospital in Alexandria, namely geriatric medicine clinic, general medical clinic, diabetes clinic, cardiovascular clinic and nephrology clinic.
Subjects: The study subjects comprised a convenient sample of 120 geriatric patients who are 60 years old and above, diagnosed with T2DM and have no or mild cognitive impairment.
Tools of the study: In order to collect the necessary data for the study, five tools were used:
Tool (I): ’’Short Portable Mental Status Questionnaire (SPMSQ) ’’
It was developed by Pfeiffer (1975) and used in this study to exclude those who have moderate and/or severe cognitive impairment. It consists of 10 items. The total score of the scale is 10 and classified as follow; 0-2 no cognitive impairment, 3-4 mild cognitive impairment, 5-7 moderate cognitive impairment and 8-10 severe cognitive impairment.
Tool II: ’’Socio-demographic and Clinical data of geriatric patients with diabetes mellitus structured interview schedule’’
This tool was developed by the researcher and consists of three parts:
Part 1: Socio-demographic data of the study older adults such as age, sex, marital status, level of education and occupation prior to retirement.
Part 2: Clinical data of the study older adults include data related to medical history and presence of physical impairments.
Part 3: participation in different activities.
Tool III: ’’Sense of coherence scale ’’
It was developed by Antonovsky, (1987) to assess sense of coherence. It was adapted by the researcher from a 7-category to a 3 category scale. The scale consists of 13 items. The total score of the scale is 39 and classified as follow: 13- 21 indicates low SOC, score 22-30 indicates moderate SOC and score 31-39 indicates high SOC.
Tool IV: ’’Resourcefulness scale ’’
It was developed by Zauszniewski, et al. (2006) to assess both personal and social resourcefulness. It was adapted by the researcher from a 6-category to a 3 category scale. The scale consists of 28 items. The total score of the scale is 56 and classified as follow: Score 0- 18 indicate low resourcefulness, score 19-37 indicate moderate resourcefulness and score 38-56 indicate high resourcefulness.
Tool V: ’’COOP/WONCA charts’’
It was originally developed by Nelson, et al. (1987) a new version approved by the world organization of family doctors (Van Weel, et al., 1995) and updated by Bensten et al. (1997). It is used to assess six core domains of functional health: physical fitness, feelings, daily activities, social activities, perception of change in health and overall health. It consists of six charts. Each domain is covered by a single question to be answered on a five-point scale ranging from (‘no limitation at all’) to (‘severely limited’); for ‘change in health’ score ( 1) means ‘much better’ and score (5) ‘much worse’.
Method:
- An official letter was issued from the Faculty of Nursing Alexandria University and forwarded to the director of the Main University Hospital and head of outpatient clinics to obtain their approval to collect the data.
- The Arabic version of tool I (Short Portable Mental Status Questionnaire SPMSQ) was used to exclude subjects with moderate or severe cognitive impairment.
- Tool II (Socio-demographic and Clinical data of geriatric patients with diabetes mellitus structured interview schedule) was developed by the researcher.
- Tool IΙΙ ”Sense of coherence scale ”, tool IV ”Resourcefulness scale” and tool V ”COOP WONCA charts” was translated into Arabic language and tested for content validity by 5 experts in the field and the required modifications was done accordingly.
- A pilot study was carried out on twelve older adults who fulfilled the inclusion criteria.
- The data collection covered a period of 3 months started from the beginning of April 2019 to the end of June 2019.
The main results obtained were as follows:
- The mean age of the study older adults was 68.51±5.67 years. More than one half (53.3%) were females, 57.5% were married, and 36.7% were widow. Illiteracy was prevailing among 43.3 % of the study older adults while, 19.2% had basic education, 15% were able to read and write, 14.2% completed secondary education and only 8.3% completed their university education. More than half (53.3%) of them reported insufficient monthly income.
- Regarding the clinical data of the study older adults, 38.3% of them reported an illness duration of 5 to less than 10 year, while 34.2% were less than 5 years.
- The majority of the study older adults (88.3%) had one or more comorbid disease with more than three quarters (81.1%) were hypertensive while only 11.7% didn’t suffer from any other diseases except DM.
- Nearly two thirds (65.8%) were using oral hypoglycemic drugs, 28.3 % use insulin and only 4.2% used both of them. Anti- hypertensive drugs were the most commonly used drug among the drugs used to treat comorbid conditions (68.3%).The majority (85%) of the study older adults were compliant to their medication regimen and more than half (56.7%) were performing periodic medical checkup.
- Around half (50.8%) of the study older adults had physical limitations with the majority (73.8%) had vision problems. One quarter (25%) of the study older adults had DM related complications especially retinopathy (26.7%) and cardiovascular complications (20%).only 12.5% of the study older adults had a previous hospitalization caused by DM within the last year.
- More than half (55.8%) of the study older adults participated in different activities with the majority (89.6%) participated in religious activities.
- Around half (44.2%) of the study older adults had moderate SOC, 35% had high SOC and 20.8% had low SOC. As for domains of SOC, meaningfulness has the highest mean percent scores (63.23±29.41) followed by manageability (59.58±27.49) and comprehensibility (52.17±24.12).
- Around two thirds (65.8%) of the study older adults of moderate overall resourcefulness, 20.8% of high overall resourcefulness and 13.3% of low overall resourcefulness. Around half (49.2%) of them of moderate personal resourcefulness, about one third (33.3%) of low personal resourcefulness and 17.5% of high personal resourcefulness. While, more than half (59.2%) of the study older adults of moderate social resourcefulness, 29.2% of high social resourcefulness and 11.7% of low social resourcefulness.
- Physical fitness was the most affected domain of functional health status among the study older adults (72.29 ± 24.21) followed by change in health domain (50.21± 19.85), overall health status domain (49.37 ± 19.84), daily activities (47.50 ± 25.40) and feelings domain (45.83 ± 28.87). Whereas the social activities was the better scored domain of functional health status of the study older adults (39.37± 27.44).
- A highly statistically significant relationship was found between SOC, resourcefulness and all the functional health status domains among the study older adults.
- Age, marital status, level of education, living condition, work status and monthly income showed significant relationship with SOC. In addition, a highly statistically significant relationship was noted between compliance with medications, periodic checkup, physical limitations, complications of DM, previous hospitalization, participation in activities and SOC.
- A statistically significant relationship was noted between personal resourcefulness and level of education, work status, monthly income, compliance with medications, periodic checkup, physical limitations, complications of DM, previous hospitalization and participation in activities.
- A statistically significant relationship was found between social resourcefulness and level of education, monthly income, presence of comorbid diseases, compliance with medications, periodic checkup, physical limitations and complications of DM.
- A highly statistically significant relationship was found between all functional health status domains and marital status, level of education, work status and monthly income. Additionally, compliance with medications, periodic checkup, physical limitations, complications of DM, previous hospitalization and participation in activities were found to be highly statistically significantly associated with all functional health status domains.
Based on the findings of this study, it can be concluded that:
There is a statistically significant relationship between SOC, overall resourcefulness and all the functional health status scores of the study older adults as higher levels of SOC and resourcefulness were associated with better functional health status among the study participants.
Based on the findings of the present study, the following recommendations are suggested:
• Develop an in service training programs for nurses and HCPs at different health care settings on how to assess SOC and resourcefulness skills and orienting them with the role of such concepts on health and wellbeing of older adults and different ways for promoting them.
• Continuous health education programs by the gerontological nurses planned for and offered on regular basis to health care teams to update their knowledge and focus the nursing care on the patient’s health assets, as a complement to the traditional approach of addressing the patient’s health problems.
• Illuminate the role of the family support in the disease management by HCPs through including family/caregivers in the treatment planning of older patients with DM.
• Communication and coordination with the ministry of social solidarity by gerontological nurses in order to facilitate the access to and participation in the presented social and recreational services such as elderly clubs that can help improve SOC and resourcefulness of the elderly.
Recommendations for future research:
• Studying the relationship between SOC, resourcefulness and functional health status on large samples and different chronic conditions to clarify factors affecting on these variables among older adults.
• Future nursing research should also explore interventional design as interventions for increasing SOC and teaching resourcefulness skills to older adults with DM and other chronic conditions.