IMPACT OF DIABETES ON PHYSICAL FUNCTION IN OLDER PEOPLE
Executive Summary
Diabetes is a syndrome of disordered metabolism resulting to high levels of blood sugar. Diabetes is common among the elderly, and which cause them many complications that affects their functionality and mobility. Aiming to contribute to the diabetes literature, this study could lead to developing systematic understanding the issue. In UK, most especially, diabetes is regarded as one among the challenges to the health sector, with 1.8 million diagnosed to be suffering from diabetes. Studies revealed that diabetes is a disease in industrialised countries and does not only lead to physical disabilities but also cognitive and emotional. Diabetes impacts directly the quality of life and loss of independence and is more common among the women. Through the interpretivism framework, the research aims to analyse the dynamics of physical functionality and dysfunctionality among the elderly group with diabetes. It seeks to answer the key question: How diabetes impacts the physical functioning of elderly people? An exploratory approach, the study will be carried out through the British Diabetic Association or simply Diabetic UK. It is planned that 200 elderly having diabetes, aged 60 and above to be surveyed and interviewed. The respondents should be living in London and must be a member to the Diabetic UK. Results of this research will be communicated and disseminated through written reports and online publishing.
1.0 Title of Research
The working title of the research is initially drafted as Impact of Diabetes on Physical Function in Older People. A syndrome of disordered metabolism, diabetes mellitus results in unusually high levels of blood sugar, due to the combined hereditary and environmental causes. Diabetes could cause many complications that might affect the functionality of an affected individual. Such complications are most common and more severe among the elderly, affecting their physical and/or mental abilities.
2.0 Justification of the Study
It is of my best belief that the study could lead to significant improvements in the health care sector especially when it comes to devising policies and strategies relating to sustaining the quality of life of diabetic people despite their lessened mobility. As such, studying how diabetes impact of the older people could lead to the development of a systematic understanding of how diabetes could likely to impede the functionality of people. Given that studies about the topic are very limited, the findings of this study will be very important in developing evidence-based healthcare service. This research will be significant for practitioners and service managers as well as policymakers and diabetic community. Such study will be also important area of study to the academia towards proper education of healthcare professionals regarding the issue. Likewise, this research will serve as a supplement to the limited study about the topic and it is hope that the findings will contribute important inputs.
3.0 Summary of Literature Review
Older people make up a significant portion of population in the UK. The population of older people aged 50 and over amounts to 20 million. As these people grow older, they increasingly experience age-related changes, diseases and disorders. Such conditions have profound impact on older people’s ability to function well, mentally and physically. A report confirms that diabetes is one of the biggest health challenges in the UK and that the 10% or £10 million of the NHS spending goes to treating diabetes and its complications on a daily basis. Three percent of the population or 1.8 million was diagnosed to have diabetes – almost 250, 000 have Type 1 diabetes and over 1.5 million with Type 2 diabetes. As such, diabetes was perceived to be a significant contributor in mortality and morbidity in the UK.
Preliminary studies indicate that such condition in which the level of sugar (glucose) in the blood is too high could cause a variety of symptoms that eventually damages some of the body organs such as the eyes, nerves, kidney and feet. Govindi (1990) argues that blood glucose is normally carefully controlled by a hormone, insulin, which is secreted from the pancreas gland. If there is insufficient or ineffective insulin in the body (as in diabetes), the glucose obtained from food cannot be stored or used for energy and thereby leading to dysfunctionalities. Increasingly becoming a common disease in elderly people in industrialised countries, diabetes not only leads to physical disability but also on comorbidities and cognitive decline, falls and fractures and other geriatric syndromes, apart from having direct impact on quality of life, loss of independence and demands on caregivers.
Studies showed that risks of disabilities are related to mobility and performance of daily tasks wherein people with diabetes find difficulties in walking for 400 metres and inability to do housework, prepare meals and manage money especially among women. Other studies revealed that diabetic women are more prone in being disabled double the rate of non-diabetic women and that they are more inclined on risks of falling and hip fractures. As well, research showed that the physical dysfunctionality among the elderly with diabetes has a direct linkage on the behavioural and sociocultural changes and the prevalence of non-participation even in small-scale activities. Social determinants of health, as discovered, played a great role in the incidence and management of diabetes mellitus.
Further, researchers experience challenges in recruiting participants for the focus groups and that response rate to survey questionnaires are moderate. Project implementation was obstructed by recruitment of focus groups, participant disappointment and survey return rates. Another challenge is on the development of valid and reliable health-related quality of life (HRQL) questionnaire for patients with type I and type II diabetes.
4.0 Research Aims and Objectives
The main purpose of this research is to analyse the dynamics of physical functionality and dysfunctionality among the elderly group with diabetes. Specifically, the objectives of the research are to:
- To evaluate the extent to which diabetes affects the physical function of elderly people
- To determine how the physical condition of the elderly people with diabetes are being managed
- To assess the physical-related comorbidities among the elderly people with diabetes
- To analyse how physical dysfunctionality among elderly people with diabetes affects the social function of the patients
To accomplish such aim, the study will seek to address the key research question: How diabetes impacts the physical functioning of elderly people? In lieu with this, the following research questions will be addressed:
1) How the physical condition of elderly people with diabetes is being managed?
2) How diabetes changes what and what cannot elderly people do? What are the activities that elderly people with diabetes engaged into?
3) To what extent do the damages to vital organs contribute to the physical disabilities of elderly people with diabetes?
4) How diabetes in elderly people lead to physical-related comorbidities? What are those physical-related comorbidities?
5) How physical functionality contributes or exacerbates the social functioning of elderly people with diabetes?
The hypotheses of this study are:
A) Diabetes among the elderly group limits the ability of these individuals to perform both small scale and large scale activities.
B) Diabetes among the elderly people influences the social functioning of these individuals because of physical disabilities.
C) Diabetes among elderly people results in physical-related comorbidities.
5.0 Theoretical Framework
The theoretical framework I have chosen to utilize in conjunction with this research is an interpretivist one. Interpretivism is the necessary research philosophy for this study because it allows searching the ‘details of the situation to understand the reality or perhaps a reality working behind them’. Limitations inherent with this type of framework would include a susceptibility to projecting my subjectivities on to the healthcare schema in the context of the research study. I would tend to think that there are serious consequences to the lack of strategies, development and regulations for diabetic patients in the UK but this may not be the case from the research’s perspective, and I would need to remain vigilant when engaging in interviews and interpreting data in this research study with regard to my own subjectivities.
I would hope to use this theoretical framework to expound on the health structure and institution applications inherent in this research study by analyzing the position of the diabetics themselves in a local organization setting. There are two reasons for situating myself in this type of theoretical framework. First, I am interested in conducting my research in a qualitative manner because I want to place myself in the position of viewing the value of healthcare services and the support of the government. Secondly, the research questions that I want to answer fit the Interpretivist framework. I want to gain first-hand knowledge about the issue and the resulting data analysis will hopefully shed new light (be it positive or negative) on how people view the value of health care structure, system, strategies, development and policies for people with diabetes.
6.0 Research Methodology
Concurrent with this theoretical framework are some pertinent research methodologies. The research strategy to be used is exploratory research because it aims to know more about the phenomenon of diabetes. Exploratory research will enable the study to look at the problem in both descriptive and exploratory manner. This approach is a preferred mean of finding out “what is happening to seek new insights” or “to ask questions or to assess phenomena in a new light.” This study will use the principal ways of conducting exploratory research, which include: literature search; talking to experts about the subject and conducting survey and interview.
My research will operate within the cross-sectional design, as I will be collecting data on more than one case, using semi-structured interviews, structured observation, and document analysis. The benefit of this would be that Ì would be able to focus on the breath and depth of the research. Moreover, by exploring the breath of the topic, I am increasing my validity and the truthfulness of my research, and thereby minimize the confounding variables. As the researcher, I will be using the Instrumental Activities of Daily Living questionnaire. The questionnaire to be developed will be based on the criteria of use of a phone book to dial, answer, or find someone’s phone number; traveling in a car or using public transportation; shopping for food or clothes; preparing meals; doing housework; using medications properly; and managing money.
The primary sampling technique to be used is the purposive sampling. This non-probability sampling refers to sampling with specific criteria in mind. As such, the researcher will survey and interview 200 elderly people taken from the list of a local medical organization in UK. From the list, simple random sampling will be applied. The researcher will consider every 4th elderly to include in the sample population. The criteria will be elderly individuals with diabetes, aged 60 and above. The respondents must be living in the London area. The researcher will work hand-in-hand with The British Diabetic Association. Simply Diabetic UK, the organisation is responsible for caring and treating people with diabetes in order to improve the quality of life for people with the condition.
7.0 Location of Research
As already mentioned, the location of the research is through a local organisation named Diabetes UK. Diabetes UK works for people with diabetes as well as their carers, family and friends with over 170, 000 members. Their mission is ‘to improve the lives of people with diabetes and to work towards a future without diabetes’. The organisation represents the interest of all people at diabetes by means of lobbying the government for better standards of care and the best quality of life. This year, Diabetes UK received a research budget of £7.38 million to be spent on research to improve the treatment of diabetes and search for a cure.
Diabetic Association became British Diabetic Association in 1954. Nonetheless, the organisation was founded in 1934 by HG Wells and RD Lawrence, aiming to ensure that every individual in UK with diabetes could gain access to insulin in whatever financial situation they may in. The organisation, along with its founder and 400 local voluntary groups continued to challenge accepted ideas of how people should be treated. British Diabetic Association was renamed as Diabetes UK in 2000 to help raise the profile of the organisation as the leading diabetes charity in the UK.
The governance structure of Diabetes UK includes a board of trustees with up to 12 members and a UK advisory council which is made up of 2 councils. The first council is the Council of People Living with Diabetes (CPD) consisting of 30 members and the second is the Council of Healthcare Professionals with 20 members. In gaining access to the respondents and the organisation, a written letter will be considered. The letter will explain the reasons of research and how it may contribute Diabetes UK, its members and the diabetic community as a whole. The list of people to be surveyed will be obtained and schedules of surveying and interview will be accomplished through personal contact with the care, information and advocacy services department. It is planned that representatives from the two councils will be interviewed.
8.0 Resource Implications/Requirements
It is hope that the research will push through simply because I believe that the evaluation and implementation will benefit the healthcare community. There are directs costs to the research including transportation costs and research materials costs as well as research administration costs. Nevertheless, the costs have differing relationships with the level of activity with respect to the study itself. For instance, the cost of research supplies is fixed while other may vary depending on the changes of the level of activities. Overall, the study is feasible considering the unit of activity. For every unit of activity, accomplishing an estimate of cost allocation would be plausible. In the meantime, the actual cost of research cannot b determined because it is yet to decide whether to use top-down or bottom up approach to cost valuation of evaluation and implementation. Initial requirements for resources, personnel and budget are described as follows:
Resources
2 research assistant
1 ream bond paper
1 desktop computer set
1 computer printer
4 ball pen
1 Sony tape recorder
8 pieces AA battery
4 recordable audio cassette tapes
Personnel
The first research assistant would draft and make the letter of permission to the Diabetic UK and hospitals while the second one will follow up and pass all the required documents needed for the research. One will be tasked to distribute questionnaires and the other one will collate and tally the answers of the respondents based on the questionnaires. A research assistant will accompany me in doing the interviews and will take care of recording the process. The first one would also transcribe the audio tapes of the interview while the other will type the answers and the findings on a document. Both can also do further library research on the subject if needed.
Budget
2 research assistant 0/day for 5 days 00
Travel expenses
1 ream bond paper
1 desktop computer set 0
1 computer printer
4 ball pen
1 Sony tape recorder
8 pieces AA battery
4 recordable audio cassette tapes
TOTAL $ 1570
9.0 Data Analysis and Presentation
Data gathered using these instruments will be collated for analysis. Data analysis will primarily be characterized by comparative and statistical approach. Initially, after gathering empirical data, comparative contextual analysis of the literature will be adopted. Comparative contextual analysis refers to the method of comparative research whereby contextual analysis of similarities and differences is possible. Qualitative data analysis will be used to collect relevant themes from the interview responses and categorize them accordingly. From those themes, the study will develop insights regarding the subject. The following statistical formula will be used in thematic content analysis.
1. Percentage – to determine the magnitude of the responses to the questionnaire.
n
% = ——– x 100 ; n – number of responses
N N – total number of respondents
2. Weighted Mean
f1x1 + f2x2 + f3x3 + f4x4 + f5x5
x= ——————————————— ;
xt
where: f – weight given to each response
x – number of responses
xt – total number of responses
The dissertation shall be divided into five chapters in order to provide clarity and coherence on the discussion of the comparisons of the effects of diabetes on the physical functioning of elderly people. The first part of the dissertation will be discussing the problem uncovered by the researcher and provide ample background of the topic. The chapter shall constitute an introduction to the whole dissertation, and the statement of the problem in order to present the basis of the study. Moreover, the chapter shall also have a discussion on the scope of its study as well as the significance of the study to society in general.
The second chapter shall be discussing the relevance of the study in the existing literature. After the presentation of the existing related literature, the researcher shall provide a synthesis of the whole chapter in relation to the study.
The third part of the study shall be discussing the methods and procedures used in the study. The chapter shall comprise of the presentation of the utilized techniques for data collection and research methodology. Similarly, it shall also contain a discussion on the used techniques in data analysis as well as the tools used to acquire the said data.
The fourth chapter shall be an analysis on the tabulated data. After the said tabulation, the data are statistically treated in order to uncover the relationship of the variable involved in the study. With the said data, the chapter seeks to address the statement of the problem noted in the first chapter.
The last chapter shall comprise of three sections, the summary of the findings, the conclusions of the study, and the recommendations. With the three portions, the chapter shall be able to address the problem stated in the initial chapters of the study.
The research will be presented in written form with the addition of data charts which will present the project’s results. Pie charts and network charts will be needed to illustrate some of the analyzed data. This cannot be confirmed, however, until the research data have been analyzed.
10.0 Ethical Considerations
The project will abide by the regulations outlined in the University’s Ethical Approval Process which identifies ethics procedure policies and principles. This means that ethics approval will be sought for all questionnaires and interview questions. For this research, I will complete the ethics checklist and, as the nature of my research does not answer “yes” to any seven of the questions in the checklist, I will sign the form and give it to my supervisor. The research will include primary data, but it will not include any personal information on individuals, so Data Protection Act does not apply for this situation.
The respondents of the survey will be able to choose whether to identify them or stay anonymous. Before sending out the questionnaires and doing interviews, I will check them with my supervisor. Participation consent forms and interview consent forms will be also accomplish (examples are provided in 1.0). I will ensure that the data will be kept confidentially. I will establish with the data providers the use of my data and will ask their permission in case of publishing data. Before getting interviews recorded, I will ensure if it is acceptable by person to be interviewed.
Further, care should always be given so that the patient can be comfortable and is in an excellent condition when doing an interview or is answering a questionnaire. As a researcher, his/her prime role is making the patient/respondent feel at ease during the interview and answering process. An interviewer therefore should refrain from pestering the respondents with regards to his/her answer. The interviewer must also see to it that confidentiality is fostered between the patient and the respondent. It must be made clear to both respondent and the interviewer that any information exchanged and stated by the patient will remain confidential.
11.0 Proposed Timescale
TASK
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Read Literature
Finalize Objectives
Draft Literature Review
Devise Research Approach
Review Secondary Data
Organize Interviews
Develop Interview questions
Conduct Interviews
Analyze secondary & primary data
Evaluate data
Draft Findings Chapter
Complete remaining chapters
Submit to tutor and await feedback
Revise draft and format for submission
Print, Bind
Submit
12.0 Dissemination Methods
I will feed back the findings of the research to everyone who takes part. There are two ways by which results will be communicated. First is through written reports. This may take the form of a summary report at the end of the project. The research is planned to be disseminated to universities across Australia as well as to international medical journals such as CHEST, Blackwell-Synergy, and MEDLINE as well, disseminating my findings through dedicated websites. The final written report will be published in medical journals accessible to users and electronically via putting the findings on a database or dissemination network accessible to both users and other stakeholders. There will be also informal discussions of the findings with relevant stakeholders.
13.0 Appendices
APPENDIX A
Sample Signature Page for Research Involving an Elderly
You are making a decision whether or not to have _____________(Name of the Respondent)_______________ participate in this study. Your signature indicates that you have read (or been read) the information provided above and decided to allow him/her to participate.
You will receive a copy of this signed informed consent document.
Signature of a Relative or Legally Authorised Representative Date
Or Legally Authorized Representative
Signature of Investigator Date
Signature of Witness
Assent of the Elderly
[Name of the Elderly] (name of the elderly) has agreed to participate in research titled [Title of Project] .
Signature of the Elderly Date
Waiver of Assent
The assent of ______________________________ (name of the elderly) was waived because of:
Age _________
Maturity ________
Psychological state of the elderly________
Signature of a Relative or Legally Authorised Representative
Date
Interview Consent Form
Title of Research __________________________________________
1. I agree to be interviewed for the purposes of the student research named above.
2. The purpose and nature of the interview has been explained to me, and I have read the assignment and/or information sheet as provided by the student.
3. I agree that the interview may be electronically recorded.
4. Any questions that I asked about the purpose and nature of the interview and research have been answered to my satisfaction.
5. Choose a), b) or c):
a) I agree that my name may be used for the purposes of the research only and not for publication.
OR
b) I understand that the student may wish to pursue publication at a later date and my name may be used.
OR
c) I do not wish my name to be used or cited, or my identity otherwise disclosed, in the research.
Name of interviewee_______________________________________
Signature of interviewee____________________________________
Date______________________
6. I have explained the project and the implications of being interviewed to the interviewee and I believe that the consent is informed and that he/she understands the implications of participation.
Name of interviewer________________________________________
Signature of interviewer_____________________________________
Date_____________________
Credit:ivythesis.typepad.com
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