Creating Effective Self-Management for Older Adults with Type 2 Diabetes and Cognitive Impairment

The primary objective of the study was to determine whether a distanced-based educational in-tervention would result in positive health outcomes for persons with both DM and cognitive impairment. Older adults with Type 2 diabetes (Diabetes Mellitus—DM) who also have cognitive impairment such as Mild Cognitive Impairment (MCI) or early stage dementia are both challenged and at risk when attempting to live independently. The ability to effectively monitor blood glucose levels and diet and exercise regimens often is severely constrained by the combination of DM and the presence of Mild Cognitive Impairment (MCI) or early stage dementia. We describe an exploratory study funded by the National Institute of Diabetes Digestive and Kidney Diseases (NIDDK) in which Certified Diabetic Educators (CDEs) were linked with 40 older adult with DM and cognitive impairment using iPads and the internet. CDEs presented personalized education sessions to participants, and 18 of the participants also received a cognitive intervention called Spaced Retrieval (SR), which is designed to train the effective use of strategies to enhance medication compliance and reach other goals. Blood glucose and cholesterol measures were assessed at baseline and at 2-, 4-, and 6-month post intervention. Hemoglobin A1c (HbA1c) levels initially declined from baseline after treatment but returned to baseline levels after 6 months. For low-density lipoprotein (LDL) cholesterol, a significant interaction effect was found for the Group × Time interaction. LDL levels increased from baseline after treatment for the control group, but showed decline after baseline in the SR group. Goals that were initially learned were retained, in general, at short-term follow-up, and self-efficacy increased significantly after training. Results show the need for follow-up and support after initial treatment, as well as the need to see if the effects produced by SR can be replicated and sustained with continued contact.

VoiceMyChoice™: Facilitating Understanding of Preferences of Residents with Dementia

The purpose of this study was to develop and evaluate the effects of visual materials (labeled pictures and a preference sorting template) on the ability to increase the convergence (agreement) of responses by persons with dementia and their nursing assistants on a Preference Assessment Questionnaire that contained 25 items related to Quality of Life (QoL). A total of 33 nursing assistants participated;54% were native English speakers and 46% were non-native English speakers. Thirty-seven residents with dementia were randomly assigned to either the treatment condition, a 10-min preference card sorting task (VoiceMyChoice?;VMC) which reflected the items and content of the Preference Assessment Questionnaire, or a control condition consisting of a 10-min card matching activity using the materials from VMC. Before and after the treatment or the control session, residents and their assigned NA were administered the Preference Assessment Questionnaire;one week later, these procedures were repeated to assess consistency in responding and improved convergence between dyad members’ responses over time. Results revealed that convergence scores between members of NA-Resident dyads increased significantly after the use of VMC for both the English and non-native English dyads, but not in the control condition. VMC has the potential to enable persons with dementia to communicate personal choices and for their caregivers of various linguistic and/or cultural backgrounds to understand them better.