Abstract
The prevalence of diabetes among Americans aged 65 years and older is greater than 25%. Medical expenditures for persons with diabetes are more than twice as high as those for patients without diabetes. Diabetes in older adults often times coexists with frailty, resulting in reduced quality of life and increased health-care use. Many older adults with type 2 diabetes have mobility impairments and experience falls, which contributes to increased frailty. Exercise has a protective effect for frailty and falls, yet less than half of persons with diabetes exercise and approximately one-quarter meet exercise recommendations. In addition to exercise, nutrition may help reduce the risk for falls; however, nutritional interventions have not been tested as a fall-prevention intervention. According to a review, there is insufficient evidence to create nutritional guidelines specific for frail older adults with type 2 diabetes. There is a need to motivate and empower older adults with type 2 diabetes to make lifestyle changes to prevent frailty. The purpose of this review was to identify and integrate what is known and what still needs to be done for this population to be successful in making health behavior changes to reduce frailty. There is some evidence that motivational approaches have worked for older adults with various chronic disease conditions. However, studies applying motivational strategies are lacking for frail older adults with type 2 diabetes. A novel motivational approach was described; it combines aspects of the Health Belief Model and Motivational Interviewing. Intervention studies incorporating this model are needed to determine whether this client-driven strategy can help various racial/ethnic populations make the sustainable health behavior changes of increasing exercise and healthy eating while taking into consideration physiological, psychological, and economic barriers.
Highlights
Diabetes is a complex, chronic disease that requires medical management with a focus on lifestyle changes to prevent complications [1]
Better glycemic control was achieved by older adults receiving a group behavioral intervention focused in diabetes self-management, including exercise and nutrition compared with individual diabetes education alone [27]
A systematic review of randomized controlled trials of exercise interventions in community-dwelling adults aged 60 years and older demonstrated a 15% greater reduction of falls for the exercise group as compared with the control group [28]. e authors concluded that exercise programs were effective in reducing both the rate of falls and the number of people experience falls [28]
Summary
Chronic disease that requires medical management with a focus on lifestyle changes to prevent complications [1]. Diabetes in older adults often times coexists with frailty, resulting in reduced quality of life and increased health-care use. Frailty affects 32 to 48% of older adults with diabetes, compared with only 5 to 10% of those without diabetes [4]. Ere is a need to motivate and empower older adults with type 2 diabetes to make lifestyle changes to prevent frailty. E purpose of this review was to identify and integrate what is known and what still needs to be done for this population to be successful in making health behavior changes to reduce frailty. The aims were to investigate and describe (1) the mechanisms why persons with type 2 diabetes are susceptible to frailty and falls, (2) the relationship between glycemic control and frailty, (3) exercise and frailty, (4) nutrition and frailty, (5) multimodal interventions for frailty in persons with diabetes, and (6) a novel motivational strategy to prevent frailty in older adults with type 2 diabetes
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