Type II Diabetes Among Elderly Persons ages 65
Type II Diabetes Among Elderly Persons (ages 65+) in San Diego JOHN EARL DOMINGO ARSENIO DON QUEJADO SARAH FLORES CHRISTINA TRAN LYNN TRAN
Introduction Purpose of Evaluation: To evaluate whether our program met the client’s needs and to determine whethere any ongoing concerns that need to be resolved as the program is implemented.
Objectives � By the end of our intervention, 90% seniors (65+) will be more educated about diabetes by practicing effective strategies to deal with the complications associated with diabetes. � By the end of our intervention, elders (65+) will effectively sustain a healthy lifestyle by motivating them to participate in at least 2 physical activities such as strength training, balance and/or endurance � After the program, older adults (65+) will increase their physical activity levels by at least 2 times a week for 30 -60 minutes � Throughout the intervention, at least 70% of seniors (65+) will have a more positive attitude towards exercising � After the intervention, A 1 c levels of participating seniors should decrease by 0. 3%-0. 6% � The participants will be able to use 95% of the knowledge gained from the presentation in order to apply it to the exercise program
Evaluation Questions Univariate � Did the participants learn about diabetes through our educational program? � What is the percentage of participants that have met the program goal (decreased A 1 c levels by 0. 3 -0. 6%)? � Is our intervention more effective in increasing positive attitude towards exercising? Bivariate � Is there correlation between A 1 c levels and physical activity [NULL-hyp]There is no correlation between A 1 c levels and physical activity. [Alternative-hyp]There is a correlation between A 1 c levels and physical activity. Multivariate � �Are attitudes towards exercise be determined by education, self-efficacy, vicarious learning, and/or education?
Conceptual Model: Theory of Reasoned Action (TRA) �Explains health behavior as well as all behaviors that can be performed at will. It presents a conceptual framework for the study of the relationship among attitude, belief, intention, and behavior. � Impact Outcomes: Positive attitude toward exercising, Intention to exercise, and the Ability to exercise at least twice a week for 30 -60 minutes � Health Outcome: Reduced A 1 c levels
Theory of Reasoned Action Behavior Outcome
Methods Design of the evaluation :
Measurement Choices Objective: Subjective: Accelerometer Monitor the motion of the participants (how intense the physical activity) Pre-/post- test surveys Needed to monitor their on self-efficacy. Higher selfefficacy scores should result in significant changes in behavior (increase PA) resulting in decrease A 1 c levels. GPS Tracks the participants in correspondence to the accelerometer. (ie. distance walked) Observation of PA Determine type of PA. (low to moderate, moderate to vigorous) A 1 c Blood Test Tracks A 1 c levels. To see if Daily logs of PA (before intervention, levels decrease with increase during and after) Physical Activity Determine type of PA. To be consistent to observation. BMI Daily Diet Menus Monitor dietary intake Logs of BMI Monitor BMI changes in correspondence to PA and A 1 c levels. Determine if participant is underweight-overweight
Measurement Time Points Measurement Time To Be Completed Pre-test Survey on Self Efficacy Before Intervention Accelerometer and GPS monitoring Daily Logs of Physical Activity Daily Dietary Menus Daily Observation of Physical Activities Daily A 1 c Blood Test Monthly BMI Weight Check/ logs Once every three weeks Post-test Survey on Self Efficacy After Intervention
Timeline Dec Develop program rationale Conduct needs Assessment Conduct pretest survey Develop Goals and Objectives create intervention Conduct Formative Evailuation Pilot test program Post-test survey Evaluate Pilot test Jan Feb Mar Apr May Jun √ √ Jul Aug Sep √ √ Oct Nov Dec √ √ √
Priority Population Priority population � Seniors 65+ with Diabetes Sampling Frame: Seniors who satisfy the following conditions � Age 65+ � Living in the one nursing home facility provided � Able to participate in our exercise program � Has a hemoglobin A 1 c level of 6. 5% or higher (indication of diabetes) Sampling procedures (Nonprobability) � Convenience sample � Homogeneous � Grab
Data Collection and Measurement Instrumentation (including information on validity and reliability) �GPS �A 1 c monitoring �Surveys �Accelerometers
Example Questions for Survey �Example Question: Approximately how many minutes of moderate physical activity (e. g. brisk walking, wheeling self in wheelchair) did you participate in on a during the previous week? How about this week? [] < 30 minutes [] 30 - 45 minutes [] 45 - 60 minutes [] 1 hour to 2 hours [] 2 - 3 hours [] More than 3 hours
Example Questions for Survey �Example Question: On a scale of 1 to 5, circle the number that best describes how confident you feel about doing physical activity? 1 being very unconfident and 5 being very confident. 1 2 3 4 5
Example Questions for Survey �Example Question: For the following select the option that best fits the given statement: 1 2 3 Disagree Somewhat Disagree Neither Agree or Disagree 4 5 Somewhat Agree �Even though I am a senior citizen I must remain physically active ____ �Because I am a senior citizen, I should lived a more relaxed lifestyle____ �Physical activity is difficult for me to perform at this age _____
Example Questions for Survey �Even though I am a senior citizen I must remain physically active ____ �Because I am a senior citizen, I should lived a more relaxed lifestyle____ �Physical activity is difficult for me to perform at this age _____
Example Questions for Survey �Example Question: Which of the following moderate physical activities did you participate in during the past week? Mark the boxes which apply [Nominal/Categorical] [] Wheeling Self in Wheelchair [] Brisk Walking (15 -20 minutes) [] Gardening (~ 30 minutes) [] Climbing Stairs (10 -15 minutes) [] Swimming laps (~20 minutes)[] Social Dancing (20 -30 minutes) [] Other (write on spaces below with duration in minutes) __________________________________________________
Statistical Analyses �Statistical Analysis: Univariate �Data analysis: Using the Measures of Central Tendency will describe the data we acquired and help determine the mean, median and mode values of the amount of physical activity performed by our target population. �Average amount of minutes per week: 60 -120 minutes per week
Results Description of findings from data analyses Measure *Percent of seniors who scored 70% or above on knowledge test about diabetes. *Percent of seniors enrolled in our exercise program who participates in at least 2 physical activities. *Percent of seniors who participate in a physical activity at least 2 times a week for 3060 minutes. *Average percent of selfefficacy levels of seniors with 10 being the highest and 1 being the lowest. Baseline/beginning value 35% Post- intervention value 72% 37% 64% 31% 69% 57. 8% 88. 6%
Correlations
Physical Activity vs. Age Group Physical Activity Percentage of Seniors 70% 60% 50% 65 -67 40% 68 -70 30% 70+ 20% 10% 0% Decline No Change Increase
A 1 c Levels vs. Age Group Increase Decrease Decrease by less No Change by 0. 1 by 0. 2 by 0. 3 by 0. 4 by 0. 5 by 0. 6 than 0. 2% 65 -67 6% 31% 9% 6% 23% 13% 9% 3% 68 -70 9% 31% 14% 12% 25% 5% 3% 1% 70+ 11% 54% 10% 15% 8% 2% 0% 0%
Example of Weekly Diet Menu
Meaning of Findings �These findings mean that there should be more programs to increase physical activity in order to reduce their A 1 c levels and thereby decreasing their risk of diabetes
Conclusions/Recommendations Results � Seniors from the nursing facility who participated in our exercise program exhibited significant improvements in knowledge, self-efficacy, physical activity, and a 1 c levels. Conclusions � Our finding shows that our senior exercise program is effective in increasing physical activity, improving a 1 c levels, and reducing the risk of type II diabetes. � Outcome measurements suggests that the program have improved their knowledge about diabetes and provided encouragement for them to be more active. � We have successfully reached the goal of reducing a 1 c levels by 0. 3%-0. 6% amongst seniors in the facility, except for 49%. Recommendations � To ensure exercises are performed correctly, maximize health benefits, and minimize risk of injury, we recommend supervision & periodic assessments by qualified exercise specialist
Limitations �Limitations More important to concentrate on program development & delivery to ensure the exercise program was implemented efficiently & appropriately for the target group. The intervention was limited to one year due to budget & resource constraints. Sensitive & vulnerable population � Must consider mental status and physical limitations �Validity Non-experimental study � Cannot make cause and effect conclusions
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