HOME DM-BAT: Home-based Diabetes-Modified Behavioral Activation Treatment for Low Income Seniors with T2DM Diversity Supplement

近三分之一的60岁及以上的成年人患有糖尿病，众所周知，老年糖尿病患者 会增加死亡和心血管疾病、慢性疼痛等并发症的风险 认知障碍(CI)。非洲裔美国人和西班牙裔/拉美裔美国人患上这种疾病的可能性是他们的两倍 糖尿病比非西班牙裔白人更容易患上糖尿病。血糖控制不佳的少数族裔老年人的比例一直是 发现与非西班牙裔白人长辈相比，这一比例要高得多。而大约有1600万人 在美国，有一定认知障碍的人，少数族裔受到的影响不成比例 认知障碍，非西班牙裔白人6.9%，NHB 9.4%，65岁及以上西班牙裔11.5% 年龄较大，已被诊断为阿尔茨海默氏症或痴呆症。认知障碍与增加的 死亡率；此外，有轻度认知障碍的人发展为阿尔茨海默氏症和 难以做出正确的判断、保持活跃或社交能力、理解演讲或书面内容 沟通，记住名字和约会，完成日常任务和糖尿病 管理自理活动。日常生活活动的功能限制(如散步、洗澡、 日常生活的辅助活动(如家务、做饭、购物) (IADL‘s)可能通过降低老年少数民族糖尿病患者的能力而影响他们的临床预后 由于认知障碍，保持先前建立的自我护理常规。研究表明， 近40%的老年糖尿病患者存在功能障碍。这些限制和残疾导致了 有功能障碍的老年人的生活质量较差。此外，还值得研究一下 知觉歧视、信任、心理控制源和灵性等文化因素对临床的影响 (糖化血红蛋白、低密度脂蛋白、血压)和行为(自我保健--饮食、锻炼和服药依从性) 结果，以及这组人的生活质量。这项研究将有三个重要的问题悬而未决 试图回答：1)多大程度的认知障碍和功能受限会导致自理能力差 老年少数民族2型糖尿病患者的行为、不良临床结果和不良生活质量？2)什么是 认知障碍和功能受限(ADL、IADL)的途径和机制 与2型老年少数民族患者不良的自我照顾行为、不良的临床结果和不良的生活质量有关 糖尿病？3)文化结构，如感知的歧视、信任、控制点和灵性 个人和累积导致不良的自我护理行为、不良的临床结果和不良的生活质量 患有2型糖尿病的老年少数民族，如果是，通过什么过程？这项研究将提供新的知识和 为未来的干预发展奠定基础，并使候选人具有竞争力 K01在为期两年的奖项结束时提交。

Nearly one third of adults aged 60 and older have diabetes, and it is known that elderly patients with diabetes have increased risk of mortality and comorbid conditions such as cardiovascular diseases, chronic pain, and cognitive impairment (CI). African Americans and Hispanics/Latinos are about two times as likely to have diabetes than non-Hispanic Whites. The proportion of minority elders with poor glycemic control has been found to be significantly higher compared to non-Hispanic White elders. While there are about 16 million people with some degree of cognitive impairment in the US, minorities are disproportionately impacted by cognitive impairment with 6.9% of Non-Hispanic White, 9.4% of NHB, and 11.5% of Hispanics aged 65 and older, having been diagnosed with Alzheimer’s or dementia. Cognitive impairment is associated with increased mortality; additionally, those with mild cognitive impairment progress to developing Alzheimer’s dementia and have difficulty exercising good judgement, remaining active or social, understanding speech or written communications, remembering names and appointments, and completing daily tasks and diabetes management self-care activities. Functional limitations in activities of daily living (i.e. walking, bathing, dressing) (ADL’s) and instrumental activities of daily living (i.e. housework, preparing meals, shopping) (IADL’s) may impact clinical outcomes in elderly minority patients with diabetes by reducing their ability to maintain previously established self-care routines due to cognitive impairment. Research has shown that almost 40% of older people with diabetes have functional limitations. These limitations and disabilities result in a poorer quality of life for older adults with functional limitations. Additionally, it is worthwhile to examine the role of cultural factors such as perceived discrimination, trust, locus of control, and spirituality on clinical (HbA1C, LDL, blood pressure) and behavioral (self-care – diet, exercise, and medication adherence) outcomes, and quality of life in this group. There are three important unanswered questions that this study will attempt to answer: 1) What degree of cognitive impairment and functional limitations lead to poor self-care behaviors, poor clinical outcomes and poor quality of life in elderly minorities with type 2 diabetes? 2) What are the pathways and the mechanisms by which cognitive impairment and functional limitations (ADLs, IADLs) lead to poor self-care behaviors, poor clinical outcomes and poor quality of life in elderly minorities with type 2 diabetes? 3) Do cultural constructs such as perceived discrimination, trust, locus of control, and spirituality individually and cumulatively lead to poor self-care behaviors, poor clinical outcomes and poor quality of life in elderly minorities with type 2 diabetes and if so via what process? This study will provide new knowledge and set the groundwork for future intervention development as well as position the candidate to be competitive for a K01 submission at the end of the 2-year award.