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

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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.