IDENTIFYING THE PSYCHOLOGICAL BARRIERS TOWARDS TAKING UP AND SUSTAINING PHYSICAL ACTIVITY IN OLDER PEOPLE WITH TYPE II DIABETES
(PART 2)
Introduction
Type II diabetes mellitus has a wide prevalence in the UK and across the globe, with significant impact on the aging population. Literature reviews have been consistent to define the disease as a growing epidemic with lifestyle implications. Lifestyle modification has been considered to be an important preventive measure against the development of the disease. Feinglos and Bethel (2008, p. 337) supported this view, indicating that behavioral and lifestyle changes should be included in the treatment program for diabetes mellitus, not only as a treatment approach but also as a preventive measure as well.
However, it is important to point out that there are many psychological barriers to the attainment of a more sustainable behavioral and lifestyle modifications in the elderly population. These psychological barriers can be complex and may tremendously produce adverse effects to the disease patterns. The major objective of the research paper entitled “Psychological Barriers to Physical Exercise among Elderly Persons with Type II Diabetes” is to further dig deeper into these psychological barriers in order to obtain a more comprehensive insight about the various psychological factors involved that prevent better health outcomes and how to overcome them. The research paper aims to identify the psychological factors that prevent the elderly population with type II diaebetes from exercising, to add more insightful knowledge about diabetes management and preventive programs, to better understand what shapes the underlying psychological factors that prevent the elderly from participating in physical activities and to provide recommendations to the larger healthcare fraternity on how to address the psychological barreirs to physical activities.
According to its literature reviews, among these psychological factors include the individual personality, social status, economic status, and the health status of the elderly patients. It can be deduced from the research findings that these barriers may also be caused by the perceived feeling of reduced physical strengths due to age, perception that active lifestyle is only associated to the youth, preference of a more sedentary lifestyle, perceived feeling of inadequacy due to poverty, impaired access and association of old age to inactive lifestyle. The research conclusively recommends the importance for the health care practitioners to address the psychological barriers that hinder the participation of the elderly population with type II diabetes mellitus to physical activity. This paper will thus provide a summary of the literature findings, analysis and recommendations of the research paper.
Background
Type II diabetes is also referred to as noninsulin dependent and is the most prevalent form of diabetes, with statistics indicating that about 90% of diabetic patients suffer from this type of diabetes (Centers for Disease Control and Prevention, 2012). It commonly affects the elderly population owing to the lack of physical activity and from being overweight. Symptoms that may be associated with the disease include weight loss, higher urination rates, fatigue and increased thirst (Diabetes UK, 2016). There are other complications that may occur with diabetes mellitus and the effective management of the disease is important. Among these complications include the risk of cardiovascular diseases, stroke and hypertension. This finding is supported by the fact that diabetes mellitus can markedly increase the risk of other macrovascular disease that can reduce the life expectancy among the elderly population (Cooper, 1999). Obesity is also a prevalent risk factor for the disease.
The disease has a tremendous impact to the UK elderly population owing mainly to various lifestyle implications. It has been pointed out that genes can also take a major role in the epidemiological patterns of the disease, but it is likely to be prevalent with environmental influence. The disease also has a major impact to the UK healthare costs with about £10 billion spent annually for diabetes mellitus management (NHS England, 2016). The risk for higher incidence of diabetes mellitus is predicted if inadequate preventive measures are taken against the disease. The implication of inefficient management of type II diabetes is the risk of a growing epidemic that can be threatening not only to the aging population but to the healthcare system as well. Because of this implication, it becomes an area of concern in the healthcare setting that requires further research on the lifestyle changes required to combat the disease.
In the management of type II diabetes, self-efficacy is pretty essential and lack of an internal locus of control can lead to exacerbation of the condition as well as its co-morbidities and accompanying diseases such as hypertension and cardiac disease (Diabetes.co.uk, 2016). Self efficiency has been identified to be a vital component in the prevention and management of type II diabetes mellitus which requires psychological commitment to be effective. The disease is incurable but preventable with lifestyle changes and behavioral modifications. It is worth noting, however, that the physical health and psychological factors can deter the elderly from engaging in physical activities. Their fragile age and individual perception about having an active lifestyle is a major challenge among the health practitioners to help overcome the disease among the elderly. Considering that type II diabetes mostly affect individuals who are over 60 years old, the disease can have a serious implication on how these patients think, interact and respond to their treatment programs (Clark & Hampson 2001).
The understanding of these psychological barriers is critical in the effective management of the disease. Patients with the type II diabetes mellitus need to understand the value of physical activities in their recovery and it is crucial to consult their doctor when identifying which exercise will be safe and fit under their health circumstances to ensure its safety and effectiveness. Self consciousness has been identified as one of the psychological barriers to physical activity among the elderly (Arnardottir et al, 2013). Their age is a major factor that affects the way the elderly thinks about their ability to engage in physical activities. This improper perception can prevent them from complying with their exercise regimen. Lack of motivation also takes a role in making the elderly disinterested about physical activity. With old age, the lack of attention can also impose a serious barrier for the elderly to become more engaged in exercise, which becomes a challenge to the health practitioner in obtaining feedback from the patient. Another barrier identified is the poor retention among the elderly that can compromise their ability to adhere to the required guidelines towards their treatment and recovery (Clark & Hampson 2001). The issue on trust can also implicate the inability of the elderly to comply with their treatment regimen. It is common to find elders who show lack of trust and defensiveness with the perception that the healthcare practitioner may cause harm to them. Changing the wrong perceptions of the elderly about physical activities can be a significant barrier in managing type II diabetes mellitus. It is therefore essential to gain a better understanding about how to help this population overcome these psychological barriers to improve their health condition.
The aim of the paper is to explore the various psychological barriers that can prevent the introduction of more sustainable physical activities among the elderly with type II diabetes. The knowledge gained from the research will help foster the proper approach in managing the disease with the use of evidence based approaches towards an effective disease management and control.
Objectives
The objectives of the research are to identify and understand the various psychological factors that prevent the elderly with type II diabetes from engaging in physical activity and exercise and to understand the influencing factors that can cause these barriers. An understanding about the perception regarding physical exercise can change with age will also be explored and to contribute all the research findings as an additional information to the already existing knowledge about diabetes management and prevention among the elderly population. Recommendations will also be given to the larger healthcare fraternity on how to go about addressing psychological barriers to physical activity.
Methodology
A systematic literature review will be conducted as a methodology for this research. Data will be extracted from various literature reviews and will be coded as a systematic collection of information that will be analyzed using statistical approaches for proper clarity and substantiation.
Search strategy
Ethical considerations
The research would be reviewed by the university (University of Bedfordshire-UK) IRB for the purposes of approval. A signed informed consent is secured from each individual participant. The ethical principles of fairness, just treatment of the subjects, subject autonomy, non-maleficence, beneficence and maximum benefit have been observed.
Inclusion/ exclusion criteria
The participants are more than 65 years old with diabetes and of sound mind.
The participants are more than 65 years old with diabetes and of sound mind. The literature review materials used are published from 2008 to the present by reputable authors of organizations including studies published from reputable websites. Studies must be based in UK, USA, Australia and the larger Europe, although UK studies will be given more priority. The studies chosen must satisfy the research question and show relevance with issue at hand and ethical considerations are observed.
Literature review
The disengagement theory associated aging with reduced activities and social interactions resulting in a more reserved and withdrawn personalities from physical activities among the elderly population (Kastenbaum, 2013), which implicates the role of reality. Self efficacy measures play an important role at this stage considering that aging can make an individual more vulnerable to various diseases like diabetes mellitus. The activity theory of aging postulates that the key to successful aging is staying active to keep oneself away from illnesses (Kosma & Cardinal, 2015). A sizeable amount of research associates decline in physical activity among elderly persons with psychological barriers (Jefferis et al., 2012). The psychological factors in diabetes mellitus are numerous and understanding them is essential in providing a mutidimensional approach in invidividual-specific treatments.
Personality is usually shaped by nurture and nature with the latter being highly influenced by genetic factors while the former being fundamentally influenced by the environmental factors. These two factors can essentially shape the perception and outlook about life by individuals (Coll, Bearer, & Lerner, 2014). Regular exercise is essential from preventing the body from becoming insulin resistant that can cause type II diabetes. With exercise, the insulin sensitivity in the body is enhanced that balances the glucose level in the body. The lack of exercise can also increase the risk to cardiovascular diseases that can further complicate type II diabetes mellitus and its management to recovery.
The lack of exercise and sedentary lifestyle among the elderly can also result to depression that can further complicate the disease. It can promote obesity which is a risk factor to diabetes mellitus. Dementia may also result from lack of physical activity that produces adverse effects in terms of compliance to medication because the patient is susceptible to forgetfulness. Exercising can help the patient maintain their optimal cognition level. The secondary impact of lack of exercise is prolonged recovery that can drain the resources of the family in helping the patient to get well. This can also impact the motivation of nurses when seeing there is poor progress from the patient. The economic status of the patient can also affect their interest to physical activity. low family income was associated with a lower likelihood or willingness to undertake physical exercise (Leonard et al., 2013). The willingness to participate in physical exercise is entirely tied to psychology and subsequently, psychology is a product of the environment, both internal and external. Because willingness is important in encouraging physical activities among the elderly, interventions that will help the patients become interested with physical activities are necessary. The use of social and nursing support, as well as evidence based approaches are valuable in this respect.
Findings and analysis
Sources of psychological barriers can be categorized as personality-associated, perceived social and economic status, mismatch between physician recommended physical exercise regimen and the personal preferences and perceived health status by the patient. The elderly population is also susceptible to introvert, reserved and anti-social personality. They also perceive that an active lifestyle is only suited to the young individuals and at their age, it is best to rest and do less. Social and economic inadequacy also plays a role in the perception on exercise engagement. Moreover, the type of physical activity regimen prescribed to the patient may not suit to the latter's preferences that adversely impact the patient's motivation.
Discussion
It is a significant challenge to the healthcare providers to help the elderly overcome the psychological barriers towards recovery from diabetes mellitus. Helping the elderly develop self efficiacy will enhance their ability to engage in physical activities that are essential towards promoting theri overall sense and outlook of life (Sun, Norman & While, 2013). Each individual patient has his own unique perception about the various aspects of life which calls for an individual approach when managing the psychological barriers towards physical activities among the elderly.
Physical exercise can go a long way in helping prevent further complications from type II diabetes mellitus, considering that the disease is not a treatable condition. An understanding of the psychological barriers that limit the capability of the elderly to participate in their treatment regimen more effectively is essential. It can assist the healthcare providers in their decision making process and allows them to formulate an individualized action plan for their patients. Emotional and counseling support can help the patients overcome the psychological barriers that prevent them from attaining an effective management of their condition. The essential action to take is digging deeper to the root cause of each psychological barrier in order to provide an adequate management to it. The declining cognition level of the elderly must also be considered when designing a treatment program. Patient education is crucial in this respect and the healthcare provider should perform a sound assessment on the needs of the individual patient to enhance their understanding about their physical activity regimen. It is also imperical to identify risk groups or aggregates within the larger population of elderly persons living with type II diabetes in Britain. There are marked pattern of perceptions towards physical activities that manifest with uniformity among certain races. Blacks, for instance, are less likely to lead a sedentary lifestyle compared to the Whites. This can make the assessment of appropriate intervention more individualized and effective in addressing the underlying problems.
Conclusion
Type II diabetes is a widespread illness across the UK and the world. Physical activity is highly correlated to the effective management of the disease. However, physical inactivity has become a serious barrier towards recovery from diabetes mellitus among the elderly population. This is usually caused by various psychological factors that can adversely affect the perception of the elderly population about physical activity. The study noted that the elderly patients who exercise regularly are able to maintain a healthy blood sugar level. The lack of psychological support has been found to be a major barrier in the engagement of the elderly to exercise. The elderly tend to become suspectible towards demoralization due to the lack of psychological and social support that can lead to emotional disturbances and the lack of physical activities.
The study noted that individual who had fatigue fears as well as those who associated the exercises with declined physical strength did not participate in regular exercises. By revealing the differences of the level of physical activity among the men and women in this cohort, the study provides valuable insights that can be used in developing specific interventions to promote the uptake of physical exercises. The study noted that men were constantly involved in physical exercises as compared to women in the same age group. Nurses therefore need to gain a better understanding about the various factors involved in the psychological barriers from individual patient in order to define a more individualized intevention plan in encouraging physical activities from their patients. This is essential in motivating and encouraging patients in adhering diligently to their treatment programs. The information obtained from the study is conclusively consistent to other studies and can be reliably used in developing strategies to promote regular exercises among the elderly patients
Recommendations
In order to enhance the interests of the elderly patient towards physical activities, it is recommended to introduce an exercise that is tailored to the individual preferences of the patient. Allowing them to perform exercises that interest them can uplift their motivation level. Patient education is also essential in helping the elderly understand the need for physical activities. Most people do not understand the benefits of taking part in physical activities such as exercise, thus leading a sedentary lifestyle. By explaining the benefits of exercise ignorance is cured and it can motivate the elderly to participate in their physical activity regimens. It is also essential to correct their wrong perception that exercise and physical activities are more suited at a younger age. Their age influence this perception that locks them out from exercising and being physically active. Using people close to the elderly such as home care nurses and relatives to inform them of the benefits of physical activities will also encourage the elderly to participate and they are more likely to trust them.
There are different approaches that can be employed in order to stir the interest of the elderly towards physical activities and in disseminating information about the benefits of exercising. This include social campaigns, forums and seminars. Regular screening of the elderly for diabetes is also highly recommended. This ensures that the medical condition is detected early enough and to propose the appropriate physical activities according to the patient’s needs and preference the soonest time possible. Early diagnosis of diabetes mellitus is important because any delay may render the patient no longer capable of responding more effectively to the intervention program because of the advanced stage of the disease that adversely cause their health deterioration. With early diagnosis and intervention, the energy level of the elderly patient remains optimal that allows them to have the capability of responding more positively against the psychological barriers towards physical activities under their condition.
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