THE CARE OF OLDER PERSONS WITH DIABETES-MELLITUS - FAMILIES AND PRIMARY-CARE PHYSICIANS

OBJECTIVES: To determine the extent to which family members participat e in the day-to-day management of diabetes mellitus in older persons, and in older diabetics' medical encounters, and to identify patient an d family member characteristics associated with this participation. DE SIGN: A longitudinal observational study, with baseline data being rep orted herein. SETTING: Three primary care practice settings in Seattle , Washington, Boston, Massachusetts, and Indianapolis, Indiana. PARTIC IPANTS: Family members of patients 70 years of age or older participat ing in the Patient Outcomes Research Team (PORT) Study of type II diab etics. MAIN OUTCOME MEASUREMENTS: The two dependent variables represen t, respectively, the extent of-family members' assistance with diabete s-related care and participation in older diabetics' medical encounter s. RESULTS: The 357 family members enrolled were older (mean age = 66. 3 years), were mostly women (76.2%), and were usually the spouses of d iabetic patients (71.3%). Between 22% and 50% of family members report ed helping with various aspects of diabetes care; 35.6% of family memb ers participated regularly in their diabetic patients' medical encount ers. A multiple linear regression model relating family assistance wit h diabetes-related care to patient and family member characteristics i ncluded four variables: patients' physical function, and the family me mber's relationship to the patient, assistance with basic activities o f daily living (ADLs), and understanding of diabetes management issues (all P < .05). A multiple logistic regression model relating family m ember participation in the medical encounter to patient and family mem ber characteristics also included four variables: patient age and phys ical function, and family member assistance with instrumental activiti es of daily living (IADLs) and with diabetes-related care (all P < .05 ). CONCLUSION: The family members studied frequently assisted older di abetics with diabetes-specific care; more than one-third were regular participants in older diabetics' medical encounters. Family member inv olvement in the day-today management of diabetes and in the medical en counter was more likely when patients were functionally disabled. Heal th care systems and physicians need to educate their older patients, a nd involved family members when patients are frail, about diabetes-rel ated care issues and support them in their roles in the management of diabetes as well as other chronic diseases.