(30 lines) 2 Nearly one third of adults aged 60 and older have diabetes, and it is known that elderly patients with diabetes 3 have increased risk of mortality and comorbid conditions such as cardiovascular diseases, chronic pain, and 4 cognitive impairment (CI). African Americans and Hispanics/Latinos are about two times as likely to have 5 diabetes than non-Hispanic Whites. The proportion of minority elders with poor glycemic control has been 6 found to be significantly higher compared to non-Hispanic White elders. While there are about 16 million 7 people with some degree of cognitive impairment in the US, minorities are disproportionately impacted by 8 cognitive impairment with 6.9% of Non-Hispanic White, 9.4% of NHB, and 11.5% of Hispanics aged 65 and 9 older, having been diagnosed with Alzheimer?s or dementia. Cognitive impairment is associated with increased 10 mortality; additionally, those with mild cognitive impairment progress to developing Alzheimer?s dementia and 11 have difficulty exercising good judgement, remaining active or social, understanding speech or written 12 communications, remembering names and appointments, and completing daily tasks and diabetes 13 management self-care activities. Functional limitations in activities of daily living (i.e. walking, bathing, 14 dressing) (ADL?s) and instrumental activities of daily living (i.e. housework, preparing meals, shopping) 15 (IADL?s) may impact clinical outcomes in elderly minority patients with diabetes by reducing their ability to 16 maintain previously established self-care routines due to cognitive impairment. Research has shown that 17 almost 40% of older people with diabetes have functional limitations. These limitations and disabilities result in 18 a poorer quality of life for older adults with functional limitations. Additionally, it is worthwhile to examine the 19 role of cultural factors such as perceived discrimination, trust, locus of control, and spirituality on clinical 20 (HbA1C, LDL, blood pressure) and behavioral (self-care ? diet, exercise, and medication adherence) 21 outcomes, and quality of life in this group. There are three important unanswered questions that this study will 22 attempt to answer: 1) What degree of cognitive impairment and functional limitations lead to poor self-care 23 behaviors, poor clinical outcomes and poor quality of life in elderly minorities with type 2 diabetes? 2) What are 24 the pathways and the mechanisms by which cognitive impairment and functional limitations (ADLs, IADLs) lead 25 to poor self-care behaviors, poor clinical outcomes and poor quality of life in elderly minorities with type 2 26 diabetes? 3) Do cultural constructs such as perceived discrimination, trust, locus of control, and spirituality 27 individually and cumulatively lead to poor self-care behaviors, poor clinical outcomes and poor quality of life in 28 elderly minorities with type 2 diabetes and if so via what process? This study will provide new knowledge and 29 set the groundwork for future intervention development as well as position the candidate to be competitive for a 30 K01 submission at the end of the 2-year award.
(2 ? 3 sentences) 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). The proportion of minority elders with poor glycemic control has been found to be significantly higher compared to non-Hispanic White elders; similarly, 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. The overarching aim of this proposal is to investigate the role of cognitive impairment, functional limitations, and cultural constructs on clinical and behavioral outcomes, and quality of life in elderly minorities with type 2 diabetes.
