Introduction
Qualitative research has achieved status and visibility in social science and particularly in the health care field. The goal of qualitative research is to answer questions that are not answered by quantitative research. Qualitative research helps researchers to gain a more detailed understanding of a specific phenomenon of interest (Gerrish & Lacey, 2010). It also helps one to understand and explain unusual situations that could not be identified through large-scale quantitative methods. This paper analyzes qualitative research issues in diabetes management in elderly patients.
Qualitative research methods
The qualitative research methodology aims to investigate why there are high cases of elderly people getting diabetes. It also aims to find out the causes which result from the elderly people suffering from diabetes. There are different methods of qualitative research which include:
Participatory action research
This method aims at working towards greater participation in healthcare so that people can contribute their ideas which will help the researchers to plan and take effective action. In the healthcare practice, it’s vital to involve a participatory approach to many of the research activities, to come up with acceptable results for both practitioners, patients, and significant others. This kind of research can involve interviewing elderly people who are in diabetes to understand the cause of the disease among them.
Discourse analysis
Discourse analysis provides an opportunity to investigate the definition in both cultural and conversational aspects, which “encompasses a broad range of theories, topics and analytical explanation of language use” (Grbich, 1999, p.98). Discourse analysis is more than just understanding the language concept. It is associated with social undertones in general interactions. Discourse analysis involves listening to people’s conversations and analyzing them for meaning. This is a very important part of nursing research as opinions would only be acquired through listening. It involves collecting qualitative data in the form of other people’s discourses or conversations. These conversations can be in written form and can include texts. Discourse analysis is interested in people talking and in interactions between people. It looks more specifically at conversation and the effect of culture. One of the main features is the examination of the people understand language and how it can be differently interpreted by different people in different situations (Mann, 2006).
Ethnographic study
The ethnographic study aims at understanding the culture and characteristics of patients. Interview questions will be set, focusing on how patients perceive themselves. The research method will aim at developing a story of the patients and how they can live with the disease. The ethnographic study provides the researcher with a much more comprehensive perspective. By observing the actual behavior of people in their natural setting the researcher will gain a much deeper and richer understanding of such behaviors. Ethnographic research also lends itself to research topics that are not easily quantified. Research in clinical practice is best understood when behavioral aspects of the patient are observed.
Research question
The seventh leading cause of death in elderly people is diabetes, a disease with long-term implications on the general healthcare of individuals (Pope & Mays, 2006). This condition is becoming more prevalent with age. It is one of the most common chronic diseases of elderly people. Therefore, it is inevitable that as the population ages, the number of older people with diabetes will increase. The likelihood of developing diabetes increases as one gets older. Almost 20 percent of people older than sixty-five have diabetes and this number increases to almost 40 percent of people over eighty (Sinclair, 2009). Despite the measures put down to prevent diabetes among the elderly the number has continued to increase. Therefore this research aims at finding out the causes of the disease among elderly people and how it can be prevented.
Research approach
This qualitative research will use a participatory action research study. Interviews will be conducted on elderly people with diabetes to know their behaviors. It will involve the researcher and the patients, working together to examine the problem to come up with an action for positive change. This method will help research participants to increase their knowledge and ideas about diabetes and thus more relevant solutions will be achieved. This approach is also the best because both the researcher and the aged diabetic will gain more from the research process when it attains greater sensitivity and self-awareness of the problem. A good relationship will be developed among research time, research participants, and the community. This qualitative approach will allow a humanistic approach through the involvement of everyone in solving the diabetes problem.
The researcher should identify participants in the research process. These will be elderly people suffering from diabetes. To achieve the research aim, which is to find out the causes of diabetes among elderly people, the researcher will have to organize the research team. When the participants have been identified, then the research team should be organized to serve as the governing body of the research process to oversee the remedial measures and solutions to diabetes. A timetable should be established and given to the research team and the research participants so that the task assigned to them will be accomplished within the stipulated time (Pope & Mays, 2006). The research team and the research participants should cooperate to conduct the participatory research project to find a solution to the problem.
Unlike other approaches of qualitative research, the participatory action research method emphasizes the importance of listening to different voices and versions (Pope & Mays, 2006). Truth becomes a product of a process in which people come together to share experiences through a dynamic process of action, reflection, and collective investigation. At the same time, they remain firmly rooted in participants’ conceptual world and interactions between them (Pope & Mays, 2006).
Ethnographic research unlike participatory action research does take a lot longer time in the fieldwork and also to analyze the material as well as write it up. The research method does not also have much breadth as compared to participatory action research. It leads to in-depth knowledge of a particular context and situation. It is also difficult to write up the research for publication for a peer-reviewed journal.
The participatory action research method is also preferred to discourse analysis (Wallen & Fraenkel, 2001). This is because discourse analysis only looks at a particular situation and so it may not be possible to repeat the study. This method also uses media as the source and the facts are often biased in the media. This method also calls for the need to use careful sampling of items to analyze, for example, if each has its own bias.
Literature review
In people with diabetes mellitus, the plasma glucose level is a continuous risk factor for all diabetes-related chronic illnesses and is a modifiable risk factor for them (Wallen & Fraenkel, 2001). As people age, many symptoms of diabetes are mistakenly accepted as normal age-related changes. Increased urination may be attributed to bladder muscle relaxation which can interfere with a person’s ability to control urination. Additionally, the decrease in visual acuity and increased levels of fatigue are thought to be normal alterations in physical abilities (Wallen & Fraenkel, 2001). As a result, the vague nonspecific symptoms are dismissed as nonsignificant thus delaying the diagnosis of diabetes among elderly people.
Factors affecting the elderly patients
Studies suggest that the caring role for the elderly with diabetes can significantly affect the physical, emotional, social, and economic wellbeing of the family and those directly involved in the care process (Wallen & Fraenkel, 2001). Many of the published studies have shown that adults with type 1 diabetes have the biggest effect, as far as impact on significant others is concerned (Wallen & Fraenkel, 2001; Sinclair, 2009; Gerrish & Lacey, 2010). It, therefore, means that relatives may get worried even more than the patients themselves, with several spouses reporting marital conflicts brought about by diabetes management and disturbed sleep (Gerrish & Lacey, 2010).
As type 1 diabetes generally develops in people younger than 30 years, newly diagnosed diabetes in older people is predominantly type 2. As people age and gain weight, the risk of type two diabetes increases with at least 20 percent of people older than 65 years having diabetes. Stolberg et al. (cited in Grbich, 1999, p.60) conducted a qualitative study dubbed, ‘lived experience’. The study revealed four main themes of being a close relative to an elderly with type 1 diabetes. They are; living in concern about the other’s health, making effort to be involved, experiencing confidence, and handling the illness (Grbich, 1999). Although many family members agreed that they accept diabetes as a normal human disease, it became apparent that they kept on worrying about how the patient felt and lived their lives.
Weight and activity
As a person ages, weight gain increases particularly around the abdomen, thereby increasing the distribution of fat to muscles which results in central obesity. Visceral fat has been identified as a more reliable indicator for the risk of diabetes than subcutaneous fat. Muscle changes such as muscle wasting, decreased muscle loss and changes in muscle fibers also contribute to increased insulin resistance. Impaired insulin resistance is further exacerbated by a decrease in physical activity (Pope & Mays, 2006). Arthritis, joint diseases, and decreased muscle mass and strength as well as changes in visual acuity can limit physical ability thereby hindering activity levels experienced at a younger age. Although aerobic exercise is beneficial to anyone with diabetes, elderly patients may not be able to participate due to physical limitations (Wallen & Fraenkel, 2001).
Changes in nutrition
Limited mobility not only affects insulin sensitivity, but it can impair the older adult’s ability to get fresh foods, especially if he has transportation issues. These factors may lead to the use of frozen meals, canned foods high in sodium, and other ready-to-eat meals. Malnutrition may also be affected by depression, social isolation, use of alcohol, and cognitive impairment (Wallen & Fraenkel, 2001). The death of a spouse and retirement can lead to loneliness, depression, and boredom which will, in turn, affect nutritional habits. In addition, changes in dentition can impact nutrition intake both in food choices and the amount is eaten. As teeth are lost of denture fits deteriorates, softer foods become easier to chew. In combination with a decreased ability to taste sweet, sour, sour, and bitter taste, the older adult may experience an increased desire for a higher concentration of sugar and salt which can further cause alleviation of blood sugar and blood pressure.
From the perspective of care, elderly persons with diabetes complications are likely to need more care than any other age group. It, therefore, means they place a lot of pressure on the significant others, whose responsibility increases when they worry more. A small qualitative study revealed that the development of qualitative study diabetic foot ulcers leads to patients and carers both experiencing reduced mobility, thus aggravating minimal social activities of the two parties (Gerrish & Lacey, 2010).
Neurologic changes
As patients age, they experience slower learning and processing time, have slower reactions, and increased risks of organic brain disease (Gerrish & Lacey, 2010). Memory loss, especially of more recent events, can make teaching basic day-to-day living skills a change. Sensory overload from the array of new information can lead to further inability to retain that information (Gerrish & Lacey, 2010). This in turn can lead to frustrations and irritations causing the patient to feel inferior and unable to care for himself. In addition, hyperglycemia can lead to impairment in learning and retention, deficits in concentration and attention span. Glucose regulation to near normal levels can help to maintain cognitive performance as well as improvement in learning and memory.
Conclusion
Qualitative research involves research techniques in which data is obtained from a relatively small group of respondents. It helps researchers to formulate their interpretations of the subject of their studies and give interpretations to add to a body of knowledge (Wallen & Fraenkel, 2001). This article has explained the different qualitative methodologies that a researcher can use giving the advantages and drawbacks of each. In the research problem of diabetes management among elderly patients, the researcher decided to use the participatory action research methodology as explained in the article.
Reference List
Gerrish, K. & Lacey, A. (2010). The Research Process in Nursing. London. John Wiley & Sons.
Grbich, C. (1999). Qualitative Research in Health: An Introduction. New York. Sage.
Mann, B. (2006). Selected Styles in Web-Based Educational Research. Boston. Idea Group Inc.
Pope, C., & Mays, N. (2006). Qualitative Research in Health Care. London. Wiley-Blackwell.
Sinclair, A. (2009). Diabetes in Old Age. New York. John Wiley & Sons.
Wallen, N. & Fraenkel, J. (2001). Educational Research: A Guide To The Process. London. Routledge.