2013 AAGP Annual Meeting

Poster Number: NR 32Psychosocial Barriers to Individualized Diabetes Care in Frail Elderly VeteransDenise Feil, MD, MPH; Nancy Y. Takahashi, MPH, MSW; Frances Nedjat-haiem, MSW, PhD

West L.A. VA Healthcare Center, Los Angeles, CA

Introduction: This is a preliminary report on a qualitative study that addresses the newer diabetes care recommendations toindividualize diabetes management in older adults using risk stratification [by what?] to better target glycemic control. Recentevidence on increased potential harms and marginal benefits of intensive glycemic control in older, frail and cognitivelyimpaired patients has further supported the need to individualize diabetes care. Despite the strong evidence, recent evaluationsin the VA and other settings suggest that providers are not consistently individualizing glycemic goals and avoiding hypo-glycemic complications. To address this quality gap, qualitative interviews are being conducted in two VA healthcare centerswith older, frail patients, caregivers of frail patients and healthcare providers to examine their supports and barriers toindividualizing diabetes care.Methods: We conducted semi-structured interviews (in-person or by phone) of patients, veterans, and healthcare providers.Patients and caregivers were asked questions on quality of life, personal preference of care, and medical co-morbidity as itrelates to their diabetes care management. The provider questionnaire consists of similar domains as they relate to individ-ualizing diabetes goals of care.Results: Currently, 36 interviews have been transcribed and interpreted using open coding and constant-comparisonmethod. Preliminary analysis suggests that comorbid neuro-psychiatric conditions (depression, PTSD, anxiety, mildcognitive impairment) of older, frail patients interfere with their ability to effectively communicate their diabetes carepreferences. Caregivers describe feeling stress from the burden these neuro-psychiatric conditions place on their rela-tionship with their loved one. The tension in the family relationship results from the burden of the diabetes care itself orfrom non-adherence to diabetes care regimen managed by the caregiver. Caregivers of family members with dementiadescribe feeling overwhelmed and stressed because they do not know how to manage behavioral problems of when theirloved ones refuses to do finger pricks, take medication or eat healthy foods. In both groups of caregivers and patients,lack of information and advice from physicians has led many to feel overwhelmed and stressed. Caregivers and patientsreport a sense of futility with diabetes management Patients with psychiatric problems (depression, PTSD, anxiety)describe the lack of support from healthcare providers impeding their diabetes care regimen. Many describe their primarycare provider as not open to addressing their mental health needs which proves to be a barrier in managing their diabetes.These patients believe that better communication between patient and provider is necessary when individualizing diabetescare. Most healthcare providers report comfort with individualizing diabetes care goals with this patient population butwithin a relatively narrow range of glycemic control. Cognitive impairment, depression and other psychosocial issues arenot usually factored in to individualizing the diabetes care plan for these patients. In addition, comfortability withaddressing the psychosocial patient and caregiver needs varies by provider. These preliminary results will be updated andfinalized for the AAGP meeting.Conclusions: In conclusion, older, frail patients with diabetes and their caregivers identify comorbid cognitive and psychiatricconditions that place heavy burden on them when managing diabetes ; clinicians do not typically recognize the importance ofthese conditions in individualizing diabetes care goals.

Poster Number: NR 33Propensity to Succeed: A New Method to Identify Individuals Most Likely to Benefit from a DepressionManagement ProgramCynthia E. Hommer, MSW, LICSW1; Kevin Hawkins, PhD2; Ronald J. Ozminkowski, PhD3; Asif Mujahid, MBA4;Timothy S. Wells, MPH, PhD2; Gandhi R. Bhattarai, PhD2; Sara Wang, PhD2; Richard J. Migliori, MD1; Charlotte S. Yeh, MD5

1United Health Group Alliances, Minnetonka, MN2OptumInsight, Ann Arbor, MI3OptumHealth Care Solutions, Ann Arbor, MI4OptumHealth, Golden Valley, MN5AARP Services Inc., Washington, DC

Introduction: Depression is correlated with an increased risk of physical decline, disability and mortality in older adults.Depression can also lead to decrements in social functioning, including social isolation and loss of independence, and is

S152 Am J Geriatr Psychiatry 21:3, Supplement 1