Full Project – DETERMINANTS OF DIABETES MELLITUS AMONGST THE ELDERLY
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Table of Content
Abstract
Chapter One: Introduction
1.1 Background of the Study
1.2 Statement of the Problem
1.3 Objective of the Study
1.4 Research Questions
1.5 Research Hypothesis
1.6 Significance of the Study
1.7 Scope of the Study
1.8 Limitation of the Study
1.9 Definition of Terms
1.10 Organization of the Study
Chapter Two: Review of Literature
2.0 Introduction
2.2 Brief History Of Diabetes Mellitus
2.2 Definition, Classification And Diagnosis
2.3 Prevalence Of Diabetes Mellitus In Adults
2.4 Diabetes Mellitus And Its Associated Risk Factors
2.5 Diagnosis Of Diabetes Mellitus
Chapter Three: Research Methodology
3.1 Research Design
3.2 Population of the Study
3.3 Sample Size Determination
3.4 Sample Size Selection Technique and Procedure
3.5 Research Instrument and Administration
3.6 Method of Data Collection
3.7 Method of Data Analysis
3.8 Validity of the Study
3.9 Reliability of the Study
3.10 Ethical Consideration
Chapter Four: Data Presentation and Analysis
4.1 Data Presentation
4.2 Analysis of Data
4.3 Answering Research Questions
4.4 Test of Hypotheses
Chapter Five: Summary, Conclusion and Recommendation
5.1 Summary
5.2 Conclusion
5.3 Recommendation
5.4 Suggestion for Further Studies
References
APPENDIX
QUESTIONNAIRE
ABSTRACT
This study was carried out to examine the determinants of diabetes mellitus amongst the elderly in Nigeria using diabetics patients in FMC Asaba, Delta State as case study. The study was carried out to find out find out the prevalence of diabetes mellitus among the old populace in Nigeria, ascertain the causes of diabetes mellitus among the old populace in Nigeria, and determine the effect of diabetes mellitus among the old populace in Nigeria. The survey design was adopted and the simple random sampling techniques were employed in this study. The population size comprise of diabetics patients in FMC Asaba, Delta State. In determining the sample size, the researcher conveniently selected 41 respondents and 35 were validated. Self-constructed and validated questionnaire was used for data collection. The collected and validated questionnaires were analyzed using frequency tables and mean scores. While the hypotheses were tested using Chi-square statistical tool. The result of the findings reveals that the prevalence of diabetes mellitus among the old populace in Nigeria is high. The study also revealed that the causes of diabetes mellitus among the old populace in Nigeria includes: lack of physical exercise, insulin resistance, genes and family history, and hormonal diseases. Therefore, it is recommended that Public health strategies that targets the populace, emphasizing the dangers of consumption of junk foods as well as energy-dense foods from fast food centres; while underscoring the benefits of consumption of food with low glycaemic index such as high fiber diets, fruits and green leafy vegetables. Indiscriminate proliferation of fast food centres within our environment should be checked. To mention but a few.
CHAPTER ONE
INTRODUCTION
1.1 Background Of The Study
Diabetes mellitus (DM) is a chronic metabolic disease characterized by hyperglycemia and high glycated hemoglobin[1‑3] with or without glycosuria. Glucose metabolism disorder (GMD) results from a defect in insulin secretion by the pancreas, insulin action on the target tissues (or insulin resistance), or both.[4] Chronic hyperglycemia leads to damage and failure of various organs, especially the heart, blood vessels, eyes, kidneys, and nerves.[5] Those macro and micro angiopathies, whichcan be observed even in newly diagnosed patients[6] are due to GMD long‑term duration.
Approximately 1.9% of the global disability adjusted life years is attributed to diabetes having doubled since 1990 [1]. The International Diabetes Federation (IDF) estimates that 450 million people are living with diabetes, with 5.1 million dying from it annually worldwide [2, 3]. The prevalence of diabetes is expected to double by 2030 from 8.3 to 17.6% globally [2, 4, 5], excluding the high numbers of undiagnosed cases estimated at 175 millions [2, 6]. In sub-Saharan Africa, 21.5 million people are living with diabetes leading to approximately half a million diabetes-related deaths in 2013 [2].
The prevalence of diabetes varies in different age groups with the older population being at a higher risk compared to the young population[7]. For instance, the prevalence of diabetes has been estimated to be between 7.7 to 20% and 5 to 8.8% for adults aged 45 years and more in Kenya and South Africa respectively [7, 8]. In addition, more diabetic people live in urban than in rural areas [8, 9].
Cross-country studies have revealed differences in social and behavioural factors of subjective well being and disability among diabetes patients as well as in the role gender plays in the well being of these patients [10, 11]. In this regard, country-specific studies have found association between diabetes and socioeconomic factors such as education, employment status, wealth and social class [12–14]. Diabetes has also been related with behavioural characteristics of the population such as physical inactivity, poor dietary intake, inadequate intake of fruits and vegetables, tobacco use and alcohol consumption [8].
Despite the demographic transition occurring in Africa, few studies have focused on understanding the magnitude of diabetes among older adults in specific countries [12, 15]. Country-specific studies on the social and behavioural determinants of diabetes have been recommended to guide the development of local diabetes prevention measures and policies [10, 11]. Specifically, in Nigeria, studies in the general population have estimated that between 3.3 and 6% of the population has diabetes with the prevalence increasing with age and being higher in urban than in rural areas [2, 15–17]. However, there has been little focus on the health status of the increasing old population, which, for instance has increased from 4.9% in 1960 to 12% in 2010 [18]. Thus, in order to provide more evidence about the magnitude of diabetes among the old population, this study will assess the determinants of diabetes mellitus amongst the elderly in Nigeria.
1.2 Statement Of The Problem
Diabetes mellitus (DM) frequency is a growing problem worldwide, because of long life expectancy and life style modifications. In old age (≥60–65 years old), DM is becoming an alarming public health problem in developed and even in developing countries as for some authors one from two old persons are diabetic or prediabetic and for others 8 from 10 old persons have some dysglycemia. DM complications and co‑morbidities are more frequent in old diabetics compared to their young counterparts. The most frequent are cardiovascular diseases due to old age and to precocious atherosclerosis specific to DM and the most bothersome are visual and cognitive impairments, especially Alzheimer disease and other kind of dementia. Alzheimer disease seems to share the same risk factors as DM, which means insulin resistance due to lack of physical activity and eating disorders. Visual and physical handicaps, depression, and memory troubles are a barrier to care for DM treatment. For this, old diabetics are now classified into two main categories as fit and independent old people able to take any available medication, exactly as their young or middle age counterparts, and fragile or frail persons for whom physical activity, healthy diet, and medical treatment should be individualized according to the presence or lack of cognitive impairment and other co‑morbidities. In the last category, the fundamental rule is “go slowly and individualize” to avoid interaction with poly medicated elder persons and fatal iatrogenic hypoglycemias in those treated with sulfonylureas or insulin. On the basis of the aforementioned, this study seek to examine the determinants of diabetes mellitus amongst the elderly in Nigeria.
1.3 Objectives Of The Study
The overall aim of this study is to examine the determinants of diabetes mellitus amongst the elderly in Nigeria. Hence, the study will be channeled to the following specific objectives;
- Find out the prevalence of diabetes mellitus among the old populace in Nigeria.
- Ascertain the causes of diabetes mellitus among the old populace in Nigeria.
- Determine the effect of diabetes mellitus among the old populace in Nigeria.
1.4 Research Questions
- What is the prevalence of diabetes mellitus among the old populace in Nigeria?
- What are the causes of diabetes mellitus among the old populace in Nigeria?
- What are the effect of diabetes mellitus among the old populace in Nigeria?
1.5 Research Hypothesis
Ho: Diabetes mellitus has no negative effect on the elderly populace in Nigeria.
Ha: Diabetes mellitus has a negative effect on the elderly populace in Nigeria.
1.6 Significance of the Study
The incidence and prevalence of DM has continued to increase globally, despite a great deal of research, with the resulting burden resting more heavily on tropical, developing countries like Nigeria. There has been a progressive increase in the prevalence of diabetes mellitus in Nigeria and the burden is expected to increase even further. This increase can be felt within our locality as the number of diabetic patients presenting at the Federal Medical Centre (FMC) Owerri, in the last couple of years has increased. More often than not, a good number of these diabetic patients seen at the General Outpatient Clinic (GOPC) of the FMC Owerri, present with co-morbidities of various kinds as well as varying degrees of complications notable amongst which are diabetic foot ulcers, diabetic nephropathy, erectile dysfunction and diabetic neuropathy. These complications contribute a significant percentage of death due to medical illnesses in the hospital. A good number of these patients do not even know that they are diabetic and this increases their vulnerability to varied forms of both short and long term complications, which often lead to their premature death. This vulnerability to increased morbidity and mortality is seen mostly in patients with type 2 diabetes mellitus because of its insidious onset and late recognition, especially in resource-poor developing countries like Nigeria; as well as the fact that it is the more prevalent type of diabetes.
DM is a chronic disease necessitating life-long therapy, usually with drugs; and its attendant complication significantly reduces the quality of life of affected individual. This creates a life-long financial burden on the family and places an enormous strain on existing healthcare facilities. As it is recognised that the onset of the disease and its complications predate the symptoms, it is expedient that screening procedures are undertaken to diagnose the disease in the individual as early as possible to minimise the risk of complications. Furthermore, a sizeable number of these complications are preventable as strategies aimed at reducing these events include lifestyle modifications, vigilant glycemic control and aggressive secondary prevention which are within the domain of the family physician.
This type of study has not been carried out in Owerri and its environs thus; there is paucity of knowledge of the disease burden. It is pertinent therefore to embark on this study, in the face of the rapid urbanization and increasing “westernized” lifestyle in the city of Owerri in recent time. It is hoped that this study will examine the determinants of diabetes mellitus amongst the elderly, thereby improving awareness and knowledge of the disease burden as well as planning of appropriate management strategies.
1.7 Scope of the Study
The scope of this study boarders on the determinants of diabetes mellitus amongst the elderly. Geographically, this study will be carried out in Asaba, Delta State. Hence, the respondents for this study will be obtained from diabetics patients in FMC Asaba.
1.8 Limitation of the Study
Like in every human endeavour, the researcher encountered slight constraints while carrying out the study. Insufficient funds tend to impede the efficiency of the researcher in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. More so, the researcher simultaneously engaged in this study with other academic work. As a result, the amount of time spent on research will be reduced.
Moreover, the case study method utilized in the study posed some challenges to the investigator including the possibility of biases and poor judgment of issues. However, the investigator relied on respect for the general principles of procedures, justice, fairness, objectivity in observation and recording, and weighing of evidence to overcome the challenges.
1.9 Definition of Terms
Diabetes: This is also known as diabetes mellitus. It is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves.
1.10 Organization Of The Study
This research work is organized in five chapters, for easy understanding, as follows. Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study. Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature. Chapter three deals on the research design and methodology adopted in the study. Chapter four concentrate on the data collection and analysis and presentation of finding. Chapter five gives summary, conclusion, and recommendations made of the study.
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Full Project – DETERMINANTS OF DIABETES MELLITUS AMONGST THE ELDERLY