[100 to 150 words]

·         State your clinical question or topic for your capstone project proposal.

·         What issue is the question/topic addressing?

·         What are the reasons you selected this question/topic?

The topic proposed for the MSN Capstone project is the prevention of type 2 diabetes mellitus in older adults. The past 50 years have seen a growing aging population with an increasing prevalence of chronic conditions like diabetes, asthma, and heart disease (Bellary et al., 2021). Today, the elderly (aged 65 years and above) account for nearly half of all individuals with type 2 diabetes mellitus (Longo et al., 2019). In the United States, the number of people aged 65 and older is estimated to reach 98 million by 2060 making the prevention of the disease crucial (Longo et al., 2019). The compelling reason that led to the selection of type 2 diabetes prevention in older adults is the differences observed in disease management compared to younger patients. For instance, frequent occurrence of comorbidities, presence of frailty, and functional impairment among the elderly make prevention and treatment complicated (Bellary et al., 2021). On the other hand, there is a greater risk of macrovascular complications among the elderly making priorities and treatment choices different in this population.

[200 to 250 words]

Address the following questions/bullets in completing this section:

·         Start at the starting point – What, Where, When, Why, and How?

·         What is known about this topic or what is the evidence on this topic (Scoping Search)?

·         What is the outcome of interest?

·         What are the gaps in our understanding or knowing related to this topic?

The most interesting outcome of interest is that this project will propose evidence-based interventions that can prevent type 2 diabetes and reduce the need for medication use. The gaps related to this topic mostly involve optimal glycemic control among elderly patients with diabetes mellitus. With all the lifestyle interventions and medication, nearly half of the elderly are not maintaining or achieving appropriate target blood glucose levels leading to rapid disease progression (Bellary et al., 2021). Additionally, there is a lack of sufficient evidence on the use of exercise among elderly patients given their physical health status and other comorbidities that impact exercise and physical activity.

[150 to 200 words]

Provide details of your exhaustive search process. Be certain to list:

·         Databases searched.

·         All the keywords or search phrases used.

·         How many articles in total that were found?

·         List the inclusion/exclusion criteria.

·         Provide the number of articles that were retained and a description on why those articles were retained.

·         Consider using a flowchart to outline the search process.

[500 to 1000 words]

Conduct a review of the literature. Include at least five (5) research articles and/or evidence-based guidelines. Address the following questions/bullets in completing this section:

·         Conduct a review of the literature.

·         Provide the highlights from the research.

·         Synthesize the literature on the topic.

·         Summarize how the project will contribute to knowledge by filling in gaps, validating, or testing knowledge.

·         Cite references in this section per APA and list the reference in the References section at the end of the form.

Weight Loss and Education

Lifestyle interventions are the primary preventive measures used to manage type 2 diabetes across all age groups. These interventions are observed to be more effective among older adults and racial/ethnic groups. However, there are gaps in the lifestyle measures that significantly contribute to diabetes management in older adults. A study was conducted to investigate the relationship between weight loss, as one of the preventive strategies for diabetes, on type 2 diabetes management with aging. The cross-sectional study recruited 63, 180 subjects from three datasets and divided the participants according to different age groups (Zhou et al., 2022). The study included participants aged 18 to 97 years and observed that the elderly had higher rates of diabetes compared to young adults. It was observed that type 2 diabetes is reduced with aging making weight loss an important strategy for disease management among young adults. The researchers concluded that type 2 diabetes prevention using weight loss approaches may yield fewer benefits compared to its application in young adults.

Type 2 diabetes is regarded as a major health concern worldwide. Various studies have focused on determining the most appropriate treatment and prevention among older adults and the results are promising. In the urban population of China, diabetes among older adults aged 65 years and above is common and is associated with many risk factors. Sun et al., 2020 conducted a study to investigate the prevalence, treatment, and control rate of type 2 diabetes in China. Using questionnaires and interviews, the researchers collected data from thousands of individuals focusing on the aspect of education and its relationship to diabetes control. The researchers observed that older people with higher education levels were more likely to be treated and have their diabetes under control (Sun et al., 2020). Health literacy was identified as a key factor in the prevention of diabetes among older adults.

Physical Activity and Screening

The adoption and maintenance of physical activity are critical for blood glucose management and the overall well-being of older adults with diabetes. This approach includes all movement that increases energy use in the body and is observed to delay the onset of type 2 diabetes. Numerous studies have focused on the role of physical activity in preventing diabetes mellitus in young and older adults. Sun et al., 2020 observed that older people with regular physical activity better control their blood glucose levels through different mechanisms. Physical activity improves metabolic flexibility in skeletal muscle leading to the prevention of diabetes. These observations are consistent with findings from Bigelow and Freeland (2017) who observed that lifestyle changes and weight reduction are the first lines to diabetes management. Healthy eating, physical activity, and weight reduction are crucial to addressing diabetes in older adults. Weight loss is observed to reduce the risk for cardiovascular complications and is an important approach to achieving glycemic control goals (Bigelow & Freeland, 2017). despite the availability of this evidence, clinicians should individualize care to specific patient needs and abilities.

The prevention of type 2 diabetes using lifestyle changes is a well-known strategy since the 1980s. Recent guidelines for the prevention of the disease have recommended early screening, treatment, and prevention of the disease using physical activity approaches. For example, Davidson et al (2021) summarize the US preventive Taskforce recommendations on weight management whereby physical activity is a central theme. Apart from this measure, the authors observed that screening for diabetes is an important factor in the early identification and prevention of the disease. Universal screening for all adults aged 45 years and above regardless of the risk factors is recommended by the American Association of Endocrinology (Davidson et al., 2021). To guide the application of these strategies, testing for prediabetes and diabetes can be done using fasting plasma glucose levels, glucose tolerance tests, or HbA1c levels.

Nutrition and Lifestyle Changes

The interest in preventing diabetes through lifestyle changes has existed for decades, yet is difficult to implement. In 2004, the Diabetes and Nutrition Study Groups (DNSG) identified the relevance of nutrition in managing diabetes and many studies have followed ever since (Uusitupa et al., 2019). A systematic review and randomized controlled trial were conducted to ascertain that lifestyle changes prevent type 2 diabetes. A total of 5286 articles were identified for the study and 166 met the inclusion criteria. From these articles, the researchers observed that lifestyle change primarily delayed the onset of type 2 diabetes in older adults. In another approach involving the use of RCTs, the use of interventions like exercise, a healthy diet, and combined therapy reduced the risk of diabetes by 38% (Uusitupa et al., 2019). Additionally, the use of these interventions served a great purpose in preventing cardiovascular disease and microvascular complications of diabetes. The use of a healthy diet and other lifestyle changes like exercise was observed to improve glycemic control due to the correction of insulin resistance.

Effectiveness of Diabetes Prevention 

The prevention of diabetes in older adults is associated with benefits like the delayed onset of the disease and reduced incidence of glucose intolerance. A systematic review conducted in the UK aimed at analyzing the benefits that can result from applying diabetes preventive strategies in adults. One of the themes that emerged was improved glycemic control after implementing diabetes control and prevention programs (Ashra et al., 2015). There was an emphasis on the use of diabetes prevention programs to manage weight and reduce HbA1c levels. Effective diabetes prevention programs should include behavior changes, self-regulatory change measures, six or more contact hours with individuals, and the use of motivational techniques (Ashra et al., 2015). Additionally, it was observed that the use of social support systems and group interventions achieved better results.

Summary

Although mounting scientific evidence provides many solutions to diabetes prevention, there exist gaps in the application of this knowledge to prevent type 2 diabetes in older adults. The above evidence identifies key interventions like physical activity, exercise, dietary modification, and the use of diabetes prevention programs to manage the disease. The gaps related to this topic mostly involve optimal glycemic control among elderly patients with diabetes mellitus. With all the lifestyle interventions and medication, nearly half of the elderly are not maintaining or achieving appropriate target blood glucose levels leading to rapid disease progression (Bellary et al., 2021). This project will fill the gap and propose evidence-based interventions that can prevent type 2 diabetes and reduce the need for medication use. This research will contribute to the identified evidence by identifying how lifestyle changes can be used to prevent type 2 diabetes in older adults. The research will test the use of approaches like exercise and physical activity among older adults to manage weight and control blood glucose levels. Additionally, this research will provide insight into the role of diabetes prevention programs in delaying the early onset of diabetes and the development of complications in older adults.

PICOt Question

State your PICOt question here. Use the elements of the PICOt in separate sections below to describe each component.

·         Population – Provide the description of the targeted population.

·         Intervention – Describe your evidence-based intervention.

·         Comparison – What is currently happening?

·         Outcomes – List at least two (2) measurable outcomes.

·         time – What duration of the study for the project? (e.g., usually 6 months or 3 months)

Population (P): The target population are adults aged 60-70 years with type 2 diabetes or prediabetic A1C 5.7-8.0 who currently receives diabetic care at Eventus Health.

Intervention (I): Implementation of physical activity and exercise among older adults aged 60-70 years with type 2 diabetes or prediabetic.

Comparison (C): Tight glycemic control with exercise for older adults with type 2 diabetes.

Outcomes (O): The primary goal is to prevent prediabetic patients developing type 2 diabetes. The second goal is to promote weight loss that can ensure better blood glucose control by increasing insulin sensitivity in the body.

Time (T): The time required to achieve the outcomes is six months.

[75 to 100 words]

Address the following questions/bullets in completing this section:

·         Who is your target population?

·         Describe your population, i.e., age, ethnicity, gender, condition/diagnosis, etc.?

·         Describe the setting where this project be implemented?

[100 to 200 words]

Address the following questions/bullets in completing this section:

·         What are you planning to investigate or implement as a policy/process or program?

·         What are you doing that is different than what is currently happening?

·         List 2-3 potential actions that will be applied in this practice change.

NOTE: Be very specific in your description.

*For purposes of this Proposal Project Form the assumption will be that the C (Comparison Group) is ‘traditional care or current care’

[100 to 150 words]

Every project is required to have an evaluation plan. Address the following questions/bullets in completing this section:

·         Which 2-3 outcomes are expected for your project?

·         What outcomes will be measured?

o   How do you plan to do this?

o   What tool will you be using to measure your outcome(s)?

o   What data will be used to validate success of the project?

Be sure your outcomes link to the identified problem.

·         How will you know if your intervention resulted in change?

The primary outcome of this project will be the effective control of blood sugar levels for patients seeking care at Eventus Health. It is anticipated that the selected patients will be able to maintain HbA1c levels below 7% as recommended by the American Diabetes Association (Davidson et al., 2021).

The secondary outcome upon implementation of exercise and physical activity will be weight reduction among the study population. Ashra et al. (2015) explain that weight loss can ensure better glucose control by increasing insulin sensitivity in the body.

The outcomes that will be measured include the patient’s weight and HbA1c levels. The HbA1c levels done in the laboratory every three months and the weight loss chart collected during routine visits will be used to measure success. Each individual’s data will be charted and compared to previous results at the end of the study period.

[200 to 250 words]

·         Provide a summary for your MSN Capstone Project.

·         Select and provide the rationale for three (3) competencies or specialty standards that you would expect to use in implementing this project [List of your specialty competencies are listed in the Week 9 Reflection Post]

9. 2 References

[Minimal of 5 research articles and references are paged on the last page.]

·         Add your references in APA formats on the last page.

The three competencies I will use to implement this project include:

Competency 1 – Scientific Foundations Competencies. This competency allows for the critical analysis of data and evidence for improving advanced nursing practice.

Competency 3 – Quality Competencies. I will use this competency to analyze how diabetes control can reduce costs and improve the quality of life of patients.

Competency 4 – Practice Inquiry Competencies. This competency ensures that advanced nurse practitioners understand research materials and translate the information into practice. I will review the literature to ascertain the relevance of diabetes control and how exercise and physical activity can help older adults to control type 2 diabetes.