The Only Way Out Is To Die: Perceptions and Experiences of Rural, Homebound, Older Diabetics

The purpose of this phenomenological study was to investigate the meaning of diabetes, as perceived and experienced by rural, homebound, 65-year and older, diabetics requiring insulin. The sixty-five year and older persons are disproportionately affected by diabetes. They are more likely than younger diabetics to have co-morbidities, disabilities and difficulty preventing diabetic complications. Guidelines for diabetes management and treatment developed by the American Diabetes Association are not specifically targeted for the 65-year and older population. Phenomenological research was used to examine and describe the understanding of diabetes from perspectives of older diabetics.

A purposive sample of participants was recruited from Senior Agencies referrals in a Southern State, following University of Tennessee Institutional Review Board approval. Participants were 65 years of age or older, female, required insulin, homebound, lived alone, lucid, English speaking, and willing to participate. Unstructured, audiotaped, face-to-face interviews were conducted individually in each person’s home. Thomas and Polio’s (2002) phenomenological method, which begins with bracketing, was used for collecting and analyzing the qualitative data in this study. Data was reviewed by the researcher and selected transcripts were read aloud to members of an interpretive, interdisciplinary, phenomenology research group at The University of Tennessee, Knoxville, to determine emerging themes described by the participants. The group assisted the researcher in identifying thematic structures from the data.

This phenomenological study revealed that diabetes had forever changed lives. Four figural themes emerged; the predominant theme was “you just go on.” Remaining themes were: “your body will let you know: if you miss it you’ll wind up in a coma;” I thought I was fine, but I wasn’t;” and “only way out is to die.”

Participants seemed pleased to have the opportunity to describe their experiences to a professional health care provider. Their perceptions and experiences of living with diabetes led to introspection and existential questioning. The participant’s experiences were unique in quality and meaning.

Based on the outcome of this study, this population requires a different approach to diabetes self-management. Understanding an older person’s perceptions and experiences with diabetes may provide a foundation for considering new diabetic protocols. Nursing interventions could include diabetes regimens planned with consideration of the context of the person’s life, which could be more efficacious than conventional regimens.