Article written by Catherine Clair

Is it a good idea to go back to school?

A mentor once told me, “Go back for more school when you have questions that you cannot answer with your current education.”

Back in 2019, I decided that I had questions I could not answer with my current education, and I applied for the doctoral program at the Johns Hopkins School of Public Health in the Department of Health, Behavior and Society. I started the program in Fall 2020.

At first, I was interested in understanding the triadic care relationship: This is the relationship between an older adult, healthcare provider, and family or friend caregiver. However, over my first year, I took classes that pushed me to learn, and my ideas changed. I had more questions:

• What if the older adult does not have any family or friends involved in their care?
• What if the older adult had more than one family or friend involved in their care?
• How many older adults only have one healthcare provider?

I realized that my original thinking was not big enough. I rephrase my ideas and thought, “What if these care relationships are healthcare networks?

Tips for Students at Johns Hopkins School of Public Health

As new doctoral students, we have the opportunity to take classes in various departments. Push yourself to take classes that seem new, different, or interesting. You never know how that knowledge will inform your research questions. Be flexible and allow your ideas and thoughts to shift and change. Bringing together thoughts and learning from different disciplines makes our research and science stronger.

My research on the relationship between an older adult, healthcare provider, and family or friend caregiver

For my research, I apply social network methods and analysis to measure personal and professional healthcare networks. Our personal healthcare network is made up of our family, friends, and neighbors. Our professional healthcare network is made up of doctors, nurses, social workers, chiropractors, direct care workers, and other professionals.

I proposed that the two smaller networks create a larger healthcare network: The social-medical network. This social-medical network may be related to using healthcare services, like the emergency department and urgent care.

My PhD study was focused on measuring the social-medical network of older adults living with type 2 diabetes. I completed data collection with 122 older adults living with type 2 diabetes. Over half of my sample identified as non-White and reported fair to poor physical health. About half were experiencing monthly financial strain. From this work, I found that having family and friends integrated with healthcare providers was protective against using the emergency room. This means that when family and friends were more connected with their healthcare providers, older adults living with type 2 diabetes used the emergency department less.

What is Type 2 Diabetes? Type 2 diabetes is a common health condition for older adults and can impact people’s lives in different ways. Type 2 diabetes is when your body cannot use insulin correctly and sugar builds up in your blood. For some people, their diabetes management is a positive experience, and they feel that they have a handle on their illness. But for other people, diabetes can be very challenging to manage. Type 2 diabetes can have serious effects on your body, including your heart, brain, and limbs. Some people need to have parts of their bodies removed or amputated due to condition. It can be constant challenge to check your blood sugar and make sure that your levels are not too high over the day and even in the middle of the night. This condition is very tricky to manage.

Why Do I Study Older Adults Living With Type 2 Diabetes?

Type 2 diabetes impacts older adults who have a hard time managing their condition. I want to create a better world for older adults with type 2 diabetes – in the present and for the future. I have had many family members and friends struggle to manage their diabetes. Prevention of type 2 diabetes is as important as managing this condition, and I want to make sure they are living their best lives.

My goal in improving quality of life for older adults with Type 2 diabetes

My goal is to improve the healthcare networks of older adults living with type 2 diabetes through their personal and healthcare networks.

• Personal Healthcare Network For some people, they do not have family or friends involved in their care. For these older adults, we want to focus on building community. We recommend strengthening connections with family and friends. It can be hard to open up with family and friends about things you need, like help around the house or driving to medical appointments. But stronger community can give you more support.

• Professional Healthcare Network For others, they do not have healthcare providers. For these older adults, we want to focus on engaging or reengaging with care. We recommend finding providers that you feel listen to you and value what matters most to you. Consider seeing healthcare providers who you can afford or who participate with your health insurance plan. If you are unsure, you can always call the provider’s office and the number on the back of your insurance card to make sure that they take your insurance.

• Integration of Family and Friends With Healthcare Providers Some older adults have family and friends, and they have healthcare providers. But these two groups are not connected. From my research, having family and friends integrated with healthcare providers was protective. Think about sharing your primary care provider’s name and phone number with trusted family and friends – just to start!

• Download the results of my project to see how it is helping older adults. We recruited 122 participants!

Resources for Type 2 Diabetes for Older Adults: Prevention and Management

For those who need community resources to prevent and manage this condition, there are resources available in Baltimore and Maryland communities. Here are several available resources that I want to share:

Food and Healthy Eating

To learn what foods to buy in the grocery store and what foods meet our health needs to manage type 2 diabetes: Giant Supermarket has a program to help people learn how to read nutritional labels and pick foods that are good for their bodies. Email: healthyliving@giantfood.com or call them at 301-341-4222 for more information about their program.

Free phone app to track what you eat: MyFitnessPal allow you to track what you are eating and how much. You do not need to pay for a subscription. If you want more features than the basic version, you can always pay for the additional app features.

Classes and Education for Older Adults

The Johns Hopkins Brancati Center offers classes related to type 2 diabetes prevention and management. They believe in community care and have served over 3,000 people in the local Baltimore and Maryland community. You can email them at brancaticenter@jhmi.edu or call them at 410-614-6441 for more information about their classes.

There are Diabetes Self-Management Programs offered across the state of Maryland. These programs and classes help individuals gain knowledge and skills to manage their diabetes effectively, improve overall health, and prevent or delay complications. They can also help connect people with resources related to dementia or cognition and other social determinants of health. If you are interested in joining one of these programs, you can find their information at this link: https://mdlivingwell.org/hub/

General Health and Support Services for Older Adults

The number to call for residents in Maryland who need to be connected to different services, including diabetes prevention and management, mental health support, and housing or aging services: call 211, which will connect you with specialists who can direct you to the right service for you.

If you have long-term care needs and you are not sure where to start, you can always call Maryland Access Point (MAP) at 1-844-627-5465. This service offered by the Maryland Department of Aging. MAP specialists work with caregivers, professionals, and all individuals with long-term care needs to plan, identify, connect, and assist with accessing private and public resources for long-term services and supports.