Mediator Role of Memory Function on Diabetes Self-Care Management in Older Adults

Purpose: Memory function is important to perform the special intended tasks. Diabetes self-care composed of several complex tasks such as regularly check the glucose monitor, balance of diet and physical activity, and foot care. For improving diabetes self-care, higher diabetes self-efficacy as an essential factor was emphasized in studies. Despite of having higher self-efficacy in cognitively intact older adults with diabetes, individual behaviors on diabetes self-care is not same level. In order to transfer the intended behavior from self-efficacy, memory should be embedded. Memory function may help the self-initiated behavior such as diabetes self-care. However, little empirical evidences regarding the effects of memory function on self-efficacy and self-care management was found in adults with diabetes. Therefore, this study was to identify the role of memory function on the relationship between diabetes self-efficacy and self-care behavior for older adults with diabetes.

Hypothesis 1: Diabetes self-efficacy and memory function will significantly associate with diabetes self-care management.

Hypothesis 2: The relationship between diabetes self-efficacy and self-care management will be mediated by memory function.

Methods: The descriptive cross-sectional study design was conducted with a sample of 259 older adults (+65 years) with diabetes. Using structure equation model, the direct effect of diabetes self-efficacy and memory function on diabetes self-care management was estimated. After then, indirect effect of diabetes self-efficacy on self-care management after controlling for memory function as a mediator was estimated in the path diagram.

Results: The mean age of participants was 72yrs, and the mean year of diabetes was 12 yrs.

Hypothesis 1: Diabetes self-care management was positively associated with self-efficacy (r=0.55, p<.001), whereas memory function was negatively correlated with diabetes self-efficacy (r=-0.19, p=.003) and self-care management (r= -0. 29, p<.001) in correlation matrix. The hypothesis 1 was confirmed

Hypothesis 2: Diabetes self-efficacy significantly predicted the diabetes self-care management (β = 0.79, p = .009) and memory function (β = -0.22, p=.006) in older adults with diabetes. Lower memory function was also significantly associated with greater self-care management (β = -0.20, p = .043). However, when memory function was entered as a mediator in the relationship between diabetes self-efficacy and self-care management, the direct effect between two was changed from β = -0.79 (p=.009) to β =0.04 (p = .017). That is, the memory function was a partial mediator between diabetes self-efficacy and self-care management in older adults with diabetes. Thus, hypothesis 2 was confirmed.

Conclusion: A structural equation model confirmed the mediator role of memory function on the relationship between diabetes self-efficacy and self-care management in older adults. Therefore, for improving the diabetes self-care management in older adults with diabetes, health care provider should consider not only to enhance the diabetes self-efficacy but also to monitor individual function of memory in older adults.