Research and apply evidence to practice
Plan the research activity
“How does Diabetes affect the cognitive
performance in older people?”
is the decided research topic. This research topic has been prepared from two
important areas of diabetes mellitus and older people.
This topic has been chosen as diabetes
is the key risk factor for developing dementia of both neurodegenerative
(Alzheimer) and vascular etiology. The Type 2 diabetes is directly linked with
over 1.5- to 2.5-fold rise in the dementia risk. Greater later-life cognitive
decline has been linked with prediabetes, longer disease duration, and poor
control (Munshi, 2017). Type 1 diabetes patients reported diminished mental
flexibility and slower mental speed in older people. Moreover, the type 2
diabetes patients represent decline in their attention, executive function, psychomotor
efficacy, memory, and learning. This needs deeper research on the presented
topic because as per Australian Bureau of Statistics (ABS) 2014–15 National
Health Survey (NHS), over 1 in 6 people of age 65years are diabetic (ABS, 2015).
Diabetes rate increases with age having highest prevalence as 19.4% in people
of age 85years and above. Thus, the chances of cognitive decline also increase
in this age group (AIHW, 2017). The mental health and diabetes specialists must
work together to define how diabetes impact cognitive functions in older
Identify the reason(s) for
undertaking your research.
This research has been conducted to
extend one’s knowledge for strengthening … nursing role to provide improved
mental healthcare education and service provision to older diabetic people in
Australia. This defined research study will support in understanding the mental
healthcare models most suitable to support older people with diabetes health
problem in the aged care service centres.
Write a clear statement
highlighting your research question or hypothesis.
“How does Diabetes affect the
cognitive performance in older people?”
Establish and define the
general research objective.
The research aims at examining the
impact of diabetes and its treatment on the change of the measures of the
cognitive domains in older people. It will also seek to find whether the
cognitive impairments are same or different in older people with and without
Identify ONE (1) other
discipline that could be connected to this research activity.
The first discipline connected to
this research activity is gerontology which is the key focus workplace. The
other discipline connected to this research activity could be mental health as
the research topic is directly related with cognitive issues in older people
due to diabetes issues.
List two (2) sources you may
use for this assignment.
1à Pubmed Central- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853928/
2à Brain Foundation Organization- http://brainfoundation.org.au/images/stories/applicant_essays/2013_essays/Dementia_Diabetes_Brodtmann_Amy.pdf
Evaluate and select a maximum
of two (2) methods of gathering information you think would be most appropriate
to answer your research question.
This research data will be gathered
from two different methods of conducting the deep literature review and also
making use of multiple search engines with the application of the accurate and
highly suitable keywords relevant for the research study. This process has the
initial step of conducting the clear and precise search through keywords which
will be followed by the conduct of literature review. These two methods have
been cost and time efficacious providing more data with higher relevance in
terms of the research topic. Other available methods to collect data are quite
time consuming and expensive.
Select 4 sources
Herath, P.M., Cherbuin, N., Eramudugolla, R. and Anstey, K.J., 2016. The
effect of diabetes medication on cognitive function: evidence from the PATH
Through Life study. BioMed
research international, 2016.
The article is relevant as its
research objective is directly linked with the prepared resrecah topic
objective. The aim is of this research paper is to examine the effect of
diabetes treatment on change of measures of specific cognitive domains over 4
years. It has become more relevant as it has sampled the research population
from a cohort study in Australia and measured their cognitive health through 10
neuropsychological tests. This assures high quality and reliable data. The
article becomes more applicable and relevant as its authors have been supported
by the Centre for Research in Ageing Health and Wellbeing from the Australian
Samaras, K. and Sachdev, P.S., 2012. Diabetes and the elderly brain:
sweet memories?. Therapeutic
advances in endocrinology and metabolism, 3(6), pp.189-196. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539178/
The article is revenant as it
summarizes the evidence in terms of changes that occur in the brain function as
well as structure in the type 2 diabetes mellitus primarily focused on studied
conducted on aged population. The systematic review conducted in this research
is valuable as it has reviewed the literature by collecting and critically comparing
multiple research studies from different decades. The data provided by this
research is appreciable and relevant for inclusion because its authors belong
to the Garvan Institute of Medical Research in the Department of Endocrinology
from St Vincent’s Hospital in Australia. Its data is generalizable to
Australian elderly population.
Moore, E.M., Mander, A.G., Ames, D., Kotowicz, M.A., Carne, R.P.,
Brodaty, H., Woodward, M., Boundy, K., Ellis, K.A., Bush, A.I. and Faux, N.G.,
2013. Increased risk of cognitive impairment in patients with diabetes is
associated with metformin. Diabetes
article is presenting efficient data to explore because it is investigating the
associations of metformin, calcium supplements, and serum vitamin B12 with the
cognitive impairment in diabetic patients with diabetes. This article becomes
highly critical and valid because the participants had been recruited from popular
two prospective studies of the Australian Imaging, Biomarkers and Lifestyle (AIBL)
study of aging and the Prospective Research in Memory (PRIME) clinics study.
Moreover, it has studied 862 participants between 2001 and 2011 defining more
accurate results and generalizable outcomes. The use of mini-mental status
examination (MMSE) format assures the outcomes to be more appropriate because
it is a standardized mental health assessment tool. Moreover, the support of the
University of Melbourne, Barwon Health, National Ageing Research Institute,
Deakin University School of Medicine, University of New South Wales, Prince of
Wales Hospital, Heidelberg Repatriation Hospital, the Queen Elizabeth Hospital,
Centre of Excellence for Alzheimer’s Disease Research & Care, Austin
hospital, and Hollywood Private Hospital in this study makes this article
attain the peak of standardization, criticality, and reliability.
Han, M., Huang, X.F., Xiu, M., Kosten, T.R. and Zhang, X.Y., 2013.
Diabetes and cognitive deficits in chronic schizophrenia: a case-control
study. PloS one, 8(6), p.e66299. http://ro.uow.edu.au/cgi/viewcontent.cgi?article=1880&context=smhpapers
This article is relevant primarily
due to its case control pyramid of evidence. It has compared the diabetic and
non-diabetic patients with schizophrenia to define the differentiation in their
cognitive impairments. This presents this article to be quite analytical in
approach. The relevance of the study increases to the peak with its application
of standardized tools like repeatable battery for the assessment of
neuropsychological status (RBANS) and following the criteria proposed by DSM-IV.
The results of this article are highly applicable in the defined research topic
also because two psychiatrists with >5years of clinical practice experience
and blind to the participant’s clinical status and treatment conditions were
made responsible to assess their psychopathology with the use of PANSS
(Positive and negative syndrome scale). There is no factor to define that any
part of this study is irrelevant or unreliable. The authors have been a key
stakeholder in University of Wollongong and Peking University enhancing data
Briefly explain why one (1) piece
of your information is particularly relevant according to your objectives and
your workplace requirements.
The study by Han et al. (2013) is
found to be most relevant for its high quality pyramid of evidence and
analytical approach. It has compared the diabetic and non-diabetic patients with
schizophrenia to present if diabetes results in more cognitive decline than
non-diabetic people or not. Moreover, it is totally supporting the research
topic with association with the research topic’s objective. In the aged care
workplace, several cases of diabetic people with disturbed mental health have
been reported specifically in people of age 50years and more. Even this study
has presented the comparison of cognitive prevalence in younger and older
people because it studied people of age 25 to 70years.
Prioritise information based on
the research objectives.
Two (2) articles prioritised for
support for the rest of the assignment are:
Herath, P.M., Cherbuin, N.,
Eramudugolla, R. and Anstey, K.J., 2016. The effect of diabetes medication on cognitive
function: evidence from the PATH Through Life study. BioMed research
international, 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853928/
Han, M., Huang, X.F., Xiu, M.,
Kosten, T.R. and Zhang, X.Y., 2013. Diabetes and cognitive deficits in chronic
schizophrenia: a case-control study. PloS one, 8(6),
Compare and contrast two (2) sources of information
Cherbuin, N., Eramudugolla, R. and Anstey, K.J., 2016. The effect of diabetes
medication on cognitive function: evidence from the PATH Through Life
study. BioMed research
Han, M., Huang,
X.F., Xiu, M., Kosten, T.R. and Zhang, X.Y., 2013. Diabetes and cognitive
deficits in chronic schizophrenia: a case-control study. PloS one, 8(6), p.e66299. http://ro.uow.edu.au/cgi/viewcontent.cgi?article=1880&context=smhpapers
The comparison of the cognitive function present between
the diabetes treatment groups represented no significant effect of
pharmacological treatment type on population’s cognitive function in
comparison to the diet only group or also known as the no diabetes group. Out
of these, the oral hypoglycaemic treatment only group with participants using
metformin alone presented improved cognitive function at baseline in terms of
the verbal learning, executive function, and working memory domains compared
to the participants on other kinds of diabetic treatment.
In comparison to healthy controls, every patient
group had substantially decreased total as well as five index RBANS scores
(all p,0.01–p,0.001), leaving the visuospatial/constructional index. Diabetes
with schizophrenia performed worse in comparison to without diabetes and schizophrenia
in immediate memory (p,0.01) along with total RBANS scores (p,0.05). This
also represented reduced attention trend (p = 0.052) and visuospatial/constructional
capacity (p = 0.063). As per the regression analysis, the RBANS presented modest
correlations with PANSS scores of schizophrenia, including their current
antipsychotic treatment duration, and diabetes diagnosis. More cognitive
impairment was seen in people with schizophrenia and having co-morbid
diabetes as compared to schizophrenia without diabetes and diabetes only, certainly
in attention and immediate memory.
Strength of Study
It is a longitudinal cohort study that falls under
the unfiltered resource. It has three cohorts including young (aged 20–24
years at baseline/Wave 1), midlife (aged 40–44 years at baseline/Wave 1), and
older (aged 60–64 years at baseline/Wave 1). All the cohorts have been followed
up twice at the 4 yearly intervals. This strength is efficient at reviewing the
existing data to ensure its reliability and validity.
It is a case control study. It is a kind of
observational study wherein two existing groups differed in outcome are identified and compared as per the
supposed casual attribute. It is an unfiltered resource. It is the first
stage of testing observations. It helps in identifying variables that can
predict a condition.
Relevance to Objectives
High- responsiveness to research question.
Moderate responsiveness towards the research
sample with three different age group cohorts.
reliability is definitely high due to its longitudinal study basis and
participants have been followed up twice at 4yearly intervals. This helps in
measuring stability of results.
level of variability.
participant’s cognitive health via 10 neuropsychological and standardized tests:
à Immediate Recall (first list of
California Verbal Learning Test)
à Wechsler Memory Scale-Digit Span
à Spot-the-Word (STW) Task
à Symbol-Digit Modalities Test (SDMT)
à Simple Reaction Time (SRT)
Choice Reaction Time (CRT)
àTrail Making Test, part A and part
à Purdue Pegboard Test (both hands)
Whitehall II study questionnaire
Heterogeneous sample (regions &
While recruitment, the diagnoses for
every patient was made by two experienced and independent psychiatrists and properly
confirmed by the Structured Clinical Interview for DSM-IV (SCID).
Higher level of variability.
Used the standardized assessment tool for
measuring neuropsychological status (RBANS).
Higher inter-rater reliability because
participant’s psychopathology has been assessed and analyzed by two
psychiatrists with >5years of clinical practice experience and blind to
the participant’s clinical status and treatment conditions with the use of PANSS
(Positive and negative syndrome scale).
Internal validity- Almost zero number of flaws as the PATH Through
Life model has been followed to conduct this longitudinal cohort study of
participants sampled from the electoral roll of the Australian Capital
Territory and Queanbeyan. This provided reliable and valid details about the
participants and even helped in examining multiple cognitive domains. But,
small follow up duration might have influenced the findings.
External validity- Generalized results because of studying a big sample
of 1814 participants with no reported selection bias.
Internal validity- Recruited participants by using a cross-sectional
naturalistic design to avoid any bias.
External validity- It is only generalized to regional people of Beijing
and Tangshang cities due to very small sample.
This is the first study which has examined the
impact of metformin on multiple cognitive domains within the longitudinal
cohort study design. Metformin appears to be protective against cognitive
function, but exact mechanisms are unclear.
It has given clear and concise knowledge about the
evidence that Schizophrenia with co-morbid diabetes have more cognitive
decline or impairment as compared to schizophrenia
without diabetes and diabetes only, certainly within the areas of attention
and immediate memory.
Applying this study and its results in the aged care
workplace will demand authority permission and might even get rejected due to
lack of solid base of this foundation.
It will be complex to apply these findings in the
aged care workplace because schizophrenia suffering patients have never been
reported here. Majority of the nurses working for aged people are also not
aware of this disorder and its key impacts on health.
Feasibility associated with information
The findings are surely applicable in every
healthcare workplace because of data assessed from standardized tools and analysis
through IBM SPSS (Version 22), and Generalized Linear Models (GLZM).
These findings are not directly applicable in the
workplace because this workplace has no patient suffering from schizophrenia
or any history of this mental disorder.
It is quite evident that diabetic people in older
population have more cognitive decline as compared to non-diabetic people. It
is essential to observe significant effect of any form of pharmacological
treatment for diabetes over the cognitive function, other than the evidence
available for metformin showing significant protective effect over the defined
domains of verbal learning, executive function, and working memory. Moreover,
schizophrenia in co-morbid diabetic people has higher cognitive impairments
that must be paid attention in aged care homes and mental health