Uncovering the Secrets to Healthier Living: A Socioecological Look at Diabetes in Rural Seniors

Summary of Key Findings

This research aimed to determine the elements linked to healthy lifestyle practices among elderly individuals with diabetes, utilizing a socioecological model as a conceptual framework. The study revealed considerable inequalities in the health profiles across five lifestyle categories: sleep, nutrition, physical activity, alcohol consumption, and smoking. Sleep, in particular, surfaced as a prominent health hazard, with only 14.71% of participants displaying healthy sleep patterns. Moreover, our findings suggest that the affecting factors primarily revolve around four dimensions: Personal Characteristics, Individual Actions, Community Environment, and Policy Framework. We believe that decision-makers should focus on these adjustable factors, diligently assessing their effects, and developing viable policy suggestions grounded in our results. Below are our reflections on the article.

Emphasize Sleep Health and Create Targeted Health Promotion Policies

Inadequate sleep correlates with an elevated risk of numerous chronic ailments, which has a profoundly negative impact on health¹⁵. On a worldwide scale, particularly in underdeveloped nations, sleep health is seldom prioritized within the public health agenda at a national level¹⁶. A growing number of elderly individuals are confronting sleep deprivation. Various studies have advised that middle-aged and older adults enhance sleep quality through measures such as increased exposure to natural light, engaging in physical activity, and participating in cognitive behavioral therapy¹⁷.

Health organizations should prioritize sleep health by integrating pertinent research findings into focused promotional and educational strategies for quality sleep. Effective techniques might include organizing health seminars and community education initiatives to elevate awareness of sleep health, utilizing telehealth and mobile health applications for effortless sleep tracking and advice, and implementing cost-effective psychotherapeutic approaches such as Cognitive Behavioral Therapy, which could prove highly beneficial. Moreover, it is strongly advised to incorporate sleep health into national public health strategies, ensuring customized intervention plans and financial aid for elderly rural populations. These initiatives hold significant potential to not only markedly enhance sleep quality among rural older adults with diabetes but also improve glycemic regulation and overall health outcomes.

Gender Disparities and Cognitive Function in Healthy Lifestyle Practices Among Elderly Individuals with Diabetes

Within the realm of Individual Characteristics, gender was recognized as a crucial factor affecting HLS among older adults living with diabetes. Prior research has indicated that gender differences in body composition lead to variations in bodily functions and lifestyle choices throughout a person’s life¹⁸. For example, disparities in body composition lead to significant differences in sleep habits between genders, with females generally reporting lower sleep quality¹⁹. When it comes to dietary preferences, men and women show variations in food selections, eating patterns, and nutritional approaches²⁰. Women are more likely to adhere to nutritionally balanced diets and lean towards healthier, low-fat foods, whereas men often choose foods high in sugar and fats. Activity levels also vary greatly, with females typically participating in less frequent and lower-intensity exercise than males. Regarding alcohol use, women not only drink less alcohol but also represent a smaller share of drinkers compared to men. Furthermore, women find it easier to quit drinking when they do consume alcohol²¹. In addition, while smoking rates are lower among females in rural settings, women generally exhibit greater success in curbing or quitting smoking compared to men²².

Cognitive capability also surfaced as a key factor influencing HLS. Research has confirmed a positive link between healthy lifestyles and cognitive performance in older adults, suggesting a reciprocated connection²³. Healthy lifestyles constitute a vital non-pharmaceutical intervention, significantly contributing to the preservation of cognitive abilities in elderly individuals²⁴. In contrast, HLS tends to be lower among those suffering from diabetic complications. Healthy lifestyles not only assist in the prevention of type 2 diabetes (T2D) but also considerably mitigate the risk of related complications^25,26,27. This indicates a mutual relationship between diabetic complications and lifestyle habits, where each can affect the other. Thus, it is crucial to advocate for the significance of adopting healthy lifestyles as part of diabetes prevention and management approaches to lower the chances of complications.

Considering the distinct lifestyle preferences and challenges that men and women encounter, it is essential to design tailored interventions that cater to these specific needs for effective diabetes management and cognitive preservation. For example, initiatives aimed at women can highlight nutritious eating habits by utilizing community workshops and online classes to promote the Mediterranean diet. These programs can encourage the intake of dark leafy greens, nuts, and fish, which are abundant in antioxidants and omega-3 fatty acids, while also providing financial support for purchasing healthy foods. On the other hand, programs targeted at men can emphasize physical activity, particularly through the introduction of strength training and high-intensity interval training (HIIT) sessions at community hubs or workplaces. Providing free or affordable access to fitness centers can further boost participation in these exercise routines. Such gender-responsive tactics not only resonate with the preferences and obstacles faced by each group but also present a more effective solution to tackling the intertwined problems of diabetes management and cognitive wellness.

Emphasize Adjustable Behaviors: Mitigating Depression and Enhancing Social Engagement

In the domain of Individual Behaviors, the study uncovered that individuals experiencing depression exhibited lower levels of HLS, potentially leading to unhealthy lifestyle choices. Several elements may clarify this observation. Firstly, those suffering from depression often endure reduced sleep durations, leading to diminished sleep quality²⁸. Secondly, depression correlates with a heightened desire for sweets, erratic eating routines, and overeating^29,30. Thirdly, individuals battling depression are more likely to smoke, and their success rates for quitting

smoking is markedly lower in contrast to smokers in the overall population^31,32. Fourth, studies reveal that persons with elevated subjective well-being are more inclined to participate in physical activities³³. Conversely, individuals experiencing depression, who generally exhibit diminished subjective well-being, frequently lack the drive and impetus to engage in physical activities and may partake in such activities less often or with reduced intensity. Extensive studies have shown that sustaining healthy lifestyles significantly diminishes the likelihood of depression. A favorable correlation exists between healthy lifestyles and depression, each exerting influence over the other.

Public health initiatives aimed at diabetes prevention and management should prioritize catering to the requirements of individuals experiencing depression. Customized interventions that promote and direct healthy lifestyle behaviors for this demographic could assist in mitigating the dual challenges posed by depression and diabetes. In rural settings, the intricacies associated with addressing depression are intensified by geographical isolation, economic inequalities, and a scarcity of specialized mental health services. Community-based initiatives could play an essential role in bridging these disparities by providing accessible and culturally relevant support. For instance, teletherapy services could offer remote counseling and therapy, overcoming obstacles pertaining to distance and transportation. Peer support networks, led by trained volunteers or healthcare professionals, could foster a sense of community and alleviate feelings of loneliness. Furthermore, integrating mental health services within primary care environments could ensure that individuals receive holistic care, with early detection and treatment of depression becoming a fundamental component of regular medical consultations.

This research also affirmed that elevated levels of social involvement were positively correlated with enhanced HLS in older adults with diabetes. Social participation is a crucial parameter of physical and mental well-being in older adults and underpins active aging. It fosters the development of healthy lifestyle behaviors, which can be reinforced through initiatives that promote greater social involvement among residents³⁴. For example, older adults exhibiting higher levels of social interaction often enjoy improved sleep quality³⁵. Ecological-level interventions may support physically inactive seniors by utilizing social activities and interpersonal connections to encourage heightened engagement in physical pursuits. Additionally, increased levels of social interaction are strongly linked to enhanced cognitive functions. Boosting and protecting cognitive capabilities can empower older adults to sustain healthier lifestyles³⁶. Promoting social engagement among older individuals benefits not only the individuals themselves but also their families and society at large, nurturing long-term commitment to healthy lifestyle habits³⁷. Public health institutions should acknowledge the significance of fostering social engagement and develop initiatives that enrich the activities and types of social experiences available to older adults to promote active aging and comprehensive wellness³⁸.

Utilizing community and policy strategies to enhance lifestyle choices and health outcomes

At the community level, we also identified that HLS was related to profession, income, and transportation. These findings align with prior research indicating that socioeconomic status, which includes education, profession, and income, greatly influences lifestyle decisions³⁹. Socioeconomic status significantly affects physical health, with lifestyle often serving as a mediating factor between socioeconomic variables and health outcomes. Research suggests that socioeconomic environments near workplaces can shape individuals’ health behaviors⁴⁰. For instance, a study in the United States evaluated how smoking, alcohol intake, and physical inactivity influenced the relationship between socioeconomic status and all-cause mortality, underscoring the complex interconnections among these factors⁴¹. Therefore, socioeconomic status and lifestyle behaviors exhibit a mutually dependent relationship that merits ongoing exploration.

At the policy level, this investigation unveiled that HLS was notably related to the type of health insurance, with insurance selections ultimately affecting both lifestyle behaviors and general health. Initially, different kinds of health insurance vary in their protection and coverage extent, which may influence patients’ access to and use of medical resources, subsequently affecting their health management awareness and behaviors. Moreover, the nature of health insurance may also indirectly shape patients’ lifestyle decisions by impacting their financial burdens. Additionally, studies concerning orthopedic patients have indicated that the type of insurance can affect health outcomes, such as recovery rates and reported quality of life⁴². Likewise, research on patients using left ventricular assist devices (LVADs) identified that payer type was associated with the incidence of adverse events, with patients covered by medical insurance exhibiting higher rates compared to those with commercial coverage⁴³. Another study in the United States investigated the influence of health insurance status and type on blood pressure management in women, highlighting the pivotal role of insurance in managing chronic conditions like hypertension.

In conclusion, the community should develop specific lifestyle promotion strategies based on occupational characteristics. Health training for agricultural workers should encompass diabetes prevention, nutrition, and exercise education. For non-agricultural workers, the community should provide health services and arrange activities to enhance social involvement. In terms of low-income populations, while the government enhances the medical assistance policy, the community should facilitate the identification and registration of eligible elderly diabetic patients, organize volunteers to assist with daily tasks such as purchasing healthy food and accompanying them to medical visits, and minimize their life stressors to concentrate on health. Regarding health insurance, as the government strengthens the system, the community should disseminate policy changes, and its personnel should support patients in insurance procedures and clarify inquiries, ensuring patients fully benefit from resources and entitlements. Through a combined approach of governmental policies and community collaboration in regard to occupation, income, and insurance factors, the influence of socio-economic elements on the healthy lifestyle of elderly diabetic patients can be mitigated, thereby improving their overall health and protecting their rights.

Strengths and limitations of the study

This research meticulously analyzed the elements impacting healthy lifestyles among older adults with diabetes in rural areas, presenting several noteworthy strengths. First, it was executed in a representative county in China, offering an extensive survey of all individuals aged 65 and over. The substantial sample size bolsters the credibility and applicability of the findings within comparable contexts. Second, the study included intricate and comprehensive indicators, providing meaningful insights into the diverse factors influencing healthy lifestyles within this demographic. These strengths offer a solid groundwork for understanding lifestyle determinants in rural elderly populations.

Nevertheless, the study does possess a few limitations. Firstly, its cross-sectional methodology limits causal conclusions surrounding healthy lifestyles and their related factors, reducing the robustness of evidence and necessitating cautious interpretation and application of the results. Secondly, this study utilized whole-cluster sampling and was a single-center study focused within a county. The research findings may be particularly relevant to similar administrative units. However, the results may be influenced by selection bias, constraining the generalizability of the findings and impacting their applicability to a wider population. While the findings offer valuable direction at the county level, extending these conclusions to broader regions, such as provinces or the entire nation, requires additional investigation and validation. Thirdly, while the socioecological model presents advantages in considering multifaceted factors, its limitations, including the assumption of factor independence and the omission of certain potential aspects, may influence result interpretation and the generality of conclusions, necessitating refinement or the integration of alternative methodologies in future inquiries. Fourthly, the study depended on self-reported data, which could introduce potential biases as participants might inaccurately portray their behaviors due to issues such as poor recall or social desirability, thereby impacting the reliability of the data, and to some extent, the accuracy of the research outcomes. Lastly, the discussion focused solely on the types of health insurance and did not comprehensively consider other policy factors that may influence the healthy lifestyle of older adults with diabetes. Future research that thoroughly considers additional policy dimensions would be advantageous in constructing a more nuanced policy intervention framework.