A qualitative study of Finnish diabetes specialist nurses’ experiences and perceptions of the impacts of cognitive impairment in older adults with type 1 diabetes

Background: Individuals with type 1 diabetes (T1D) are increasingly living into older age, when cognitive impairment (CI) may co-exist. T1D further increases the risk of CI, which can result in physical, psychological, and social impacts in the individual, their families, and/or informal carers. These factors also present professional challenges for the healthcare professionals (HCPs) who support them. Diabetes specialist nurses (DSNs) are well positioned to provide insights on the impact of CI in this group, suggest potential support solutions, and identify care delivery pathways aimed at improving outcomes. Previous research in this area is very limited. Methods: Data were collected via individual semi-structured interviews with a purposive sample of eight Finnish DSNs, with experience of working with older adults with T1D and CI. Interviews were audio-recorded and transcribed verbatim. Inductive thematic analysis was conducted to analyse the data. Findings: Four key themes were identified: 1) indicators of CI; 2) impact of CI; 3) professional challenges; 4) solutions and care delivery. Our findings suggest a lack of consistent CI screening practices in this group and multiple impacts on an individual’s ability to self-manage. Potential hazards and increased care needs, in turn, affect their families/close social networks, as well as care providers. Participants suggested several solutions, including: the value of a consistent therapeutic nurse/patient/family relationship, non-stigmatising early screening and identification of CI, advanced care planning, and patient education involving the person and their families. Incorporating a multi-disciplinary team approach, and the development of CI-specific education and guidelines for carers, HCPs, and policy makers, were identified as key priorites. Conclusion: There are several impacts of T1D complicated by CI. However, our participants were able to identify mitigating strategies and solutions that deserve further exploration and implementation. Whilst this study was based in Finland, the results may be applicable to other geographical locations with similarly increasing prevalence rates of CI in T1D.