Snapshot of Diabetes Risk, Risk Awareness, and Lifestyle Change Factors in Older Adults Attending Delaware Senior Centers

Diabetes prevalence increases with age.Senior centers offer an opportunity to reach communitydwelling older adults to educate them about diabetes and its prevention.Objective.The objective of the study was to examine diabetes/pre-diabetes occurrence, risk factors, and awareness, and lifestyle behaviors; and compare lifestyle behaviors in three diabetes risk-related subgroups (diabetes, lower risk; higher risk) in older adults attending senior centers.Methods.A single occasion cross-sectional self-report survey was conducted at two Delaware senior centers.A total of 159 individuals participated in the survey.Results.Demographic characteristics were: 76.08 years old on average (SD = 7.89); 77.4% female; 1.9% Hispanic/Latino/Latinx; 84.2 White, and 13.3% Black/African American.Of this sample, 20.0% self-reported a diabetes diagnosis, 66.3% without known diabetes may have increased risk, and 29.8% were aware of their diabetes risk.Furthermore, more than half reported a lack of knowledge about pre-diabetes.For lifestyle behaviors, 73% reported being in the action/maintenance stages of change for physical activity, 53%-72% across areas of healthy eating, and 93% were nonsmokers.No significant differences were found between risk groups for these lifestyle areas.Conclusions/Policy Implications.These findings suggest potential gaps in older adults' awareness of diabetes risk and opportunities for promoting healthy lifestyle behaviors.Senior centers offer a convenient opportunity to reach older adults, to offer tailored approaches to address gaps in their awareness of pre-diabetes and diabetes risk, and to link individuals with current senior center, state, and other programs to further support diabetes prevention in older adults.Doi: 10.32481/djph.2026.03.13 diabetes incidence continued for the lifestyle group at 10-year and 15-year follow-ups. 4,5The National Diabetes Prevention Program (NDPP) is a national initiative developed by the Centers for Disease Control and Prevention (CDC) to disseminate the effective one-year intensive lifestyle intervention. 6This program has also been endorsed by the Centers for Medicare and Medicaid Services.Delaware currently has multiple organizations, including the University of Delaware, listed in the CDC registry of diabetes prevention programs with availability of both in-person and distance learning options.In-person delivery options are currently available in each county, and some organizations offer their program in multiple locations.In addition, the Medicare Diabetes Prevention Program is now available to specifically reach older adults, and multiple organizations in Delaware are Medicare Diabetes Prevention Program suppliers.Given the greater risk of diabetes in older adults and the positive impact of the DPP lifestyle intervention, tailored efforts are needed to reach older adults to educate them about risk factors and connect them with available programs and services (e.g., NDPP).Senior centers offer a convenient location to reach community-dwelling older adults to raise awareness about diabetes and its prevention.Research is needed to better understand risk and risk awareness in older adults to maximize the potential opportunity to reach and impact older adults in Delaware at risk of diabetes.Therefore, the purpose of this study was to better understand diabetes risk, risk awareness, and relevant lifestyle behaviors in older adults attending Delaware senior centers. Methods Study ObjectivesThe primary study objectives were (1) to examine diabetes/pre-diabetes occurrence, risk factors, and lifestyle behaviors; (2) to examine lifestyle behaviors and attitudes across diabetes risk subgroups, including those with diabetes, at higher risk for diabetes, and at lower risk for diabetes; and (3) to examine the awareness of diabetes risk and current efforts to address risk. DesignThis study used a single occasion cross-sectional self-report survey. Recruitment and ParticipantsIndividuals were recruited through electronic newsletters, sent by the senior center directors, fliers posted at the center sites, and through in-person recruitment at two Delaware senior centers in New Castle County.All senior center members, staff, and guests over 60 years of age who were interested were eligible to take part in the survey.Individuals were informed of the survey's purpose and that it was anonymous and voluntary.Participants were provided with a $10 gift card to a local store for participation in the survey.The study protocol was reviewed by the University of Delaware Institutional Review Board and determined to be exempt. Survey and Implementation.The self-report survey included questions about sociodemographic characteristics, diabetes risk factors; diabetes or hypertension diagnosis; health status; lifestyle behaviors; awareness of diabetes risk factors and Diabetes Prevention Lifestyle intervention.Doi: 10.32481/djph.2026.03.13 Demographics.Demographic and health status items were generally taken or adapted from the Behavioral Risk Factor Surveillance System. 7Diabetes Risk.The American Diabetes Association (ADA)/CDC's Risk Test question responses were collected and used to calculate the participants' risk scores.The Risk Test is based on seven questions related to age, gender, family history of diabetes, physical activity, weight, hypertension, and personal history of gestational diabetes. 8Zero to three points are assigned based on the presence of each risk factor, and points are summed to create the score.The scoring indicates that an individual who scores 5 or higher is at increased risk for having pre-diabetes and at high risk for type 2 diabetes.For this study, those with scores below 5 were identified as "lower risk" and those with scores of 5 or greater were identified as "higher risk".Research on pre-diabetes/diabetes risk tests has demonstrated the utility and validity of these screening tools in various populations. [9][10][11] Stages of Change for Lifestyle Factors.Stage of change questions based on the Transtheoretical Model 12,13 were used to examine participant's intentions or engagement in each health behavior.Questions addressed the following behaviors: eat five or more fruits and vegetables per day, eat whole grains, avoid high fat proteins, avoid high fat dairy, avoid sugary drinks, and engage in 30 minutes of physical activity per day.Participants were asked to select one of the following responses related to intention or engagement in each behavior: "No, and I do not intend to start in the next six months" (i.e., precontemplation stage); "No, but I intend to start sometime in the next six months (i.e., contemplation stage); "No, but I intend to start in the next month" (i.e., preparation stage); "Yes, I have been but for less than 6 months" (i.e., action stage); and "Yes, I have been for 6 months or more" (i.e., maintenance stage). Lifestyle Factors and Risk Awareness.The following open-ended question addressed knowledge of pre-diabetes: "What do you know about pre-diabetes?".Participants were also asked "If you were told by a healthcare professional that you are at risk of diabetes, did you try any of the following.Check all that apply".Checklist responses included: lose weight, get more physical activity, eat less, eat more fruits and vegetables, eat less fried foods, dine out less, eat less fast food, eat smaller portions, cut back on fat intake, cut back on calorie intake, drink less sugary beverages, drink more water, read nutrition labels, get more aerobic exercise, walk more, and sit less.Several questions about lifestyle behaviors were also taken from the Summary of Diabetes Self-Care Activities measure. 14These questions focused on the number of days per week that the individual followed a healthful eating plan, ate at least 5 fruits and/or vegetables, ate high fat foods, and engaged in 30 minutes of physical activity.In addition, for those informed of diabetes risk by a provider, survey questions addressed their engagement in lifestyle change strategies to address diabetes risk.