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fa از مراقبت تا توانمندسازی: خودمدیریتی مبتنی بر مدل 5A به‌عنوان راهبردی نوین برای ارتقای سلامت سالمندان مبتلا به دیابت From Care to Empowerment: 5A Model-Based Self-Management as an Innovative Strategy for Improving Health Outcomes Among Older Adults with Diabetes عمومى General پژوهشي Research مقدمه :دیابت یکی از مهم‌ترین چالش‌های نظام‌های سلامت است و در سالمندان به دلیل چندبیماری، کاهش عملکرد جسمی و افزایش خطر عوارض، نیازمند رویکردهای جامع و توانمندساز است. خودمدیریتی دیابت با تأکید بر مشارکت بیمار، تصمیم‌گیری و رفتارهای خودمراقبتی، نقش مهمی در بهبود پیامدهای سلامت دارد. این مقاله با هدف تبیین نقش و کاربرد خودمدیریتی مبتنی بر مدل 5A در ارتقای خودکارآمدی، کیفیت زندگی سالمندان مبتلا به دیابت و پیامدهای آن برای پرستاری و نظام سلامت انجام شد. روش کار:این مقاله به‌صورت مرور تحلیلی–روایتی انجام شد. منابع علمی مرتبط با خودمدیریتی دیابت، مدل 5A، آموزش و حمایت از خودمدیریتی دیابت (DSMES)، مراقبت بیمارمحور و نقش پرستاران در مدیریت بیماری‌های مزمن از پایگاه‌های معتبر PubMed، Scopus و Web of Science بررسی شدند. مطالعات منتشرشده در سال‌های اخیر که بر سالمندان مبتلا به دیابت، مداخلات خودمدیریتی، تغییر رفتار سلامت و کاربرد مدل‌های توانمندسازی تمرکز داشتند، انتخاب و تحلیل شدند. یافته‌ها:شواهد نشان داد که برنامه‌های خودمدیریتی ساختاریافته می‌توانند موجب بهبود خودکارآمدی، رفتارهای خودمراقبتی، کیفیت زندگی و کنترل بهتر بیماری در سالمندان مبتلا به دیابت شوند. مدل 5A با تأکید بر ارزیابی فردی، تعیین اهداف مشترک، شناسایی موانع، حمایت مستمر و پیگیری، بیمار را از دریافت‌کننده منفعل مراقبت به مشارکت‌کننده فعال در مدیریت سلامت تبدیل می‌کند. همچنین، اجرای این مدل موجب ارتقای نقش پرستاران از ارائه‌دهنده مراقبت به مربی سلامت، تسهیل‌کننده تغییر رفتار و هماهنگ‌کننده مراقبت می‌شود. از دیدگاه نظام سلامت، ادغام این مدل در مراقبت‌های اولیه و کلینیک‌های دیابت می‌تواند به کاهش عوارض قابل پیشگیری، بهبود بهره‌وری منابع و توسعه مراقبت ارزش‌محور کمک کند. نتیجه‌گیری:خودمدیریتی مبتنی بر مدل 5A می‌تواند به‌عنوان یک چارچوب تحول‌آفرین برای بازطراحی مراقبت دیابت سالمندان مورد استفاده قرار گیرد. این مدل با تقویت مشارکت بیمار، افزایش استقلال سالمندان و ارتقای کیفیت مراقبت، مسیر گذار از «کنترل بیماری» به «توانمندسازی فرد برای زندگی با بیماری» را فراهم می‌کند. با این حال، اجرای موفق آن نیازمند تدوین پروتکل‌های استاندارد، آموزش کارکنان سلامت، حمایت سیاستی و ایجاد زیرساخت‌های پیگیری مستمر است.   Background :Diabetes mellitus is one of the most significant public health challenges of the twenty-first century, and its burden is increasing rapidly among older adults due to population aging, longer life expectancy, and the growing prevalence of chronic diseases. Older adults with diabetes experience complex health challenges, including multimorbidity, functional decline, cognitive limitations, polypharmacy, increased risk of cardiovascular, renal, and ocular complications, and reduced independence in daily activities. These challenges place a considerable burden on healthcare systems and highlight the need for a transition from disease-centered management toward patient empowerment and sustainable self-management approaches. Traditional diabetes care models have primarily focused on monitoring biochemical indicators and providing medical recommendations; however, these approaches are often insufficient to achieve long-term behavioral changes and improve patient participation. Effective diabetes management requires active involvement of patients in decision-making, medication adherence, dietary management, physical activity, symptom monitoring, and problem-solving. Therefore, diabetes self-management has emerged as a fundamental component of chronic disease care, emphasizing patients’ ability to manage their health conditions, maintain healthy behaviors, and adapt to living with diabetes. The 5A model, consisting of five structured components including Assess, Advise, Agree, Assist, and Arrange, has been introduced as a patient-centered behavioral change framework that can bridge the gap between health education and sustainable behavior modification. Unlike conventional educational approaches that mainly focus on information transfer, the 5A model emphasizes individualized assessment, shared decision-making, goal setting, identification of barriers, continuous support, and follow-up. This approach may provide an effective framework for transforming nursing care from a traditional provider-centered model toward empowerment-oriented chronic disease management.This article aimed to explore the role and application of 5A-based self-management as an innovative strategy for improving health outcomes among older adults with diabetes and to discuss its implications for nursing practice and healthcare policy. Methods: This narrative review was conducted to analyze current evidence regarding diabetes self-management, the 5A behavioral change model, diabetes self-management education and support (DSMES), patient empowerment, and the role of nurses in chronic disease management. Relevant scientific literature was searched in major electronic databases, including PubMed, Scopus, and Web of Science. Recent studies published in the last five years were prioritized, with additional landmark studies included when necessary to provide theoretical and conceptual foundations.The search strategy included combinations of keywords and Medical Subject Headings (MeSH), such as: “diabetes mellitus,” “older adults,” “elderly patients,” “self-management,” “5A model,” “behavior change,” “patient empowerment,” “diabetes self-management education,” “nurse-led intervention,” and “patient-centered care.” Studies focusing on older adults with diabetes, structured self-management interventions, behavioral change strategies, nursing-led programs, and healthcare system implementation were included. Articles unrelated to diabetes management, non-peer-reviewed publications, and studies without relevance to patient empowerment or self-management were excluded. Findings:The findings indicate that structured diabetes self-management programs can significantly improve self-efficacy, self-care behaviors, diabetes knowledge, treatment adherence, and patient-reported outcomes among older adults. Evidence suggests that successful diabetes management requires interventions beyond conventional education and should incorporate individualized goal setting, problem-solving skills, motivational support, and continuous follow-up.The 5A model provides a practical framework for implementing these principles in clinical settings. Through the Assess component, healthcare providers can identify patients’ physical, cognitive, psychological, social, and economic needs. The Advise and Agree stages support personalized education and shared decision-making by establishing realistic and achievable health goals. The Assist component focuses on overcoming barriers and strengthening self-management skills, while Arrange ensures continuity of care through regular monitoring and follow-up.The application of the 5A model can also contribute to redefining the professional role of nurses. Nurses, as the largest group of healthcare professionals and the providers with the closest and most continuous contact with patients, have a unique position in implementing empowerment-based interventions. Through assessment, counseling, coaching, and coordination of care, nurses can facilitate behavioral change and enhance patients’ ability to manage diabetes effectively. From a healthcare system perspective, integrating the 5A model into primary care, diabetes clinics, and elderly health programs may support value-based healthcare by reducing preventable complications, unnecessary healthcare utilization, and disease-related costs. However, successful implementation requires organizational readiness, standardized clinical protocols, workforce training, digital follow-up systems, and supportive health policies. Conclusion:Self-management based on the 5A model represents a transformative approach for improving diabetes care among older adults by shifting the focus from disease control to patient empowerment. This framework enables individuals to actively participate in managing their condition, improves self-efficacy, and promotes sustainable health behaviors. For nursing practice, the 5A model provides an opportunity to expand nurses’ roles from care providers to health coaches, behavioral change facilitators, and care coordinators.Although the potential benefits of this model are considerable, widespread implementation requires addressing healthcare system barriers, including limited resources, insufficient professional training, lack of standardized protocols, and inadequate follow-up mechanisms. Future research should focus on multicenter intervention studies evaluating the long-term clinical, economic, and patient-centered outcomes of 5A-based self-management programs.Integrating the 5A model into diabetes care for older adults can represent a strategic pathway toward patient-centered, value-based, and sustainable healthcare systems. By promoting empowerment, participation, and continuous support, this approach may contribute to improving the quality of life of older adults living with diabetes and reducing the preventable burden of this chronic disease.     کلمات کلیدی: خودمدیریتی دیابت؛ مدل 5A؛ توانمندسازی بیمار؛ مراقبت بیمارمحور؛ سالمندان Diabetes Self-Management, 5A Model, Patient Empowerment, Patient-Centered Care, Older Adults 0 0 http://ijnv.ir/browse.php?a_code=A-10-1727-1&slc_lang=fa&sid=1 Maedeh Maedeh Sadeghigolafshani مائده صادقی گل افشانی maedeh.sadeghigolafshani@yahoo.com 100319475328460014863 100319475328460014863 No majedeh heravi مجیده هروی heravi@shahed.ac.ir 100319475328460014864 100319475328460014864 No nahid Rezah ناهید رژه reje@shahed.ac.ir 100319475328460014865 100319475328460014865 Yes