When I wrote these two blogs, here and
here, I did not realize I would be revisiting the topic for the
elderly so quickly. However, a blog by Joslin Communications brought
some good points back into the discussion and need to be considered,
especially for elderly patients with diabetes. Since I have to
classify myself as elderly, I have a special interest in these
discussions. Wishing it was easier doesn't solve any problems and
makes these articles and blogs that much more valuable. More doctors
specializing in geriatrics are also learning about diabetes and
diabetes management for the elderly. This can definitely be a step
forward in assisting the elderly to maintain excellent management of
diabetes. The Joslin blog starts with the over 70 elderly and my two
blogs were for the elderly of age 60 and over.
Yes, I am concerned about the age many
decide to consider elderly. This 10-year difference can mean many
things to different people. I cannot tell if this is because the
people doing the writing are nearing one age and want to not be
classified in the elderly, or if this is done for another reason.
Since I fit in either group, I have nothing to keep me from writing
about the elderly as being age 60 and over. Health problems are
still problems regardless of a person's age. Often many healthcare
providers do not assess the elderly correctly and therefore do not
prescribe the correct medication levels. Other doctors feel these
people are a burden to society and will not properly treat them.
Still other doctors and especially some healthcare providers believe
that anyone over 80 should be euthanized and are an expense to
society. This is not right as many of these people are still
productive and contributors to society.
This article about the elderly just
approaches the topic as a one-size-fits-all subject and degrades
people that are capable of managing their diabetes. I know that for
some people, the guidelines are reasonable, but not for everyone.
I'll be darned if I will accept A1c targets of between 7.0 and 7.5
mg/dl, but this is what this article says and it states that this
should be individualized for co-morbidities, cognitive and functional
status. This means they will encourage higher A1c levels for many
people. I take to mean that because we are classified as over the
age of 70, they want diabetes complications to take over and end our
life sooner, rather than later. Even though they say individualized,
nothing is mentioned about those that are capable and able to manage
their diabetes with no problems. Everything is aimed at the elderly
that have problems and difficulty managing life.
“The
International Association of Gerontology and Geriatrics, the European
Diabetes Working Party for Older People, and the International Task
Force of Experts in Diabetes combined resources to tackle the problem
of addressing the needs of older adults with diabetes. The group
addressed eight categories of concern: hypoglycemia, therapy,
diabetes in the nursing home, influence of co morbidities, glucose
targets, family/caretaker perspectives, diabetes education, and
patient safety.”
These are great topics to be discussed
and some of the elderly are affected by these areas and the need for
concern for these people is well placed. I am happy to see that
'diabetes in the nursing home' is one of the areas for concern. Too
often, people with diabetes in nursing homes are barely cared for and
what little care they do receive is done by care providers that do
not care and do not understand diabetes. It would be interesting to
know what A1c's these people have. But forget that, most nursing
homes are not even required to have these records for people
incarcerated in their facilities. Even if states have regulations
about safety and patient abuse, diabetes is not even mentioned and
this goes unmanaged in many states.
Even though I find much to be concerned
about in this blog, I will quote much of the last part of the blog as
these tips are valid for anyone having these problems. “In
addition to the medical establishment loosening their guidelines for
acceptable control in the elderly, you can do things for yourself
that can make your diabetes self-management easier.
If memory is
an issue
1. Use your meter to set alarms to remind
you to take your medicine or check your blood glucose. Even
though I did not believe this – many meters do have alarms. Get
help if necessary from someone that is tech savvy.
2. Get a pill dispenser—if you take a lot
of pills this can help you keep track of which medications you need
to take and which you have already taken.
If vision is a
problem
1. Have a bright task light available—you
will see better with direct lighting for reading such things as drug
labels
2. Contrast helps! Put light objects against
a dark background and vice-versa to make them stand out.
3. Ask your educator about syringe
magnifiers that can help you see the markings on the insulin vial.
If an educator is not available,
please talk to your pharmacist.
4. Ask your educator for a meter that talks
or has large print. This may be of
help for some, but if privacy is an issue, the meter that talks may
not be for you.
If dexterity
is an issue
Ask
your educator about meters and supplies that are easy to handle. If
an educator is not available, please talk to your pharmacist.
Joslin’s Geriatric Diabetes Clinic is
apparently different from many diabetes clinics and worth reading
about here and here. The only objection I can find is the
one-size-fits-all discussion, but why should I be surprised, this is
the stance of the American Diabetes Association, the American
Association of Clinical Endocrinologists, and supporting groups.
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