December 18, 2012

Therapeutic Goals for Older Adults with Diabetes

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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