Gaps in Diabetes Care Means We Have to Pay More Attention to Our Aging Adults
Early Intervention for Newly-Diagnosed Could Make a Huge Impact on Long-Term Health
(Part II in a Series)
In my first blog in this series, I advocated for everyone with diabetes to seek more education and support for controlling their condition. Taking advantage of self-management programs at any stage of diabetes can give patients a sense of empowerment in caring for themselves.
In my experience, patients have relied too much on general advice and encouragement their doctors dispense within the time limits of a typical visit. This "head-in-the-sand" approach deprives people of improving their outcomes, but I am especially concerned by what this lack of care means for our most vulnerable segment – our seniors.
We have all heard the saying "it takes a village to raise a child." I say it takes a village to support seniors living with diabetes, especially given the gaps in care that affect all patients.
Older adults represent the fastest growing segment of the diabetes population, and projections suggest that these numbers will grow at alarming rates over the next 20 years.[i] Here in the U.S., nearly one-third of adults over the age of 65 have diabetes, with half of them being undiagnosed and an additional one-third of these adults having pre-diabetes.[ii]
Diabetes care management for seniors can be complicated when you consider that many of them have multiple co-existing conditions. Half of aging adults are dealing with two or more chronic ailments, and about 40% have constant pain as an added challenge.[iii]
In this regard, it seems that doctors chalk-off their senior patients' diabetes as a factor of aging, with the justification that the cocktail of prescriptions may be sufficient enough to maintain overall health. After all, every doctor knows that insulin production decreases with age while insulin resistance increases. While these are factors of getting older, they also explain the higher prevalence of type 2 in this age group. Whether a patient is young or old, type 2 is type 2. We need to provide the senior population with more attention.
The Benefits of Early Intervention Diabetes Education
What we would like to see as a best practice is for doctors to recommend early intervention diabetes education to all of their patients over the age of 60 who are bordering on a pre-diabetic condition.
We understand the tremendous financial burden of diabetes care for seniors, which is why we advocate strongly for early intervention that involves a CDE (Certified Diabetes Educator). Early intervention can help younger seniors adopt healthier and life-sustaining dietary and exercise habits, which are more difficult to start later in the golden years when appetite and mobility become more limited.
A 2013 study showed that self-management interventions for community-dwelling older adults resulted in higher glycemic improvements and controls, as well as a greater frequency in glucose checks and overall self-care than the same programs achieved for younger adults. The criteria for "self-care" included reporting depressive symptoms and distress, measuring the quality of life and self-sufficiency, acknowledging frustration with self-care, and emotional coping, all of which improved dramatically for the seniors.[iv]
Encouraging self-care is a smart idea because the typical signs and symptoms of onset type 2 can mistakenly be attributed to another chronic condition or even unrecognized by physicians when examining older patients.
- Common symptoms include fatigue, urinary incontinence, dehydration, confusion, poor wound healing, and neuropathy, which are also common conditions of aging.[v]
- Some of these signs, along with dizziness, delirium, weakness, and falls, are indicative of hypoglycemia, which is a severe risk for adults.
- In addition to these overlooked signs, there are other standard risk factors for hypoglycemia like medications that may lower glucose, thus making seniors more vulnerable.
It begs the question if patients and caregivers are getting the proper training on understanding the risks for hypoglycemia (as well as hyperglycemia) and if each doctor visit includes an evaluation of hypoglycemic events.
Therefore, while education is important for diabetes patients of all ages, "individualizing" treatment recommendations for older adults is especially crucial. For example, instead of aiming for glucose targets being in a certain range or doing HBA1c testing annually, senior patients should opt for more individualized glucose targets based on their overall health, as well as more frequent testing when health status or drug therapy changes.
Self-management for seniors also requires reality checks on "self-care ability" depending on their overall health. Having patients demonstrate the use of their blood glucose meters is a good way for caregivers to:
- check for errors in technique,
- determine if the patients can distinguish between high or low readings, and
- see if they understand what necessary steps should be taken based on the reading.
Home glucose monitoring for aging patients should also be individualized based on their dexterity, cognition, co-morbidities, caregiver support, and glycemic goals.
In closing, proper care for many of our seniors already requires a team-based approach, but individualizing treatment recommendations is critical for identifying diabetic conditions and related serious risks. Extensive training is essential for patients and caregivers, but early intervention education for aging adults in their 60s and early 70s could result in a better quality of life throughout the golden years -- without the high costs of diabetes care.