Management of Diabetes in the Older Adult

Thesis (M.Nurs.), College of Nursing, Washington State UniversityDiabetes is a common problem in older adults, as they increasingly comprise a larger proportion of patients newly diagnosed with diabetes. Approximately 13% of adults 70 years and older have diabetes mellitus, and 11 % of adults between age 60 and 74 have diabetes that remains undiagnosed. The increasing burden of caring for aging Americans will require improved patient care, greater public health involvement, and innovative clinical strategies and interventions. Management of diabetes is complex and challenging, involving diet, exercise, daily medication and glucose testing. Older adults often have functional, physical, or cognitive deficits that make management even more challenging. Uncontrolled blood glucose levels compound conditions such as heart disease, hypertension, eye and circulatory problems that are often found in the older adult. Age complicates treatment because of the patient's concomitant chronic illnesses, age related physiological changes, sedentary lifestyle and medications that either promote the development of insulin resistance and hyperglycemia or complicate its management. Diabetes is one of the most costly chronic medical conditions due largely to complications. In the United States, one in every seven health care dollars and 25% of the Medicare budget are spent on patients with diabetes. As glycemic control worsens health care costs increase. Goals for therapy should include an assessment of the older adults' functional status, life expectancy, financial and social support, and their desire for treatment. The Chronic Care Model identifies essential elements of a health care system that encourage high-quality chronic disease care. These important elements are the health system, self-management support, community, decision support and clinical information systems. Specific examples of how clinicians can implement elements of the Chronic Care Model to improve diabetes management with an older adult population will be provided