-Older adults who are functional and cognitively intact and have significant life expectancy should receive diabetes care with goals similar to those developed for younger adults.
– Glycemic goals for some older adults might be relaxed, using individual criteria, but hyperglycemia leading to risk of acute hyperglycemic complications should be avoided.
-Other cardiovascular risk factors should be treated in older adults with consideration of the time frame of benefit and the individual patient. Treatment of hypertension is indicated in
virtually all older adults, and lipid-lowering and aspirin therapy may benefit those with life expectancy at least equal to the time frame of primary or secondary prevention trials.
– Screening for diabetes complications should be individualized in older adults, but particular attention should be paid to complications that would lead to functional impairment.
– Older adults with diabetes should be considered a high-priority population for depression screening and counselling treatment.
-Goals for glycemic control in the older adults are different from that of the general adult population.
The Elderly and Diabetes:
Did you Know aging increases the risk of developing type two diabetes?
This is because aging leads to decline in βeta-cell function and reduction in blood insulin levels. Aging may be associated with lack of physical activity and loss of muscle mass which increase the risk of developing the condition. The classic symptoms of Hypoglycemia (low blood sugar) may not be present in elderly persons with diabetes and you will find most of them with a fasting blood glucose level of 7 Mmol/l and postprandial levels above 11Mmol/l
It is also known that the elderly has weakened counter-regulatory response to hypoglycemia and have reduction in autonomic warning symptoms leading to “hypoglycemia unawareness”. Due to physiological changes, there are variations in drug absorption, metabolism and clearance,
which must be taken into account while treating or managing diabetes in the elderly patient. Complications like major amputations of the lower limb, myocardial infarction, visual
impairment and end-stage renal disease occur with a higher rate in the elderly patient with diabetes, compared to any age group. Those aged 75 years and above have higher rates of
most complications than those aged 65–74 years. Hyperglycemic hyperosmolar state, a form of hyperglycemic crisis with a high mortality rate is also common in this age group. The elderly has a much higher rate of emergency department visits with hypoglycemia compared to the general population with diabetes.
What to Consider in Management of Diabetes in the Older Adults.
Alzheimer’s disease and multi-infarct dementia are twice as likely to occur in those with diabetes, compared with age matched non-diabetic control subjects. The presence of these disorders, along with functional impairment, affects the patient’s ability to perform glucose monitoring, to measure insulin doses and to be compliant with medications and diet. They therefore need 24/7 help
Normal aging and diabetes, along with associated complications like peripheral neuropathy and gait and postural problems are associated with higher risk of falls and fractures. Avoidance of severe hyperglycemia and hypoglycemia can decrease the
risk of falls. The environment where they stay also needs to be flat and friendly
#Polypharmacy: It is common for elderly patients with diabetes to be prescribed more than six medications, which increase the risk of drug adverse effects and interactions, and also affect compliance. Effort should be made to reconcile medication and assess adherence and compliance on each visit.
They are known to occur more commonly in those with diabetes. Regular screening and management of impairment should be done to improve quality of life and self-care.
Urinary incontinence occurs commonly in the elderly, especially in females with diabetes. Apart from other causes, uncontrolled hyperglycemia can increase the amount and frequency of urine.