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Diabetes Management in The Older Adult PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Diabetes Management in the Older Adult" by Carolyn Jennings, MPH, RD, CDE.

This medical PowerPoint presentation talks about Managing diabetes in older adults.

Managing diabetes in older adults requires a collaborative approach that takes into account their unique needs and preferences. Its important to work closely with healthcare professionals, including doctors, dietitians, and diabetes educators, to develop a personalized diabetes management plan.

Tags : Diabetes Management in the Older Adult, Managing diabetes, diabetes management plan, endocrinology, endocrinology PowerPoint presentation

Published on : Apr 18, 2023 | Views : 1246 | Downloads : 5

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Slide 1-

1 Diabetes Management in the Older Adult Presented by Carolyn Jennings, MPH, RD, CDE SouthEast Michigan Diabetes Outreach Network (SEMDON) www.diabetesinmichigan.org
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2 Myths: DM in the Older Adult High prevalence of diabetes in older adults is inevitable Hyperglycemia in older adults is usually a benign condition Reduced life expectancy makes the consequences of uncontrolled diabetes irrelevant The majority of older adults with type 2 DM are obese and need to lose weight Older adults are less capable of self-monitoring their blood glucose
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3 Prevalence of Diabetes
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4 Pathogenesis of Hyperglycemia in Elderly Poor Nutrition Coexisting Illness Reduced Insulin Secretion Increased Adipose Tissue Decreased Physical Activity Medications Genetics
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5 Diabetes in Older Adults 50% under-diagnosed – WHY?? Early signs: Metabolic Abnormalities Insulin resistance  1st phase insulin release  PPG with normal FPG Early symptoms: (if any) Often gradual onset Commonly mistaken for signs of normal aging
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6 Case of Mistaken Identity Blurred Vision Polyuria and nocturia Fatigue MI and CVA’s 2 times more common High Blood Pressure Neuropathy and foot deformities Restlessness/confusion with high and low BG. Needing glasses More frequent urination Can’t do things like you did when you were 20 Atherosclerosis High Blood Pressure Change in gait Restlessness, confusion, slower cognition. Signs of Diabetes Signs of Aging
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7 Aging and Diabetes Poor diabetes control exacerbates the aging process. Poor diabetes control causes age related disease to develop earlier. Poor diabetes control makes co-morbid conditions worse and harder to manage.
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8 OBJECTIVES State three areas of assessment for the older adult with diabetes. State two recommendations for the care of the older adult with diabetes. List education strategies appropriate for the older adult with diabetes.
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9 Diabetes Assessmentin the Older Adult Physical Assessment Mobility/ Physical Activity Nutritional Assessment Neurological Assessment Psychosocial Assessment Other Areas
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10 Diabetes Assessmentin the Older Adult Common Geriatric “Syndromes” Depression Polypharmacy Cognitive Impairment Urinary incontinence Injurious falls Persistent pain
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11 Physical Assessment Ophthalmic Higher rates of cataracts, glaucoma and macular degeneration. Auditory Renal Thickening of basement cell membranes. Immune system Flu, herpes zoster, cancer
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12 Physical Assessment Cardiovascular System Reduction in CVD risk factors may have greatest impact on morbidity and mortality Hypertension Lipids Increased risk of CVA’s and MI’s. Heart rate  in response to exercise reduced. Thickening of basement cell membranes. 50% of newly diagnosed people with T2DM have CVD.
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13 Physical Assessment Dexterity/coordination History of injurious falls Mobility/Physical Activity Joint disease/ Bone mass  Aerobic capacity  Lean body mass  Fat mass Activity Current level? Limitations, preferences
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14 Nutritional Assessment Preferences and Lifelong habits Meal Planning considerations Food Preparation Lifestyle changes Mobility issues Dentition High Risk considerations
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15 Nutritional Assessment Malnutrition Altered nutrient absorption Vitamin deficiencies (B12) CHO intolerance Decline in renal function Depression Cognitive Impairment
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16 Nutritional Assessment Nutritional status Change in nutrient needs Change in body composition Hydration status Alcohol use/abuse Supplement/herbal use Gastrointestinal tract Absorption Gastroparesis Appetite
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17 Neurological Assessment Cognitive Impairment Increased rate in PWD Mini-mental status exam recommended Check for reversible causes: B12 levels Thyroid hormone Neuroimaging Depression screening Blood glucose control
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18 Neurological Assessment Autonomic and peripheral neuropathies: Heart Incontinence Sexual function Protective sensation Hypoglycemia unawareness Body Temperature regulation Reduced ability to sense: Thirst, Smell, Taste
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19 Psychosocial Assessment Depression Support systems Loss of peers Change in family role Health Beliefs Locus of Control Internal vs. External
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20 Other Areas of Assessment Co-morbidities Pain Polypharmacy Diabetes medications appropriate? Drug interactions Ability to administer medications Safety Finances
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21 OBJECTIVES State three areas of assessment for the older adult with diabetes. State two recommendations for the care of the older adult with diabetes. List education strategies appropriate for the older adult with diabetes.
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22 Treatment Recommendations Glycemic Control Hypertension Lipids Tobacco cessation Eye care Foot care Nephropathy Diabetes Self-Management Training
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23 Treatment Recommendations When and how to prioritize interventions? Stratifying older adults: Comorbities Complications Risks vs. benefits of (intensive) therapies
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24 Glycemic Control A1c- <7% in healthy adults with good functional status <8% appropriate in: Frail older adults Life expectancy less than 5 years Those whom risk of intensive glycemic control outweighs benefits Frequency
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25 Risks of Intensive Glycemic Control Hypoglycemia Polypharmacy Drug to drug interactions Drug to disease interactions
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26 Who benefits most from Intensive Glycemic Control? Older adults in good health Those with microvascular complications Frail elderly without microvascular complications will probably not live long enough to develop them
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27 Hyperglycemia Can cause: Delirium Mood swings and irrationality Appetite changes Sleep disturbances Increases risk for: Diabetic Ketoacidosis Hyperglycemic Hyperosmolar State (HHS)
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28 Hyperglycemia Impairs cognitive ability Reduces energy Impairs memory Decreased wound healing Increased risk of HHS Increases urine output Impacts incontinence/dehydration Increased risk of UTI Impairs immune system
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29 Aging increases risk of hypoglycemia: Reduced hormonal counter regulation Renal and hepatic changes Hydration status Inadequate or irregular nutrition Decreased intestinal absorption Autonomic neuropathy Polypharmacy Use of alcohol, other sedating meds Hypoglycemia
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30 Hypoglycemia May cause: Heart arrhythmias Increased risk of falls Signs and symptoms may be masked by co-morbidities (i.e. Parkinson’s) Impairs concentration and cognition Impairs reaction time
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31 Hypertension Goal: Less than 140/80 if tolerated Less than 130/80 may produce further benefit Blood pressure reduction should be done gradually to minimize complications (no more than 20mm/hg reduction in systolic BP/3 mo)
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32 Hypertension: Medication Precautions ACE-I or ARB Therapy Monitor K 1-2 weeks after initiating therapy and with each dose increase ACE-I associated with decreased renal function in elderly Hyperkalemia common at moderate and high doses
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33 Hypertension: Medication Precautions Thiazide or loop diuretic Check electrolytes within 1-2 weeks of initiation and at least yearly Hypokalemia associated with ventricular arrhythmias.
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34 Lipids Secondary to overall health status assessment Goals: LDL< 100mg/dl HDL > 40 men, 50 women TG < 150mg/dl LDL<100 reassess q 2yrs LDL 100-129: MNT w/ physical activity LDL > 130 pharmacologic therapy + lifestyle intervention
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35 Lipids: Medication Precautions Increased side effects Myalgias and myositis Rhabdomyolysis Elevated liver function? Niacin or Statin: Measure ALT w/in 12 weeks of initiation or dosage change Fibrate: evaluate liver enzymes at least annually Precaution with reduced renal function
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36 Aspirin Use The older adult (who is not on any other anticoagulant therapy and has no contraindications to aspirin) should be offered 81-325mg/d.
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37 Tobacco Cessation 12% of PWD over age 65 smoke Assess use/willingness to quit Offer counseling and/or pharmacologic interventions to assist with cessation
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38 Retinopathy Screening Dilated eye exam at diagnosis High risk (symptoms of eye disease, retinopathy, glaucoma, cataracts, A1c>8, T1DM or BP>140/80mm/hg): at least yearly follow-up exams Low(-er) risk : every 2 years
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39 Foot Screening At least annual comprehensive foot exam and at all non-urgent outpatient visits. Assess changes in: Skin integrity Loss of protective sensation Early detection of neuropathy Decreased perfusion Bone deformity
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40 Nephropathy Screening Screen for microalbumin and GFR at diagnosis and (at least) annually
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41 Diabetes Self-Mangement Training More likely to include family members and/or other caregivers Essential topics: Hypoglycemia prevention and treatment Benefits of MNT and physical acitvity Medication review Evaluation of foot care- amputation prevention Evaluate Geriatric Conditions
Slide 42-

42 OBJECTIVES State three areas of assessment for the older adult with diabetes. State two recommendations for the care of the older adult with diabetes. List education strategies appropriate for the older adult with diabetes.
Slide 43-

43 The Adult Learner Perceives need Self-directed Experienced Problem-oriented Task-centered Internally motivated
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44 Patient Centered Education Assessment of where patient is with disease “Health Beliefs” Assessing where patient is in regard to “readiness to change” current behaviors to improve (diabetes) health  WITH THIS INFORMATION the patient and educator can work together to develop individualized self-management plan
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45 Patient Centered Education Patients Role: Determine personal self-care goals Find solution Take responsibility for own health HCP’s Role: Active Listener Source of accurate Information Provide essential knowledge and skills training Understand client’s perspective Acknowledge the client’s feelings Support Person Facilitator
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46 Education Strategies LISTEN, LISTEN, LISTEN… Positive attitude Provide meaningful practical individualized information. Prioritize needs with the patient Assist with problem solving and goal setting Empowerment Model- Patient Centered
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47 Education Strategies Assess baseline knowledge. Dispel any misinformation Update information Overcome generational barriers. Consider financial, accessibility, safety, support systems and the effect on perceived quality of life
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48 Education Strategies Assess functionality and special needs Adaptive teaching strategies Visual accommodations Low vision aids Bright illumination Large print and bright contrast Detailed verbal explanations Use support system.
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49 Auditory Accommodations Eliminate distractions Minimize background noise. Reinforce with written materials. Speak slowly in short sentences. Speak to best hearing side. If patient reads lips, keep mouth uncovered and do NOT chew gum. Education Strategies
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50 Education Strategies Cognitive Accommodations Simplify instruction. Frequently summarize. Focus on single topics. Teach simple tasks first then move on to more complex. Use memory aids. Evaluate learning often.
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51 Education Strategies What is the present degree of Blood Glucose control? If currently Hypo or Hyperglycemic: Teach Survival Skills Schedule follow-up when BG control improved Give educational materials for reinforcement
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52 Education Strategies:Nursing Care Facilities Assess patient’s ability to participate in self care. Prioritize care to patient and family. Involve family in education. Appropriate snacks to bring. Reinforce behaviors that promote optimal control.
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53 Education Strategies:Nursing Care Facilities Safety issues Hyper/hypoglycemia signs/symptoms Adult Learner Guidelines Evaluate level of control with respect to quality of life, safety. Advocate for your patients whose diabetes control is sub optimal.
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54 Summary- Education Goals Assist older adults to optimally self-manage diabetes. Individualized BG goals to avoid both hyper- and hypoglycemia. Prevent or delay progression of complications. Promote optimal control for all older PWDs Hospitalized • Residential care Group living
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55 Resources Guidelines for Improving Care of the older person with diabetes AM J Geriatric Soc 51(2003): S265-S280 Geriatric Resource Directory www.bphc.hrsa.gov Working Together to Manage Diabetes Diabetes Medications Supplement www.ndep.nih.gov/diabetes/publications Oral Health Care for Older Adults www.nohic.nidcr.nih.gov Working with Your Older Patient, a clinician’s handbook www.nia.nih.gov Exercise, A Guide from the National Institute on Aging www.nia.nih.gov