Elderly/Long-Term Care
Greater reduction in diabetes-related complications and deaths among people 65 and older who have diabetes may result from control of cardiovascular risk factors such as hypertension and high cholesterol than from the tight glycemic (blood-sugar) control emphasized by most diabetes guidelines, according to the California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes.
The panel has published an evidence-based guideline to improve the care of older people who have diabetes. Their work was supported in part by the Agency for Healthcare Research and Quality (HS09424).
The guideline recommendations cover eight components of care and emphasize the importance of individualized goal setting. They include:
- Hypertension should be treated gradually to avoid complications, with a target blood pressure of less than 140/80 if it is tolerated.
- Older patients with diabetes who have high blood lipids should be counseled about lifestyle changes or put on lipid-lowering medication.
- Providers should screen and treat for the following geriatric syndromes (i.e., age-related conditions that are more common in older people with diabetes than in the general population): depression, polypharmacy, falls with injury, urinary incontinence, memory problems, and persistent pain.
- For glycemic control, target hemoglobin A1c should be individualized, with 7 percent or lower being a reasonable goal for relatively healthy adults with good functional status and 8 percent for frail older adults and others in whom the risks of intensive glycemic control outweigh the benefits.
- Unless there are contraindications, the older patient with diabetes should be offered aspirin therapy of 81 to 325 mg per day to reduce the risk of cardiovascular problems such as stroke or heart attack.
- Patients who smoke should be helped with counseling and medications to quit smoking.
- Patients should have regular eye exams, foot exams, and tests of kidney functioning.
- Patients and their family members and caregivers should be regularly educated about diabetes, including symptoms, monitoring, and risk of problems such as foot ulcers and amputation.
For more information, see "Guidelines for improving the care of the older person with diabetes mellitus," by Arleen F. Brown, M.D., Ph.D., Carol M. Mangione, M.D., M.S.P.H., Debra Saliba, M.D., M.P.H., Catherine A. Sarkisian, M.D., M.S.P.H., and the "California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes," in the May 2003 Journal of the American Geriatrics Society 51, pp. S265-S280.
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