Diabetes mellitus is a common metabolic disorder that affects carbohydrate, lipid, and protein metabolism. It is estimated that about 4.4 to 17.4% percent of adults in the United States have diabetes mellitus (Cory , Ussery-Hall, Griffin-Blake et al., 2010). It is estimated that 11.5 million women and 12.0 million men over the age of 60 have diabetes, but many do not know it. The Indian Health Service reported via the National Diabetes Survey of 2007 that of the 1.4 million Native Americans and Alaska Natives in the United States, 14.2% age 20 years or older have diagnosed diabetes. Rates vary by region, from 6.0% of Alaska Natives to 29.3% of the Native Americans in southern Arizona (CDC, 2007). There are two major types of diabetes, type 1 (T1DM) and type 2 ( T2DM). T1DM is characterized by autoimmune destruction of the insulin-producing beta cells of the pancreas, leading to a deficiency of insulin. New-onset of adult T1DM in older adults rarely happens; however, due to better treatment of T1DM, older adults who have been diagnosed at an earlier age are living longer. About 90% of older adults with diabetes have T2DM, which is often related to obesity. T2DM is characterized by hyperglycemia and insulin resistance; however, impaired insulin secretion may also be present. Diabetes mellitus is a major cause of disability and death in the United States, and is the seventh leading cause of death among older adults.
The risk of diabetes increases with age (45 years and older). Other risk factors include family history, obesity, race (African Americans, Hispanics, Native Americans, Asian Americans, Pacific Islanders), hypertension, less “good” cholesterol (less than 35 mg/dl), lack of exercise, having a history of delivering large babies (≥9 pounds), personal history of gestational diabetes, and pre-diabetes in men and women (Laberge, Edgren, & Frey, 2011). Type 2 is the most common type in older women (CDC, 2007). The risk of death from DM is significantly higher among older ¬Mexican American, African American, and Native American women when compared to Whites. The Centers for Disease Control CDC (2005) names obesity, weight gain, and physical inactivity as the major risk factors for DM among women.
The most common presentation for older adults with T1DM is hyperglycemia (high blood sugar). Older adults may not have the classical symptoms such as polydipsia, polyuria, polyphagia, and weight loss. Instead, they may have an atypical presentation (Halter Chang & Halter, et al., 2009). They may first present with falls, urinary incontinence, fatigue, or confusion. Because older adults may have T2DM for years before it is diagnosed, they often have macrovascualar and microvascular complications at the time of diagnosis, so evaluation of these should be considered at that time.
Prevention is the best approach to care, which involves identifying those at risk and encouraging lifestyle change. Older adults with diabetes mellitus have a high risk for complications related to macrovascular disease, microvascular disease, and neuropathy. Macrovascular diseases include coronary heart disease, stroke, and peripheral vascular disease, which can lead to amputation. Microvascular diseases are chronic kidney disease, which is the most common cause of end-stage renal disease, and diabetic retinopathy, that which can lead to blindness. Peripheral neuropathy presents as uncomfortable, painful sensations in the legs and feet that are difficult to treat. A lack of sensation may also be present and contribute to the risk of falls. There is no cure for peripheral neuropathy, and it tends to be a complication for which patients experience daily challenges trying to manage the symptoms. A combination of medication to address pain and interventions by a physical therapist seems to be the best current treatment.
Treatment is aimed at helping patients to achieve and maintain glycemic control to decrease risk of complications. The initial treatment approach is to work with the older adult to establish treatment goals aimed at reducing long-term complications. This often requires working within an interprofessional team. Aggressive treatment may be appropriate for most older adults; however the risk of hypoglycemia (low blood sugar) is higher in older adults. Older adults with hypoglycemia may have an atypical presentation with acute onset of confusion, dizziness, and weakness instead of tremors or sweating. The best measure of good blood glucose management and controlled blood sugars is HgbA1c levels (glycosylated hemoglobin). This measure of hemoglobin provides insight into the previous 3 months of blood sugar control. If HgbA1c is elevated, it indicates that the blood sugar has been high over time. For most people, a HgbA1c ≤ 7% indicates optimal glycemic control; however, due to poor health outcomes, for frail older adults or those with a life expectancy ≤ 5 years this may not be the best, and a Hgb A1c of 8% might be more appropriate.
Management is successful when a balance is achieved among exercise, diet, and medications. Medications may be oral hypoglycemics or insulin injection. Insulin injection is used in T1DM and may be prescribed for T2DM because as the person ages, beta-cell function declines. If insulin is needed, it is important to consider if there are visual problems and or hand arthritis that limits the dexterity that is necessary to prepare and inject the medication. For some, a simple regimen, such as premeasured doses and easier injection systems (e.g.,insulin pens with easy-to-set dosages) is the best.
Thorough evaluation of readiness to learn and of the ability of an older person to manage his or her medications must be done. Older adults who need to give themselves insulin injections may experience anxiety about learning this task. Demonstration, repetition, and practice are good techniques for the older age group. Adaptive devices such as magnifiers may help if the syringes are hard to read. A family member should also be taught to give the insulin to provide support and encouragement, although the older adult should be encouraged to remain independent in this skill if possible. Williams and Bond’s (2002) research suggested that programs that promote confidence in self-care abilities are likely to be effective for those with diabetes. A plan for times of sickness and the use of a glucometer to monitor blood sugars will also need to be addressed. Additionally, the dietician may be consulted to provide education for the patient and family on meal planning, calorie counting, carbohydrate counting, and nutrition. Many patients benefit from weight loss, so the nutritionist can assist with dietary planning in this regard also.
Due to the increased risk of infection and slow healing that result from diabetes, foot care is an essential component in teaching older adults to manage DM. Some experts believe that good preventive foot care would significantly reduce the incidence of amputation in the elderly. Older persons with DM should never go barefoot outside. Extremes in temperature should be avoided. Shoes should be well fitting and not rub. Socks should be changed regularly. Elders should be taught to inspect their feet daily, with a mirror if needed. Corns and ingrown toenails should be inspected and treated by a podiatrist, not by the patient. Older persons should see their podiatrist for a foot inspection at least yearly. Patients should be cautioned that even the smallest foot injury, such as a thorn or blister, can go unnoticed and unfelt—and often results in partial amputations that lead to a cascade of lower extremity problems.
Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L.
Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Sudbury, MA: Jones and Bartlett Publishers. Used with permission.
Reaching the golden age does not always come only with a great life experience but also with reasons to make you feel lonelier than ever. Years have passed by and many of those people you encountered and loved so much may have passed away over time. This is something that remains in your heart forever.
Feeling lonely is not something to be ashamed of but also not something to control your life. Discover below the best ways in which to reduce loneliness for the elderly in your life. They deserve to live happy during this new stage in their existence. Help them rediscover the joy of living!
Develop a Strategy to Defeat Seclusion
If you have elder people you love, you must engage more in their life. It is unavoidable for them to feel lonely from time to time. This is why they need your love and support more than ever. Make them feel loved and an important part of your life. Offer them reasons to smile and continue every day. Do not forget about them or ever leave them feeling like no one has time for them anymore.
Allow Them to Feel Useful
Feeling like there is nothing left for you to do in life is the worst possible feeling. Older people should be treasured because they have a life experience to share. Learn to listen to them more often, spend more time with them and allow these amazing people to teach you what they know. Engage with them in activities that are suitable for their age and help them keep themselves active. Never leave them alone for too much time and always advise them on how to stay clear of sadness and depression.
New Bridge for the Generation Gap
The generation gap between young people and older ones is obvious. However, there should always be a bridge built with love, compassion, and respect or understanding to help keep these two generations together. Teach your children to appreciate the elderly. If they have grandparents, guide them towards building close relationships with them. Spending time together and sharing experiences will be a great way in which to reduce loneliness for the elderly in your life. It will also be a great life lesson for your children.
To ensure a better life experience for them at this stage you can also consider professional help in care homes in Maidstone. The main stages of life are the same for all of us. We may go through them differently and face varied challenges, but we all get to the same place sooner or later. Let’s treasure the amount of experience and life stories these amazing people have to share. We will learn more from them than from any other experience in our life.
Kristen L. Mauk, PhD, DNP, RN, CRRN, GCNS-BC, GNP-BC, ACHPN, FAAN
Dr. Mauk has been a Professor of Nursing for 26 years. Prior to moving to Colorado, she was a Professor of Nursing at a large private university in Indiana for nearly 25 years, and there she held the first Kreft Endowed Chair for the Advancement of Nursing Science, a position dedicated to gerontological nursing. She earned a BSN from Valparaiso University, an MS in Adult Health from Purdue University, a PhD from Wayne State University, a Post-Master’s GNP certification from University of Virginia, and a Doctor of Nursing Practice (DNP) degree from Valparaiso University.
Dr. Mauk has more than 35 years of experience in chronic illness nursing, rehabilitation, and gerontological nursing, and teaches in these specialties at both the graduate and undergraduate levels. She is certified in rehabilitation, as a gerontological nurse practitioner and clinical nurse specialist, and as an advanced palliative care and hospice nurse. She has authored or edited eight books, including two that were recognized with an AJN Book of the Year Award. She has served on editorial boards for Rehabilitation Nursing and Geriatric Nursing, and has written numerous articles and book chapters. Dr. Mauk is a frequent presenter at conferences at the regional, national, and international levels. She is the Co-Founder and President of Senior Care Central/International Rehabilitation Consultants, providing educational, clinical, and legal nurse consulting in rehabilitation and senior care in the U.S. and internationally. Dr. Mauk is also a recent past president of the Association of Rehabilitation Nurses (ARN) and has served ARN in many roles, most significantly including the Council of Leaders, Editor of the 5th edition of the Core Curriculum, PRN course faculty, and the task force to develop the ARN Professional Rehabilitation Nursing Competency Model, and current Editor in Chief of Rehabilitation Nursing.
Some of Dr. Mauk’s recognitions include: Nominee for the 2016 National Robert Foster Cherry Award for Great Teachers, three AJN Book of the Year Awards (2017, 2010 & 1999), CASE/Carnegie Indiana Professor of the Year (2007), VU Caterpillar Award for Excellence in Teaching (2007), ARN Educator Role Award (2007), and the ARN Distinguished Service Award (2005). Dr. Mauk has taught nurses and students in China over the past few years. She has a passion for helping other countries to develop rehabilitation nursing into a strong specialty to promote quality care for their aging population and those with disabilities.
Lets be honest, exercising is not always fun. It can create discomfort, make you sweaty, and take you away from some other pleasurable pastimes or methods of relaxation. However, research clearly shows that those who are active on a regular basis have better weight management, are more relaxed, have higher energy and typically experience a better quality of life. For seniors, exercise is especially crucial since it has positive effects on memory, mood, balance, posture, strength and pretty much any issue involved in healthy aging. For those that find it difficult to start or stick with an exercise program, here are 5 ways seniors can make exercising more fun. Be sure to check with your doctor before starting any exercise regimen.
1. Find what you like to do. Do you enjoy playing golf, tennis or swimming? Have you considered taking long walks or gardening as pleasurable activities? Well if you enjoy any of the above activities, that is good news. All of these can be considered as some form of exercise. Exercise doesn’t always have to mean going to the gym. Experts tell us that we can accumulate the positive effects of exercise throughout the day by doing such activities.
2. Make it social. For people who enjoy socializing, you can incorporate exercise to add to the experience. Mall walking or group exercise programs have allowed people to interact and get in better shape in the process; just make sure you do as much exercising as you do talking.
3. Add music. Line dancing or Zumba, which are popular forms of exercising for seniors, use music to keep rhythm and add to the fun of the dance class. In these exercise classes, music helps weight management, muscle tone, balance and coordination. Whether you incorporate music during group exercise or during a long walk; music can give us energy, relax us and enhance exercise.
4. Add variety. Our minds and bodies typically love variety. Physically, variety is good for our bodies because it allows the use of different muscles, preventing wear and tear on joints. The body is also stimulated more when you do different exercises, which gives more health benefits from the activity. For our minds, variety is good for the brain. When you do different activities it can prevent you from becoming bored of the same exercises continually.
5. Attach a reward. If achieving results is important for you, attaching fitness rewards can make exercising more fun. Some examples of fitness rewards could be having a low calorie dessert if you’ve finished exercising that day, getting a pedicure, going shopping, or having a massage after exercising. Positive reinforcement encourages us to exercise while knowing that if we do it, there is something good coming at the end.
About the Author: Eric Daw is an active aging specialist and the owner of Omni Fitt. Omni Fitt is dedicated to the wellbeing, health and quality of life of people aged 65 and over. Eric motivates and empowers the older adult population to take responsibility for their independence, health, and fitness through motivating and positive coaching experiences.
Experiencing back, shoulder or neck pain? Your body may be speaking to you and you just don’t know it. Getting older doesn’t have to mean accepting regular aches and pains. Depending on your day to day activity, environment, and mobility, your back pain can be sending loud and clear messages like:
You’re not active enough: This might seem counter intuitive, especially to older adults who are avoiding activity so they don’t “further injure” themselves or cause more pain. The reality is, low-impact exercise and activity helps to alleviate pain and soreness by stretching out your muscles and spine, boosting blood circulation, and reducing inflammation in your muscles, joints, and tendons. Along with keeping off excess weight.
You’re not sleeping well: A bad night’s sleep can undo any number of steps you took towards relieving back pain during the day. Older mattresses that don’t support proper spine alignment while you sleep can result in the pull and strain of your muscles and tendons and lead to bad posture during the day. Optimize on the natural curve of your spine while you sleep by simply using a pillow – on your side in a fetal position, try sleeping with a pillow between your knees. If you sleep on your back, place a pillow underneath your knees.
You’re stressed: Feelings of stress, anxiety or depression can physically translate into tense muscles that lead to back pain and thoughtless behaviors like eating poorly or not exercising, which exacerbate existing conditions. Aging seniors with complex medical conditions or cognitive decline are more likely to experience stress and anxiety as well as feelings of frustration and anger.
You’re not practicing self-care: Incorporating daily care routines into your life can make a huge difference in both your experience of back pain as well as your personal outlook on life. Self-care can be as simple as eating a healthy diet, stretching and exercising to care for your body, meditating, decluttering your environment, and practicing self-soothing techniques like rubbing lotion on your hands and feet before bed. Relieving back pain starts with you and your own self-awareness of what you need and deserve to live your best life.
You’re sitting down too much: Countless aging seniors will spend hours each day sitting down – at meals, watching tv, reading, and at the computer. Sustained inactivity and sitting in one spot for an extended period of time puts significant pressure on the spine and promotes bad posture, all of which lead to back pain and discomfort. Experts recommend not going more than 30 or 45 minutes sitting in one place without getting up to stretch, walk around, and change positions.
According to a recent report published by the American College of Physicians*, people who experience moderate to acute back pain are actually more likely to experience relief when they try exercise, yoga, acupuncture or massage instead of taking pain killers. The comprehensive study revealed that most types of back pain go away over time whether they are treated or not and that drugs should be a last resort for alleviating pain, after mindfulness-based practices, exercise, spinal manipulation, even heat wraps.
Co-Founder, Vive Health
Constipation is the most common bowel problem in older adults. The definition varies by patients and health care providers, but generally it means less frequent bowel movements than usual, and those which are hard, dry, and difficult to pass. Constipation is a preventable and treatable problem. Changes that occur with normal aging, such as peristalsis in the gut slowing down or decreased physical activity, predispose older persons to constipation.
Risk Factors/Warning Signs
Constipation is often due to a combination of causes. Some of the risk factors include decreased activity, medications (such as certain pain pills, iron supplements, and calcium supplements), depression, neurological conditions (dementia, Parkinson’s disease, stroke, diabetes mellitus, and spinal cord injury), dehydration, low dietary fiber, metabolic disturbances (such as hypothyroidism), undergoing dialysis, obstruction, and decreased access to the toilet (Halter et al., 2009). The range of “normal” for bowel movements is three times per day to three times per week. A decrease in number of stools that is “normal” for the person and the occurrence of hard, dry stools that are difficult to expel are typical signs of constipation.
If constipation is severe enough for the person to seek medical care, the patient may complain of abdominal pain and even have symptoms similar to other problems such as an appendicitis or diverticulitis. These more serious ailments can be ruled out through x-rays, CT scan or MRI. The diagnosis is based on clinical presentation, history, and physical examination. It is important to determine the onset and duration of the constipation, along with functional and nutritional status.
Before starting a bowel program to prevent constipation, the existing problem should be dealt with. A physician may prescribe laxatives, suppositories, and/or enemas to get the stool moving and eliminated. Many such products can be obtained over the counter as home remedies, but severe and recurrent problems should be referred to the primary care provider for further examination of the cause. After starting with a clean bowel, interventions should focus on lifestyle and dietary modifications. All natural means should be tried first before adding medication to the regimen. This includes regular exercise, establishment of a regular routine for toileting (assure privacy), and encouragement of a high-fiber diet with adequate fluid intake (unless contraindicated)(Joanna Briggs Institute, 2008). Medications may be considered for those who do not respond to lifestyle changes. Residents of nursing homes appear to respond to stimulant laxatives (e.g., senna, bisacodyl) or Miralax. Enemas should not be used on a regular basis because they promote lazy bowel function. Most older persons can avoid constipation if they remain active, have proper nutrition high in fiber, and drink plenty of fluids.
Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L. Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Sudbury, MA: Jones and Bartlett Publishers. Used with permission.