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Posted: August 31, 2008

Helping Our Elderly Deal with Diabetes

Caregiver Challenge

Type 2 diabetes is on the rise, especially in our elderly.  Over the next 25 years, people 65 and older will make up most of the diabetic population in the United States, while those 75 or older will make up an even larger portion of the overall diabetic community. Either way, our fast-aging society is facing a diabetes crisis.

Even today, the largest proportion of all newly diagnosed diabetics occurs in older Americans. And diabetes appears when these aging loved ones are often already dealing with multiple conditions or diseases. At least half of them, in fact, already have a physical or cognitive disability.  As these numbers increase, related cognitive and physical disability will continue to impact quality of life, loss of independence, and of course, demands on caregivers.

On the whole, it’s not a pretty picture, of course, and it means that more and more family caregivers will need to understand diabetes and help their loved ones deal with the condition.

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Caregivers who are well informed about diabetes in the elderly and who continually assess their knowledge and the changes in their loved one’s condition will be equipped to provide the best care.  Though the diabetes caregiver role can present many challenges, Health and Family Services Cabinet Secretary Mark D. Birdwhistell says, “With the right tools and knowledge, caregivers can help their loved one reduce the number of diabetes-related complications he or she experiences and live a long and healthy life.”

How Diabetes Works

Diabetes is a disease in which the body does not produce or properly use insulin, a hormone that’s needed to convert sugar, starches, and other food into energy needed for daily life.  It is characterized by chronic high blood sugar which harms body and brain.  In type 2 diabetes, the most common form of the disease, the body either does not produce enough insulin or it may be resistant to it.  Insulin resistance increases with age, especially in midlife when the adult body may not respond to normal insulin amounts.

Health risk factors for type 2 diabetes are many, and age itself poses a significant risk.  The risk of developing type 2 begins to rise significantly at about age 45 and continues to rise considerably after age 65.  A strong genetic link means family history increases risk of the disease, as does ethnicity.  African Americans, Latinos, Asians, and Native Americans are all at higher risk than non-Hispanic whites.

According to the federal Centers for Disease Control, obesity, or being overweight, and lack of physical activity are responsible for nearly 95% of all diabetes cases in the United States.  If your loved one has any of these risk factors, testing should be done right away.  In many cases, type 2 diabetes can be managed with lifestyle changes in diet and activity as well as adopting generally healthy habits. 

Elderly Pose Special Challenge

Diagnosing and treating diabetes in the elderly pose some challenges.  Elderly patients who are developing or already have diabetes don’t necessarily show classic symptoms of the disease.  Age-related changes in the body mask symptoms or make them difficult to spot. Classic symptoms of diabetes – such as severe increased thirst, frequent urination, unexplained weight loss, increased hunger, and tingling in the hands and feet -- may not be present in older diabetics who are often asymptomatic early on. 

Instead, the symptoms our elderly may exhibit -- such as weight loss, fatigue, confusion, and urinary incontinence -- may be less specific and can be confused with other conditions.  With this understanding, it’s easy to see why so many have been diabetics for years before diagnosis.

The goal of treating diabetes in the elderly should be the reduction of diabetes-related complications.  Lifestyle changes in diet, weight loss, and exercise represent the treatment of choice. 

Yet the challenges of the elderly in these areas are many – and the caregiver must take on a multidisciplinary role to adjust to the varied aspects of treatment which require a unique and flexible approach.  Obstacles like physical and mental impairment make self-management difficult, and there are increased risks in the elderly because they are more frail and susceptible to illness.  Difficulty chewing or swallowing, or even poor-fitting dentures, can pose eating obstacles, not to mention age-related changes in taste perception and a reluctance to change long-held eating habits. Yet, even moderate weight loss helps regulate blood sugar, as well as blood pressure and cholesterol, so it’s well worth the effort.

Exercise Holds a Key

Exercise is also highly effective in regulating type 2 diabetes, improving glucose tolerance, blood pressure, fat levels, heart status and insulin effectiveness.  It will also lighten stress on hips, knees, ankles, and feet and give more energy.    Walking, swimming and low impact aerobics are options for the more active older patient.  Taking into consideration your loved one’s individual condition and ability, even the sedentary and frail can do strength-building exercises to improve flexibility, coordination and balance.

Joan in Chicago feels the frustration of caring for her aging mother who was recently diagnosed with diabetes.  Trying to make sure her mother is eating right and taking medications on time has not been easy.  She says her mom “used to be the type of person who would eat anything she wanted at any time.  I feel that she is starting to resent me because I have meals planned out and tell her not to eat some of the things she wants to.  I have been in yelling battles and don’t know what to do.”

Ironically, when Joan turned to her family for support, they would bring mom sugary treats and say, “She can do what she wants.”  It seems an uphill battle, but Joan’s persistence with her mother may pay off, especially if she seeks other support.  Local support groups and online chat rooms may provide a safe place to vent and get advice from others in similar situations.

Quality-of-Life Decisions

If lifestyle changes fail to control blood glucose, then drugs will be prescribed.  The aggressiveness of drug therapy is based on life expectancy and the diabetic’s current functional condition.  Drug-related side effects like hypoglycemia make aggressiveness of treatment in the elderly controversial.  It comes down to a quality- versus quantity-of-life decision.  

Caring for the elderly diabetic involves doing everything you can to keep your loved one’s blood sugar as close to the level of someone without diabetes.  Every day you can, the caregiver in you should strive to eat healthy foods, exercise, take medication if needed, and test blood sugar.  The Department for Public Health recommends that caregivers read up on literature and locate helpful websites to help them keep up to date on diabetes-related news like medication, nutrition and lifestyle habits.

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Lori Zanteson is a California-based freelance writer. She specializes in topics related to families and can be reached at lorizanteson@verizon.net.

Resources:

National Diabetes Education Program
American Geriatrics Society
American Diabetes Association
ElderCare Online’s Caregiver Support Center
Diabetes Society
 

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