Diabetes Awareness: A Unique Approach for Older Adult Patients

November 21, 2019

By NCECE Staff

Female physician discussing diabetes with a patientNot all patients with diabetes are alike. With vast differences in the approach to the management of symptoms across the lifespan, Joslin Diabetes Geriatric Diabetes Program Director and NCECE Consultant Medha Munshi, M.D. discusses the unique and personal approach necessary for appropriate treatment of older adults with diabetes. In observance of Diabetes Awareness Month ¹ we explore their unique aspects.

“Older adults, in general, are living longer and are more functional, healthier, and more active through later years of life,” said Dr. Munshi. “All of us will be seeing more older adults with diabetes. Just as clinicians treat pediatric patients with diabetes differently, older adults aren’t just adults with wrinkles.”

Dr. Munshi’s point underscores the research ² that screening and treatment of older adult patients with diabetes is unique to that population; the same approach across the lifespan would be unsuitable. “They are a unique population with unique challenges, necessitating a tailored approach for diabetes management,” she explained. “There are very different clinical, functional, and psychosocial challenges. There may be other diseases they’re managing as well. They may have disabilities. They can be lonely and may or may not have someone to help them at home. Financial resources may be limited. There are also different living statuses – in communities, on their own, in a rehab facility, in a nursing home – and all of these factors impact the person’s ability to take care of their diabetes.”

Even within an otherwise healthy, active older adult patient with diabetes a common assumption is that the treatment approach is the same or similar to that of a younger patient.

“The aging body has limitations,” she said. “Through this phenomenon known as homeostenosis, an older adult's ability to compensate for injury or organ failure is limited. When diagnosing and treating any older adult, respect their age and be careful of how you plan to treat them.”

The demands of self-care for diabetes can contribute to rates of depression in this population, Dr. Munshi explained.

“We know that both depression and dementia have a bi-directional relationship with diabetes,” she said. “If depression is controlled, it may help people care for their diabetes. When a patient has cognitive dysfunction, it is important to recognize and treat that. Be mindful of cognitive decline and don’t give your older adult patients tasks that go beyond their capabilities.”

Setting appropriate goals, she said, will not only lead to proper management of diabetes, but it avoids setting the patient up for failure. “The goal shouldn’t necessarily depend on age, but rather, what other medical problems they have,” Dr. Munshi explained. “What is their cognitive and functional status? What are they being treated with? Develop a regimen that fits their ability to take care of themselves.”

Ultimately, Dr. Munshi has found much success in managing her older adult patient with diabetes when she seeks to understand their motivation for managing their disease. 

“Do not just chase after the numbers,” she advised. “Seek to prevent complications. As we age, the goal is to remain functional and independent, so clinicians should not give treatment that is counter-productive to those goals. The patient may end up not following the doctor’s regimen because they can’t do it themselves. Quality of life is important and needs to be considered in the context of all these other factors.”

¹ https://beyondtype1.org/diabetes-awareness-month/

² https://care.diabetesjournals.org/content/42/Supplement_1/S139

For additional resources, check out our recent publication with the Corporation for Supportive Housing, entitled Diabetes Management and Oral Health among Older Adults Experiencing Homelessness. An archive of diabetes-related webinars and learning collaboratives are also available on the NCECE website.