Aging and diabetes. The first is inevitable; the other is increasingly more common (1). Each comes with its own set of challenges but put them together and you’ve got a potential powder keg of health issues to contend with.
Diabetes care for older adults has a unique set of challenges, points out Dr. Diana Sherifali – a Clinical Nurse Specialist with the Diabetes Care and Research Program at Hamilton Health Sciences. Many older adults are living with more than one disease (multimorbidity) and trying to juggle multiple medications to treat or manage their conditions. “It’s not just diabetes that’s competing for their attention. It could be arthritis, osteoporosis, chronic back pain, blood pressure, heart failure… you name it,” Dr. Sherifali says, “We may prescribe medications for diabetes, but how does that impact or interfere with other health issues?” She calls it a “huge conundrum” that must be addressed in order to help older adults with diabetes live as well as possible.
Chronic diseases like diabetes are often “self-managed,” a widely supported care model that empowers patients to be in control of their own treatments (2). But given the number of older adults also managing other conditions, medications and other age-related issues, questions remain about whether that approach is right for everyone. To address that gap in knowledge, Dr. Sherifali led a systematic review and meta analysis of 13 randomized controlled trials to determine which features of a diabetes self-management program are most effective in helping older adults cope successfully with the disease (3).
The studies involved more than 4,500 participants – all over the age of 65 and living with diabetes. About half were randomly assigned to one of four self-management programs, each focusing on a particular approach: tailored/individualized support; group settings; education and feedback; and an emphasis on psychological issues. Participants’ blood sugar, blood pressure and cholesterol readings were measured and compared to participants in control groups or usual diabetes education programs (3).
What the research tells us
According to the review evidence, diabetes self-management programs can benefit older adults. There was a small but significant drop in blood sugar levels, as well as slight decreases in blood pressure and cholesterol in the study group participants. Programs that offer tailored support based on the needs, goals and situations of the individual were most effective, followed by programs that address psychological issues including distress and depression (3). Self-management programs featuring technology may also be helpful for people managing their diabetes – a recent review found that mobile phone apps can help control blood sugar levels in people with type 2 diabetes (4).
Dr. Sherifali says she’s not surprised by the results (3) and believes tailoring programs to people’s individual needs is the only way to go given the diversity in the senior population in terms of health and how they live. “We know folks who are 65 that look like they’re 85 and are immobile or frail. And we know 80 year olds that are still active and run half marathons!”
Likewise, programs with a psychological emphasis help address both the physical and emotional needs of older adults as one directly affects the other and has implications for how well they take care of themselves: “Are they coping? Are they lonely? Do they have support? Maybe they’ve lost a loved one, their driver’s license or they’re retired. Some of those things are part and parcel of aging. But negative emotions may also be reflective of their multi-morbidity or medications.” Dr. Sherifali says having the “big picture” is the first step in understanding how best to support patients in managing their diabetes.
She says the next step is adapting programs to better address those unique limitations and needs. That could mean healthcare providers schedule more time with patients to learn about their circumstances, develop a workable program, screen for other conditions that could further complicate self-management (cognitive impairment, for example) and consult with family members and caregivers as needed.
Self-management can be an effective care strategy for older adults with diabetes, but it doesn’t mean they have to do it all by themselves. As Dr. Sherifali maintains, tailored support and frequent follow ups will go a long way towards keeping people out of the hospital and better able to enjoy their senior years.