Diabetes Management in the Very Elderly: An Integrative Review of Glycemic Guidelines and Assessment of Current Practice for the Treatment of Diabetes in the Elderly

2.50
Hdl Handle:
http://hdl.handle.net/10755/304160
Category:
Abstract
Type:
Presentation
Title:
Diabetes Management in the Very Elderly: An Integrative Review of Glycemic Guidelines and Assessment of Current Practice for the Treatment of Diabetes in the Elderly
Author(s):
Mason, Charlotte K.
Lead Author STTI Affiliation:
Non-member
Author Details:
Charlotte K. Mason, MS, FNP-BC, charlottekmason@gmail.com
Abstract:

Session presented on: Wednesday, July 24, 2013

Purpose:
  1. To explore existing literature and current practice regarding treatment of diabetes in the population over age 75.
  2. To propose individualized clinical guideline recommendations for care of the elderly with diabetes.

Methods: A  review of literature was collected via search of online databases.  A questionnaire was administered to local providers responsible for the care of elderly diabetics to explore how decisions are made regarding diabetes care.

Results: Three themes  identified; frailty, glycemic recommendations, and guidelines.

General consensus: Healthy elderly should strive for glycemic goals established for younger diabetics.  The frail elderly were recommended an A1C <8%.  A single study explored outcomes of elderly diabetics with various A1C levels.  Results suggested that A1C levels between 8% and 8.9% were optimal.

Guidelines agreed that maintaining glycemic targets leads to decreased morbidity and mortality.  All recommended optimizing lifestyle, avoiding obesity, tobacco cessation, and exercise for diabetics.  A major limitation of the literature was lack of scientific data to support recommendations for the elderly.

Questionnaire responses:

  1. 20.5% of offices have a written protocol elderly patients with diabetes
  2. 92.7% found guidelines helpful.
  3. 78.5% reported that preventing hypoglycemia was a primary concern.
  4. 52.5% do not treat elderly diabetics the same as younger diabetics.
  5. 18.1 percent reported an A1C <7.0% was optimal in the elderly
  6. 7.6%, stated 7.0% to 7.9%.
  7. 23.4 percent state 8.0%.

Conclusion: Individualize treatment of diabetes in the elderly.  Providers should consider quality of life.  Aggressive pursuit of an A1C of < 7% not recommended.  Patient centered care and patient goals should guide management.

Recommendations

  1. Individual assessment.
  2. Assess comorbid conditions.
  3. Assess risk of hypoglycemia.
  4. Avoidance of “diabetic diet”
  5. Exercise
  6. Reassessment of medications
  7. Evaluation of limitations.
  8. Simplification.
  9. Relaxed A1C guidelines
Keywords:
frail elderly; diabetes guidelines
Repository Posting Date:
22-Oct-2013
Date of Publication:
22-Oct-2013
Conference Date:
2013
Conference Name:
24th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International, the Honor Society of Nursing
Conference Location:
Prague, Czech Republic
Description:
24th International Nursing Research Congress Theme: Bridge the Gap Between Research and Practice Through Collaboration. Held at the Hilton Prague Hotel.
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleDiabetes Management in the Very Elderly: An Integrative Review of Glycemic Guidelines and Assessment of Current Practice for the Treatment of Diabetes in the Elderlyen_GB
dc.contributor.authorMason, Charlotte K.en_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsCharlotte K. Mason, MS, FNP-BC, charlottekmason@gmail.comen_GB
dc.identifier.urihttp://hdl.handle.net/10755/304160-
dc.description.abstract<p>Session presented on: Wednesday, July 24, 2013</p><b>Purpose: </b> <ol> <li>To explore existing literature and current practice regarding treatment of diabetes in the population over age 75.</li> <li>To propose individualized clinical guideline recommendations for care of the elderly with diabetes.</li> </ol><p><b>Methods: </b> A  review of literature was collected via search of online databases.  A questionnaire was administered to local providers responsible for the care of elderly diabetics to explore how decisions are made regarding diabetes care. <p><b>Results: </b> Three themes  identified; frailty, glycemic recommendations, and guidelines. <p>General consensus: Healthy elderly should strive for glycemic goals established for younger diabetics.  The frail elderly were recommended an A1C <8%.  A single study explored outcomes of elderly diabetics with various A1C levels.  Results suggested that A1C levels between 8% and 8.9% were optimal. <p>Guidelines agreed that maintaining glycemic targets leads to decreased morbidity and mortality.  All recommended optimizing lifestyle, avoiding obesity, tobacco cessation, and exercise for diabetics.  A major limitation of the literature was lack of scientific data to support recommendations for the elderly. <p>Questionnaire responses: <ol> <li>20.5% of offices have a written protocol elderly patients with diabetes</li> <li>92.7% found guidelines helpful.</li> <li>78.5% reported that preventing hypoglycemia was a primary concern.</li> <li>52.5% do not treat elderly diabetics the same as younger diabetics.</li> <li>18.1 percent reported an A1C <7.0% was optimal in the elderly</li> <li>7.6%, stated 7.0% to 7.9%.</li> <li>23.4 percent state 8.0%.</li> </ol><p><b>Conclusion: </b> Individualize treatment of diabetes in the elderly.  Providers should consider quality of life.  Aggressive pursuit of an A1C of < 7% not recommended.  Patient centered care and patient goals should guide management. <p>Recommendations <ol> <li>Individual assessment.</li> <li>Assess comorbid conditions.</li> <li>Assess risk of hypoglycemia.</li> <li>Avoidance of “diabetic diet”</li> <li>Exercise</li> <li>Reassessment of medications</li> <li>Evaluation of limitations.</li> <li>Simplification.</li> <li>Relaxed A1C guidelines</li> </ol>en_GB
dc.subjectfrail elderlyen_GB
dc.subjectdiabetes guidelinesen_GB
dc.date.available2013-10-22T20:30:16Z-
dc.date.issued2013-10-22-
dc.date.accessioned2013-10-22T20:30:16Z-
dc.conference.date2013en_GB
dc.conference.name24th International Nursing Research Congressen_GB
dc.conference.hostSigma Theta Tau International, the Honor Society of Nursingen_GB
dc.conference.locationPrague, Czech Republicen_GB
dc.description24th International Nursing Research Congress Theme: Bridge the Gap Between Research and Practice Through Collaboration. Held at the Hilton Prague Hotel.en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.en_GB
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