Most areas of care in diabetes are relevant to all age groups, but there are some specific changes due to growing older which might affect diabetes.
If you care for an older person living with diabetes, there are some age-related changes that can affect how they manage their condition. Understanding these changes can help you support the person you care for to stay as healthy and independent as possible.
Food choices
In some cases, dietary advice for older people living with diabetes may differ from general recommendations. Older people in care homes are often more likely to be underweight than overweight, and there is a high rate of undernutrition.
It may not always be appropriate to reduce fat, salt or free sugar for every older person with diabetes. Lower appetite or irregular eating can often be a cause of hypos.
Decline in oral health, effects of some drugs on the digestive system, limited mobility, dexterity or vision can all cause discomfort associated with eating. Other physical (such as swallowing difficulties) or mental health problems can also affect the volume and types of foods people can manage. Fluid intake is often lower in older people, which can cause dehydration, particularly during bouts of illness.
If the person you care for is at risk of undernutrition or has specific nutritional needs due to medical conditions, they should have a nutritional assessment and individual advice from a dietitian to address areas of concern, such as needing extra calories, meal supplements and replacements, weight reduction, a low salt diet or manageable foods.
Nutritional assessment and diet should form part of their individual care plan if they live in a care home. Personal food preferences are important in any diet plan, and older people living with diabetes should be able to continue to enjoy a wide variety of foods that they can manage.
Staff, including catering staff in older people's care homes, should have training to give them an understanding of the specific needs of individuals with diabetes.
Keeping active
Keeping active in later life helps to strengthen muscles, maintain mobility and balance and improve insulin sensitivity. It can also help the person you care for continue to manage daily tasks, improve their mental wellbeing and reduce the risk of falls. Encourage them to be as active as they are able.
Older people, including those with frailty, have been shown to benefit from light resistance and balance training. Exercise to build limb strength and flexibility for those who are housebound and confined to a bed or chair can be taught by a physiotherapist and supported by carers.
Remember to check with their GP before starting any new exercise.
Hypos
Hypoglycaemia or hypos occur when blood sugar levels drop below 4mmols/l. Older people may have added risk factors which can lead to hypo:
- use of insulin or certain diabetes medication
- chronic kidney problems
- reduced food intake
- having other illnesses or conditions.
Many older people find their hypo warning symptoms become less obvious, and some have no symptoms at all. This may mean that the first signs you notice are:
- inability to concentrate
- personality change
- morning headaches
- sleep disturbance.
Hypos which go unnoticed can cause very unpleasant symptoms:
- confusion
- speech and self-care difficulties
- poor appetite
- aggressive behavior
- unsteadiness and falls
- losing consciousness
- cognitive damage
- heart attack or stroke.
Treatment
A hypo should be treated immediately in a conscious person with fast-acting glucose, such as a sugary (non-hot, non-milky) drink or some glucose tablets and followed up with something starchy like biscuits, a sandwich or the next meal. If someone is unconscious, call for medical help or an ambulance.
For older people in care homes, a personal hypo box with hypo treatments and instructions for treatment can be kept at hand.
Prevention
To prevent hypos, it is helpful for the person you care for to have regular mealtimes and snacks containing carbohydrates. Knowing the signs of a hypo and what to look out for can help you act quickly if one happens.
Target levels for blood glucose management, may need to be higher in older people. This is something to discuss with their GP or healthcare team.
Blood glucose monitoring can help to identify whether the person you care for is at risk of hypos. These results should always be looked at together with longer-term blood results, such as HbA1c, to give a clear picture.
Residential settings providing care for people with diabetes should have a diabetes policy that includes the management and prevention of hypos, diabetes care plans for individuals, and diabetes skills training for staff.
Mental health and well-being
Depression is more common in people with long-term conditions but could be harder to spot in older people with complex health problems. Painful neuropathy, foot ulceration and adverse effects of medication can all contribute to depression.
The risk of dementia also increases with age. Anything which affects the mental well-being of the person you care for may affect their ability to successfully manage their own diabetes.
Simple tests are available from their GP to screen for depression or dementia. Recognising these issues at an early stage can help limit their longer-term impact.
For older people living in care homes, screening on admission and annually is recommended.
For more information, see our page on diabetes and dementia.
Illness and hospital admission
Older people living with diabetes, particularly those living in care homes, may be more likely to be admitted to hospital when they are unwell. This is because diabetes can have an additional effect on the illness, and the illness can impact on diabetes.
Blood glucose can rise quickly during illness, particularly in older people who are dehydrated. Extra monitoring and medication may be required, and you may need to give the person you care for some extra support.
It is important that there is guidance for carers in their personal care plan. This should also show very clearly when medical attention must be sought.
If the person you care for does have to go to hospital, it is very helpful to take a copy of the care plan with you so that staff can easily see their diabetes medical history and current treatment.
Managing self-care
Physical changes as people grow older may affect their ability to self-care. As changes can occur at any time, they may also indicate that something should be investigated, and they may need a change of medication.
Age is the most significant factor in common eye conditions like glaucoma, cataract, and macular degeneration. Worsening eyesight and reduced mobility may lead to a reduced level of daily foot care, meaning early warning signs are missed. Urinary incontinence can be a symptom of many conditions, including high glucose levels and changes in kidney function.
It is easy to assume that symptoms are simply due to the ageing process or because the person you care for has diabetes. However, it is important to seek advice for any new symptoms and to ask for support where self-care and monitoring has become difficult for them.
