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 your diabetes.
Food choices
In some cases dietary advice for the older person 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 the fat, salt and sugar for every older person with diabetes. Poor or irregular eating can often be a cause of hypos.
Poor oral health, effects of some drugs on the digestive system, limited mobility, dexterity or vision can all cause discomfort associated with eating. Fluid intake is often lower in older people which can cause dehydration, particularly during bouts of illness. People at risk 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, low salt diet or manageable foods.
Nutritional assessment and diet should form part of your individual care plan if you live in a care home. Personal food preferences are important in any diet plan and older people with diabetes should be able to continue to enjoy a wide variety of foods. 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 improves insulin sensitivity. It can help you to continue to self-care, can improve your mental well-being and prevent falls. You can aim to be as active as you 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 your GP before starting any new exercise.
Hypos
Hypoglycaemia or hypo occurs at blood glucose levels of less than 4mmols/l. Older people may have added risk factors which can lead to hypo:
- insulin or certain diabetes medication
- chronic kidney problems
- poor 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 noticed by a carer 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 to have regular mealtimes and snacks containing carbohydrate and to be aware of hypo symptoms and what to look out for in individuals who may be at risk. Target levels for blood glucose control should not be too tight and medication must be right for the individual. This is something to discuss with the GP.
Blood glucose monitoring can help to identify older people who may be at risk of hypos but must always be looked at together with longer term blood results like HbA1c to give a clear picture.
Residential settings providing care for people with diabetes should have a diabetes policy which includes 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 may go unnoticed 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 your mental well-being may affect your ability to successfully manage your own diabetes.
Simple tests are available from your GP to screen for depression or dementia. Recognizing 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. If you are living with diabetes and dementia, Living with Diabetes and Dementia is a helpful guide with practical tips.
Illness and hospital admission
Older people 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 the diabetes.
Blood glucose can rise quickly during illness, particularly in older people who are dehydrated. Extra monitoring and medication may be required and carers may need to give you extra support. It is important that there is guidance for carers in your personal care plan. This should also show very clearly when medical attention must be sought.
If you do 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 your diabetes medical history and current treatment.
Managing self-care
Physical changes as you grow older may affect your ability to self-care. As changes can occur at any time they may also indicate that something should be investigated as you may need a change of medication.
Age is the most significant factor for common eye conditions like glaucoma, cataract and macular degeneration. Failing eyesight and reduced mobility may lead to a reduced level of daily foot care, meaning early problem signs are missed. Urinary incontinence can be a symptom of many conditions, including poorly controlled diabetes and changes in kidney function.
It is easy to assume that symptoms are simply due to the ageing process or because you have 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 you.
