Unique Diabetes Needs in Older Adults

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Unique Diabetes Needs in Older Adults

Barbara EichorstContributor: Barbara Eichorst, MS, RD, DCES
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Diabetes is a very common condition among older adults. According to the 2020 National Diabetes Statistics Report, 26.8% of those 65 or older have diabetes. As we get older, our diabetes needs change. Aging itself does not make it more difficult for older adults to manage diabetes. However, being older with diabetes means that different care priorities support a healthy aging process. Your psychological, functional, and social geriatric domains provide a framework to determine your goals for diabetes management. Your doctor is likely to screen you for geriatric syndromes that include cognitive impairment, depression, urinary incontinence, falls, and persistent pain. All of these can negatively impact the way you care for your diabetes.

Areas of concern for older adults with diabetes are:

  • Higher risk of hypoglycemia: Older adults have higher hypoglycemia risks, and recognizing it can be difficult. As an older adult, you might experience dizziness or visual disturbance as your main hypoglycemia symptoms. Other symptoms, such as anxiety and confusion, might be misleading, as they are similar to dementia. Overall, hypoglycemia symptoms tend to be less specific among the elderly, making it hard to recognize. Symptoms such as trembling, palpitations, sweating, anxiety, hunger, nausea, and tingling usually occur at a lower blood glucose level, while cognitive dysfunction occurs at a higher blood sugar level. Some patients struggling with hypoglycemia awareness might benefit from using a continuous glucose monitor (CGM).
  • A1C goals: Risks associated with hypoglycemia unawareness may call for higher A1C goals for those with cognitive or functional impairment. If you are on glucose-lowering medications like sulfonylureas, you might consider switching to medication classes with a low risk of hypoglycemia. Also, the amount of medication you take might change to reduce overtreatment.
  • Coexisting conditions: Your goals for treating hypertension, cardiovascular risks, and lowering lipids are also individualized based on the time frame of benefit. Much attention is given to conditions that would lead to functional impairment that can interfere in achieving diabetes care goals.
  • Nutrition: Healthy eating can become more challenging as we age, as well. We need fewer calories but still need to get enough nutrients like protein, minerals, vitamins, and fluids. At the same time, we may experience challenges related to healthy eating, like not being able to prepare food, afford it, taste, chew, or swallow it, or decreased appetite. You can talk to a qualified dietitian to help with your challenges related to healthy eating. Generally, you can try to eat foods that provide many nutrients without a lot of extra calories, such as fruits, vegetables, whole grains, low-fat dairy, dairy alternatives, seafood, lean meats, poultry, eggs, beans, nuts, seeds, and healthy fats. Foods with empty calories like chips, candy, baked goods, soda, and alcohol will not provide your body with the nutrients needed to be well. Also, if you are overweight or obese, you might benefit from engaging in programs designed for weight reduction that improve quality of life, physical functioning, and cardiometabolic risk factors.
  • Physical activity:  As far as exercise is concerned, the movement of daily living still matters! Schedule your daily activities to include aerobic and resistance training. You can work with a physical therapist when you have difficulties with movement and, consequently, cannot exercise safely.
  • Affordability: Do not be afraid to tell your medical providers if you are not taking your medications as prescribed because you cannot afford them. In many cases, there are more affordable alternatives that will work well for you.

As always, communicate all challenges about managing your diabetes with your doctor and Certified Diabetes Care and Education Specialist (CDCES). Remember that what used to work well in managing your diabetes in the past might not work now.

Diabetes can be part of your healthy aging process. In fact, many lifestyle habits you have because of diabetes help with your healthy aging process. You probably have a lot of healthy lifestyle habits already in place. Don’t forget that you are wiser and more insightful about your needs and priorities now. These different perspectives that you did not have when younger help you in managing your diabetes. Remember to be happy, keep your stress down, spend time with those you love, do things you enjoy, and embrace your age.

Barbara Eichorst, MS, RD, DCES, is the Associate Vice President of Clinical Practice and Research at Kindred at Home. Prior to Kindred at Home, Barbara has worked with Voluntis as a Diabetes Clinical Liaison, and with Healthy Interactions as Vice President of Clinical Care on a global program that involved over 120 countries. With the Conversation Map program, she has traveled to over 40 countries within the last eleven years. Barbara’s experience also includes work in Chicago as an insulin education specialist and a medical liaison. Barbara’s professional experience includes work at the Association of Diabetes Care and Education Specialists as a program director. Also, at the Chicago-based Rush University Medical Center, Barbara was a diabetes program manager. She has provided patient education in diabetes, weight management, cardiovascular disease, among many other chronic conditions at Loyola University Medical Center and Northwestern Memorial Hospital. Barbara’s professional focus is on behavioral interventions in disease management. She has contributed to multiple publications with her expertise in change activation, empowerment, and engagement.