Building Competency in Diabetes Education THE ESSENTIALS

CHANGES ACROSS THE LIFESPAN| 4-37

Table 9: Interventions for older persons

INTERVENTIONS

Challenge

Intervention

1. Physical functionality

Screen for barriers

•

Appropriate aids supplied

•

Encourage participation in physical activity

•

2. Comorbidities: Physical and cognitive, including depression

Screen early/treat early

•

Refer for education/counselling

•

Individualize targets

•

3. Polypharmacy

Simplify routine

•

Encourage use of one pharmacy

•

Blister packs

•

Communication with caregivers

•

4. Hypoglycemia

Individualize targets

•

Choose appropriate agents

•

Education

•

Targets for Control With the wide variation of functionality in this age group and the increasing rate of comorbidities, diabetes management becomes highly individualized (3,70,71,80). Targets for treatment are based on many factors, including the frailty of the patient as measured by frailty scales. The 2018 Guidelines recommend that:

“Functionally independent older people with diabetes who have a life expectancy of greater than 10 years should be treated to achieve the same glycemic, BP, lipid targets as younger people with diabetes” (3,71).

In contrast, the frail elderly with limited life expectancy have very different treatment expectations. The suggested targets for the glycated hemoglobin (A1C) in the frail elderly can be as high as 8.5% (3,70,80). As frailty increases, the treatment programs should be simpler and with less stringent targets (3,70,82).