Building Competency in Diabetes Education THE ESSENTIALS

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can be impaired making it difficult for the elderly person to deal with their diabetes on a daily basis. The executive functions of problem solving, and judgement needed for any behavior change are also impacted by accelerated cognitive decline.

Due to the individual variance in the development of cognitive dysfunction is it essential that the health care provider determine the domains affected in order to understand which of the skills of diabetes self management the patient will have difficulty with (94).There are several assessment tools available to screen for dysfunction in the various domains of cognition, as well as for depression and diabetes distress- all of which will have an impact on the ability of the patient to carry out self-care activities. The Clock Drawing Test and the Mini-Mental State Examination (MMSE) are recommended screening tools for dementia and cognition (99-102). With the high prevalence of depression in the elderly, screening

Assessment tools: • Cognitive changes:

o The Folstein Mini Mental State Examination (MMSE) o Montreal Cognitive Assessment (MoCA) o Clock Drawing Test o Mini-COG o Geriatric Depression Scale (GDS)

• Depression:

measures, such as the Geriatric Depression Scale, should also be used to detect depression. The deleterious effects of depression on self-care behaviours can be improved by early detection and treatment (102-104). Research has also shown us that there are differences between type 1 and type 2 diabetes in the area of cognitive dysfunction (94).