A presentation on the care of diabetes in elderly people. This presentation is chiefly based on ADA guideline 2015 and focuses on the management of diabetes in persons aged >65 years.
A presentation on the care of diabetes in elderly people. This presentation is chiefly based on ADA guideline 2015 and focuses on the management of diabetes in persons aged >65 years.
Introduction and pathophysiology of hypertension in elderly. Differences among hypertension in adults and elderly in terms of symptoms, treatment consideration. Issues and Challenges among elderly patients. Stroke among Elderly population. Issues and challenges in stroke elderly population.
Diabetes is fast gaining the status of a potential epidemic in India with more than 65 million diabetic individuals currently diagnosed with the disease. Ranked second in the world, the burden of the disease is expected to compound in the years to come. Worryingly, diabetes is now being shown to be associated with a spectrum of complications and to be occurring at a relatively younger age within the country.
It is a known fact that most of the diabetes cases in our country is managed by primary care Physicians(PCP) who have a pivotal role to play in ensuring that diabetes patients receive effective care by practicing evidence based management. This said, the sad fact is that health care providers-primary care and specialists alike are not managing our patients with diabetes as well as we should be.
The complexities of the disease and its association with lot of other medical conditions make the management of diabetes more challenging to the PCPs. Patients feeling of frustration and denial about having the chronic condition often are a challenge to the practitioners in convincing the patients for initiation of treatment. With no clear cut national policy guidelines for management of diabetes, we rely on western guidelines which have certain pitfalls and fallacies in our setting.
This is a brief discussion on diabetes mellitus as medical emergency that can be encountered in any dental office.
What to do in such conditions is what I've briefly tried to explain over here.
Regards,
Dr. Abhishek Sharma
(M.D.S - 2016 Batch ; Oral & Maxillofacial Surgery)
This presentation was delivered by 3rd year MBBS students of Frontier Medical College during 4th Clinico-Pharmacological Conference held in the Pharmacology Dept of College. The Presentation aims at providing key features in detail about diabetes and its Pharmacological treatment. The Presentation was well applauded by the Faculty and students of Medical College. (Abbottabad, Pakistan).
Introduction and pathophysiology of hypertension in elderly. Differences among hypertension in adults and elderly in terms of symptoms, treatment consideration. Issues and Challenges among elderly patients. Stroke among Elderly population. Issues and challenges in stroke elderly population.
Diabetes is fast gaining the status of a potential epidemic in India with more than 65 million diabetic individuals currently diagnosed with the disease. Ranked second in the world, the burden of the disease is expected to compound in the years to come. Worryingly, diabetes is now being shown to be associated with a spectrum of complications and to be occurring at a relatively younger age within the country.
It is a known fact that most of the diabetes cases in our country is managed by primary care Physicians(PCP) who have a pivotal role to play in ensuring that diabetes patients receive effective care by practicing evidence based management. This said, the sad fact is that health care providers-primary care and specialists alike are not managing our patients with diabetes as well as we should be.
The complexities of the disease and its association with lot of other medical conditions make the management of diabetes more challenging to the PCPs. Patients feeling of frustration and denial about having the chronic condition often are a challenge to the practitioners in convincing the patients for initiation of treatment. With no clear cut national policy guidelines for management of diabetes, we rely on western guidelines which have certain pitfalls and fallacies in our setting.
This is a brief discussion on diabetes mellitus as medical emergency that can be encountered in any dental office.
What to do in such conditions is what I've briefly tried to explain over here.
Regards,
Dr. Abhishek Sharma
(M.D.S - 2016 Batch ; Oral & Maxillofacial Surgery)
This presentation was delivered by 3rd year MBBS students of Frontier Medical College during 4th Clinico-Pharmacological Conference held in the Pharmacology Dept of College. The Presentation aims at providing key features in detail about diabetes and its Pharmacological treatment. The Presentation was well applauded by the Faculty and students of Medical College. (Abbottabad, Pakistan).
Dr Vivek Baliga - Chronic Disease Management In Heart Failure And DiabetesDr Vivek Baliga
Dr Vivek Baliga, Consultant Internal Medicine at Baliga Diagnostics discusses the management of 2 common problems in medical practice - heart failure and type 2 diabetes, including the link between the two. For more articles for patients, visit http://heartsense.in/author/dr-vivek-baliga-b/. For scientific articles and short reviews, visit http://drvivekbaliga.net/
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
1. Diabetes Management in the
Older Adult
Presented by
Carolyn Jennings, MPH, RD, CDE
SouthEast Michigan Diabetes Outreach
Network
(SEMDON)
www.diabetesinmichigan.org
1
2. 2
Myths: DM in the Older Adult
• High prevalence of diabetes in older adults is
inevitable
• Hyperglycemia in older adults is usually a benign
condition
• Reduced life expectancy makes the
consequences of uncontrolled diabetes irrelevant
• The majority of older adults with type 2 DM are
obese and need to lose weight
• Older adults are less capable of self-monitoring
their blood glucose
5. 5
Diabetes in Older Adults
• 50% under-diagnosed – WHY??
• Early signs: Metabolic Abnormalities
– Insulin resistance
1st phase insulin release
PPG with normal FPG
• Early symptoms: (if any)
– Often gradual onset
– Commonly mistaken for signs of normal
aging
6. Case of Mistaken Identity
Signs of Diabetes
• Blurred Vision
• Polyuria and nocturia
• Fatigue
• MI and CVA’s 2 times
more common
• High Blood Pressure
• Neuropathy and foot
deformities
• Restlessness/confusion
with high and low BG.
Signs of Aging
• Needing glasses
• More frequent urination
• Can’t do things like you
did when you were 20
• Atherosclerosis
• High Blood Pressure
• Change in gait
• Restlessness, confusion,
slower cognition.
6
7. 7
Aging and Diabetes
• Poor diabetes control exacerbates the
aging process.
• Poor diabetes control causes age
related disease to develop earlier.
• Poor diabetes control makes co-morbid
conditions worse and harder to manage.
8. 8
OBJECTIVES
• State three areas of assessment for
the older adult with diabetes.
• State two recommendations for the
care of the older adult with diabetes.
• List education strategies appropriate
for the older adult with diabetes.
9. Diabetes Assessment
in the Older Adult
• Physical Assessment
– Mobility/ Physical Activity
– Nutritional Assessment
• Neurological Assessment
• Psychosocial Assessment
• Other Areas
9
10. 10
Diabetes Assessment
in the Older Adult
Common Geriatric “Syndromes”
• Depression
• Polypharmacy
• Cognitive Impairment
• Urinary incontinence
• Injurious falls
• Persistent pain
11. Physical Assessment
• Ophthalmic
– Higher rates of cataracts, glaucoma and
macular degeneration.
• Auditory
• Renal
– Thickening of basement cell membranes.
• Immune system
• Flu, herpes zoster, cancer
11
12. 12
Physical Assessment
Cardiovascular System
– Reduction in CVD risk factors may have
greatest impact on morbidity and mortality
• Hypertension
• Lipids
– Increased risk of CVA’s and MI’s.
– Heart rate in response to exercise reduced.
– Thickening of basement cell membranes.
– 50% of newly diagnosed people with T2DM
have CVD.
13. Physical Assessment
• Dexterity/coordination
– History of injurious falls
• Mobility/Physical Activity
– Joint disease/ Bone mass
Aerobic capacity
Lean body mass
Fat mass
– Activity
Current level?
Limitations, preferences 13
15. Nutritional Assessment
• Malnutrition
– Altered nutrient absorption
– Vitamin deficiencies (B12)
– CHO intolerance
– Decline in renal function
• Depression
• Cognitive Impairment
15
16. Nutritional Assessment
• Nutritional status
– Change in nutrient needs
– Change in body composition
– Hydration status
– Alcohol use/abuse
– Supplement/herbal use
• Gastrointestinal tract
Absorption
– Gastroparesis
Appetite
16
17. Neurological Assessment
• Cognitive Impairment
– Increased rate in PWD
• Mini-mental status exam recommended
• Check for reversible causes:
– B12 levels
– Thyroid hormone
– Neuroimaging
– Depression screening
– Blood glucose control
17
18. Neurological Assessment
• Autonomic and peripheral neuropathies:
–Heart
–Incontinence
–Sexual function
–Protective sensation
–Hypoglycemia unawareness
–Body Temperature regulation
–Reduced ability to sense:
• Thirst, Smell, Taste 18
19. Psychosocial Assessment
• Depression
• Support systems
– Loss of peers
– Change in family role
• Health Beliefs
• Locus of Control
– Internal vs. External
19
20. Other Areas of Assessment
• Co-morbidities
• Pain
• Polypharmacy
– Diabetes medications appropriate?
– Drug interactions
– Ability to administer medications
• Safety
• Finances
20
21. 21
OBJECTIVES
• State three areas of assessment for
the older adult with diabetes.
• State two recommendations for the
care of the older adult with diabetes.
• List education strategies appropriate
for the older adult with diabetes.
22. 22
Treatment Recommendations
• Glycemic Control
• Hypertension
• Lipids
• Tobacco cessation
• Eye care
• Foot care
• Nephropathy
• Diabetes Self-Management Training
23. 23
Treatment Recommendations
• When and how to prioritize interventions?
• Stratifying older adults:
– Comorbities
– Complications
– Risks vs. benefits of (intensive) therapies
24. 24
Glycemic Control
• A1c-
– <7% in healthy adults with good functional
status
– <8% appropriate in:
• Frail older adults
• Life expectancy less than 5 years
• Those whom risk of intensive glycemic
control outweighs benefits
– Frequency
25. 25
Risks of Intensive Glycemic
Control
• Hypoglycemia
• Polypharmacy
• Drug to drug interactions
• Drug to disease interactions
26. 26
Who benefits most from
Intensive Glycemic Control?
• Older adults in good health
• Those with microvascular complications
• Frail elderly without microvascular
complications will probably not live long
enough to develop them
28. 28
• Impairs co
Hgn
yit
piv
ee
ra
gb
lli
yylit
cy
emia
• Reduces energy
• Impairs memory
• Decreased wound healing
• Increased risk of HHS
• Increases urine output
– Impacts incontinence/dehydration
• Increased risk of UTI
• Impairs immune system
29. 29
• Aging increases risk of hypoglycemia:
– Reduced hormonal counter regulation
– Renal and hepatic changes
– Hydration status
– Inadequate or irregular nutrition
– Decreased intestinal absorption
– Autonomic neuropathy
– Polypharmacy
– Use of alcohol, other sedating meds
Hypoglycemia
30. 30
Hypoglycemia
• May cause:
– Heart arrhythmias
– Increased risk of falls
– Signs and symptoms may be masked by
co-morbidities (i.e. Parkinson’s)
– Impairs concentration and cognition
– Impairs reaction time
31. 31
Hypertension
• Goal: Less than 140/80 if tolerated
• Less than 130/80 may produce further
benefit
• Blood pressure reduction should be done
gradually to minimize complications (no more
than 20mm/hg reduction in systolic BP/3 mo)
32. 32
Hypertension:
Medication Precautions
• ACE-I or ARB Therapy
– Monitor K 1-2 weeks after initiating therapy
and with each dose increase
– ACE-I associated with decreased renal
function in elderly
– Hyperkalemia common at moderate and high
doses
35. 35
Lipids: Medication Precautions
• Increased side effects
– Myalgias and myositis
– Rhabdomyolysis
– Elevated liver function?
• Niacin or Statin: Measure ALT w/in 12 weeks of
initiation or dosage change
• Fibrate: evaluate liver enzymes at least annually
– Precaution with reduced renal function
36. 36
Aspirin Use
• The older adult (who is not on any other
anticoagulant therapy and has no
contraindications to aspirin) should be
offered 81-325mg/d.
37. 37
Tobacco Cessation
12% of PWD over age 65 smoke
• Assess use/willingness to quit
• Offer counseling and/or pharmacologic
interventions to assist with cessation
38. 38
Retinopathy Screening
• Dilated eye exam at diagnosis
• High risk (symptoms of eye disease,
retinopathy, glaucoma, cataracts, A1c>8, T1DM
or BP>140/80mm/hg):
– at least yearly follow-up exams
• Low(-er) risk : every 2 years
39. 39
Foot Screening
• At least annual comprehensive foot exam
and at all non-urgent outpatient visits.
Assess changes in:
– Skin integrity
– Loss of protective sensation
– Early detection of neuropathy
– Decreased perfusion
– Bone deformity
41. 41
Diabetes Self-Mangement Training
• More likely to include family members
and/or other caregivers
• Essential topics:
– Hypoglycemia prevention and treatment
– Benefits of MNT and physical acitvity
– Medication review
– Evaluation of foot care- amputation
prevention
– Evaluate Geriatric Conditions
42. 42
OBJECTIVES
• State three areas of assessment for the
older adult with diabetes.
• State two recommendations for the care
of the older adult with diabetes.
• List education strategies appropriate for
the older adult with diabetes.
43. The Adult Learner
• Perceives need
• Self-directed
• Experienced
• Problem-oriented
• Task-centered
• Internally motivated
43
44. 44
Patient Centered Education
• Assessment of where patient is with
disease “Health Beliefs”
• Assessing where patient is in regard to
“readiness to change” current behaviors to
improve (diabetes) health
WITH THIS INFORMATION the patient and
educator can work together to develop
individualized self-management plan
45. 45
Patient Centered Education
• Patients Role:
– Determine
personal self-
care goals
– Find solution
– Take
responsibility for
own health
• HCP’s Role:
– Active Listener
– Source of accurate
Information
– Provide essential
knowledge and skills
training
– Understand client’s
perspective
– Acknowledge the client’s
feelings
– Support Person
– Facilitator
46. Education Strategies
LISTEN, LISTEN, LISTEN…
• Positive attitude
• Provide meaningful practical individualized
information.
– Prioritize needs with the patient
– Assist with problem solving and goal setting
– Empowerment Model- Patient Centered
46
47. Education Strategies
• Assess baseline knowledge.
– Dispel any misinformation
– Update information
• Overcome generational barriers.
• Consider financial, accessibility, safety,
support systems and the effect on perceived
quality of life
47
48. Education Strategies
• Assess functionality and special needs
• Adaptive teaching strategies
–Visual accommodations
• Low vision aids
• Bright illumination
• Large print and bright contrast
• Detailed verbal explanations
• Use support system.
48
49. • Auditory Accommodations
– Eliminate distractions
– Minimize background noise.
– Reinforce with written materials.
– Speak slowly in short sentences.
– Speak to best hearing side.
– If patient reads lips, keep mouth uncovered
and do NOT chew gum.
Education Strategies
49
50. Education Strategies
• Cognitive Accommodations
– Simplify instruction.
– Frequently summarize.
– Focus on single topics.
– Teach simple tasks first then move on to
more complex.
– Use memory aids.
– Evaluate learning often.
50
51. Education Strategies
What is the present degree of Blood
Glucose control?
• If currently Hypo or Hyperglycemic:
– Teach Survival Skills
– Schedule follow-up when BG control
improved
– Give educational materials for
reinforcement
51
52. 52
Education Strategies:
Nursing Care Facilities
• Assess patient’s ability to participate in
self care.
• Prioritize care to patient and family.
• Involve family in education.
– Appropriate snacks to bring.
– Reinforce behaviors that promote optimal
control.
53. 53
Education Strategies:
Nursing Care Facilities
• Safety issues
– Hyper/hypoglycemia signs/symptoms
• Adult Learner Guidelines
• Evaluate level of control with respect to
quality of life, safety.
• Advocate for your patients whose diabetes
control is sub optimal.
54. 54
Summary- Education Goals
• Assist older adults to optimally self-manage
diabetes.
– Individualized BG goals to avoid both hyper-
and hypoglycemia.
– Prevent or delay progression of
complications.
• Promote optimal control for all older PWDs
– Hospitalized • Residentialcare
– Group living
55. Resources
• Guidelines for Improving Care of the older person with
diabetes
AM J Geriatric Soc 51(2003): S265-S280
• Geriatric Resource Directory www.bphc.hrsa.gov
• Working Together to Manage Diabetes
Diabetes Medications Supplement
www.ndep.nih.gov/diabetes/publications
• Oral Health Care for Older Adults www.nohic.nidcr.nih.gov
• Working with Your Older Patient, a clinician’s handbook
www.nia.nih.gov
• Exercise, A Guide from the National Institute on Aging
www.nia.nih.gov
55