Please use APA format for your paper and follow the following steps to complete the plan of care. I. Assessment A. Specify the aggregate level for study (e.g., group, population group, or organization). Identify and provide a general orientation to the aggregate (e.g., characteristics of the aggregate system, suprasystem, and subsystems). Include the reasons for selecting this aggregate B. Describe specific characteristics of the aggregate. 1. Sociodemographic characteristics: Including age, sex, race or ethnic group, religion, educational background and level, occupation, income, and marital status. 2. Health status: Work or school attendance, disease categories, mortality, health care use, and population growth and population pressure measurements (e.g., rates of birth and death, divorce, unemployment, and drug and alcohol abuse). Select indicators appropriate for the chosen aggregate. C. Provide relevant information from the literature review, especially in terms of the characteristics, problems, or needs within this type of aggregate. Compare the health status of the aggregate with similar aggregates, the community, the state, and the nation. D. Identify the specific aggregate’s health problems and needs based on comparative data collection analysis and interpretation and literature review. Include input from clients regarding their need perceptions. Give priorities to health problems and needs, and indicate how to determine these priorities. II. Planning A. Select one health problem or need, and identify the ultimate goal of intervention. Identify specific, measurable objectives as mutually agreed upon by the student and aggregate. B. Describe the alternative interventions that are necessary to accomplish the objectives. C, Use preventive approach if applicable ( primary, secondary and tertiary) III. Intervention A. Implement at least one level of planned intervention when possible. B. If intervention was not implemented, provide reasons. C. Levels of prevention if its applicable IV. Evaluation A. Evaluate the plan, objectives, and outcomes of the intervention(s). Include the aggregate’s evaluation of the project. Evaluation should consider the process, product, appropriateness, and effectiveness. B. Make recommendations for further action based on the evaluation, and communicate these to the appropriate individuals or system levels. Discuss implications for community health nursing. Running head: DIABETES MANAGEMENT IN PATIENTS 1 DIABETES MANAGEMENT IN PATIENTS 11 Diabetes Management in Patients Aged 65 Years and Older (CUTLER BAY, FL) Student name Universal Career School Professor: Mirelys Yanes Abstract The study will be based on older adults living with diabetes in CUTLER BAY, FL. The focus will be the elderly age above 65 years. The dynamics of debates will be assessed by observing possible causes of diabetes to the older adults that consequently affect their well ...

1. Please use APA format for your paper and follow the following
steps to complete the plan of care.
I. Assessment
A. Specify the aggregate level for study (e.g., group, population
group, or organization). Identify and provide a general
orientation to the aggregate (e.g., characteristics of the
aggregate system, suprasystem, and subsystems). Include the
reasons for selecting this aggregate
B. Describe specific characteristics of the aggregate.
1. Sociodemographic characteristics: Including age, sex, race or
ethnic group, religion, educational background and level,
occupation, income, and marital status.
2. Health status: Work or school attendance, disease categories,
mortality, health care use, and population growth and
population pressure measurements (e.g., rates of birth and
death, divorce, unemployment, and drug and alcohol abuse).
Select indicators appropriate for the chosen aggregate.
C. Provide relevant information from the literature review,
especially in terms of the characteristics, problems, or needs
within this type of aggregate. Compare the health status of the
aggregate with similar aggregates, the community, the state, and
the nation.
D. Identify the specific aggregate’s health problems and needs
based on comparative data collection analysis and interpretation
and literature review. Include input from clients regarding their
need perceptions. Give priorities to health problems and needs,

2. and indicate how to determine these priorities.
II. Planning
A. Select one health problem or need, and identify the ultimate
goal of intervention. Identify specific, measurable objectives as
mutually agreed upon by the student and aggregate.
B. Describe the alternative interventions that are necessary to
accomplish the objectives.
C, Use preventive approach if applicable ( primary, secondary
and tertiary)
III. Intervention
A. Implement at least one level of planned intervention when
possible.
B. If intervention was not implemented, provide reasons.
C. Levels of prevention if its applicable
IV. Evaluation
A. Evaluate the plan, objectives, and outcomes of the
intervention(s). Include the aggregate’s evaluation of the
project. Evaluation should consider the process, product,
appropriateness, and effectiveness.
B. Make recommendations for further action based on the
evaluation, and communicate these to the appropriate
individuals or system levels. Discuss implications for
community health nursing.
Running head: DIABETES MANAGEMENT IN PATIENTS
1
DIABETES MANAGEMENT IN PATIENTS 11

3. Diabetes Management in Patients Aged 65 Years and Older
(CUTLER BAY, FL)
Student name
Universal Career School
Professor: Mirelys Yanes
Abstract
The study will be based on older adults living with diabetes in
CUTLER BAY, FL. The focus will be the elderly age above 65
years. The dynamics of debates will be assessed by observing
possible causes of diabetes to the older adults that consequently
affect their well-being, leading to poor physical health,
emotional and mental disruption, and financial constraints. A
history of the debates and various planning ways in combating
debates as one of the diseases causing many social problems in
the community and especially to the CUTLER BAY, FL
population. Stages of prevention like primary, secondary, and

4. tertiary prevention levels will be discussing analyzing
procedures to help to minimize diabetes to the aging population
by having the right intervention means that will ensure the
community is well informed about the causes, measures,
preventions, and intervention processes. Healthcare systems,
including Medicare and Medicaid being some of the programs
that help in ensuring quality care to children and elderly adults,
also play a vital role in the process of curbing the issues of the
debate hence giving the required guidelines on how to deal with
the aging population living with diabetes and how people
around them like a family should treat them.
Diabetes Management in Patients Aged 65 Years and Older
(CUTLER BAY, FL)
History
The discovery of diabetes by the clinician ever since they had
the idea that what people eat has an impact directly on the
progression of health. Around 1900 the only known cure for the
diabetes was specific diets that were preferred as natural food,
which was not processed, for example, milk diet.
Trikkalinou,Papazafiropoulou & Melidonis ( 2020) Having no
real treatment, the people of young age, if discovered with
diabetes, his or her life expectancy could only be one year 30-
year individual with diabetes could only have four years to live,
and the 50 years individual diagnosed with diabetes the life
expectancy could only be eight years. The research began to
commence, and in 1951s, it was discovered of diabetes Type1
vs. Type2, and clinicians could work on a specific individual
depending on the types diagnosed.

5. The rate of diabetes has changed over the period, and today,
around 200,000 Americans under the age of 20 have diabetes.
The causes of diabetes depend on the types, and some reasons
are beyond individual control with age, gene inherence, and
ethnicity play a part. Diabetes treatment has grown over with
clinicians designing drugs that mimic the pancreases functions
and insulin release and glucose meter regulators. As the study
evolved, it was discovered that individuals who could moderate
their sugar level to know they were less likely to get diabetes.
That declined with age with older people who are physically
inactive, having more chances of getting diabetes.
The future of diabetes is unknown, yet as in the 21st century, no
more development has taken place. More than 24% of
Americans age above 65 years live with diabetes, and the aging
population is in danger of getting the disease. It has higher
mortality to the elderly adult American Diabetes Association.
(2015). American Diabetes Association (ADA) has tried to
develop presentations aimed to address some diabetes issues,
especially to the older age.
Assessment
The selected aggregate for this paper is patients living with
diabetes within the community and the suprasystem includes
elderly patients. Further down, the plan of care for the project is
directed towards caring for patients who are 65 years and above
and who are managing their diabetes at home. There are many
personal responsibilities that come along with the management
of diabetes among them ensuring complete adherence to
medication, observing the right nutrition and checking for any
complications such neuropathy leading to diabetic foot ulcers,
eye damage, kidney damage and skin conditions. In turn, this
has financial implications that requires the patients to get
deeper into their pockets especially when they have no
insurance. In 2017, Trikkalinou, Papazafiropoulou, & Melidonis
mentioned that diabetes has a negative effect on the quality of
life (QoL) in terms of physical, social, mental, cognitive, and
psychological component. This specific aggregate has been

6. selected because of this high numbers of the baby boomer’s
population. They are in high numbers in the nation and within
the community and hence the need to have more concentration
towards them as they greatly affect the health indicators of the
nation and the society.
Elderly and diabetic population for those having 65 years and
above is made up of different sociodemographic and health
status. According to the American Diabetes Association, people
who are 45 years and above are usually at high risk for
developing diabetes (American Diabetes Association, 2015).
The risk also increases with advancement with age. Gender is
also another factor and diabetes affect people of both genders.
When it comes to race, there are races that have high prevalence
for developing diabetes than others. In a descending order, these
include American Indians, Non-Hispanic blacks, Hispanics,
Asian American and finally the Non-Hispanic whites (American
Diabetes Association, 2015). Different factors further play a
role on why some races would have high prevalence than others
and just to mention these factors they include living in poor
communities of neighborhoods, high insulin resistance rates
among some races and also those with high level of obesity
have high risk of developing diabetes. It is also likely that
patients who have low levels of education and with low income
would not manage the diabetes as needed due to lack of
resources.
In regard to health status as specific characteristic, there are a
number of health issues that affect elderly patients. Just to
mention some few, these include mental health problems such as
depression, Alzheimer’s diseases and dementia which affects
their memory, schizophrenia, hypertension, Parkinson’s disease,
cataracts and diseases of the joints such as arthritis. It is also
likely to find a patient who has been diagnosed with more than
one of these diseases. This affects their quality of life due to
physical and psychological changes happening to them.
According to the National Diabetes and Statistics Report of
2020, 34.2 million Americans of all ages already had diabetes in

7. 2018. This is equivalent to 10.5 % of the population. 34.1
million Of these were adults. The report also shows that with
increase in age, the percentage of adults diagnosed with
diabetes also increased. 26.8% of these were aged 65 years and
older. Men were also found to be at high risk than women.
White, non-Hispanics had more prevalence, followed by
Hispanics, Black non-Hispanics and Asian non-Hispanics with
the lowest numbers. In the same year, 1.5 million newly
diagnosed diabetes cases were reported. The incidence rates
were also higher in adults aged 45 to 64 years and those aged 65
years and above. Those aged 18 to 44 years had lower
incidences compared to the other two (Centers for Disease
Control and Prevention, 2020).
Literature from Giri & Putra (2020) on the perceptions and
needs that the diabetic patients have indicate that patients
diagnosed with diabetes report fear because they do not know
their nutritional needs. They reported lack of knowledge of the
food patterns they should take and what to avoid. Some patients
do not understand what it means by a food intake with high
calories. This, therefore, formed the basis for having the project
focus on nutrition and other non-pharmacological approach of
exercising. Giri & Putra further stated that nutrition is very
important for diabetic patients. Lack of this knowledge turned
to be a trigger to their stress levels causing deterioration of
their health.
Planning
The need identified for this population is management of
diabetes using non-pharmacotherapy interventions. As
aforementioned, there is needed to continuously manage
diabetes because it is a chronic illness and therefore patients
must take the responsibility of caring for themselves with the
help of their doctor for a long-term period. Taking the
medications helps the body in getting rid of the glucose that is
in excess in the blood. The body also used the insulin in a better
way. Depending on the patient’s condition, the doctor decides
what form of treatment is needed. Some patients may only need

8. to take pills while others take pills and also inject insulin. The
non-pharmacological therapy involves observing a healthy diet,
going for exercise, and weight loss. Taking a diet with low
calories is very crucial. Regular exercising helps in weight loss
since obesity only complicates diabetes.
On agreement, the student and the aggregate decided to work
towards encouraging adherence to the non-pharmacological
approaches. The main goal of the intervention was to
compliment the use of medications for the best patient
outcomes. Taking the medications without observing the
mentioned non-pharmacological approach would not result to
full effect. This is why it is important to include this
intervention. As agreed, upon by the student and the aggregate,
there are three areas of focus. These include coming up with a
list of all low calories food and preparing sample meal plans,
understanding what exercises are needed for a patient who has
diabetes and keeping daily reading record of diabetes at least
for three months to help track the management of diabetes
following adherence to the interventions mentioned herein. This
would help in determining whether the approaches applied
currently are effective or there is need to change course of
treatment. Setting measurable objectives is important as a way
of evaluating the effectiveness of the intervention. Below are
the objectives to be achieved with this intervention.
I. Patients prepare different meal plans every week with the
right number of calories.
ii. Ensuring that they engage in exercises at least three times
per week.
iii. Have daily records of the blood sugar level.
These are measurable objectives because patients can report
whether they have been able to do as agreed and provide
evidence such as the meal plans and the daily records. In regard
to exercising, it is possible to tell whether the patients adhered
to it by comparing their weight over time to see if they have
lost some pounds. To accomplish these objectives, the aggregate
needs to have a good understanding of why they need to do so.

9. The intervention that can help in ensuring that they comply is
educating them on the benefits of each of the approaches in
their diabetes management journey and the outcomes they
should expect. Understanding why that is importance increases
compliance. This would be considered a preventive approach
because it intends to encourage the patients towards proper
management of the disease and hence reduces the prevalence of
having poorly controlled diabetes and related complications.
Hence, they are proactively prevented.
The primary level of prevention
It is believed type2 diabetes results from the genetic interplay
and environmental factors, but a continued study has further
evidence that current diabetes is mostly due to change in diet
and lifestyle. Clinicians have demonstrated that some extent can
be prevented primarily through moderating lifestyle and diet
observation (Kalra, Kumar & Gupta, 2016). Excess adiposity is
the most significant risk factor. Keeping body weight and
avoiding weight gain in old age can be a right way better way to
prevent diabetes. Being physically active with few sedentary
behaviors like being on TV, smoking low consumptions of
alcohol, avoiding a lot of fats, getting more used to unsaturated
fats, and avoiding refined. Generally, diets that are rich in
minerals salts liken magnesium and calcium can be of value in
the prevention of diabetes,
The secondary level of prevention
The secondary level of diabetes prevention aims to decrease
mortality rate by working on macrovascular complications and
focusing on preventing coexisting risk factors; it is achieved
through a screening test to determine the type of diabetes and
carry out practical measures that include; working on lipid
disorders (Kalra, Kumar & Gupta, 2016). Statin treatment is
considered to person diagnosed with diabetes; individuals who
are over 65 years and have no cardiovascular disease are
recommended to moderate statin dose if they have a CVD risk
factor then average to high statin dose. Again, at this level,

10. blood pressure control is paramount for patients who have
diabetes.
Tertiary level of prevention
Quality of life through minimizing possible disabilities by
delaying complications and restoring the functionality; it is
more rehabilitative and enhances the patient's condition At this
level, treatment should commence where a series of detection is
done, which includes a screening of retinopathy, nephropathy,
and cardiovascular and other underlined diseases. Earlier
detection calls for proactive measures and retinopathy detection
can prevent more severe complications like blindness, which is
more prevalent to people at old age hence reducing more
progression of diabetes (Kalra, Kumar & Gupta, 2016).
Discovering nephropathy, then managing other coexisting
factors like hypertension, is crucial. Generally, tertiary
prevention serves the goal of improving.
Intervention
Glazier, Bajcar, Kennie, & Willson (2006) explain that there are
different levels of planned interventions that can be applied.
These include interventions directed to the health systems, to
the health providers or patient-level interventions. Health
system intervention focus on changing the policies used in an
organization or facility while health providers’ interventions
affects the practices of care providers. The patient-level
intervention is most applicable here and this is because all the
attention is given to the patient with the ultimate goal of
helping them become more accountable of their health. When
the intervention is designed towards the aggregate, it should be
within their level of understanding in terms of the language
used.
This intervention was applied with a good number of the
aggregate population increasingly remaining active during the
period of learning and also when it came to evaluating whether
the objectives were met. Findings indicated patients having
different meal plans for different weeks, recording of readings
everyday using digital applications for diabetes management

11. and weight loss in some of the patients who actively engaged in
daily exercises.
Evaluation
The plan implemented for this project towards addressing the
need for diabetes management among elderly patients is with no
doubt found to be beneficial to them. Following its
implementation and completion, there are many positive
outcomes to be reported including reduces levels of A1C and
lower risk of developing complications. Furthermore, with
proper diet and exercising, this does not only improve diabetes
management but also the overall health. Looking back, the
objectives are undeniably very much measurable in nature and
this helps in assessment of the response that the aggregate had
on the project. Specific to the project, the aggregate’s evaluated
the project in a positive way stating the benefits relating to the
whole process of educating them on why they need to comply. It
proved to be an appropriate approach and also one that is
effective (Giri, & Putra, 2020). The recommendations made is
to have more programs like this which will eventually transform
the health of the community, state and nation at large. Different
healthcare facilities can implement the approach within their
facilities too. Additionally, a follow-up is needed after the
completion to ensure that patients develop a culture of taking
care of their health using the taught approach. Community
health nursing can result to complete transformation of the
health status for different illnesses. The designed used can be
generalized for use in communities with high prevalence and
burden of diabetes complications not only for this specific
aggregate but also for all the other age groups.

12. References
American Diabetes Association. (2015, January 1). 2.
Classification and diagnosis of diabetes. Retrieved from
https://care.diabetesjournals.org/content/38/Supplement_1/S8
Centers for Disease Control and Prevention. (2020). National
Diabetes Statistics Report. Retrieved from
https://www.cdc.gov/diabetes/pdfs/data/s tatistics/national-
diabetes-statistics-report.pdf
Giri, M. K., & Putra, A. (2020). Perceptions and needs among
diabetes patients: A qualitative study. Proceedings of the 3rd
International Conference on Innovative Research across
Disciplines (ICIRAD 2019). doi:10.2991/assehr.k.200115.033
Glazier, R. H., Bajcar, J., Kennie, N. R., & Willson, K. (2006).
A systematic review of interventions to improve diabetes care in
socially disadvantaged populations. Diabetes Care, 29(7), 1675-
1688. Doi: 10.2337/dc05-1942
Kalra, S., Kumar, A., & Gupta, Y. (2016). Prevention of lip
hypertrophy. J Pak Med Assoc [Internet].
Trikkalinou, A., Papazafiropoulou, A. K., & Melidonis, A.
(2017). Type 2 diabetes and quality of life. World Journal of
Diabetes, 8(4), 120. doi:10.4239/wjd.v8.i4.120