Diabetes and the Elderly. Overall Agenda

Transcription

1 Diabetes and the Elderly Presented By: Michelle H Murphy, OTRL, CLT Sandi Healy Johnson, OTRL October 9 th, 2010 Overall Agenda Part I Michelle H Murphy, OTR, CLT Diabetes Overview Types I and II Signs, Treatment, Complications and Elderly Adaptation Part II Sandi Healy Johnson, OTRL Occupational Therapy Evaluations and Considerations Intervention Recommendations

2 Agenda Part I Introduction to Diabetes Type 1 and Type 2 Hyperglycemia and Hypoglycemia Glucose and Insulin Prevention and Treatment Complications Adaptations for the Elderly Introduction to Diabetes Statistics 1 American Diabetes Association, 2010 Expo.

3 Introduction to Diabetes Statistics continued Death Rate Since 1987: A 45% Increase Rates for Breast Cancer and AIDS have DECLINED 1 Close to 300,000 Americans Die Annually More than Breast Cancer and AIDS Combined 1 American Diabetes Association, Pamphlet, 2010 Expo. Diabetics are: Introduction to Diabetes Statistics continued 2 to 4 Times More Likely to Die from Heart Attack 2 to 4 Times More Likely to Die from Stroke In the United States Leading Cause of Blindness in People Aged American Diabetes Association, 2010 Expo.

4 Types of Diabetes Type 1 Diabetes 1 Juvenile Diabetes Occurs in 10% of Diabetics Diagnosed Usually at Age 20 Years or Younger Older Adults Can Develop (Rare) Little or No Insulin Secreted by Pancreas Must Take Insulin Type 2 Diabetes 1 Adult Onset Occurs in 90% of Diabetics Diagnosed Mostly at Age 20 or Older Rare to be Diagnosed in those Under Age 20 Pancreas Produces Enough Insulin Cells are Resistant and/or Insulin Cannot Move Glucose 1 American Diabetes Association, 2010 Expo. Glucose and Insulin Glucose (sugar) Two Sources: What One Eats Carbohydrates = Highest Impact Followed by Protein, Fat What One s Liver Produces Through Glycogen Breakdown Insulin Insulin is the: Key to Unlocking Microscopic Doors that Allow Insulin to Enter the Bloodstream

5 The Liver and Diabetes Stores Glucose and Manufactures It When Insulin level is High (after a meal), Liver Stores Excess Glucose as Glycogen Liver Releases Glycogen as Blood Glucose is Needed Throughout the Day/Night Natural Variations in Blood Glucose (sugar) in Everyone, More Pronounced in Diabetics Type 2 Diabetes May Remain Undiagnosed for Many Years Average: 6.2 million 1 Number of Patients Diagnosed: 20.8 million Americans Keys to Prevention: Diet Control Weight Management Exercise 1 Mayo Clinic Women s Healthsources, Special Edition Report. November, 2007.

6 Diabetes Treatment Type 1 Diabetes Insulin Diet Healthy Weight Exercise Type 2 Diabetes Weight Loss to BMI < 25 Exercise Balanced Diet Oral Medication (Metformin, etc.) Insulin The Role of Genetics Type 2 Diabetes Chances are Increased for Development of Type 2 Diabetes if: Parent/s Diagnosed with Type 2 Patient is Overweight Patient is Non Caucasian ARE YOU AT RISK? TAKE THE SURVEY AT: risk test/

7 Some Signs of Diabetes Hyperglycemia (High Blood Sugar) Frequent Urination Weakness Dehydration Coma Hypoglycemia (Low Blood Sugar) Hunger Weakness Dizziness Blurred Vision Treatment: More Insulin/Medication Treatment: Consumption of Sugar (Glucose) and Wait 15 Minutes and then Re test Diabetic Complications Neuropathy (numbness, sharp shooting pains in foot or hand, bladder numbness, hypotension, bowel disturbances) PAD: Peripheral Arterial Disease Eye Disease: Retinopathy and/or Glaucoma Kidney Disease (end stage renal disease) Damage to Blood Vessels in Kidney

8 Diabetic Complications Continued Heart Attack and Silent Heart Attacks Increased Risk of Infections Stroke Periodontal Disease Alzheimer's Disease Many of the complications listed may be prevented or have less dramatic implications if blood glucose control is optimal.

9 A1C Testing for Diabetes Level of Glucose Average in Bloodstream over 3 Month Period Glycated Hemoglobin Test Glucose Attached to a Red Blood Cell Protein 4 6 Normal <7 Optimal for diabetic >7 is of concern Possible Rapid Development of Complications Elderly Adaptations Magnifying Glass Alarm Clock for Regular Eating Times Nutritious Prepared Meals Healthy Choice Microwavable Meals Schwan s LiveSmart meals that also have easy to read food labels Home Grocery Delivery Pill Box Extra Large

10 Elderly Adaptations Continued Insulin Pen: Dose dialing with Magnifying Enhancer Magnifying Enhancer for a Conventional Syringe Pre fill Syringes and Medications Weekly Large Face Glucose Meter Large Print Glucose Log Book Elderly Adaptations Continued Cold/flu: Sick ready Cabinet: Juice, Gatorade, Crackers, Soup and 7 Up Lifeline Home Blood Pressure Monitor Easy to use with Large Display Microlife AHA Endorsed Monitor ($100) Omron Wrist Meter ($65.00 )

11 Part II Evaluation and Treatment Strategies for the Diabetic Patient Occupational Therapy Evaluations Considerations Interventions Recommendations Agenda Part II

12 Patient Sam Chief Complaint/Reason for Referral to Therapy: Weakness Infected Left Toe History of Present Illness 80 year old male admitted yesterday for weakness. He a has a UTI with a mild fever. Appetite is decreased. Left great toe is erythematous, discolored and foul smelling. Medical History Type 2 Diabetes Coronary Artery Disease Peripheral Neuropathy Right BKA (5 years)

13 Evaluation Concerns A complete evaluation is needed addressing: ADL s Self cares (grooming, bathing, and dressing) Current living situation (alone, with family, group home) Adaptive equipment present and utilized/durable medical equipment Support system available (family, services) currently and utilized Type of home and layout (stairs, ramp, etc.) Functional mobility Muscle Strength Range of Motion Cognition Pain Endurance (cardiac/lung/kidney concerns) Sensation (vision/hearing/tactile) Is there neuropathy?

14 Treatment Concerns Education needs Is the patient recently diagnosed with Diabetes? Will they need to give themselves injections? Do they have limited coordination/vision that would effect their independence with insulin injections? Is skin care a concern? Do they have open areas? Are they at risk for infection? Is Foot Care a concern? Is meal preparation /safety with cooking a concern? Foot Care 1 1 ) Have your feet examined regularly by a physician or podiatrist. 2) Inspect your feet daily. 3) Wash and dry your feet well. 4) Protect your feet from injury. 5) Take proper care of your nails. Do not use a nail scissors file recommended 6) Good Shoes with toe coverage and arch support, Velcro closures may be helpful. 7) Non binding socks. 1 (accessed August 15, 2010)

15 Patient Sarah Chief concern/reason for referral to rehab Syncope falls Recent fatigue and general malaise History of present Illness 68 year old female admitted yesterday from ER after fall at home in the bathroom. She states she did not hit her head. There are no fractured boned present. Per family increase confusion is present. Sarah s Medical History COPD Type 2 Diabetes Depression Diabetic Retinopathy

16 Evaluation Concerns Is there a known cause of fall? Vision, neuropathy of the feet, confusion, environmental cause Confusion? Is it do to high or low blood sugar? Depression How does it influence their diabetic control? Medications? Changes, compliance Treatment Strategies CPT /Cognitive testing to determine baseline and effective treatment approaches Assist patient to break down overwhelming task such meal planning, laundry, medication regiment Incorporate work simplification Evaluate home environment for hazards

17 Recommendations Work with your team to initiate diabetic education and training immediately Use the resources available to you Pharmacy Vision Loss Resources ADA website Peers, family, friends Adaptive Equipment Durable Medical Vendors References American Association of Diabetes Educators. (2010, February). Small Changes Equal Big Results. Health Monitor Guide to Diabetes. American Association of Diabetes Educators. American College of Cardiology and American Diabetes Association. (2006). Choose to Live: Your Diabetes Survival Guide. American Diabetes Association. Curry, A. (2010, September). Diabetes and Dementia. Diabetes Forecast, pp Kraft Foods, Incorporated. (2008). Good Eating: Good Living(1). KF Holding. Mayo Clinic. (2006). Mayo Clinic on Managing Diabetes. (M. Collazo Cavell, Ed.) Rochester, Minnesota: Mayo Clinic Health Information. Mayo Clinic. (2007, November). Special Report: Diabetes Prevention. Women's HealthSource Newsletter. National Institute on Aging. (n.d.). Diabetes Linked to Increased Risk of Alzheimer's in Long Term Study. Retrieved August 20, 2010, from National Institute on Aging: Wallace, J. I. (1999). Management of Diabetes in the Elderly. Clinical Diabetes, 17(1), p. 19.

18 Questions? Thank You