Diabetes and older people: issues of diagnosis and care

In the UK approximately 16% of the population are above the age of 65, with 7% above the age of 70 (Croxson 2002) through 2025 it is also predicted that the figures for those above 80 in the UK will increase by means of 50% and that the number of race over 90 years will also have doubled (World Health Organization and the International Diabetes Federation, 2004) Older family with diabetes have additional point in disputes to the general older population--for example, hospitalisation rates of older nation are 70% higher for those with diabetes (Croxson 2002) This article explores these enigmas and some ways in which diabetes care approaches may tackle them.

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- Intellectual functioning

- Diet and exercise

- Eyesight

- Urinary and sexual problems

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The National Service Framework [NSF] for Older family (Department of Health [DoH], 2001) states that health and social care services should treat older race as individuals and enable them to make choices about their have care, and that this should be achieved by the agency of among other things, an 'integrated provision of services'. However, this may not be achievable in the not absent climate of limited resources (Richmond, 2004)

The incidence of diabetes in older family is higher than for the quiescence of the population for a number of reasons, on the other hand mainly because increasing insulin resistance accompanies ageing, plane if the older person is not particularly obese or sedentary (Reaven, 1988) It is not known on what account insulin resistance increases with age, as the pancreas appears to exhibit insulin at a normal rate, with the fasting life-blood glucose actually rising very slowly above time. However, postprandial glucose horizontals rise much more quickly and lead to the diagnosis (Jarvis and Rubin, 2003)

Older family with diabetes may not complain of any symptoms, or not those usually associated with stamp 2 diabetes (Jarvis and Rubin, 2003) They may have a los of appetite, or weakness, and may have experienced weight los In addition, symptoms of urinary incontinence (usually associated with prostrate point to be solved [i]or[/i] settleds in men and urinary tract infections in women) may be met with (Jarvis and Rubin, 2003). Older clan with diabetes may not complain of thirst as their ability to perceive thirst is altered (Jarvis and Rubin, 2003) Nevertheless, any of these symptoms may indicate diabetes in the older person

While there are many older tribe who manage their diabetes actual well, a number of point in disputes can exist in older clan with the condition. This article explores a certain quantity of of the areas in which older age could affect diabetes management.

Intellectual functioning

The intellectual functioning of an older individual with diabetes may need assessment if cognitive impairment is suspected because management of the condition requires a fairly high horizontal of mental functioning; the individual has to come [i]or[/i] go after [i]or[/i] behind a given diet and medication regimen, and might ne to trial his or her blood diabetic sugar level. Studies have shown that older clan with both type 1 and impressed sign 2 diabetes have a higher incidence of dementia (defined as los of mental functioning by the agency of Ryan et al [2003]) and Alzheimer's disease (Den Heijer et al, 2003; Arvanitakis et al, 2004) making it plenteous harder to perform these tasks.

The somebody with diabetes can undergo cognitive screening ordeals to determine their level of functioning, and to diocese if they can remain self-sufficient. These trials may show that older nation who live alone with no assistance may require a carer to visit, sheltered housing, or relocation to a nursing home

Diet

Many older family with diabetes do not require this horizontal of care and may solitary have problems associated with nutrition. As well as the intellectual functioning required to understand and prepare a healthy diet, the individual may have other moot points associated with proper nutrition. These include:

* depressed income

* poor vision

* poor appetite to be paid to decreased taste and smell

* arthritis or tremor, making preparation of provisions difficult

* poor teeth or dried mouth

* depression affecting the appetite (Sinclair and Barnett, 1993)

* feeling that he or she is too elderly to worry about caring for his or her diabetes (Jarvis and Rubin, 2003)

single or a number of these moot points may mean an inadequate diet and resultant poor diabetes control

Exercise

Older clan with diabetes may be touched about their diet and exercise if they have previously l a fit and healthy lifestyle. Exercise as a treatment option may be limited in the older individual with diabetes. However, studies have shown that, level in the very old, exercise brings blood glucose concentration and Hb[A.sub.1c] (Watson, 2001) However, older clan are more likely to have coronary heart disease, arthritis, organ of sight disease, neuropathy and peripheral vascular disease (Jarvis and Rubin, 2003) potentially meaning exercise is difficult.

Eyesight

Older clan are particularly at risk of organ of vision disease brought on by diabetes, which may compromise all aspects of their care. They are susceptible to cataracts, macular degeneration, and open-angle glaucoma in addition to diabetic retinopathy (Shotliff and Duncan, 2005) Evans et al (1996) reported that one-third of older family have never had an organ of sight examination. This highlights the issue of detecting and treating organ of vision disease early. Indeed, a report from Diabetes UK (2005) stated that the vast majority of cases of diabetes-related blindness can be stoped if those at risk are treated 'early and adequately'.