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5 ways to help seniors with diabetes

The senior population is perhaps the most diverse age group: An active 65-year-old who just enrolled in Medicare may have very different health needs from those of an 85-year-old in an assisted living community.

“The main thing is it’s a very heterogeneous population,” says Medha Munshi, MD, head of the Joslin Diabetes Center’s Geriatric Diabetes Clinic. “If I ask someone to think about an 80-year-old patient with diabetes, they can think about a very healthy, functioning person who is playing sports or someone who is in a nursing home.” The key to assessing a senior’s needs? Talking early and often to discuss changes as they occur.

Start the conversation. Your partner or parent has probably been managing his or her diabetes alone (with the help of health care providers) for quite some time. You don’t have to jump in right away—but it’s important to get an idea of what the regimen is like. “The benefit of the doubt always goes to the patient,” Munshi says. “If they didn’t take care of themselves, they wouldn’t have made it this far.” By talking about how your loved one manages his or her diabetes, you’ll be able to spot changes if they occur, and you’ll know what barriers, such as dwindling finances or social support, might pop up in the future. Diabetes care requirements can also affect where an older person might live, says Barbara Resnick, PhD, CRNP, FAAN, FAANP, past president of the American Geriatric Society and professor at the University of Maryland School of Nursing. So begin those chats early.

Tune in to changes. Signs of the aging process may be gradual, and you might not notice changes in your loved one right away. A change in temperament can be a sign that other aspects are changing or declining. Keep in mind that age-related memory lapses, difficulty or pain with physical activity, vision problems, and loss of fine motor function (important for drawing insulin into a syringe or doing a finger stick to test blood glucose, for example) can take their toll on diabetes self-care.

When changes happen, discuss them and create solutions together. “Often, I’ve found the older adult is generally happy to have someone take over,” says Resnick. Be tactful when you suggest stepping in—focus on how your help will make your loved one feel better. “Say, ‘You know what, you’re having some trouble with this. How about I help and we do it together?’ ” Resnick suggests. So engage your loved one, and remind him or her that you’re in this together, while you oversee stocking a pillbox or administering insulin.

Keep it simple. Munshi says she focuses on simplifying her older patients’ care. As we age, we lose frontal-lobe function in the brain—that’s the area that controls starting new behavior and stopping old behavior. “It’s not memories; it’s how people put things together,” Munshi says. “It seems like people are being stubborn, but it’s very hard for them to change their behavior in any way.” So even if there are new medications on the market that might suit them, if her patients are doing well on the older drugs, she keeps them on the regimen that she knows works. And if a regimen that worked for 20 or 30 years is suddenly feeling complicated, Resnick says there’s “no bad outcome” in simplifying treatment. But “if it’s not broken, don’t fix it.”

Consider mental health. Depression is very common in older adults, and often they don’t talk about how they feel. “A lot of times when patients come to me, they don’t want to complain,” Munshi says. So as a caregiver, try to monitor mental and emotional well-being, and step in when you can. Talk to your loved one’s physician if you notice any changes in personality, such as moodiness, irritability, change in eating or sleeping habits, or loss of energy. Bear in mind, though, that after years of diabetes care, your loved one might be facing some burnout, and that’s OK. “I don’t think it’s wrong for someone in their late 80s to say, ‘If I don’t want it, I don’t want it,’ ” Munshi adds. But ask gently to see if that statement is really masking depression or loss of memory.

Play it cool. Especially in later years, managing diabetes is really about managing short-term risks such as hypoglycemia (low blood glucose)—and expectations. Resnick says it’s her goal to help older patients avoid hypoglycemia, which could lead to passing out or falling. “We don’t get carried away on monitoring diet and monitoring aggressively for finger sticks,” she says. After years of tightly controlling blood glucose levels, some older folks might just want a break, which is all right—the risk of developing complications needs to be weighed against overall quality of life, Munshi says.

While you want to show you care, too much pressure can damage your relationship and your loved one’s health. “[Caregivers] need to learn to back off,” Munshi adds. “Many times, I would see the children of the patient, and I would say, ‘Your mother is doing well. These high blood sugars aren’t going to hurt her, but what you are doing certainly is going to cause a heart attack!’ ” So don’t put too much pressure on your loved one—or yourself.

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