Caring for an Elder With Diabetes
When and how to offer an older person more help
We're born helpless, grow more independent, and may be caught unawares when assistance is once again needed later in life. With older adults, it may be hard to broach the topic of taking over some functions of diabetes management, as well as helping with other health challenges that may come along with diabetes. By taking prudent steps, asking the right questions, and being supportive, you can ensure that your loved one will receive the best care possible.
Services for the Aging
Vanessa Jones Briscoe, PhD, NP, CDE, chair of the American Diabetes Association's older adult work group, notes that Medicare will reimburse for diabetes education and diabetes care training. Medicare provides benefits for both type 1 and type 2 diabetes care, but there are limitations; continuous glucose monitors are not covered at this time, for example. This fall, watch for three ADA brochures about the risks of diabetes in people ages 65 and above. "Diabetes 101," "Caregiving for Someone With Diabetes," and "Complications" will be available free of charge by calling 1-800-DIABETES (1-800-342-2383).
Assess the Situation
To gauge your loved one's capabilities, observe him or her in everyday situations, suggests Ronald Schorr, MD, MS, director of the Geriatric Research Education and Clinical Center at Malcolm Randall Veterans Affairs Medical Center in Gainesville, Fla. "[Aging] would rarely be, in my experience, isolated to just a problem in diabetes management," Schorr says. "It would be pervasive across the spectrum that [the person is] 'losing a step.' "
Such changes in ability may be physical—poor balance that can add another degree of danger to episodes of hypoglycemia or problems with eyesight that can make it difficult to distinguish the tiny unit markings on a syringe. Cognitive function is also an indicator of how much control someone can have over his or her diabetes care—missing meals and taking too much insulin can wreak havoc on a person's health. Vanessa Jones Briscoe, PhD, NP, CDE, chair of the American Diabetes Association's older adult work group, says changes in mental state can appear slowly.
Action Item: Check in on your loved one. Is he or she struggling to balance a checkbook, drive a car, or make executive decisions? Does he or she mix up medications? Has his or her personality changed? If so, it may be time for someone to help with diabetes management.
Raise the Topic
Previously independent adults may bristle at the thought of relinquishing control of their health care. And no two people will react the same way. "These are really sensitive conversations that are going to be managed differently by different caregivers and different patients," Schorr says. "Caregivers are sometimes afraid to confront the patient with their concerns."
Schorr suggests contacting your loved one's doctor with any concerns you have. You may set up a family meeting during your loved one's next diabetes visit to address concerns and chart out what changes, if any, can aid his or her diabetes management plan.
Action Item: Contact the doctor and ask if he or she will moderate a conversation about the diabetes care plan. Briscoe says it's important to ask questions. "Ask, 'How can I … help you take care of yourself?' " she says. " 'I'm not trying to take over; I just want you to be happy and active.'"
Divide and Conquer
People with diabetes know that their care regimen is always changing, Briscoe says, so your loved one may be open to modifying his or her routine. Talk together with a health care provider, such as a certified diabetes educator, to establish what your loved one is comfortable handling alone, what you might help with, and what might need to be done by a visiting or in-home nurse. You want your loved one to feel independent while still maintaining good health.
Simplifying the diabetes care plan and making a chart of who handles what (such as medications, injections, and blood glucose test results) can go a long way in helping you keep your loved one safe and healthy. It's also important to outline goals at the onset, says Schorr. An older person's immediate safety may take precedence over avoiding long-term complications. For example, the doctor may suggest a higher blood glucose target range to avoid bouts of hypoglycemia. Adds Schorr: "You just have to step back and say, 'What are our goals here?' "
Action Item: Discuss what your loved one feels comfortable with in the diabetes care plan and what he or she might want or need help with. Draw up a chart so it's easy to see what each person is doing and how often. Check in frequently to make sure everyone involved is comfortable with the level of care.