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How Is Diabetes Different for Older Adults than Younger Adults? (Cont'd)
Myths About Diabetes in Older Adults
Overall, management strategies for diabetes, such as making changes in eating habits and physical activity and using diabetes medications, are no different for older people than for younger groups. However, older adults are diverse in terms of their physical and cognitive abilities, health, life expectancy, and desire to remain healthy. As a result, there are a number of prevalent myths about diabetes in older adults.
Myth: All older adults with diabetes are frail.
Reality: While frail elders, such as those residing in nursing homes, need highly individualized care to determine appropriate blood glucose levels, taking into account whether they are underweight and what their life expectancy is,80 most older adults with diabetes live in the community and would not be considered frail. "Frail" implies that the person does not have long to live and should be made comfortable. Because the percentage of older adults who meet the definition of frail is relatively small,81 we should question whether we would make more of an effort to help this person improve their health if they were 10 or 20 years younger (see glossary for definition of “frail”).
Myth: The high prevalence of diabetes in older adults is inevitable.
Reality: Despite the high rate of diabetes and prediabetes among older adults, the Diabetes Prevention Program study showed that diabetes can be prevented or delayed through changes in eating habits and physical activity. In fact, older adults in the study who made changes in these habits had better health than younger groups!82
Myth: High blood glucose in the older adult population is usually a benign condition.
Reality: While frail older adults (such as most nursing home residents) tend to have higher blood glucose levels than younger or healthier groups, high blood glucose levels can be prevented through medication, physical activity, and eating better. Many older adults are hospitalized each year and go into a coma because they have high blood glucose and undiagnosed diabetes. This underlines the importance of older adults getting screened to see if they have diabetes (see next section).
Myth: Reduced life expectancy makes the consequences of ongoing high blood glucose irrelevant. (They don't have long to live so why treat them?)
Reality: Ongoing high blood glucose can result in many severe complications, such as foot wounds leading to amputation and eye problems leading to blindness, that can be prevented by proper diabetes care. People with high blood glucose levels are also more likely to suffer from heart disease and stroke. And they are more likely to suffer from memory loss. These complications are painful and costly. They are also needless -- in most cases, such complications can be prevented or even reversed if treated appropriately.
Also, life expectancy for persons at every age group also has increased during the past century. Based on today's age-specific death rates, individuals aged 65 years can be expected to live an average of 18 more years, for a total of 83 years. Those aged 75 years can be expected to live an average of 11 more years, for a total of 86 years.83
Medications can be adjusted to prevent high blood glucose levels. The use of specific medications can maximize blood glucose control and minimize the risk of low blood glucose in older adults.84 Treatments exist for all diabetes-related complications.85 Studies have shown that people who are treated appropriately for ongoing high blood glucose live longer, too! So people may have more good years left in them than some might think.
Myth: The majority of older adults with type 2 diabetes are obese and need to lose weight.
Myth: Older adults are less capable of self-monitoring of their blood glucose than younger adults.
Reality: While older adults may experience some changes in learning ability and memory retention, once a change in routine becomes a habit, many older adults are better at maintaining the change than younger groups. Studies have shown that older adults may need extra training in the beginning to learn to monitor blood glucose, but that they are just as capable as anyone else of learning to do so.86
80 Life expectancy can determine how much healthcare providers want to focus on keeping blood glucose low vs. improving the overall quality of life in the short remaining time left. For example, a nursing home resident may benefit more in the end of life from a liberalized diet than from being given diabetic diet-type foods that do not appeal to them. See the American Dietetic Association position paper on nutrition issues across the continuum of care for older adults and the position paper on liberalized diets in nursing homes.
81 Less than 5 percent of adults ages 65 and older live in nursing homes, although more frail elders may live in group homes or assisted living settings or may be homebound. Federal Interagency Forum on Aging Related Statistics. (August 2000) Older Americans 2000: Key Indicators of Well-Being, p. 92.
82 Diabetes Prevention Program Research Group. (2002) "Reduction in the Incidence of Type 2 Diabetes With Lifestyle Intervention or Metformin." New England Journal of Medicine 346(6):393-403.
83 U.S. Department of Health and Human Services. (November 2000) Healthy People 2010: Understanding and Improving Health, 2nd ed. Washington, DC: U.S. Government Printing Office, p. 8.
84 Figure 1 in Mooradian, A.D., et al. (1999) "Diabetes Care for Older Adults." Diabetes Spectrum 12(2):70-77.
85 National Diabetes Education Program. (2004) Guiding Principles for Diabetes Care: For Health Care Providers. NIH Publication No. 99-4343.
86 Mooradian, A.D., et al. (1999) "Diabetes Care for Older Adults." Diabetes Spectrum 12(2):70-77.
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