Diabetes Care for the Older Patient (eBook)

Foreword: Diabetes in the Elderly 7
Preface 9
Contents 11
List of Contributors 13
Chapter 1: The Epidemiology of Diabetes in Older People 15
Background 15
The Elderly Population of the UK – Size and Trends 16
The Prevalence of Diabetes in the Elderly in the UK 18
Method of Diagnosis and Prevalence of Diabetes in the Elderly 21
The Distribution of Diabetes in the Elderly by Ethnicity 22
The Distribution of Diabetes in the Elderly by Socio-Economic Status 23
Association of Diabetes with Morbidity in the Elderly 24
Association of Diabetes with Mortality in the Elderly 25
Screening for and Diagnosis of Diabetes in the Elderly 27
Summary 29
References 29
Chapter 2: Type 2 Diabetes and Dementia 32
Introduction 32
Causes of Dementia 34
Risk Factors for Dementia 35
Why is Type 2 Diabetes only now being recognised as a Risk factor for Dementia? 37
Why is dementia more common in People with Type 2 Diabetes? 38
Genetic Factors 39
Hyperglycaemia 40
Cerebral Small Vessel Disease 42
Hypoglycaemia 43
Depression 45
Is There Sufficient Evidence to Warrant Screening for Cognitive Impairment and Dementia in People with Diabetes? 46
Conclusions 46
Practical Points 47
References 47
Chapter 3: Depression in Older People with Diabetes 52
The Old and Depression 52
Depression and Diabetes in the Older Person 53
Physical Changes Associated with Diabetes 54
Functional Disability 55
Health Care Costs and Quality of Life 56
Glycemic Control in Older Patients with Depression and Diabetes 57
Management of Depression in Diabetes in the Older Person 57
Treatment of Depression in Diabetes 59
Integration Treatment Approaches 61
Psychological Treatment Trials 62
Summary 62
Practical Points 63
References 63
Chapter 4: Hypoglycaemia and the Older Person 67
Hypos 67
Symptoms of Hypoglycaemia in Elderly 67
Knowledge of Hypoglycaemia 69
Epidemiology of Hypoglycaemia 71
Causes and Risk Factors 71
Moving Targets a Risk Factor for Hypoglycaemia
Driving Down the HbA1c and Measures of Glucose a Risk Factor for Hypoglycaemia
Effects of Hypoglycaemia Glucose Levels
Effects of Hypoglycaemia Cognitive Function
Effects of Hypoglycaemia Cardiac and Mortality
Effects of Hypoglycaemia Inpatient Stay
Effects of Hypoglycaemia Falls and Fractures
Nocturnal Hypoglycaemia 79
Conclusion 79
Practical Points 80
References 81
Chapter 5: Cardiovascular Risk, Glucose and Targets for Management of Diabetes in Older People 86
Cardiovascular Risk 87
Glucose Control 89
Practical Recommendations 95
Targets for Glycaemic Control 95
Oral Glucose Lowering Treatment 95
Hypertension 97
Practical Recommendations 99
Target BP 99
Choice of Medication 100
Lipids 100
Practical Recommendations 101
Aspirin 102
Practical Recommendations 102
Physical Activity 102
Practical Recommendations 103
Life Expectancy and Clinical Decision Making 103
Conclusion 105
Practical Points 105
References 105
Chapter 6: Diabetes and Frailty 111
What is Frailty? 111
Diabetes and Co-morbidities 113
Vascular Disease 113
Osteoporosis and Falls 114
Endocrine Disease 116
Type 1 Diabetes 116
Thyroid 118
Impact of Frailty on Care 119
Aims of Treatment 119
Neurological Disorders 119
Cardiovascular/Respiratory Disorders 120
Gastrointestinal and Nutrition Problems 120
Polypharmacy 121
Tissue Viability 121
Sensory Impairment 121
Cognitive Impairment 122
Social Aspects 123
The Importance of Carers 123
Care Homes: A Special Case? 124
Summary 127
Practical Points 128
References 129
Chapter 7: Perceptions of Users and Carers in Supporting Diabetes Care: Practical Guidance, Support and Information for Carers 132
Introduction 132
Point of Diagnosis 133
Information Needs – Older People 133
Information Needs – Carers 135
‘Trust me! I’m a Patient/Carer’ – Living with Diabetes 135
Education and Training 138
The Theory 139
The Evidence 140
The Critique 142
Ethical Issues 143
Cultural Issues 144
Personal Budgets 146
Conclusions 147
Practical Points 148
References 148
Chapter 8: Management of Elderly People with Diabetes in Primary Care 151
Introduction 151
Treating Older People with Diabetes in Primary Care – The English NHS Response 153
Treating Older People with Diabetes in Primary Care – Delivering Care in Practices 158
Diabetes in Care Home Residents 164
Summary 169
Practical Points 170
References 170
Appendix 174
Index 177