Management of Diabetic Older Adults in Nursing Homes

Management of Diabetic Older Adults in Nursing Homes

Overview

The elderly present a crucial and distinctive but heterogeneous group of persons living with diabetes since they possess a unique biomedical, mental, as well as social composition (In Bates et al. 2014). This makes them require needs that are different from younger adults. In light of this, care must be taken in the evaluation and planning of the nursing and management of these populations. The management of diabetes should concentrate on deterring and limiting medical conditions that are common in the elderly, low levels of blood glucose as well as the impairment of the brain and nervous system. This paper will be centered on the management of elderly patients at the Tower Hill Nursing Home. It will provide the epidemiology of the disease, the demographic prevalence, conduct a root cause analysis, and identify a possible action for one of the factors in the analysis. Additionally, it will provide clinical quality measures to gauge the success of the possible action.

Population

Rising with the diabetes pandemic is the number of older adults who have diabetes. This is motivated by the fact that scientific and medical advancements allow people with diabetes to live longer. The population under study for this discourse is the elderly. Older and Elderly are overworked terms but whose meaning is uncertain. The International Diabetes Federation has limited the use of the adjective to refer to persons above seventy years of age (Statistics About Diabetes n.d). On the other hand, the American Diabetes Association uses the adjective to refer to persons aged sixty-five years and older. Contrary to these two, the World Health Organization has extended the label to cover persons aged sixty-years of age or more.

The management of this population should, therefore, be tailored to the needs of a particular individual and should similarly encompass comprehensive interdisciplinary from all healthcare providers. The resources available for this particular population include health care facilities, transportation, healthcare providers committed to providing care for the patients. The population has significant strengths, including the fact that there is constant volunteering by other older adults who are in better health as well as the engaging of the diabetic patients by the storytellers in the nursing home with a perspective of a long life (In Bates et al. 2014). Additionally, most of the elderly patients are concerned with the health of their fellow patients and makes management easy. Conversely, the challenges for this population include low literacy levels, little knowledge of their condition and how to take care of themselves, and financial impediment.

Problem Statement

The population of the elderly is rapidly increasing all over the world, and statistics show that they constitute fifteen percent of the entire world population that is estimated to be seven and a half billion people. Notably, this generation of baby boomers is predisposed to Diabetes through factors such as genes and lifestyle. It has been noted that the number of patients with diabetes in nursing homes aged sixty-five years and above was twenty-six percent. Patients with diabetes have several demands, including specific diets, daily exercising, monitoring of glucose levels, and constant intake of required medication (In Bales et al. 2014). The increasing numbers of patients with diabetes have made it difficult for healthcare providers at the Tower Hill Nursing Home to attend to all the specific needs of each patient. This discourse will, therefore, look into the management of elderly patients in nursing homes.

Epidemiology

The diabetes pathophysiology is related to the insulin levels within the body as well as the ability for the body to make use of the existing insulin. For patients with type 1 diabetes, their bodies fail to produce insulin while the bodies of patients with type 2 diabetes produce insulin, but the peripheral tissues create a resistance to the insulin (In Bates et al. 2014). The body systems work in such a manner that the beta cells in the pancreas will release insulin when the glucose concentration levels in the body increases.

The prevalence of diabetes nationally presents ten percent, which is thirty-four million people of the United States population to be suffering from diabetes. The percentage of people with diabetes was found to increase with an increase in age. The report found that half of the persons living with diabetes were older adults. Men had the highest risk of getting diabetes, and this could be shown through the fact that there were a higher number of men with diabetes compared to women (Statistics About Diabetes n.d).  According to these statistics, African Americans recorded the highest number of diabetes cases while the Caucasian white recorded the lowest number of diabetes.  It is pertinent to note that this number has been projected to increase with the aging of the baby boomers generation.

Diabetes in nursing homes has been estimated to be between twenty-four percent and thirty-four percent. This is equal to or higher than the trends in the general population. The National Diabetes Statistics has estimated that twenty-six percent of persons aged sixty-five years and above have diabetes. The report also noted that there was an increase of 113% in the number of patients suffering from diabetes age between sixty-five years and seventy-four years (Statistics About Diabetes n.d). The American Diabetes Association has ranked diabetes as the seventh cause of death in the United States. Notably, Type 2 diabetes is the most common type of diabetes, accounting for ninety to ninety-five percent of diabetes in the United States.

Demographic Representation

The national statistics for diabetes provided that American Indians had the highest cases of diagnosed diabetes with a 14.7% rate. Hispanic Americans were second with 12.5% rate, African Americans come third with and 11.7%, Asians reported a 9.2%, and lastly, Caucasian whites had reported a 7.5% prevalence rate (Statistics About Diabetes n.d). Within Tower Hill nursing home, there are one hundred and sixty-six residents, of which forty-eight percent of them are suffering from diabetes. This translates to seventy-eight patients at the nursing home having diabetes (Statistics About Diabetes n.d). The nursing home does not have patients of Asian descent and Hispanic descent, and therefore, most of the patients with diabetes are of African-American descent.

Impact of the Problem

The impacts of diabetes on the person, the nursing home, and the community at large are insurmountable. Firstly, most of the patients with diabetes at the nursing home have type 2 diabetes, which leads to amputation at the advanced stage. This limits the mobility of the patients for those that were able to move around, and as such, the nursing home is necessitated to assist the patients with their activities of daily living (Ebrahim et al. 2014). It is to be noted that statistics from the nursing home show that the average time spent by a staff with a patient is between 15 minutes to forty-five minutes, which means that the nursing home is unable to meet the needs of the patients who have been incapacitated. Secondly, diabetes when not, when not managed, severe health conditions such as cardiovascular problems, kidney issues, visual problems, nerve damages and sometimes, for people with type 2 diabetes, it can lead to cancer and Alzheimer’s disease.

Thirdly, managing diabetes and its complications is costly; in 2007, the total cost used to manage diabetes in the United States was estimated to be one hundred and seventy-four billion dollars. These costs included directly related costs as well as the indirect costs emanating from disability, loss of work, and death (Ebrahim et al. 2014). Older patients with diabetes have reported higher expenditures, mainly because they are continually using the medication, medical services, and they are in nursing homes. The amount spent by an individual older adult was $9713 billion, amounting to sixty-four billion dollars for all patients, which was fifty-six percent of the total health care expenditures across the United States. Lastly, the psychological burden that diabetes places on the patients and their families, especially when it causes other health conditions, is immense.

Root Cause Analysis

Several issues negatively impede the management of elderly patients at the nursing home. These issues fall under the patient, providers, ‘ and system factors. The patient factors include Diet, Lifestyle, Age, Genetic background, Obesity, and little knowledge on the monitoring of blood sugar levels. The provider’s factors include the nursing staffs’ beliefs, attitude, and knowledge towards diabetes. The staff’s communication skills towards the patient also influence the perception of the patients towards the management of diabetes (Chawla, 2014). The system factors include the lack of enough staff to attend to all the patients in the nursing home. There is also an issue of the time that the staff at the nursing home spends with the patients. Concerning the needs of the patients with diabetes, these periods are too less for their specific needs to be addressed. Additionally, the nursing home lacks a functional pharmacy dedicated to the patients in the home; this impedes the management of medication for the patients.

Possible Action

Among the factors identified above, the one that could be addressed is the issue of a functional pharmacy for the nursing home. It is prudent to note that the Tower Hill Nursing Home is an appendage of the Tower Hill Healthcare Center. This, therefore, means that the dedication of a single pharmacy to attend to the medical needs of the residents in the nursing home will not require much funding. Achievement of this will go a long way in ensuring that the medical needs of the patients, more so, diabetic patients are well taken care of without the need to go to the health center for their medicine.

Clinical Quality Measures

The clinical quality measure which will be instrumental in establishing successful possible action will be the Hemoglobin control. This is a transitional outcome that will be assessed during the process of taking action. Secondly, there is a measure of preventive care and screening of the Body Mass Index. This will be a process that will be continuously undertaken for diabetic individuals. The preventive care will be instrumental in ensuring that other conditions that the patient may develop, for example, high blood pressure and cancer, and as such, they will be able to be managed early (Chawla, 2014). The screening of the body mass index will be instrumental in the management of the right weight since obesity is a predisposing factor for diabetes.

Summary

There is an urgent need among healthcare providers to address the diabetes issue among older Americans in nursing homes. The extent of the pandemic has revealed a significant increase in mortality, morbidity, medical as well as communal burdens and guided by the projections of the American Diabetes Association, the numbers will continue growing. The fact that most people in nursing homes have preexisting conditions such as cardiovascular diseases and cancer. Additionally, nursing homes and especially Tower Hill Nursing Home should modify the management of elderly patients with diabetes to cater for their complex and specific needs.

Appendix

References

TOWER HILL HEALTHCARE CENTER – SOUTH ELGIN Nursing Home. (n.d.). Retrieved February 27, 2020,

Ebrahim, Z., Villiers, A. D., & Ahmed, T. (2014). Factors influencing adherence to dietary guidelines: a qualitative study on the experiences of patients with type 2 diabetes attending a clinic in Cape Town. Journal of Endocrinology, Metabolism, and Diabetes of South Africa, 19(2), 76–84. doi: 10.1080/16089677.2014.11073604

Chawla, R. (2014). Diabetes in the Elderly. Manual of Diabetes Care, 135–135. doi: 10.5005/jp/books/12161_13

In Bales, C. W., In Locher, J. L., & In Saltzman, E. (2014). Handbook of clinical nutrition and

Statistics About Diabetes. (n.d.). Retrieved February 27, 2020, from https://www.diabetes.org/resources/statistics/statistics-about-diabetes