Diabetes Epidemic Now Poses Challenges for Nursing Homes

By Serena Gordon

06 jan 2009-- More and more people with diabetes are living to older ages, thanks to medical advances. But the long-term facilities, such as nursing homes, that care for aging Americans may not be ready for the additional challenges that come with treating patients with diabetes.

"We need to spend appropriate time to think of a way to successfully provide care for people with diabetes as they enter their elder years, and we're just beginning to understand how to do that," said Dr. Paul Strumph, vice president and chief medical officer for the Juvenile Diabetes Research Foundation.

Although as many as one in four nursing home residents has diabetes, not all are getting care that meets the American Diabetes Association's goals for community-dwelling adults, according to a recent study.

The study, published in Diabetes Care, found that while 98 percent of nursing home residents with diabetes had their blood glucose levels monitored, only 38 percent met short-term glucose goals.

The better news from the study was that 67 percent of the nursing home residents with diabetes met their long-term glucose control goals, which meant they scored less than 7 percent on their A1C tests. A1C is a measure of long-term blood sugar control.

"One of the key differences in managing diabetes in a nursing home is that it's often not the condition of primary importance," said Helaine Resnick, director of research at the Institute for the Future of Aging Services for the American Association of Homes and Services for the Aging.

Resnick said one of the concerns she had with the study findings was that no one has yet to come up with specific guidelines for caring for elderly people with diabetes. Glucose control goals for someone who's 40 and living at home may well be different than for someone who's 85, cognitively impaired, and living in a long-term care facility, she said.

"Diabetes medications are designed to lower glucose levels, which can prevent complications from developing in diabetic people. But, when you take medicines to lower blood glucose, it can go too low, which can be extremely dangerous, especially for older adults," Resnick said, noting that it's difficult to find "the appropriate balance between keeping sugars low with the risk of keeping it too low."

Strumph pointed out that the needs of older people with diabetes may be different as well. People with type 1 diabetes and people with type 2 diabetes who need insulin often choose to use an insulin pump when they're younger, but pumps may not be the best choice for someone who's older and not as aware, he said.

"Someone in a nursing home could pull out a pump site and not know. In that case, you may want to be on a longer-acting insulin instead. We haven't yet defined what the ideal insulin [regimen] is for someone in a facility with a fairly predictable schedule," Strumph said.

Both Strumph and Resnick said it's important for family members, the nursing home resident, and the staff to come up with a realistic care plan.

"Families need to become more actively involved in working with care teams, and that's true for diabetes and for other conditions. Ensure that the facility understands the family's and the resident's preferences. Is your mother more interested in keeping her blood glucose control tight and risk [low blood sugar]? Or is it better for her to ease up on glucose control and work more on quality-of-life issues? Resnick said.

"Families have to be very involved, and the communication needs to be ongoing, because people's values can change," she added.

More information

For tips on selecting a nursing home, visit the AARP Web site.