Older adults

  Population considerations:

  • Disproportionate disease burden. Older adults suffer a disproportionate rate of burden from diabetes because it is often later in life that complications from diabetes appear. Older adults may have other medical problems that complicate their diabetes management (Glasgow, 1992).
  • Lack of access to affordable care. Insurance coverage can influence help-seeking behavior (Oladele, 2006). Some older adults may not understand the health benefits available to them through Medicare or other health insurance plans. For others, their insurance may not cover the care needed.  For example, foot care to prevent or treat diabetes-related foot problems is often not included in the public health care system or some insurance plans (Hamalainen, 1998).
  • Food preference and lifestyle habits. Food preferences and lifestyle habits can be difficult to change. The familiarity and enjoyment of certain foods and cooking methods could reduce an older adult’s willingness to change to healthier options (Wahlqvist, 2000).
  • Lack of education. Older individuals typically have received less diabetes education than their younger counterparts, since many education interventions have not included older adults nor addressed their specific needs (Glasgow, 1992).
  • Aging process. Older adults often face impaired vision, difficulty learning new information, memory loss, loss of dexterity, and complications with additional medications (Gilden, 1989).

  Strategies to address considerations:

  • Addressing chronic diseases and medications. Working with older adults on how to communicate with their healthcare provider can help individuals address issues such as undesirable side effects of medication and personal care needs or concerns related to diabetic and other chronic disease care (Teutsch, 2003). It may be useful to work with medical professionals to coordinate medical care and self-management. It may also be important to screen for complications associated with diabetes and other chronic diseases.
  • Improve access to affordable care. Provide education regarding the coverage that is available and advocate for increased services where appropriate (Glazier, 2006). In order to screen for foot problems related to diabetes, access should be provided to podiatrists or visits should be provided at reduced cost or free of charge (Hamalainen, 1998).
  • Provide opportunities to learn about and practice self-management. Training programs targeted to older adults can give them opportunities to practice self-management skills for the control of diabetes and in turn improve health outcomes (Glasgow, 1992). Examples of skills include blood glucose monitoring, physical activity, and dietary changes. Including the spouse in these diabetes education programs can also improve self-care and health outcomes (Gilden, 1989).
  • Build and maintain social support. Interventions that incorporate social support strategies may help increase adherence to diabetes management. It may be useful to work with individual seniors as well as agencies and organizations that work with seniors to identify strategies to increase the ability of individuals to continue to provide self care. Automated voice messaging is an example of an outreach effort that can identify serious health problems that would otherwise go unnoted (Piette, 1997).

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