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Caring for Elderly Diabetics

Life wasn’t always this tough for eighty-four year old Lolo Marcelo.

In his younger days, he used to have a high-paying job and he enjoyed the fruits of his labor by spending one too many nights out with his beer buddies. Since he had more than enough money, he never really cared about his health. He would eat everything he fancied which resulted in obesity.

The frail grandfather of twelve could only look back with regret how he failed to take heed of the early signs of diabetes. With all his five children already married and his wife dead, he doesn’t have anyone to look after his condition, except for strings of personalnurses who would only last for months. He experiences a lot of pain related to his disease, but he’d rather keep mum.

Frail Bones, Poor Eyesight
Age-related factors. Be it a family member or a personal nurse, elderly patients need dependable people who could help and support them. In caring for elderly diabetics like Lolo Marcelo, an octogenarian, there are a bunch of factors to keep in mind. According to the American Geriatrics Society and the University of California at Los Angeles (UCLA), which recently released a new set of guidelines regarding the care of elderly diabetics, caregivers should take into account not only the age and blood sugar but also the mobility or functional capability of the patient.

“Mobility is an important factor especially for older people who are more prone to bad falls and fractures,” said endocrinologist Dr. Roberto Mirasol of St. Luke’s Medical Center and Manila Doctors Hospital.

The American Academy of Family Physicians explain that factors associated with aging such as poor eyesight and hearing affect strength and the body’s sense of balance. This can also result in frequent instances of falling. With thin arms and legs, the elderly can easily get bruised. It is therefore strongly suggested that a companion always be present to assist the elderly patient.

Conflict in Medications. While age-related factors are easily recognized, caregivers should be extra attentive in determining the oblivious factors. Since diabetes among the elderly triggers a web of complications, such as stroke and heart attack, the patient usually consumes another set of medications aside from the anti-diabetic drugs. Elderly diabetics, in general, take seven different drugs; UCLA medical experts believe this is a loophole.

“(As) we know from the literature, every time you add another medication, you decrease the chance of taking the drugs correctly,” Dr. Carol Mangione was quoted as saying in the Journal of the American Geriatrics Society. It is advisable to ask the doctor first if a particular medicine is compatible with other drugs before endorsing it to the patient.

Too Low Sugar. According to Dr. Mirasol, who is also the immediate past president of the Philippine Society of Endocrinology and Metabolism, blood sugar monitoring is just as important for elderly patients. “Some doctors fail to emphasize the need for blood sugar monitoring but older diabetics are actually more prone to hypoglycemia (low blood sugar),” he said.

A study published in the Singapore Medical Journal shows that hypoglycemia among the elderly is an effect of hypoglycemia agents (insulin, glibenclamide, chlorpropamide), so that the dosage for any of these agents must be adjusted according to a patient’s health condition. Hypoglycemia results from drugs, age-related factors and disorders. If not managedwell, low blood sugar can cause hypothermia, brain damage and stroke.

With this in mind, caregivers should be familiar with the signs of hypoglycemia which include irritability, fatigue, blurred vision, fainting, and dizziness among others. Even if blood sugar monitoring is significant, it should be done in moderation. “Caregivers should not be too aggressive in terms of controlling the blood sugar,” Dr. Mirasol said.

Lifestyle Check. An elderly diabetic might have been accustomed to chomping fatty meals in his younger days but by the time he reaches his seventies, even his appetite for wrong food would noticeably decline. “The appetite is not as much as when they were younger. More likely than not, the elderly would not get enough nutrition,” Dr. Mirasol said. He added that chronic bad dietary habits such as missing meals can interfere with a hypoglycemic agent.

Considering the diminishing appetite of the elderly, wise food choice is the key. Caregivers should check out the food’s nutritional facts and ingredients to uncover hidden fat or sugar contents. Elderly diabetics are also prone to dehydration, which could eventually result in complications, so make sure the patient chugs down water every once in a while and not wait until his throat runs dry.

Along with proper diet, exercise is necessary. Elderly diabetics who are sedentary must start a suitable exercise routine. Depending on the physical condition of the patient, physicians can recommend specific forms of exercise. Lack of exercise promotes not only obesity but also thrombosis andinsulin resistance, according to medical experts.

“C” is for Compassion
While the above mentioned guidelines are important, compassion, more than anything, is essential in ensuring that family members or nurses are giving enough care for the patient. Since we live in a society of busy families, there is a tendency to neglect the sick elderly members.

“It’s more of psychological but we should give them (the elderly) appropriate importance and not just let them take care of themselves,” said Dr. Mirasol. “Sometimes, the aged diabetic already has a problem in the bladder or lungs and other complications that could have been prevented early on if given proper attention,” he added. Having a supportive family that would make sure medications and meals are taken on time makes a world of difference.

The patients, for their part, must not take themselves for granted. According to Dr. Mirasol, one notable thing about elderly Filipinos is their ‘dahil matanda na’ mindset. The elderly have the tendency not to complain so much and dismiss everything as part of growing old. Perhaps, this mindset is rooted in the fear and shame of becoming an added burden to the immediate family.

Dr. Mirasol advises elderly diabetics to always look at the bright side of life, no matter how hard the situation may be. “When you are elderly, the more important thing is finding meaning in your life, don’t ever think wala ka ng silbi,” he said. Hope is indeed crucial in these trying times so the elderly need all the support and love they could get.

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