How do we care for elderly diabetics

HOW DO WE CARE OUR ELDERLY WITH DIABETES?

Vinod Kumar, Geriatrician and Endocrinologist, New Delhi

Life style and drug prescription apart, two more prescriptions, functional prescription and social prescription are required for better caring for elderly diabetics who are often more prone to functional decline compared to non-diabetic elderly.

Functional prescription aims to prevent age-related decline in various functions such as cognition, mobility, vitality (nutrition), vision, hearing and psychology-all collectively termed as intrinsic capacity (IC) by WHO. Simple training is required to screen these functions as evident from WHO’s quick 10-minute tool1 (https://youtu.be/92qX9IVWsrI?si=iYMFdY4NTaqRz1ge) developed by its Integrated Care for Older People (ICOPE) program for health workers, doctors to use for older persons. Used for older diabetics also2,3,4. In case any of the above 6 domains of IC is impaired, further preventive measure in the form of cognitive stimulation, exercises, diet, eye care, ear care and psychological support respectively can be provided through proper referrals or/and an in-depth Comprehensive Geriatric Assessment (CGA) by geriatrician to help detect and manage geriatric syndromes like dementia, frailty, falls, depression etc.  Both ICOPE Screening tool for IC and CGA help stratify functional health of older diabetics to improve diabetes care through individualizing the management, determining treatment goals, and assessing and strengthening diabetes self-managing abilities. This also supports a person-centred holistic approach as a useful addition to well-established comprehensive diabetes evaluation (CDE)5.

Social prescription by doctor to connect patient with non?clinical activities at voluntary and community sectors lead to improved health including better glycaemic control6.  Examples are music, new reading, new language, gardening, fun with games, befriending children, exploring the internet, knitting, cooking, cleaning the environment, tutoring, spirituality, volunteering etc. This needs to be formalized and integrated in diabetes care7.  

References

1. WHO 2019(WHO/FWC/ALC/19.1

2. 10.26502/acmcr.96550574

3. https://ssrn.com/abstract=4449100

4. https://doi.org/10.1016/j.archger.2024.105687

5. https://doi.org/10.1002/9781118954621.ch5

6. https://doi.org/10.3310/AQXC8219

7. https://www.researchgate.net/publication/337402647