Geriatric Diabetes PDF

Preface

The world population is rapidly aging, and the prevalence of diabetes is reaching epidemic proportions. Diabetes in older populations poses unique challenges that have not been fully addressed in medical textbooks or educational programs for health care professionals. Diabetes is not the same disease in the elderly as it is in the young. Its pathophysiology, diagnostic criteria, pharmacologic management, dietary recommendations, and lifestyle impact are quite different. In addition, older adults are not a homogeneous population. Community-dwelling adults, individuals in assisted living facilities, and nursing home residents all have unique functional characteristics and needs. Before developing a management plan the physical, social, emotional, and cognitive status of an older adult must be considered. Specific barriers to their ability to perform self-management must be taken into account. Moreover, the goals of care may differ in elderly patients, emphasizing quality rather than quantity of life.

At present there are few evidence-based recommendations to guide the care of elderly patients with diabetes, largely because there are very few prospective studies that include adequate numbers of representative elderly subjects. When the same criteria and strategies used in young adults are applied to the elderly without considering their special circumstances, there is increased risk of non-adherence, complications of treatment such as hypoglycemia or falls, and diabetic complications.

The unique feature of this book is its primary focus on diabetes in older adults and the challenges encountered in caring for these patients. The chapters in this book illustrate how diabetes presents differently in older adults, how it affects other diverse systems of the body, and how it should be diagnosed and treated with attention to its protean manifestations and related comorbidities. There is a detailed discussion of physical, social, emotional, and cognitive problems that affect older adults with diabetes, and the effects of these problems on their disease and their ability to perform self-management. In addition, the authors have presented strategies to modify the management plan to overcome these barriers and thereby improve diabetes control without compromising quality of life.

Optimal diabetes care has much in common with geriatric medicine, since it requires multidisciplinary teamwork, attention to comorbidity, knowledge of pharmacology, and a variety of social, psychological, nutritional, economic, and environmental interventions. It is our hope that this book provides enough practical information about all of these aspects to help clinicians provide excellent care for their elderly patients with diabetes.

The editors would like to thank the Joslin Diabetes Center and Beth Israel Deaconess Medical Center for supporting our mission and providing us with the opportunity to care for many elderly patients with diabetes. We also thank our distinguished colleagues who have contributed the chapters of this book. Finally, we wish to acknowledge the John A. Hartford Foundation's Center of Excellence in Geriatric Medicine and the Donald W. Reynolds Program to Strengthen Training in Geriatric Medicine at Harvard Medical School, for supporting our efforts to educate physicians about the care of elderly patients.