Tips from Joslin’s Geriatric Clinic

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Dr. Medha Munshi is the Director of the Geriatric Clinic at Joslin

It isn’t easy getting older. So many things just don’t work as well anymore and everything seems a bit more complicated. Throw diabetes into the mix and –for one in four adults over the age of 65, that is a reality—you have the making of a big problem, both for the individual.

Caring for diabetes in older adults is made harder by the fact that diabetes is rarely the only problem they have. Many elderly people have a host of co-morbidities, some related to their diabetes, such as hypertension or heart disease, and some that may not have a direct connection to diabetes, such as arthritis or joint problems, but impact the person’s capacity to manage self-care nevertheless. For example, patients with knee, hip or back problems have a harder time exercising, which compromises their diabetes care and makes it more difficult for them to maintain the muscle mass needed to complete the activities of daily living.

Another sometimes poorly recognized problem in the geriatric population is cognitive dysfunction. Now most people think of memory loss or Alzheimer’s when the subject of cognitive impairment is broached. But for a number of people, memory may remain intact but a far more insidious deterioration is taking place.

Dr. Medha Munshi, Director of Joslin’s Geriatric Clinic states, “We have noticed that elderly patients with diabetes suffer not so much from memory loss but from difficulties with problem solving, planning and organizing. They also often have difficulty being attentive, starting a new behavior or stopping old behaviors.

Since much of diabetes care involves these skills and behaviors, managing diabetes can become very difficult,” she continued. “For example, someone with cognitive dysfunction could have trouble monitoring blood glucose, taking medication, following diet plans and getting more physical activity. It is a major reason why older adults experience problems managing their disease.”

That is why it is important that family members and friends remain alert to what may be subtle changes in a loved one’s mental status and have them evaluated for cognitive dysfunction. The following symptoms may signal concerning cognitive changes in a previously well-functioning elderly family member.

  • Blood glucose control is suddenly worse in an individual who has done fairly well on his/her own.
  • Subtle changes in mental status. For example, being more forgetful about monitoring or taking medications, making mistakes in doses of insulin or even forgetting to eat a meal.
  • Difficulty coping with multiple medical conditions or medications and seeming stressed or overwhelmed by it.
  • Gradually becoming less socially active, dropping activities that they used to enjoy, or showing other signs of depression, such as sadness or hopelessness or isolation from friends and family.

Depression and social isolation also play a major role in the ability of people to manage their disease. Diabetes itself is associated with a higher risk of depression; people with diabetes are about twice as likely to be depressed as the general public. The good news is that advancing age itself does not necessarily put people at greater risk for depression. When people are depressed they often don’t have the energy to complete basic care behaviors such as monitoring, taking medication on a regular basis, eating healthfully or engaging in regular physical activity.

Despite the litany of Job-like calamities that can befall the older adults with diabetes, life after 70 doesn’t have to be a long grueling slog fest to the end. Many seniors with or without diabetes are in better mental and physical shape that those decades their junior. And treatment of depression, simplification of medication regimens, healthy diet, strength training and aerobic exercise can greatly ease the burden of diabetes and its co-morbidities for those whom time has not treated as kindly. As Dr. Munshi states a positive attitude is half the battle.

3 Responses to Tips from Joslin’s Geriatric Clinic

  1. Akbar Niazi says:

    Wonderful article.I w’ll read it again and again.

  2. Deborah Ramos says:

    Thank you, Great Article! We need more good information like this on a daily basis.
    New to your Web site. Will read your articles daily. Please keep it up Joslin Communications…

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