Challenges in managing elderly people with diabetes in primary care settings in Norway

Objective
To explore the experiences and clinical challenges that nurses and nursing assistants face when providing high-quality diabetes-specific management and care for elderly people with diabetes in primary care settings.

Design
Focus-group interviews.

Subjects and setting
Sixteen health care professionals: 12 registered nurses and four nursing assistants from nursing homes (10), district nursing service (5), and a service unit (1) were recruited by municipal managers who had local knowledge and knew the workforce. All the participants were women aged 32–59 years with clinical experience ranging from 1.5 to 38 years.

Results
Content analysis revealed a discrepancy between the level of expertise which the participants described as important to delivering high-quality care and their capacity to deliver such care. The discrepancy was due to lack of availability and access to current information, limited ongoing support, lack of cohesion among health care professionals, and limited confidence and autonomy. Challenges to delivering high-quality care included complex, difficult patient situations and lack of confidence to make decisions founded on evidence-based guidelines.

Conclusion
Participants lacked confidence and autonomy to manage elderly people with diabetes in municipal care settings. Lack of information, support, and professional cohesion made the role challenging.

Gender specific age-related changes in bone density, muscle strength and functional performance in the elderly: a-10 year prospective population-based study

Background: 

Protein-enriched diet, with the use of lean red meat, combined with progressive resistance training enhances lean tissue mass and muscle strength and reduces circulating IL-6 concentrations in elderly women: a cluster randomized controlled trial.

Physical inactivity, inadequate dietary protein, and low-grade systemic inflammation contribute to age-related muscle loss, impaired function, and disability.

Disease burden evaluation of fall-related events in the elderly due to hypoglycemia and other diabetic complications: a clinical review

A hypoglycemia-induced fall is common in older persons with diabetes. The etiology of falls in this population is usually multifactorial, and includes microvascular and macrovascular complications and age-related comorbidities, with hypoglycemia being one of the major precipitating causes. In this review, we systematically searched the literature that was available up to March 31, 2014 from MEDLINE/PubMed, Embase, and Google Scholar using the following terms: hypoglycemia; insulin; diabetic complications; and falls in elderly. Hypoglycemia, defined as blood glucose <4.0 mmol/L (70 mg/dL) requiring external assistance, occurs in one-third of elderly diabetics on glucose-lowering therapies. It represents a major barrier to the treatment of diabetes, particularly in the elderly population. Patients who experience hypoglycemia are at a high risk for adverse outcomes, including falls leading to bone fracture, seizures, cognitive dysfunction, and prolonged hospital stays. An increase in mortality has been observed in patients who experience any one of these events. Paradoxically, rational insulin therapy, dosed according to a patient's clinical status and the results of home blood glucose monitoring, so as to achieve and maintain recommended glycemic goals, can be an effective method for the prevention of hypoglycemia and falls in the elderly. Contingencies, such as clinician-directed hypoglycemia treatment protocols that guide the immediate treatment of hypoglycemia, help to limit both the duration and severity of the event. Older diabetic patients with or without underlying renal insufficiency or other severe illnesses represent groups that are at high risk for hypoglycemia-induced falls and, therefore, require lower insulin dosages. In this review, the risk factors of falls associated with hypoglycemia in elderly diabetics were highlighted and management plans were suggested. A target hemoglobin A1c level between 7% and 8% seems to be more appropriate for this population. In addition, the first-choice drugs should have good safety profiles and have the lowest probability of causing hypoglycemia - such as metformin (in the absence of significant renal impairment) and incretin enhancers - while other therapies that may cause more frequent hypoglycemia should be avoided.

Association between alcohol consumption and self-reported depression among elderly Australian men

Background: Links between alcohol consumption and depression have been reported; however, associations amongst the elderly remain unclear. We aimed to investigate the relationship between alcohol consumption and self-reported depression in a population-based sample of 514 men aged 65+ (median 76.4yr, IQR 71.2-82.4). Methods: Alcohol intake over the previous 12 months was estimated from a food frequency questionnaire. Participants were classified as non-drinkers or habitual consumers of ≤2 or ≥3 standard drinks per day. Symptoms of past and 12-month depression were ascertained by self-report based on DSM-IV criteria. Using logistic regression, we estimated the association between alcohol intake and depression, adjusting for age and lifestyle factors. Results: There were 91 non-drinkers (17.7%), 249 (48.4%) consuming ≤2 drinks/day, and 174 (33.9%) consuming ≥3 drinks/day. Forty eight (9.3%) were identified as having lifetime depression and 31 (6.0%) with 12-month depression. With those consuming ≤2 drinks/day as the reference, the odds of lifetime depression were greater for non-drinkers (OR=2.50, 95% CI 1.15-5.44) and tended to be greater for those consuming ≥3 (OR=1.45 95% CI 0.70-3.00). After excluding those with past depression, the likelihood of 12-month depression tended to be greater for non-drinkers (OR=2.38 95% CI 0.89-6.38) and those consuming ≥3 drinks/day (OR=1.68 95% CI 0.70-4.07). These associations were not explained by age, mobility, smoking, BMI, SES or number of medications. Conclusions: These results suggest a U-shaped relationship between alcohol consumption and depression in this sample of elderly men.