By Laura Hieronymus, DNP, MSEd, RN, Bob Moss, PharmD, and Parminder Kaur, PharmD, MBA
Aging seems to be the only available way to live a long life.
–Daniel Francois Esprit Auber
America is aging. The number of senior citizens, ages 65 and older, in the United States is growing faster than the number of younger people. It now exceeds 40 million, making up about 13% of the total population. Experts estimate that by 2030, one in five U.S. citizens will be considered an “older American.”
The older population is also living longer than in years past, with many seniors living for 15, 20, or more years past the typical retirement age. Given the sheer number of adults over 65, this population is now classified as “younger old,” “older old,” and “oldest old.” The “younger old” are those between the ages of 65 and 75, the “older old” are those between ages 75 and 85, and the “oldest old” are those who live past 85 years.
Regardless of specific age, as a person gets older, his risk for a chronic illness such as diabetes rises. In fact, almost 26% of Americans ages 65 and older have diabetes — in most cases, Type 2 diabetes. In addition, one out of two people this age has a condition called prediabetes, in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. (Prediabetes often leads to the development of Type 2 diabetes.)
Both prediabetes and Type 2 diabetes — and, of course, Type 1 diabetes — merit serious attention from the person who has it and his health-care providers. All of these conditions can lead to a reduced quality of life and to long-term health complications if not cared for properly.
For people with prediabetes, medical care should focus on lifestyle changes that may reduce the chances of developing Type 2 diabetes. For people with diagnosed diabetes, ongoing diabetes self-management education and training is essential to understand what is necessary for managing diabetes, and how those needs may change over time.
Education about diabetes and its care is available in numerous places and formats. Most insurance plans cover a certain number of hours of education at the time of diagnosis and yearly thereafter. It is important that you discuss with your health-care provider the resources for education that exist in your community as well as the information that you and he believe will be beneficial to your ability to self-manage your diabetes.
As adults age, the risk of physical, cognitive, and sometimes psychological impairment increases. So it can be a good idea to include family and friends in the process of learning about your diabetes. Knowing more about how diabetes is best managed will enable them to help with your diabetes needs if a situation arises where you need help.
The American Association of Diabetes Educators (AADE) recommends a framework for diabetes education that focuses on seven areas of self-care: healthy eating, being physically active, monitoring blood glucose levels, taking medicines correctly, learning to solve problems that arise in your diabetes management, taking steps to reduce your risk of diabetes complications, and learning to cope with the emotional ups and downs that come with living with a chronic condition. There are no set lessons for each of these areas; instead, diabetes educators can use the framework to guide what is covered in group education classes or one-to-one education sessions.
Making healthy food choices and becoming familiar with how various foods — and amounts of food — affect your blood glucose level are essential for optimal blood glucose control. Your diabetes education should cover how to estimate food portion sizes, how to read Nutrition Facts labels, and how to time your meals in relation to physical activity and taking your diabetes medicines. (Some medicines, for example, must be taken within a certain time frame, such as before or after you eat.) Your physician or dietitian may also have individualized nutrition recommendations for you, such as eating more calcium-rich foods or taking vitamin D supplements, based on your age or other medical conditions you may have.
As you get older, it is particularly important to notice any significant changes in your weight. Gaining or losing weight can affect your blood glucose control and require changes in your diabetes management regimen. Gaining or losing weight unintentionally may also be a sign of other medical problems that should be attended to. If you’re experiencing any issues that affect your eating habits — including problems with chewing or swallowing, diminished ability to taste food, feeling full soon after starting meals, or eating more or less than usual because of a depressed mood — take the time to discuss those issues with your physician and/or diabetes educator.
If you’re on a budget and need to limit the amount of money you spend on food, discuss this with your dietitian or diabetes educator. These professionals may be able to help you identify inexpensive foods that are high in nutrients or to locate resources that can assist you in eating healthfully at a lower cost. For example, many senior centers offer low-cost meals, and there are programs — such as Meals on Wheels — that prepare and deliver meals to seniors with limited physical mobility.
Not only is physical activity beneficial to blood glucose and weight control, but it also helps you to feel better and stronger physically and emotionally. When aerobic physical activity such as walking or swimming is performed on a regular basis, it can improve your cardiovascular health by helping to lower high blood pressure and high triglycerides and to raise your HDL, or “good,” cholesterol.
Regular strength training (also called “resistance” training) also has numerous benefits, particularly as you grow older. Like aerobic exercise, strength training can improve your heart health and help with blood glucose control. Other benefits include being stronger, having more muscle mass and less body fat, feeling less depressed, and feeling more self-confident.
Exercise is also important for bone health, and women especially need to be attentive to bone health as they age. Women with Type 1 diabetes are at an increased risk for osteoporosis, a condition in which bones lose their density and strength over time, raising the risk of fractures. Women with Type 2 diabetes and a sedentary lifestyle are also at increased risk of fractures. In either case, regular weight-bearing activities, such as walking, jogging, playing tennis, and dancing, are beneficial to protecting bones. Strength and balance exercises, such as tai chi, may also help you avoid falls, reducing your chance of breaking a bone.
When you have diabetes, it’s a good idea to talk to your health-care team about the types and amounts of physical activity that are safe and appropriate for you. If you have physical limitations that prevent you from engaging in basic activities such as walking or bicycling, ask your health-care team for advice on how to be more active within your limitations.
Using a meter to monitor your blood glucose levels is important no matter what your age. Routine checks of your blood glucose level help you know how you’re doing and allow you to take action to avoid extreme highs and lows that could cause serious problems. Regular monitoring also helps you and your health-care providers determine how well the components of your treatment plan are working to keep your diabetes under control.
A diabetes educator can help you determine which meter — or type of meter — best meets your needs, as well as advise you on when and how often to monitor. When choosing a blood glucose meter, consider the size of the equipment and how easy it is to hold and manipulate, as well as how well you can see the display screen.
If you have severe visual impairment and are unable to use a conventional meter, there are some meters that offer features such as audible (voice) directions and a minimal number of steps to make monitoring easier. Be sure to tell your health-care providers about any difficulties you’re having using your meter. Chances are, they can help you find a different way to do it or different equipment that will be easier to use.
High blood pressure is another condition that gets more common with age. If you have it, your doctor may advise you to regularly check your blood pressure at home. Go over the use of your home blood pressure meter and any other monitoring devices you use with your physician or diabetes educator to make sure you are using them correctly.
Because aging is associated with the development of chronic health issues, it’s not surprising that many older people take several different medicines to control several different conditions. Keeping track of a complicated drug regimen is difficult for anyone, and it can be even more so if you can’t hear or remember instructions well, can’t see your medicines well or read medicine labels easily, or have trouble remembering to take your medicines. Some other reasons that people may not take drugs as prescribed include not being able to afford them, being depressed, and fearing drug side effects such as hypoglycemia (low blood glucose).
Taking your diabetes medicines as prescribed — at the right times and the right doses — is key to maintaining blood glucose levels in the near-normal range. If you are having trouble sticking with the drug regimen prescribed by your doctor (or perhaps by multiple doctors), talk to your health-care providers about how to make it easier on you. One solution may be to switch to a combination medicine (in which two drugs are combined in one pill) so you have fewer pills to take. If drug side effects are a problem, there may be a similar drug with fewer side effects you could try. There also may be less expensive ways to treat your condition if the cost of your medicines is prohibiting you from taking them as prescribed.
Your pharmacist may also be able to help you locate tools that will help you keep your medicines straight or services that can help you remember to take them.
Because you provide most of your own diabetes care, you need to know what to do when something goes wrong. The most common problems you’ll encounter are high and low blood glucose. Not only will you want to take action to correct the immediate problem (particularly when it’s low blood glucose) but you’ll want to think about what caused it and how to prevent it from happening again.
Your diabetes educator can help you learn to solve these types of diabetes-related problems. But if you’re having trouble remembering or following instructions related to your diabetes care, it’s a good idea to enlist a family member or friend to help. Bring your friend or family member to your diabetes education classes or office visits. Ask that person to take notes, if you think that will help. If you’re not sure what your friend can do to help, include your diabetes educator in the discussion; he may have some suggestions for things you haven’t thought of.
If you don’t have a close friend or family member to bring with you to health-care appointments, talk to your diabetes educator about other sources of help that may be available to you. Perhaps there are services or support organizations in your community that you can call on for particular types of help. In addition, ask your diabetes care providers for health information in writing so you can refer back to it as needed.
The longer a person has diabetes, the higher his risk of developing disease-related complications. The good news is that these complications can be prevented or at least minimized by maintaining optimal blood glucose, blood cholesterol, and blood pressure control.
To achieve good control, it’s important to schedule and keep regular appointments with your health-care provider. Your health-care provider can advise you on self-care measures for you to do on your own, and prescribe medicines, if necessary. He can also make arrangements for preventive measures such as getting annual flu vaccines, a pneumonia vaccine if you need one, routine foot care, and eye exams. Smoking raises your risk of developing long-term health complications such as heart disease and cancer, so if you smoke, ask your doctor for help in quitting.
One of the risks of uncontrolled diabetes that may be particularly important to older people is the risk of falling. Both high and low blood glucose can cause symptoms such as drowsiness, dizziness, and an inability to think clearly — all of which can contribute to a fall. Longer-term diabetes complications that cause visual impairment or loss of sensation in the feet (neuropathy) can also raise the risk of falling. When an older person falls, the risk of fracture is high, and the outcome of a fracture is frequently a loss of independent functioning.
“Fall-proofing” yourself and your home is a big job, but it’s worth thinking about to stay safe and healthy. Talk to your doctor about how your medical condition and the drugs or other therapies you use affect your risk of falling. Have a look at http://mysafehome.org to start thinking about how to make your home safer.
The stress of living with diabetes can be enormous at times. If you develop diabetes-related complications or other chronic health conditions, you are likely to feel even more stressed. And the loss of family members, friends, and other social connections that inevitably occurs with aging can test your coping skills as well.
Having skills to cope with stressful life events or ongoing situations is important at any age — and it’s never too late to develop new ones. Even if you have never felt you “needed” such activities before, don’t rule out the possibility of joining a support group, participating in faith-based or interest-based activity groups, or joining an exercise class or group that is appropriate to your level of fitness. Building new relationships can help you to feel more supported and less alone.
Even with good coping skills, living with a chronic disease or experiencing a serious loss can lead to depression. Depression affects more than 6.5 million Americans over 65. But while depression is common in seniors, it should not be considered a normal part of aging. When recognized, depression can be treated successfully.
If you are experiencing signs and symptoms of depression such as frequent or constant irritability, disruption in sleep patterns, fatigue, feelings of social isolation or neglect, or increased use of alcohol or drugs, talk to your health-care provider. While you may or may not be depressed, you do have a problem, and talking it over with your health-care provider can help to clarify what is going on and what to do about it.
While an ounce of prevention may be worth a pound of cure, there is generally a cost associated with that ounce. To find out what that cost is, familiarize yourself with your health insurance coverage, and ask questions of your health-care providers up front about the costs of medical care, supplies, and treatment.
If you have prescription drug coverage through Medicare Part D, the provider of your plan must tell you what’s on the plan, how much it will cost, and how you will be able to access it. The plan must also give you 60 days’ notice before they remove a drug that you are using from their plan. If you need a drug that is not covered by your drug plan, you can file an appeal or an exception. (To learn more about Medicare Part D, go to www.medicareinteractive.org and click on “What does Medicare cover (Parts A, B, C, and D).”)
Your health-care provider can help you make the best use of your prescription drug coverage and may have suggestions for managing costs. For example, if you can take a combination medicine instead of two separate medicines, you may be able to pay one co-pay instead of two.
Your pharmacist may also be able to help you manage costs by determining, for example, how your blood glucose meter and strips are covered by your health plan: Are they covered under your prescription plan, or as durable medical equipment? If the meter you want isn’t covered by your insurance, is there a similar one that is?
When you are referred for diabetes education services, check with the program to see if it meets the requirements for Medicare reimbursement. You will also want to know what coverage you have for further diabetes education in case you’re having difficulties or your diabetes treatment plan changes. To find out about Medicare coverage, go to www.medicare.gov/Coverage/Home.asp, or call (800)-MEDICARE (633-4227). In addition, ask your health-care provider if he is aware of any diabetes teaching or support group sessions in your area that are offered at no charge.
For other living expenses, keep in mind that senior citizen discounts are widely available. For example, some grocery stores offer senior discounts once a week, once a month, or on certain items all the time. Ask at the customer service desks of your local stores to see whether any of them have such programs. Some drugstores also have a senior discount on all or some purchases, and some have discount pharmacy services, usually featuring generic drugs at low prices.
There are also many drug discount cards available that may help you save on drug costs. Your pharmacist may be able to offer guidance on these. Your pharmacist and physician are also likely aware of patient assistance programs, which can help cover the costs of prescription drugs and sometimes of diabetes supplies for people with low incomes or no health insurance or prescription drug coverage. Speak to your physician if paying for your prescription drugs is a struggle; he may be able to point you toward programs that can help.
Some exercise facilities offer discounts to seniors, and many churches and malls have organized walking groups. Even malls that don’t have organized groups offer a free place to walk indoors. With any resource you find, it is important to determine how accessible it is and whether there are any restrictions that may apply, such as availability only on certain days or at certain times.
Change is inevitable, and while you can’t predict exactly what will happen as you get older, it’s reasonable to put safety nets in place now that will provide support in the future if you need it.
Establishing a relationship with a primary health-care provider, diabetes educator, or pharmacist is one place to start. Learning about the resources available to you for staying healthy with diabetes is another.
In addition, talk with your family and friends about what you expect as you age with diabetes. Let them know there could come a time when you need additional assistance, and make it clear ahead of time how you would like those needs handled. Be aware, however, that your friends and family members have limits, too: They may not have the resources to provide all that you need. That’s why it’s important to be willing to look beyond your immediate social circle for support and help. For help locating services in your community, trying looking on www.eldercare.gov.
When considering your future health and health care, it’s a good idea to think about and prepare legal documents such as a living will and a health-care power of attorney. These documents spell out your medical preferences so that your wishes are known and will be carried out if you become unable to speak for yourself. You can learn more about these documents and download forms at www.aarp.org.
For take-away tips on caring for your diabetes as you age, click here.
Aging comes with challenges, but the better you feel, the easier it is to deal with those challenges and to see and embrace new opportunities. Take care of your diabetes now to feel your best in the years to come.
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