| Home Health Care Improves Diabetes Management in Elderly Patients |
The authors note several challenges to providing effective home diabetes management. They stress the importance of creating individualized glucose-monitoring plans appropriate for both age and condition. This includes insulin dose calculation and schedule, meal composition, and patterning. The authors point out that optimal care involves the integration of the management plan with all others aspects of the patient’s daily life, including coordination with any other health care providers, such as cardiologists, nephrologists, and podiatrists. HOW HOME CARE HELPS The authors note that home care nurses provide diabetes patients with critical services. These include: • Reducing preventable medication adverse effects through medication reconciliation. • Assessing patient/caregiver for ability, willingness to care for self/patient. • Using the Clox test to evaluate cognitive ability, executive function. • Educating patient/caregiver about: o Medication treatment plan (timing, need for self-blood glucose monitoring; preparing/administering injectable and/or oral medication; and signs, symptoms of, and treatment for hypoglycemia/hyperglycemia). o When to contact medical provider/home health agency. o Emergency care plan (early signs, symptoms). • Following national diabetes-care practice standards and work with patients and caregivers to prevent acute complications and manage chronic manifestations. • Addressing blood pressure, cholesterol, wounds, and coagulopathies. • Obtaining patient information otherwise unavailable to medical provider. • Identifying how complications can adversely affect the patient’s ability to manage self-care, including activities of daily living (ADLs), instrumental ADLs, and patient safety awareness and impairments. • Working to provide comprehensive treatment plan with other disciplines, such as physical, occupational, and speech therapy; medical social work; and home health aide. DIABETES CARE OF THE ELDERLY The authors offer insights into managing elderly patients’ special needs, which include: • Achieving optimized glycemic control will decrease risk of infection, delayed healing, and progression of diabetes-related complications, as well as improve elderly persons’ overall quality of life. • Advanced age should not preclude insulin use. • When treatment goals are not met, add medications in a sequential way. EASING FINANCIAL BURDEN The authors conclude, “The individual cost to treat diabetes in an elderly patient can be overwhelming, given the multiple medications, complications, comorbidities, outside support, and beneficiary circumstances. Early intervention, aggressive education, regular follow-up and appropriate use of health care can decrease the financial burden on health care systems.” Source: “In-Home Chronic Disease Manage-ment in Diabetes: A Collaborative Practice Model for Home Health Care and Endocrinology Providers,” Home Health Care Management & Practice, 21(4):246-254. Hartman A, Litchman ML, Reed P, Burr RE; Salt Lake City, Utah
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