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Diabetes Care in the Elderly
Curriculum Development Project
Curriculum Development Project: Diabetes in the Skilled Nursing Home Residents
Curriculum Development Project: Diabetes in the Skilled Nursing Home Residents
The increased prevalence of diabetes in developed nations has been blamed in part on the obesity epidemic, but a portion of that increase is also due to longer life-spans (reviewed by Vischer et al., 2009). While this may be a mixed blessing from the perspective of health policy makers, the increased prevalence of diabetes among the elderly contributes to the emergence of a variety of debilitating comorbid conditions and a significant decline in quality of life.
What makes matters worse is that diabetes sometimes goes untreated or undiagnosed in the elderly (reviewed by Vischer et al., 2009). When 2,307 skilled nursing home residents were assessed for the presence of this disease, 77 were found to be undiagnosed (Dybicz, Thompson, Molotsky, and Stuart, 2011). While this represents a mere 3% of the study population, these patients were under 24-hour care by skilled medical professionals. Even though the prevalence of undiagnosed diabetes among elderly patients is unknown, it is likely vary high, since an estimated 27% of Americans of all ages are estimated to be undiagnosed (CDC, 2011).
Goals and Learner Outcomes
Elderly patients are therefore at risk for experiencing a significant decline in quality of life when diabetes remains undiagnosed or improperly managed, especially as comorbidities develop or worsen. The following lesson plan intends to provide information on how to properly diagnose and manage diabetes in elderly patients for nurses and physicians working in geriactric care settings. By the end of this course, the student should be able to identify patients at risk for diabetes, screen for the disease, and effectively manage the disease to lower the severity or prevalence of comorbid conditions and improve the patient's quality of life.
Learning Objectives
1. Develop an awareness of the prevalence of diabetes among older adults in the U.S.
2. Be able to identify high risk diabetes patients...
Develop a working knowledge of effective diabetes screening tools.
4. Become competent to design a diabetes management approach for elderly patients.
5. Become competent to implement diabetes treatment for elderly patients.
6. Learn the essentials needed for proper follow-up care once the patient's hyperglycemia is under control.
Instructional Model
The lesson plan presented here is based on a behaviorist, object driven model using a holistic approach (Saunders, 2003). The target student population is licensed nursing staff working in the field of elder care, including home, outpatient, inpatient residential, and hospice settings, who may be seeking advanced care training specific to their specialty. The learning theory implemented in this lesson plan used a combination of didactic and experiential, because students will be required to study and memorize information, in addition to engaging in hands-on laboratory and clinical tutorials.
Content Outline
Day 1 -- Diabetes Statistics
All students will be assigned computers for the completion of this objective to facilitate gaining access to the internet. Students will be required to navigate to the websites operated by the Centers for Disease Control and Prevention (CDC) and the National Institute of Diabetes and Digestive and Kidney Diseases to locate diabetes statistics. The focus will be limited to statistics for adults over the age of 65. Students will be expected to know the prevalence of diabetes among this age group and recall this information at the end of the practicum. Students will be required to compose a 2-page, double-spaced essay describing the information they found during the study period. These essays must be turned in electronically to the professor by the end of the class period.
Day 2 -- Identify Patients with a High Risk for Diabetes
De-identified medical charts will be used to present the signs and symptoms commonly associated with diabetes. These include obesity, cardiovascular disease, depression, memory problems, vision and hearing problems, poor global functioning (Munshi, Medha N.,…
References
CDC (U.S. Centers for Disease Control and Prevention). (2011). National Diabetes Fact Sheet, 2011. CDC.gov. Retrieved 3 Aug. 2012 from http://apps.nccd.cdc.gov/DDTSTRS/FactSheet.aspx.
Cotter, Valerie T. And Strumpf, Neville E. (Eds.). (2002). Advanced Practice Nursing with Older Adults: Clinical Guidelines. New York, NY: McGraw-Hill.
Dybicz, Sharon B., Thompson, Stephen, Molotsky, Sandra, and Stuart, Bruce. (2011). Prevalence of diabetes and the burden of comorbid conditions among elderly nursing home residents. American Journal of Geriatric Pharmacotherapy, 9(12), 212-223.
Lisko, Susan A. And O'Dell, Valerie. (2010). Integration of theory and practice: Experiential learning theory and nursing education. Nursing Education Perspectives, 31(2), 106-108.
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