Diabetes Diagnosis in Elderly Patients

Diabetes Diagnosis in Elderly Patients

Diabetes is a disease with very serious implications for human health, and according to available data, about 24 million Americans suffer from diabetes and about 57 million have what is called "pre-diabetes." Healthcare professionals and researchers predict that about one in three Americans will develop diabetes in their lifetime. Why, given the seriousness and prevalence of this disease, is it often difficult for physicians and other healthcare professionals to detect diabetes in elderly people? This paper researches reasons why the elderly are not diagnosed correctly, and why diagnosis gets trickier as people get older. The paper also compares the results of early diagnoses of diabetes with the consequences of late diagnoses.

The Literature

How serious is the problem of diabetes? An article in The Journal of Employee Assistance reports that while nearly 24 million Americans have diabetes, about one quarter of that number is not aware they have diabetes. Also, the article claims that some 57 million Americans have pre-diabetes, and that even people without a family history of Type 2 diabetes (the form of diabetes most common among the elderly) can suffer from Type 2 if they lead an "unhealthy lifestyle" and especially if they become obese (Draheim, et al., 2009, p. 1).

Why is it difficult to detect diabetes in the elderly? An article in the journal Prevention claims that it just "makes sense that diagnosis gets trickier as we age" (O'Neil, 1995, p. 86). It gets trickier because after living for seventy years or so, "each of us has a unique medical history," O'Neil writes. One of the principles and realities of getting older is "heterogeneity," O'Neil quotes from Dr. Ken Schmader, assistant professor of medicine at Duke University. That is, as we age we become "more unlike each other," Schmader explains.

Testing for diabetes is "seriously sneaky among seniors," O'Neil writes on page 87. The reason for this is the normal process of aging can "hide two of the classic warning signs of diabetes -- extreme thirst and frequent urination." O'Neil explains that it is perfectly normal for an older person to become thirsty quite often and have kidney functions "decline." Going to the rest room frequently does not set off alarm bells or raise red flags for the elderly. Besides, doctors suggest drinking a lot of water, and older people do. The writer goes on to say that while a 40-year "undiagnosed diabetic" will almost always have "unquenchable thirst and the need to urinate frequently," his 75-year-old father "may show neither symptom" (87).

Moreover, experts suggest that about 25% of Americans between 65 and 74 have diabetes but many of those are not diagnosed (O'Neil, 87). O'Neil reminds readers that another reason it may be hard to detect diabetes in older people is they may be less forthcoming about their symptoms "because they're afraid of being labeled complainers or that their reporting of symptoms may lead to their placement in a nursing home" (94). The older person might also be reticent to reveal symptoms because "…they're frightened about what the doctor might find," O'Neal concludes. "Doctors can't have too much information. Unfortunately, they often have too little," O'Neal explains (94).

Meanwhile, Doctors Andrew Kagan and Henry J. (FRW) Heimlich, and actor Edward Asner teamed up to write a book on Type 2 Diabetes, in which they assert that the development of type 2 diabetes "increased naturally with aging" (Kagan, et al., 2009, p. 203). In fact, the authors explain, making the diagnosis is "difficult" because the symptoms "are not always typical" (203). Classically, the initial symptoms in young and middle age people with Type 2 diabetes are a high level of thirst and appetite and "frequent urination"; and those exact same symptoms may occur with elderly people who are near to getting diabetes.

However, the difference is that the above-mentioned typical symptoms "may be replaced or accompanied by episodes of confusion, incontinence, and dryness of the eyes and mouth," Kagan continues. Another bit of confusion for doctors seeking signs of diabetes is the fact that the elderly, when their blood sugar levels are high, they are "…less likely to spill sugar into their urine, and as a result, "many elderly-onset diabetics go undiagnosed" (203). There are estimates that as many as 2.4 million people (many elderly) have diabetes but are unaware they have it, Kagan explains.

From a technical point-of-view, the commonly used method of diagnosis, which is "repeated fasting glucose levels," can miss up to 31% of new cases of people past the age of 65, Kagan continues. Indeed, elder-onset Type 2 diabetes is challenging in terms of diagnosis because people over 65 often have "insulin resistance" which researchers don't yet understand.