Elderly patients disproportionately suffer from diabetes and related comorbid conditions and will often go undiagnosed. This is because healthcare providers, including nurses and physicians, are faced with obstacles uncommon to younger patients, including cognitive impairment and polypharmacy. This essay presents a lesson plan for recognizing the signs and symptoms associated with untreated diabetes, screening patients for diabetes, and designing and implementing a treatment approach.
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 based on comorbid conditions.
3. 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., Maguchi, Megumi, and Segal, 2012), renal insufficiency or failure, peripheral neuropathy, gastroparesis, skin conditions, hypertension, peripheral vascular disease, and recurrent infections (Dybicz, Thompson, Molotsky, and Stuart, 2011). This is in addition to the symptoms commonly associated with poor glycemic control. Students will then be required to assign the level of burden for comorbid conditions based on the Centers for Medicare and Medicaid Services Hierarchical Condition Category model. The students will be expected to take notes and study the material presented on their own. All students will be tested for their knowledge about this topic at the end of the course.
Day 3 -- Diabetes Screening Tool Laboratory Practicum
Under the supervision of a laboratory instructor, students will draw each other's blood and test it for indicators of diabetes. The test used will be fasting plasma glucose at least 126 mg/dL, a post-load 2-hour glucose level at least 200 mg/dL, and a causal plasma glucose level at least 126 mg/dL when combined with polyuria, polydipsia, and/or unexplained weight loss (Dybicz, Thompson, Molotsky, and Stuart, 2011). Obtaining accurate test results will be considered a passing grade for this objective.
Days 4 and 5 -- Designing a Diabetes Treatment Program
De-identified medical charts will be used to develop the skills necessary for designing a treatment approach for an elderly patient with diabetes. The material presented will be based on the information contained in the articles authored by Vischer and colleagues (2009) and Munshi and colleagues (2012). The primary focus will be establishing tight glycemic control, identifying comorbidities, and understanding the risks of polypharmacy. Students will be expected to take notes, study the relevant material in these articles, and refer to the advanced geriatric nursing textbook by Cotter and Strumpf (2002). Students will be tested for their knowledge and required to design a diabetes treatment based on a mock patient chart at the end of the course.
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