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Diabetes Standards of Care & Clinical Practice Resources

Older Adults and Patients with Multiple Comorbidities

Older adults differ markedly in their functional abilities, level of diabetes complications, and other comorbidities, life expectancies, and level and type of social and financial resources. Older adults with diabetes are more likely than those without diabetes to develop geriatric-related difficulties, including depression, cognitive impairment, urinary incontinence, falls causing injury, and pain syndromes. All of these issues should be factored in as providers and patients set diabetes-related treatment targets. Providers who get to know their patients, their families, and their life contexts can address their patients’ medical concerns while helping them to enjoy the highest possible quality of life for many years to come.

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Clinical Practice Recommendations

Recommendations for Older Adults and Patients with Multiple Comorbidities

  • For elders with limited comorbidities, significant life expectancies, and good functional abilities, treatment targets may be similar to those for younger patients, with the caution that older patients often do not tolerate hypoglycemia well.
  • For frail elders and patients with multiple comorbid conditions, treatment targets should be selected cautiously, balancing the benefits of tighter control with the risks (e.g., hypoglycemia, hypotension, etc.) posed to them by the multiple medications required to achieve these targets:
    • Assess patients for fall risk, cognitive impairment, depression, urinary difficulties, and chronic pain,
    • Ask about social and functional support, financial resources, access to nutritious foods, etc., and
    • Refer for evaluation/intervention as needed.

For elders with recent onset of diabetes and/or limited complications, significant life expectancies, and good functional abilities, treatment targets will be similar to those for younger patients. However, for frail elders and patients whose bodies are older than their chronological ages due to multiple comorbid conditions, treatment targets should be selected cautiously – to balance the benefits of reasonable control of specific targets with the risks posed by the multiple medications required to achieve these targets. Further, the particular medications selected need to be considered for both their individual effects as well as their interactions with the patient's other medications, disease conditions, and overall quality of life.

As diabetes has been diagnosed in younger AI/AN people over the last few decades, more patients are living with diabetes longer, and consequently developing multiple diabetes complications during what is usually considered middle life. This trend has many implications for these patients – for their physical health as well as their mental health and the ability to function effectively in their many life roles (e.g., as parents, employees, caregivers to elderly parents, community members, etc.).

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