Running head: DIABETES MANAGEMENT IN COMMUNITY HEALTH NURSING
Diabetes Management in Community Health Nursing
Diabetes Management in Patients Aged 65 Years and Older
The selected aggregate for this paper is patients living with diabetes within the community and the suprasystem includes elderly patients. Further down, the plan of care for the project is directed towards caring for patients who are 65 years and above and who are managing their diabetes at home. There are many personal responsibilities that come along with the management of diabetes among them ensuring complete adherence to medication, observing the right nutrition and checking for any complications such neuropathy leading to diabetic foot ulcers, eye damage, kidney damage and skin conditions. In turn, this has financial implications that requires the patients to get deeper into their pockets especially when they have no insurance. In 2017, Trikkalinou, Papazafiropoulou, & Melidonis mentioned that diabetes has a negative effect on the quality of life (QoL) in terms of physical, social, mental, cognitive, and psychological component. This specific aggregate has been selected because of this high numbers of the baby boomer’s population. They are in high numbers in the nation and within the community and hence the need to have more concentration towards them as they greatly affect the health indicators of the nation and the society.
Elderly and diabetic population for those having 65 years and above is made up of different sociodemographic and health status. According to the American Diabetes Association, people who are 45 years and above are usually at high risk for developing diabetes (American Diabetes Association, 2015). The risk also increases with advancement with age. Gender is also another factor and diabetes affect people of both genders. When it comes to race, there are races that have high prevalence for developing diabetes than others. In a descending order, these include American Indians, Non-Hispanic blacks, Hispanics, Asian American and finally the Non-Hispanic whites (American Diabetes Association, 2015). Different factors further play a role on why some races would have high prevalence than others and just to mention these factors they include living in poor communities of neighborhoods, high insulin resistance rates among some races and also those with high level of obesity have high risk of developing diabetes. It is also likely that patients who have low levels of education and with low income would not manage the diabetes as needed due to lack of resources.
In regard to health status as specific characteristic, there are a number of health issues that affect elderly patients. Just to mention some few, these include mental health problems such as depression, Alzheimer’s diseases and dementia which affects their memory, schizophrenia, hypertension, Parkinson’s disease, cataracts and diseases of the joints such as arthritis. It is also likely to find a patient who has been diagnosed with more than one of these diseases. This affects their quality of life due to physical and psychological changes happening to them.
According to the National Diabetes and Statistics Report of 2020, 34.2 million Americans of all ages already had diabetes in 2018. This is equivalent to 10.5 % of the population. 34.1 million of these were adults. The report also shows that with increase in age, the percentage of adults diagnosed with diabetes also increased. 26.8% of these were aged 65 years and older. Men were also found to be at high risk than women. White, non-Hispanics had more prevalence, followed by Hispanics, Black non-Hispanics and Asian non-Hispanics with the lowest numbers. In the same year, 1.5 million newly diagnosed diabetes cases were reported. The incidence rates were also higher in adults aged 45 to 64 years and those aged 65 years and above. Those aged 18 to 44 years had lower incidences compared to the other two (Centers for Disease Control and Prevention, 2020).
Literature from Giri & Putra (2020) on the perceptions and needs that the diabetic patients have indicate that patients diagnosed with diabetes report fear because they do not know their nutritional needs. They reported lack of knowledge of the food patterns they should take and what to avoid. Some patients do not understand what it means by a food intake with high calories. This, therefore, formed the basis for having the project focus on nutrition and other non-pharmacological approach of exercising. Giri & Putra further stated that nutrition is very important for diabetic patients. Lack of this knowledge turned to be a trigger to their stress levels causing deterioration of their health.
The need identified for this population is management of diabetes using non-pharmacotherapy interventions. As aforementioned, there is needed to continuously manage diabetes because it is a chronic illness and therefore patients must take the responsibility of caring for themselves with the help of their doctor for a long-term period. Taking the medications helps the body in getting rid of the glucose that is in excess in the blood. The body also used the insulin in a better way. Depending on the patient’s condition, the doctor decides what form of treatment is needed. Some patients may only need to take pills while others take pills and also inject insulin. The non-pharmacological therapy involves observing a healthy diet, going for exercise, and weight loss. Taking a diet with low calories is very crucial. Regular exercising helps in weight loss since obesity only complicates diabetes.
On agreement, the student and the aggregate decided to work towards encouraging adherence to the non-pharmacological approaches. The main goal of the intervention was to compliment the use of medications for the best patient outcomes. Taking the medications without observing the mentioned non-pharmacological approach would not result to full effect. This is why it is important to include this intervention. As agreed, upon by the student and the aggregate, there are three areas of focus. These include coming up with a list of all low calories food and preparing sample meal plans, understanding what exercises are needed for a patient who has diabetes and keeping daily reading record of diabetes at least for three months to help track the management of diabetes following adherence to the interventions mentioned herein. This would help in determining whether the approaches applied currently are effective or there is need to change course of treatment. Setting measurable objectives is important as a way of evaluating the effectiveness of the intervention. Below are the objectives to be achieved with this intervention.
i. Patients prepare different meal plans every week with the right number of calories.
ii. Ensuring that they engage in exercises at least three times per week.
iii. Have daily records of the blood sugar level.
These are measurable objectives because patients can report whether they have been able to do as agreed and provide evidence such as the meal plans and the daily records. In regard to exercising, it is possible to tell whether the patients adhered to it by comparing their weight over time to see if they have lost some pounds. To accomplish these objectives, the aggregate needs to have a good understanding of why they need to do so. The intervention that can help in ensuring that they comply is educating them on the benefits of each of the approaches in their diabetes management journey and the outcomes they should expect. Understanding why that is importance increases compliance. This would be considered a preventive approach because it intends to encourage the patients towards proper management of the disease and hence reduces the prevalence of having poorly controlled diabetes and related complications. Hence, they are proactively prevented.
Glazier, Bajcar, Kennie, & Willson (2006) explain that there are different levels of planned interventions that can be applied. These include interventions directed to the health systems, to the health providers or patient-level interventions. Health system intervention focus on changing the policies used in an organization or facility while health providers’ interventions affects the practices of care providers. The patient-level intervention is most applicable here and this is because all the attention is given to the patient with the ultimate goal of helping them become more accountable of their health. When the intervention is designed towards the aggregate, it should be within their level of understanding in terms of the language used.
This intervention was applied with a good number of the aggregate population increasingly remaining active during the period of learning and also when it came to evaluating whether the objectives were met. Findings indicated patients having different meal plans for different weeks, recording of readings everyday using digital applications for diabetes management and weight loss in some of the patients who actively engaged in daily exercises.
The plan implemented for this project towards addressing the need for diabetes management among elderly patients is with no doubt found to be beneficial to them. Following its implementation and completion, there are many positive outcomes to be reported including reduces levels of A1C and lower risk of developing complications. Furthermore, with proper diet and exercising, this does not only improve diabetes management but also the overall health. Looking back, the objectives are undeniably very much measurable in nature and this helps in assessment of the response that the aggregate had on the project. Specific to the project, the aggregate’s evaluated the project in a positive way stating the benefits relating to the whole process of educating them on why they need to comply. It proved to be an appropriate approach and also one that is effective. The recommendations made is to have more programs like this which will eventually transform the health of the community, state and nation at large. Different healthcare facilities can implement the approach within their facilities too. Additionally, a follow-up is needed after the completion to ensure that patients develop a culture of taking care of their health using the taught approach. Community health nursing can result to complete transformation of the health status for different illnesses. The designed used can be generalized for use in communities with high prevalence and burden of diabetes complications not only for this specific aggregate but also for all the other age groups.
American Diabetes Association. (2015, January 1). 2. Classification and diagnosis of diabetes. Retrieved from https://care.diabetesjournals.org/content/38/Supplement_1/S8
Centers for Disease Control and Prevention. (2020). National Diabetes Statistics Report. Retrieved from https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
Giri, M. K., & Putra, A. (2020). Perceptions and needs among diabetes patients: A qualitative study. Proceedings of the 3rd International Conference on Innovative Research Across Disciplines (ICIRAD 2019). doi:10.2991/assehr.k.200115.033
Glazier, R. H., Bajcar, J., Kennie, N. R., & Willson, K. (2006). A systematic review of interventions to improve diabetes care in socially disadvantaged populations. Diabetes Care, 29(7), 1675-1688. doi:10.2337/dc05-1942
Trikkalinou, A., Papazafiropoulou, A. K., & Melidonis, A. (2017). Type 2 diabetes and quality of life. World Journal of Diabetes, 8(4), 120. doi:10.4239/wjd.v8.i4.120
Running head: ELDERLY PEOPLE IN KENDALL 2020 1
ELDERLY PEOPLE IN KENDALL 2020 2
Analysis of elderly people in Kendall 2022
When the use of the research in Kendall, Florida my living town, I want to explain the incidence of illness and differences process of medical attention for elderly people. In honor of those professional that every day make the best work for this kind of people in our society I be mention step by step all the medical process inside and outside sometimes of houses and medical center’s. In this project I been mention difference medical process such as assessment, nursing diagnosis, implementation of difference nursing work in dependence of severity of illness in elderly population, nursing consideration, and evaluation process for every situation. In addition, I will also refer to the diseases that elderly people suffer in this area and information related to the difference care processes. We know a little about history of elderly people in the United State and its accelerated growth.
Analysis of elderly people in Kendall 2022
Traditionally, the “elderly” is considered to be those persons age 65 and older. By that definition, in 1987 there were just over 30 million elderly people in the United States, more than 12 percent of the total U.S. population of nearly 252 million.
The rate of growth of the elderly segment of the U.S. population has been much more rapid than the rate of growth in the overall population, a phenomenon often referred to as “the graying of America.” Data from the National Center for Health Statistics (NCHS) indicate that, from 1960 to 1986, the population age 65 and older increased by 75 percent, from almost 17 million people to over 29 million people, while the population under 65 increased only 30 percent (NCHS, 1989). Among those over age 65 in 1986, about three-fifths were between age 65 and 74; about one-third were 75 to 84, and one-tenth were 85 and older. The rate of growth of the subgroups of the elderly population between 1960 and 1986 was substantially higher for the older age groups (i.e., 75 to 84 and 85 and older) than for the 65 to 74 age group.
Between 1987 and 2030, the total U.S. population is projected to increase by 26 percent from 252 million to 317 million, while the population age 65 and older is expected to increase by more than 100 percent from the present 12 percent of the total population to nearly 21 percent of the total population (67 million).
Almost half of the elderly in the United States live in eight states: Florida, Pennsylvania, New York, Ohio, Illinois, Michigan, California, and Texas. In the first four of these states, the percentage of the state’s population that is elderly exceeds the national average of 12.1 %, with Florida having the highest concentration of persons over age 65. Other than Florida, many states with a large share of elderly are in areas where the high concentration arises more from out-migration of the young than from shifts in the residence of the elderly population.
We have in Kendall according to the recent census 60,621 adults, (13,831 of whom are seniors), this represents the 22.82% of the total adult age in this region. A lot of this elderly people suffer different illness according with his or her age. Illness such as heart disease, stroke, cancer, and diabetes are among the most common and costly chronic health conditions causing two-thirds of deaths each year. Cognitive health, mental health, physical injury, HIV/AIDS and other sexually transmitted diseases, malnutrition, sensory impairments, oral problems, substance abuse, bladder control and constipation are other illness that can be present in our older adults. In this time the most important illness that affect and are the principal risk for the elderly population is Covid -19, that caused a lot of death in all the world and have incidences in our area too.
Older adults become more susceptible to infections due to several factors. As people get older, it is more frequent that they have comorbid conditions, such as diabetes, renal insufficiency and arthritis. Many comorbid conditions, both the number and type of comorbid conditions, predispose people to infections. Often, when people age, there is immunosenescence, which means that the immune system does not function as well or as vigorously. The combination of increased comorbid conditions and the decrease in activity of the immune system can make people more prone to infections. The other syndrome that occurs when people become old is frailty. When people become frail, their body mass index drops and they have a harder time functioning independently, in terms of their daily living activities. They become more prone to falls and injuries. All these things predispose older people to infections. There is an increased association with being older and an increased risk of infection, but it probably has more to do with how successfully some people age. Some people age and they remain active and healthy, and individuals such as that probably do not have an increased risk of infections. But individuals who become frailer and more dependent on others for maintaining their health status and their daily activities, their risk for infections increases greatly. With an aging population comes an increasing need for healthcare, long-term care, and social services to support older adults as they age. Adults over age 65 have different healthcare needs more than children and younger adults because they lack a mayor part of the immunity response. It is estimated that 90% of adults over age 65 experience one or more chronic condition, and need specific treatments and medical care, setting them apart from the rest of the population.
As a senior’s body changes with age, there are a few subtler symptoms to be aware of that can affect overall health and quality of life, including:
•A slowed reaction time, which is especially important when judging whether a person can safely drive.
•Thinner skin, which can lead to tears and wounds that heal very slowly.
•A weakened immune system, which can make fighting off viruses, bacterial infections, and other diseases more difficult.
•A diminished sense of taste and smell, especially for smokers, which can lead to a loss of appetite and dehydration.
•A risk of falling increases because the decrease in muscle strength increases and sudden changes can occur in states of consciousness at this stage of life.
COVID-19 is caused by a coronavirus called SARS-CoV-2. Older adults and people who have severe underlying medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness. The virus moves down your respiratory tract. That is the airway that includes your mouth, nose, throat, and lungs. Your lower airways have more ACE2 receptors than the rest of your respiratory tract. So COVID-19 is more likely to go deeper than viruses like the common cold.
COVID-19 affects different people in different ways. Infected people have had a wide range of symptoms reported – from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus.
People with these symptoms during the assessment may have COVID-19:
-Fever or chills
-Shortness of breath or difficulty breathing
-Muscle or body aches
-New loss of taste or smell
-Congestion or runny nose
-Nausea or vomiting
Look for emergency warning signs for COVID-19. If someone is showing any of these signs, seek emergency medical care immediately:
-Persistent pain or pressure in the chest
-Inability to wake or stay awake
-Bluish lips or face
Everyone, especially older adults, and others at increased risk of severe illness, should take steps to protect themselves from getting COVID-19. In fact, 8 out of 10 COVID-19-related deaths reported in the United States have been among adults aged 65 years and older.
How has said the most relevant affection that our elderly people afront today is covid-19 ill that affect millions of people in all word and was considered by the OMS, and CDC in the U.S as the most worst pandemic situation in the humanity history. Elderly people are especially susceptible to get this ill because their lack of immunity system make them the perfect candidates to get sick and die more suddenly.
In order to prevent and protect the elderly people face to this problem is important know and implement the levels of prevention because if we are capable to put in practice this levels of prevention that are applicable for this group of age we can save a lot of live and can avoid the extension of this pandemic situation for more time in our country and area in specific words. The medical model of disease is a useful allegory for health disparities in the US. The initial stage of understanding a disease is to assess the history and characterize the signs and symptoms of the illness. Subsequently the causes of the disease and mechanism of disease facilitates development of targeted therapeutic intervention to treat, cure, and hopefully eradicate and prevent illness.
The different levels of disease prevention, the primary, the secondary, and the tertiary are derived from this medical model of care.
Primary level of prevention
Includes those measure that prevent the onset of illness before the disease process begins.
Examples of primary prevention in case of covid 19 include:
•Wash your hands for al list 20 second if you were away from your home or in contact with an environment outside your home.
•Stay in home especially if you are old and do not need to go outside of your home for any reason.
•In case that you need go outside home wear your face with mask and maintain social distance for at list 6 feet between the other peoples around you.
•Health education about all reference for covid 19.
All of this element is part of the health promotion that the government and the medical policies make for avoid that elderly people can get infected because they are the most susceptible target in this specific time.
Secondary level of prevention
Aims to detect and treat disease or its complications at an early stage, before symptoms or functional losses occur, thereby minimizing morbidity and mortality.
Examples of secondary prevention in case of covid 19 include:
•Screening test for people that have symptoms and specially for elderly people.
• Special screening program directly at home if you are sick and you cannot go to the center or hospital for be evaluated.
•Supervision all time via zoom or video call for the Health Practitioner and PCP regarding elderly population.
Tertiary level of prevention
In tertiary prevention, an existing symptomatic, usually chronic disease is appropriately managed to prevent further functional loss. Disease management is enhanced by using disease-specific practice guidelines and protocols.
Examples of tertiary prevention include:
•Disease-specific care management: A specially trained nurse, working with a primary care physician or geriatrician, coordinates protocol-driven care, arranges support services, and teaches patients.
•Special attention for patient that successfully pas the illness and recovery at home but maintain some limitations because adverse effect of the illness and need help for well-being, because they cannot do it but themselves.
•Specialists: Patients with a chronic disease that is difficult to stabilize can be referred to a specialist. This approach works best when the specialist and primary care physician work collaboratively.
One of the most important intervention that do it together the medical and governmental leaders in order to alleviate this situation is precisely provide all information through the social medias and for the tv for avoid the spread of the covid19. This is an example of primary prevention level that cause effect because instruct the people about the severity of the moment that we are living.
Another important intervention is the screening test that can we do if we have any symptoms related to the disease, and the special solution for the elderly people that get this test in home if they are suspect that have the disease. This is an important implementation plan that our government put in practice for avoid the spread of the virus and reduce the incidence of the affected people that have more that 65, because they are the most dangerous target that virus can affect. This implementation is part of the secondary prevention levels that our medical system considers necessary.
The mayor goal during the implementation of this levels regarding our National Health Department is avoid the spread of virus and contribute to put down the line off illnesses people and take care for all of hem that unfortunately are sick, fighting for his lives and promoting all time the needed to follow strain all the requirements that we need to follow in this special time. Avoiding more life lost and the economic cost of this pandemic war in all the word but specially in our country.
If we want to evaluate the work of our leaders and our medical staff attending the mayor goal that they have facing to the pandemic situation caused by the spread of virus covid 19 we can see that they are putting all their effort and resources in the way to progress in order to eliminate the real dangerous situation that are present in most of the word today. Sometimes the take a lot of precaution that are successfully prevent the spread of virus , but sometimes for different misunderstanding ideas some of the independence leader are taking decision that can affect more the elderly people, but thanks god our government put all, the bad and the good result over the table and at the end of the day always enforce the situation to save live and promote wellbeing in all the word. They work without rest for improve our medical system and for find the definitive vaccine that can cure forever this virus.
My own recommendation for all people that are living in this special time that we facing today is that we need to follow all the instructions that our government provide us in order to alleviate and finish this situation. All the times we need to remember that the most important person that we need to care is our elderly person because they are the most risk part of our society that this virus are affecting today. If we really love our elderly people, we need to think in protect us and protect them because this is the only way that can be save and can win this fight.