Special Issues For Older Adults And Elderly Diabetics

Individuals that are diagnosed with type 2 diabetes in their late adult years may have additional considerations than those diagnosed when they are younger. Elderly patients with diabetes tend to have greater difficulty with overall blood glucose regulation, additional health complications and concerns often associated with long periods of undiagnosed high blood glucose levels and more issues with cardiovascular issues such as heart attack and stroke. In addition elderly people diagnosed with type 2 diabetes may have mobility problems that make regular exercise very difficult to impossible without modifications.

Physical Issues

The links between weight gain, obesity, lack of exercise, high fat and high carbohydrate diets, a sedentary lifestyle and the development of type 2 diabetes are well established. As the population of the United States and other developed countries ages the rate of diagnoses of type 2 diabetes later in life continues to be an issue. The very symptoms of the development of diabetes, including frequent urination and thirst combined with fatigue and weight loss may, in fact, be attributed to aging instead of to the specific medical condition.  This can delay diagnosis and increase the physical health concerns when diagnosis is finally made.

Lack of exercise and structured activities may also pose a risk factor for the elderly, especially if the only type of exercise offered is cardiovascular and aerobic types of exercises. In a study of the use of resistance training in older adults to control blood glucose levels it was found that three times per week of resistance training showed very positive results. Participants in the exercise group had lower plasma glycosylated hemoglobin levels, better muscle glycogen stores and used lower amounts of diabetes medication.  1

Exercise training and structured exercise programs are also seen as essential in minimizing the risk for the cardiovascular issues and hypertension typically associated with a diagnoses of diabetes. As risk factors for these conditions increase even in the healthy population as it ages, increased awareness is important for those with a current diagnosis of type 1 or type 2 diabetes.

Regular exercise has been known to be important to overall health since Hippocrates, who said, “Eating alone will not keep a man well; He must also take exercise. For food and exercise… work together to produce health.” Exercise is associated with an improvement in vasodilator function as well as left ventricular diastolic function. Different studies also indicate that exercise helps to reduce arterial stiffness, which is typically associated with high cholesterol and triglyceride levels, common in those with diabetes. Systemic inflammation as a whole is decreased and positive changes in body composition are noted with routine exercise. This includes reduction of total and abdominal fat, decreased blood pressure, increased glycemic control and increased insulin sensitivity in cells. 2

Decreased blood circulation due to microvascular complications is more common in elderly patients with diabetes. This leads to higher levels of diabetic neuropathy, nephropathy and retinopathy. Often these conditions have developed to significant levels before the diagnosis of diabetes was made, leaving patients with lack of feeling, numbness, tingling in the fingers, toes, hands and feet, kidney problems  and eye and vision problems.

Having a complete diagnosis of all possible complications due to undiagnosed type 2 diabetes or poorly managed blood glucose levels for extended periods of time is essential. This may include much more significant testing, especially if there are mild to severe cognitive difficulties occurring with the physical issues that may make accurate patient self reporting of symptoms more challenging.

Cognitive Issues

As people age there is a decrease in brain functioning and cognitive abilities although there are many different factors that influence this progression. Diabetes itself contributes to changes, both structural and neurophysiological, in the brain that may lead to the development of cognitive difficulties. This condition is referred to as diabetic encephalopathy and can results in dementia. In studies in animals researchers now believe that this condition is caused the acceleration of aging in the cells of the brain due to sustained high blood glucose levels, oxidative stress, nonenzymatic protein glycation and neuronal calcium homeostatis. 3

In studies to determine the impact of diabetes on cognitive impairment research has shown a positive connection. Mild cognitive impairment was noted in patients with diabetes at an earlier onset age (before age 65), or when diabetes was present for at least 10 years or longer. It was also higher when insulin was prescribed and when there had been complications with the treatment of diabetes or concurrent diabetes related health conditions. The research findings suggest that the severity, duration and onset of diabetes have a direct influence on the level of mild cognitive impairment noted in people over the age of 70. 4

Cognitive disabilities may be expressed in a variety of different categories. These can include memory and recall, processing speed, problem solving abilities and executive function. Of these categories researchers have determined that processing speed is often decreased dramatically. Previously undiagnosed and untreated elderly diabetics in the study had the greatest reduction in processing speed attributed by the researchers to prolonged high blood glucose levels.5

Decreased cognitive functioning, even at the mild level, poses additional issues for seniors and older adults that are self-managing their type 2 diabetes. Incorrect or inaccurate blood glucose testing, poor adherence to diet and routine, lack of understanding of possible problem health concerns and maintaining proper health routines to prevent infections and skin problems may be a major concern. Individuals that are living by themselves and have mild cognitive impairments may be at greater risk for poorly regulated blood glucose levels that increase the risk of developing other related health conditions.

The development of depression in seniors with type 2 diabetes or type 1 diabetes and associated health conditions is also higher than in the non-diagnosed population of the same age. Depression can contribute to inactivity, poor diet, lack of socialization and lack of participation in blood glucose management and regular doctor’s visits. Depression can also lead to withdrawal from social situations, providing fewer people that interact with the patient that may recognize the signs of deteriorating health.

References

1 Castaneda, C., Layne, J. E., Munoz-Orians, L., et al. (2002). A Randomized Controlled Trial of Resistance Exercise Training to Improve Glycemic Control in Older Adults With Type 2 Diabetes. Diabetes Care , 2335-2341.

2 Stewart, K. J. (2002). Exercise Training and the Cardiovascular Consequences of Type 2 Diabetes and Hypertension. Journal of the American Medical Association , 1622-1631.

3 Biessels, G. J., van der Heide, L. P., Kamal, A., et al. (2002). Ageing and diabetes: implications for brain function. European Journal of Pharmacology , 1-14.

4 Roberts, R. O., Geda, Y. E., Knopman, D. S., et al. (2008). Association of Duration and Severity of Diabetes Mellitus With Mild Cognitive Impairment. Archives of Neurology , 1066-1073.

5 Saczynski, J. S., Jonsdottir, M. K., Garcia, M. E., et al. (2008). Cognitive Impairment: An Increasingly Important Complication of Type 2 Diabetes. American Journal of Epidemiology , 1132-1139.

This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.