over 65 yrs old and T2DM

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Over 65 years old and Type 2 Diabetes:

Over 65 years old and Type 2 Diabetes Emily M. Gamboa MSN 6007 – Advanced Physiology and Pathophysiology U08a1 – Care Plan Presentation

Objectives :

Objectives Overview of U.S. aging population and the relationship of Type 2 Diabetes Mellitus in this population Identify physiological changes of aging client with Type 2 Diabetes Mellitus (T2DM) Identify modifiable/non-modifiable pathological factors in T2DM Discuss rehabilitation services and interventions for T2DM Discuss treatment plan and use of technology in implementation of care plan for T2DM client Summary of presentation via concept map

Aging Population in the U.S.:

Aging Population in the U.S. 65 years and older – growth rate continues to exceed rate of growth of nation’s population as a whole (Hobbs, n.d .) Over next 40 years, largest percent increase in diabetes diagnoses projected to occur among 75 years or older ( Fravel , McDanel , et al, 2011) Increasing age increases need for assistance with activities of daily living Increasing number of the elderly choose to remain living in their home, or live with other family members

General Overview of Type 2 Diabetes Mellitus:

General Overview of Type 2 Diabetes Mellitus Glucose is food to cells in our body Glucose normally transported into cells when cells need energy; insulin binds to cell allowing glucose to enter cell With diabetes, glucose unable to enter cells Increased Insulin resistance Pancreas secretes insulin – levels may be normal, decreased, or increase Insulin unable to bind to insulin receptor sites on cells Increased levels of circulating insulin decreases number of insulin receptor sites available--- hyperglycemia

PowerPoint Presentation:

Physiological & Pathophysiological Changes in Aging and Type 2 Diabetic Client

Endocrine:

Endocrine Hormone levels either increase or decrease with aging; homeostasis of body not maintained Pancreas – loss of insulin receptor cells ------  Type 2 Diabetes Mellitus Pituitary gland shrinks , reduced hormone secretion Growth hormones (anabolic)----  decreased muscle mass and strength (Morley, 2003) Antidiuretic hormone – reabsorption of water in kidney tubules decreases -------  dehydration

Cardiovascular:

Cardiovascular Cardiac muscle fibers replaced with fibrous tissue; decreased contractility and filling capacity; and thickening of heart valves, which affect closing of valves and can cause murmurs (Scott & Fong, 2009) Increased risk of ischemic heart disease and strokes compared to younger diabetic pts (Hayashi, Kawashima, & et al, 2011) Macrovascular changes - Cerebrovascular changes, coronary artery disease, peripheral artery disease Microvascular changes – thickened, damaged capillaries Nephropathy, hypertension, retinopathy

Respiratory:

Respiratory Loss of elasticity and increased rigidity of the respiratory tract T2DM effects: damage to blood vessels of alveolar capillaries and pulmonary arterioles, chronic low-grade inflammation, nerve damage involving respiratory muscles, loss of elasticity to the lung-parenchyma , and hypoxia-induced insulin resistance (Klein, Krishnan, Glick, & Smith, 2010) Reduced capacity for exercise and increased susceptibility to respiratory infections

Urinary:

Urinary Kidneys shrink due to loss of nephrons , collapsing glomeruli , the larger blood vessels in the kidneys become sclerotic, and a decline in the glomerular filtration rate (GFR) (Scott & Fong, 2009) Decreased thirst sensation ----  dehydration Diabetes Mellitus Insulin resistance can result in build-up of glucose Renal glucose excretion---  Water loss Diabetic nephropathy eventually leads to end-stage renal failure Higher risk for developing myocardial infarction, cerebrovascular disease, severe forms of diabetic retinopathy, and diabetic neuropathy ( Jungmann , 2003)

Musculoskeletal:

Musculoskeletal Muscle atrophy, fibrous tissue replaces muscle tissue, and decreasing storage of muscle glycogen ---- decreased energy reserves (Scott & Fong, 2009) Skeletal system starts to exhibit a decline in bone mass and density approximately around age 40 Diabetes shown to contribute to muscle cramps, acute pain/swelling, deposits of calcium hydroxyapatite crystals in tendons around the shoulder, limited joint mobility of the hand, neuropathic joints, carpal tunnel syndrome, and osteoporosis (Wyatt & Ferrance , 2006)

Neurological:

Neurological Most common cognitive change is decreased response times Correlation with type 2 diabetes and impairments in planning, coordinating, sequencing, and monitoring of cognitive operations (Rucker, McDowd , & Kluding , 20120) Neuropathy can affect sensory and motor function Diminished sensation, parasthesia Common complication: non-healing sores

Modifiable Pathological Factors :

Modifiable Pathological Factors Glycemic Control Macrovascular complications Coronary artery disease Peripheral artery disease Stroke Microvascular complications Retinopathy Nephropathy Neuropathy

Non-modifiable Pathological Factors:

Non-modifiable Pathological Factors Ethnicity Incidence of diagnosed diabetes varies significantly among ethnic groups (Khan, Wang, et al, 2011) Gender  The variance of diabetes incidence among different cultures and races may be due to diet---  the foods normally eaten within a culture.

Prevention:

Prevention Primary Diet & Exercise----- Glycemic control Diabetes Education Stress management Secondary Annual physicals Lab work – i.e. A1C Self-reported eye exams, foot exams Blood pressure checks Tertiary Medications – i.e. Metformin , Insulin

Nursing Interventions:

Nursing Interventions Detailed physical assessment Assessment of factors that can affect health and well-being of client Financial and social support Access to transportation Spiritual being Liaison to other care providers Education Disease process Use of medical equipment – i.e. glucose monitor

Technology and Diabetes:

Technology and Diabetes Glucose monitoring systems Glucose monitors that do not require finger sticks; via transcutaneous monitor Real-Time Diabetes Monitoring System (RT-DMS) Collect glucose reading data and transmit information through cellular phone network to a website accessible to patient’s physician-----  active monitoring of patient ( Recupero , Mahnke ,& Pinsker , 2013)

PowerPoint Presentation:

Over 65 years of age Normal aging physiological changes Physiological changes with Type 2 Diabetes Modifiable Factors Non-modifiable factors Ethnicity Glycemic control Macrovascular Microvascular Coronary Artery Disease Peripheral Artery Disease Stroke Retinopathy Neuropathy Nephropathy Over 65 Years of Age and Type 2 Diabetes Concept Map Gender

Summary:

Summary Aging and Type 2 Diabetes Mellitus Physiological and Pathophysiological Changes Modifiable/Non-modifiable factors in T2DM Primary, Secondary, and Tertiary Prevention Nursing Interventions (including a nurse’s role) Technology and Diabetes Concept Map

References:

References Fravel , M.A., McDanel , D.L., Ross, M.R., Moores , K.G., and Starry, M.J. (2011). Special considerations for treatment of type 2 diabetes mellitus in the elderly [Electronic version]. American Journal of Health-System Pharmacy, 68 :500-509. doi : 10.2146/ajhp080085. Hayashi, T., Kawashima, S., Yoshizumi , M., Ina, K., and Kubota, K. (2011). Age, insulin, and blood glucose control status alter the risk of ischemic heart disease and stroke among elderly diabetic patients [Electronic version]. Cardiovascular Diabetology , 10 (1): 86-97. doi : 10.1186/1475-2840-10-86. Jungmann , E. (2003). Prevention and treatmnet of diabetic nephropathy in older patients [Electronic version] . Drugs Aging, 20 (6): 419-435. doi : 1170-229x/03/0006-0419. Khan, N.A., Wang, H., Anand , S., Jin, Y., Campbell, N.R., Pilote , L, and Quan , H. (2011). Ethnicity and sex affect diabetes incidence and outcomes [Electronic version] Diabetes Care, 34(1): 96-101. doi : 10.2337.dc10-0865.

PowerPoint Presentation:

Klein, O.L., Krishnann, J.A., Glick, S., and Smith, L.J. (2010). Systematic review of the association between lung function and Type 2 diabetes mellitus [Electronic version]. Diabetic Medicine, 27 :977-987. doi: 10.1111/j.1464-5491.2010.03073.x. Morley, J.E. (2003). Hormones and the aging process [Electronic version]. Journal of the American Geriatrics Society, 51 : S333-S337. doi: 10.1046/j/1524-4725. Rucker, J.L., McDowd, J.M., and Kluding, P.M. (2012). Executive function and type 2 diabetes: Putting the pieces together [Electronic version]. Physical Therapy, 92 (3): 454-462. Recupero, A., Mahnke, B., Pinsker, J.E. (2013). Emerging technology in diabetes care: The real-time diabetes monitoring system [Electronic version]. Military Medicine, 178 (2): 218-221. doi: 10.7205/MILMED-D-12=00317. Scott, A.S., and Fong, E. (2009). Body Structure and Function, (11 th ed) . Clifton Park, NY: Delmar, Cengage Learning. Wyatt, L.H., and Ferrance, R.J. (2006). The musculoskeletal effects of diabetes mellitus [Electronic version]. Journal of the Canadian Chiropractic Association, 50 (1): 43-50.

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