Diabetes Care for the Older Patient - A Practical Handbook
von: Gillian Hawthorne
Springer-Verlag, 2011
ISBN: 9780857294616
Sprache: Englisch
175 Seiten, Download: 838 KB
Format: PDF, auch als Online-Lesen
| Foreword: Diabetes in the Elderly | 7 | ||
| Preface | 9 | ||
| Contents | 11 | ||
| List of Contributors | 13 | ||
| Chapter 1: The Epidemiology of Diabetes in Older People | 15 | ||
| Background | 15 | ||
| The Elderly Population of the UK – Size and Trends | 16 | ||
| The Prevalence of Diabetes in the Elderly in the UK | 18 | ||
| Method of Diagnosis and Prevalence of Diabetes in the Elderly | 21 | ||
| The Distribution of Diabetes in the Elderly by Ethnicity | 22 | ||
| The Distribution of Diabetes in the Elderly by Socio-Economic Status | 23 | ||
| Association of Diabetes with Morbidity in the Elderly | 24 | ||
| Association of Diabetes with Mortality in the Elderly | 25 | ||
| Screening for and Diagnosis of Diabetes in the Elderly | 27 | ||
| Summary | 29 | ||
| References | 29 | ||
| Chapter 2: Type 2 Diabetes and Dementia | 32 | ||
| Introduction | 32 | ||
| Causes of Dementia | 34 | ||
| Risk Factors for Dementia | 35 | ||
| Why is Type 2 Diabetes only now being recognised as a Risk factor for Dementia? | 37 | ||
| Why is dementia more common in People with Type 2 Diabetes? | 38 | ||
| Genetic Factors | 39 | ||
| Hyperglycaemia | 40 | ||
| Cerebral Small Vessel Disease | 42 | ||
| Hypoglycaemia | 43 | ||
| Depression | 45 | ||
| Is There Sufficient Evidence to Warrant Screening for Cognitive Impairment and Dementia in People with Diabetes? | 46 | ||
| Conclusions | 46 | ||
| Practical Points | 47 | ||
| References | 47 | ||
| Chapter 3: Depression in Older People with Diabetes | 52 | ||
| The Old and Depression | 52 | ||
| Depression and Diabetes in the Older Person | 53 | ||
| Physical Changes Associated with Diabetes | 54 | ||
| Functional Disability | 55 | ||
| Health Care Costs and Quality of Life | 56 | ||
| Glycemic Control in Older Patients with Depression and Diabetes | 57 | ||
| Management of Depression in Diabetes in the Older Person | 57 | ||
| Treatment of Depression in Diabetes | 59 | ||
| Integration Treatment Approaches | 61 | ||
| Psychological Treatment Trials | 62 | ||
| Summary | 62 | ||
| Practical Points | 63 | ||
| References | 63 | ||
| Chapter 4: Hypoglycaemia and the Older Person | 67 | ||
| Hypos | 67 | ||
| Symptoms of Hypoglycaemia in Elderly | 67 | ||
| Knowledge of Hypoglycaemia | 69 | ||
| Epidemiology of Hypoglycaemia | 71 | ||
| Causes and Risk Factors | 71 | ||
| Moving Targets | 73 | ||
| Driving Down the HbA1c and Measures of Glucose | 74 | ||
| Effects of Hypoglycaemia | 75 | ||
| Effects of Hypoglycaemia | 75 | ||
| Effects of Hypoglycaemia | 76 | ||
| Effects of Hypoglycaemia | 78 | ||
| Effects of Hypoglycaemia | 78 | ||
| Nocturnal Hypoglycaemia | 79 | ||
| Conclusion | 79 | ||
| Practical Points | 80 | ||
| References | 81 | ||
| Chapter 5: Cardiovascular Risk, Glucose and Targets for Management of Diabetes in Older People | 86 | ||
| Cardiovascular Risk | 87 | ||
| Glucose Control | 89 | ||
| Practical Recommendations | 95 | ||
| Targets for Glycaemic Control | 95 | ||
| Oral Glucose Lowering Treatment | 95 | ||
| Hypertension | 97 | ||
| Practical Recommendations | 99 | ||
| Target BP | 99 | ||
| Choice of Medication | 100 | ||
| Lipids | 100 | ||
| Practical Recommendations | 101 | ||
| Aspirin | 102 | ||
| Practical Recommendations | 102 | ||
| Physical Activity | 102 | ||
| Practical Recommendations | 103 | ||
| Life Expectancy and Clinical Decision Making | 103 | ||
| Conclusion | 105 | ||
| Practical Points | 105 | ||
| References | 105 | ||
| Chapter 6: Diabetes and Frailty | 111 | ||
| What is Frailty? | 111 | ||
| Diabetes and Co-morbidities | 113 | ||
| Vascular Disease | 113 | ||
| Osteoporosis and Falls | 114 | ||
| Endocrine Disease | 116 | ||
| Type 1 Diabetes | 116 | ||
| Thyroid | 118 | ||
| Impact of Frailty on Care | 119 | ||
| Aims of Treatment | 119 | ||
| Neurological Disorders | 119 | ||
| Cardiovascular/Respiratory Disorders | 120 | ||
| Gastrointestinal and Nutrition Problems | 120 | ||
| Polypharmacy | 121 | ||
| Tissue Viability | 121 | ||
| Sensory Impairment | 121 | ||
| Cognitive Impairment | 122 | ||
| Social Aspects | 123 | ||
| The Importance of Carers | 123 | ||
| Care Homes: A Special Case? | 124 | ||
| Summary | 127 | ||
| Practical Points | 128 | ||
| References | 129 | ||
| Chapter 7: Perceptions of Users and Carers in Supporting Diabetes Care: Practical Guidance, Support and Information for Carers | 132 | ||
| Introduction | 132 | ||
| Point of Diagnosis | 133 | ||
| Information Needs – Older People | 133 | ||
| Information Needs – Carers | 135 | ||
| ‘Trust me! I’m a Patient/Carer’ – Living with Diabetes | 135 | ||
| Education and Training | 138 | ||
| The Theory | 139 | ||
| The Evidence | 140 | ||
| The Critique | 142 | ||
| Ethical Issues | 143 | ||
| Cultural Issues | 144 | ||
| Personal Budgets | 146 | ||
| Conclusions | 147 | ||
| Practical Points | 148 | ||
| References | 148 | ||
| Chapter 8: Management of Elderly People with Diabetes in Primary Care | 151 | ||
| Introduction | 151 | ||
| Treating Older People with Diabetes in Primary Care – The English NHS Response | 153 | ||
| Treating Older People with Diabetes in Primary Care – Delivering Care in Practices | 158 | ||
| Diabetes in Care Home Residents | 164 | ||
| Summary | 169 | ||
| Practical Points | 170 | ||
| References | 170 | ||
| Appendix | 174 | ||
| Index | 177 |