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The Management of Metabolic Diseases is Crucial for Older Adults in Long-Term Care

Medical care in long-term care facilities, such as nursing homes, is a complex task due to the high number of dependent older adult residents with comorbidities varying in severity, polypharmacy, and psychological, physical, and neurosensory impairments.  Unfortunately, the management of chronic illnesses such as diabetes mellitus and the prevention of atherosclerotic issues are very rarely addresses in this vulnerable population.

The risk of diabetes increases significantly for older adults over the age of 75.  Approximately 32% of residents in nursing homes have diabetes. However, the objective of glucose management is not very stringent in this population compared to younger adults due to the limited benefit of severe glucose control on chronic cardiovascular problems and of the risk of severe hypoglycemia. Indeed, severe glucose control in elderly individuals has been related to an increased vulnerability to severe hypoglycemia because of a lower awareness of warning symptoms and the absence of coordinated response associated with cognitive impairment.  Severe hypoglycemia could result in exacerbated confusion, higher risk of falls, hypertensive emergencies, stroke, and coma.  Furthermore, experiencing frequent hypoglycemia could have deleterious effects on the psychological wellbeing of elderly people.

Older adult patients with diabetes must receive specialized care with respect to proper food intake and insulin dosage adaptation, taking into account the intricate situation with challenges associated with the influence of mental disorders on the regularity of meals.  Training the medical staff of nursing homes in diabetes management is critical for these patients to achieve positive outcomes.

Cardiovascular diseases, such as atheromatous problems, are the primary cause of death among patients in the nursing home. The normal function of cholesterol is diminished in older adults; however, its effect on coronary heart disease is more critical than in younger adults.  A recent study found that the risk of cardiovascular events and mortality significantly decreased when statins were used as secondary prevention and among patients at high cardiovascular risk.  Thus, it is important to discuss blood lipid management as secondary preventative treatment in older adults residing in nursing homes.  Substantial evidence has shown that statin use is a safe treatment option for older adults when taking into account the prescription of intensive doses and the effects of combining medications.  According to a recent article published in the Journal of the American Medical Directors Association (JAMDA), the discontinuation of a well-tolerated statin therapy in elderly residents under secondary prevention is not substantiated.

In conclusion, research has shown that metabolic control should not be treated lightly in nursing home patients.  For patients with diabetes, capillary glucose monitoring is appropriate, especially in insulin-treated older adults, to prevent hypoglycemia and chronic hyperglycemia and their short-term detrimental effects.  There is no reason for a well-tolerated statin therapy to be discontinued in secondary prevention due to its limiting effect on the progression of atherosclerosis.

The kind of care that an elderly patient in a long-term care facility receives is crucial when it comes to their quality of life and overall wellbeing.  It is imperative that nursing homes and assisted living facilities, such as those in Carson and Cerritos, California, provide their residents with high quality care in order to prevent adverse health problems and improve psychological, physical, social, and emotional wellbeing.