A Hospital Survey of the Care of Elderly Patients with Diabetes Mellitus

Abstract

Elderly diabetic patients are at especially high risk of developing hypoglycaemia, diabetic retinopathy, foot ulcers and infection. We have surveyed 100 elderly diabetic inpatients to assess level of diabetes supervision, prevalence of risk factors for complications, and uptake of chiropody and fundoscopic services. Of all the diabetic patients, 19% received no supervision. A large proportion (71%) had two or more risk factors for the development of foot complications, yet only 50% had seen a chiropodist within the preceding 12 months. Forty-eight per cent did not undergo annual fundoscopic examination and 14 patients were regularly taking long-acting oral hypoglycaemic agents. The results highlight the particular needs of elderly diabetic patients and a strategy should be devised to optimize the care of these patients.

Self management and patient understanding of diabetes in the older person

“…Only 3.0% of participants were not seeing a medical professional of any description for their diabetes, much lower than a previous survey estimate of 100 UK patients aged at least 65 years, which found 19% of patients had no medical supervision [10]. Less than 3% of our study population reported taking no treatment whatsoever.…”

“…They add to the overall quality of care and increase patient knowledge [2,11–17]. Previous estimates in institutionally based elderly populations have suggested eye examination to occur in between 52 and 72% of older people each year [10,18]. A high proportion of older community‐dwelling people with diabetes underwent regular eye and foot examination, but less than one third saw a dietician.…”

Health care use by diabetic patients in the Netherlands: patterns and predicting factors

“…Other studies investigated differences in health care use by diabetic patients. Under utilisation has been registered among elderly patients [17]. The use of services is somewhat lower by ethnic minority groups [18].…”

A systematic review of foot ulcer in patients with Type 2 diabetes mellitus. I: prevention

“…The St Vincent Declaration called for a 50% reduction in amputations resultant from diabetic gangrene, reflecting the belief that much morbidity is preventable by better patient management[11]. Nevertheless, surveys indicate sub‐optimal supervision of elderly patients in hospital, residential care and general practice[4, 12–14]. An audit of care for people with diabetes discharged into primary care (where most practices have registers and recall systems) suggested an erratic and generally poor standard of supervision[15].…”