Cognitive and psychosocial aspects of caring for elderly patients with diabetes

Abstract

The population is aging in the United States as well as worldwide. The prevalence of diabetes increases with increasing age. To provide optimal care to older adults with diabetes, unique psychosocial barriers need to be considered by medical providers. Unlike in younger adults, cognitive dysfunction/dementia and depressive mood disorders are common coexisting conditions in older adults with diabetes. This article reviews recent literature on epidemiology and clinical implications of cognitive and psychosocial dysfunctions in older patients with diabetes. This article focuses on cognitive dysfunctions, dementia, depression, and other psychosocial stresses, and their implications in the care of older adults with diabetes.

The association of mental conditions with blood glucose levels in older adults with diabetes

“…The implications of mental disorders for effective diabetes management is understudied, despite the fact that outcomes of ineffective diabetes management are known to be poor (Bayliss, Ellis, & Steiner, 2007; Colton & Manderscheid, 2006; Gijsen et al, 2001; Iwata & Munshi, 2009). Older patients with diabetes are not often screened or evaluated for cognitive impairment and other affective disorders (Iwata & Munshi, 2009; Piette & Kerr, 2006).…”

“…Older patients with diabetes are not often screened or evaluated for cognitive impairment and other affective disorders (Iwata & Munshi, 2009; Piette & Kerr, 2006). Screening for unrecognized barriers to successful management of diabetes may be important when complex treatment regimens are prescribed.…”

“…Screening for unrecognized barriers to successful management of diabetes may be important when complex treatment regimens are prescribed. Additionally, the research to date has largely focused on specific effects such as depression or GAD, with very few studies documenting cognitive dysfunction on glucose management in older patients with diabetes (Iwata & Munshi, 2009). Implicit in this strategy is the assumption that not all comorbidities are the same and their unique characteristics and symptoms may present different levels of disability and functioning.…”

“…We hypothesized that certain mental health conditions may have a greater effect on glycemic control than others. Though cognitive dysfunction, depressive disorder and mood, and anxiety can co-occur (Iwata & Munshi, 2009; Potvin, Hudon, Dion, Grenier, & Preville, 2010), they are distinct conditions (DSM-IV, 2000). We therefore examined executive function, depressive symptoms, and symptoms of GAD separately to determine which conditions are associated with blood glucose levels.…”

Tiotropium for the treatment of chronic obstructive pulmonary disease

“…This topic is particularly important because cognitive impairment is common in patients with diabetes, but cognitive function is often not screened or evaluated in this population [19]. Delineating the independent association of cognitive function with health literacy may have important implications, namely in the form of targeted interventions or educational strategies that are tailored to accommodate the cognitive changes associated with diabetes to address health literacy limitations.…”