Type 2 Diabetes in Older Adults in Long-Term Care Homes: An Educational Intervention to Improve Diabetes Care

Lega, Iliana C.; Kapur, Alisha; Leung, Freda; Zahedi, Afshan

doi:10.1016/j.jcjd.2020.01.009

Cited by 2 publications

(1 citation statement)

References 17 publications

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“…The persistent use of SSI from the time of NH admission suggests interventions should promote reassessment of short-acting insulin regimens at regular intervals throughout an NH stay through education interventions and reminder systems in addition to changing admission order sets. [29][30][31] Education interventions should also emphasize alternative strategies to managing hyperglycemia in NH residents beyond adding fixed dose short-acting insulin, such as simpler regimens that rely more heavily on long-acting insulin and less on tailoring meal-time doses. 17 Based on our findings, we have several recommendations to reduce the use of SSI in NH residents.…”

Section: Discussionmentioning

confidence: 99%

Sliding scale insulin use in a national cohort study of nursing home residents with type 2 diabetes

Lam

Gan

Nguyen

et al. 2022

J American Geriatrics Society

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Background Guidelines discourage sliding scale insulin (SSI) use after the first week of a nursing home (NH) admission. We sought to determine the prevalence of SSI and identify factors associated with stopping SSI or transitioning to another short‐acting insulin regimen. Methods In an observational study from October 1, 2013, to June 30, 2017 of non‐hospice Veterans Affairs NH residents with type 2 diabetes and an NH admission over 1 week, we compared the weekly prevalence of SSI versus two other short‐acting insulin regimens – fixed dose insulin (FDI) or correction dose insulin (CDI, defined as variable SSI given alongside fixed doses of insulin) – from week 2 to week 12 of admission. Among those on SSI in week 2, we examined factors associated with stopping SSI or transitioning to other regimens by week 5. Factors included demographics (e.g., age, sex, race/ethnicity), frailty‐related factors (e.g., comorbidities, cognitive impairment, functional impairment), and diabetes‐related factors (e.g., HbA1c, long‐acting insulin use, hyperglycemia, and hypoglycemia). Results In week 2, 21% of our cohort was on SSI, 8% was on FDI, and 7% was on CDI. SSI was the most common regimen in frail subgroups (e.g., 18% of our cohort with moderate–severe cognitive impairment was on SSI vs 5% on FDI and 4% on CDI). SSI prevalence decreased steadily from 21% to 16% at week 12 (p for linear trend <0.001), mostly through stopping SSI. Diabetes‐related factors (e.g., hyperglycemia) were more strongly associated with continuing SSI or transitioning to a non‐SSI short‐acting insulin regimen than frailty‐related factors. Conclusions SSI is the most common method of administering short‐acting insulin in NH residents. More research needs to be done to explore why sliding scale use persists weeks after NH admission and explore how we can replace this practice with safer, more effective, and less burdensome regimens.

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Section: Discussionmentioning

confidence: 99%

Sliding scale insulin use in a national cohort study of nursing home residents with type 2 diabetes

Lam

Gan

Nguyen

et al. 2022

J American Geriatrics Society

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Lighting Design for Elderly Living in Residential Care Facilities

Kunduracı

2022

L&E

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Associated with aging, elderly suffer from various visual impairments that require specialized illumination conditions. Elderly should be supported by a well-balanced visual environment in residential care facilities to ensure active living and visual comfort. Although literature focused on age related eye diseases, significance of illumination to elderly and satisfaction level evaluations are detailed, translations to lighting design are mostly limited to illuminance-related guidelines. The aim of this study is to identify lighting design cues that enable visual comfort conditions through a systematic literature review. Scopus, Web of Science, and Google Scholar are searched from January 2000 to February 2022 and finally 11 papers that meet inclusive criteria are included. This study highlights illumination related problems of elderly and proposes spatial design recommendations to overcome visual discomforts. The reviewed papers’ results have been presented under categories as daylighting, colour rendering index, correlated colour temperature, night illumination, illumination distribution, illumination control, illumination layout, glare, adaptation, and interior design. Presented design recommendations can be applied to existing or future residential care facilities to reduce various visual challenges that elderly have been experiencing.

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Type 2 Diabetes in Older Adults in Long-Term Care Homes: An Educational Intervention to Improve Diabetes Care

Cited by 2 publications

References 17 publications

Sliding scale insulin use in a national cohort study of nursing home residents with type 2 diabetes

Sliding scale insulin use in a national cohort study of nursing home residents with type 2 diabetes

Lighting Design for Elderly Living in Residential Care Facilities

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