Cited by 70Geriatric Care and Nursing HomesDiabetes Treatment and ManagementDiabetes Management and Research

Status of Diabetes Management in the Nursing Home Setting in 2008: A Retrospective Chart Review and Epidemiology Study of Diabetic Nursing Home Residents and Nursing Home Initiatives in Diabetes Management

Feldman, Stephen M., Rosen, Ronald, DeStasio, Jonathan·2009·Journal of the American Medical Directors Association

Abstract

Purpose Diabetes mellitus (DM) is associated with significant morbidity and mortality, and can present with atypical signs and symptoms in elderly residents of nursing homes who often have altered functional and cognitive capacity representing a particularly challenging population to manage. Researchers conducted this study to better understand the current status of DM management in the long-term care facility from the perspective of the facility (use of guidelines, policies, and so forth) as well as that of a resident. Methods Thirteen nursing home facilities in 6 states were studied. A 13-question survey instrument was used to collect data from interviews of the directors of nursing and medical directors. A 26-question data collection form was also used to perform a retrospective chart review of studied residents. Results Data from the interview surveys showed that only 15% of facilities studied had a policy for the use of treatment algorithms to manage residents with DM. In addition, only 1 of 13 facilities had a quality improvement tool to evaluate compliance with current policies. In regard to hemoglobin A1C (A1C) testing, only 7.1% of facilities had a house policy in place. Furthermore, only 1% of studied residents had an established target for their A1C despite American Diabetes Association (ADA), American Geriatrics Society (AGS), and American Medical Directors Association (AMDA) guidelines recommending target values and monitoring frequency for A1C testing. The survey instrument also found that just 30.8% of facilities had a policy in place for blood glucose monitoring. Data from the chart review shows that only 57% of residents in this study were taking aspirin or clopidogel bisulfate, although prevention of cardiovascular disease (CVD) is recommended by the American Heart Association (AHA) and ADA in persons with diabetes who are older than 40. Data from this study indicate serious hypoglycemia occurs only occasionally in the nursing home because hypoglycemic episodes requiring hospitalization occurred in only 1% of studied residents. Furthermore, researchers found each of these residents were sent to the hospital only once in the preceding 6 months. One unanticipated finding of the study reports the incidence of delusions from patients' Minimum Data Set (MDS) was 87.63% compared with the national average of 3.7%. Conclusion Data obtained through this study demonstrates numerous opportunities for improvement in the quality of care for nursing home residents with DM. A multidisciplinary approach is required to properly manage this complex disease in a challenging elderly population. The development of protocols and tools that embrace the latest strategies and treatment algorithms for the management of DM in the geriatric resident are necessary, while implementation of a quality improvement tool can help facilities to further improve on management of DM in the long-term care setting.

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Crossref · 10.1016/j.jamda.2009.02.010

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  • There is often inadequate oversight of glycemic control related to infrequent review of glycemic trends, complex and difficult-to-read glucose logs, and lack of specific diabetes treatment algorithms including glycemic parameters for provider notification.

    “There is often inadequate oversight of glycemic control related to infrequent review of glycemic trends, complex and difficult-to-read glucose logs, and lack of specific diabetes treatment algorithms including glycemic parameters for provider notification128.”

    From Diabetes in Older Adults: A Consensus Report (2012) · cites this paper as [128]

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Authors
Feldman, S. M., Rosen, R., & DeStasio, J.
Affiliations
Northeastern University (US)
Venue
Journal of the American Medical Directors Association
Publisher
Elsevier BV
Published
2009-06
Volume
10
Issue
5
Pages
354-360
ISSN
1525-8610 (ISSN-L)
OpenAlex
W2110507784
Cited by
70
References
34
Citations by year
2024: 2 · 2022: 1 · 2021: 1 · 2020: 1 · 2018: 3 · 2017: 3 · 2016: 7 · 2015: 7 · 2014: 5 · 2013: 7 · 2012: 8
FWCI
20.04
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of the American Medical Directors Association (publishedVersion)
  • PubMed (publishedVersion)
Funders
Novo Nordisk
Topics
  • Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
diabetes mellitus, nursing home residents, diabetes management, long-term care, hemoglobin A1c testing, blood glucose monitoring, treatment algorithm, quality improvement policy, cardiovascular disease prevention, hypoglycemia, delusions, Minimum Data Set, quality of care, elderly patients, nursing directors, medical directors, guideline adherence, hospitalization, multidisciplinary care
MeSH terms
Adult, Aged, Aged, 80 and over, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Humans, Interviews as Topic, Male, Medical Audit, Middle Aged, Nursing Homes, Retrospective Studies, United States, Organizational Policy, Disease Management

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