Dietary Challenges and Solutions for Diabetic Elderly in Nursing Homes

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Nov 24, 2024

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1 Diabetic in Elderly Living in Nursing Home, Lack of Change in Life Style, And Diet Name of the Student Name of the Supervisor Course Date

2 Literature Review Despite the long tenure in nursing homes, diets for diabetic patients are ineffective and outdated to managing the older adults in the nursing homes (Powers et al., 2021). Diabetic diets to patients in the nursing homes should be restricting foods that are high in sugar content such as cookies and cakes; besides, other sugary beverages like juice and pop have an increased range of sugar and should be avoided in the nursing homes (American Diabetes Association, 2019). This is because when consumed results in a sharp rise in blood sugars. Nurses taking care of diabetic patients are supposed to ensure that sugar is taken under consideration. Instead of the diabetic diet orders that are not adequate for the management of levels of blood sugars, the liberalized diet allows for an opportunity of different choices that is important in attaining nutritional needs as well as goals to the levels of blood sugars to nursing home patients with type 1 and 2 diabetes (Powers et al., 2021). The joy of eating and reducing the risk of malnutrition and dehydration in elderly patients can enhance the management of diabetes by using medication instead of dietary changes. An adequate amount of dietary fiber found in different plant foods should be consumed by elderly diabetic patients in nursing homes. Low consumption of fruits, legumes, vegetables, whole, and high fiber grain products make the suggested intake of 20-30 grams per day is not attained (Liu et al., 2018). Blood cholesterol, insulin, and levels of glucose are reduced by consumption of insoluble dietary fiber. Therefore, it is worth understanding that a diet with adequate food containing fiber has less refined sugar, calories, and fat (American Diabetes Association, 2017). Besides, it usually is rich in nonnutritive and macronutrient constituents, which are beneficial to an individual's health. Safety gets promoted since a fiber-rich meal gets digested more slowly while in the digestive tract. Therefore, type 2 diabetes, overweight,

3 cardiovascular disease, and obesity are prevented and treated by a high fiber diet's salubrious feature. However, supplements are required with a high fiber-rich diet to have fiber intakes being brought to the point that it is satisfactory to prevent constipation. According to Rizvi (2019), the population living in diabetes has been projected to take two-thirds of adults 60 years and above by the end of the year 2025. Elderly diabetic individuals in nursing homes have a higher likelihood of having coexistent chronic conditions, including cardiovascular diseases, hypertension, and dyslipidemia. These condition ends up impacting their nutritional requirements (Levesque, 2017). As in other age groups, the maintenance and attainment of ideal body weight in old diabetic patients are not forthright. There are chances of insulin resistance and hyperglycemia due to the increased obesity or overweight in the elderly population. However, the elderly diabetic patients in nursing homes who have lasting care amenities tend to be underweight (Haywood & Sumithran, 2019). Both underweight and hyperglycemia cases indicate inadequate nutritional status, increasing mortality and morbidity. The quantity and type of food that elderly persons consume may be affected by the associated difficulties of variations in appetite, depression, palatability of food, restrictions on diets, and loneliness. Organized broadcast tools recognize nutritional issues in elderly patients that permit evidence-based interferences ( Balk-Møller, Poulsen, & Larsen, 2017). Apart from controlling glucose and health concerns in diet modification to the older people in nursing homes, other deliberations like individual preferences and quality of life also modify the diet. Besides, it makes sense to customize nutritious strategies to the requirements of diabetic patients. According to Kalra and Sharma (2018), the Elderly is a distinct and essential heterogeneous group of people living with diabetes. This study found that diabetic adults with 50

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4 years and above tend to live an average of 8.2 and 7.5 years below people deprived of diabetes. Nutritive factors modulate all old-style risk features for atherosclerotic ailment. In pursuit of healthy aging to diabetic patients aged 50 years and above, suitable nutritional variations in the scenery of diabetic are a very critical task (Liu et al., 2018). Diabetic in the elderly is associated with adverse effects where it increases the risks of physical disability, sub optional nutrition, nursing home admission, and hospitalizations. Minorities found to be residing in the United States' urban areas and away from nursing homes are highly susceptible to poor nourishment, diabetes, amplified obesity rates, and glucose intolerance. Diabetic older people are treated less energetically than younger persons having diabetes (American Diabetes Association, 2018). Besides, most elderly diabetic patients do not control glucose, which professional organizations usually advocate. Although frequently overlooked, the overlap intolerance to glucose and malnutrition in elderly adults has been typical (American Diabetes Association, 2019). This prevalence tends to increase with institutionalization, frailty, and physical infirmity. Pieces of evidence from various sources have indicated that about 16 percent of elderly persons in the United States and communities are undernourished (Mogreet al., 2019). Malnutrition means either being overnutrition or undernutrition. Overnutrition results from overeating and lack of physical activities, while undernutrition occurs due to deficiency of nutrition. Most older adults are experiencing economic, social, and domestic variations. The occurrence of diabetic disease adds to the harshness of these difficulties leading to an increment of daily self-care activities (Spence, & Youssef, 2021). Screening tools and comprehensive assessment and intervention manuals that identify individuals at risk of malnutrition are used to identify and treat issues accurately.

5 According to Egan and Ferrucci (2018), diabetes prevalence tends to increase with age and higher than adults having 60 years and above. As a result of decreasing the body mass and increasingly sedentary lifestyles, the metabolism rate tends to slow down, resulting in reduced daily energy requirements (Apolzan et al., 2019). Gaining weight and physical inactivity central to metabolic syndrome's pathophysiology and type 2 diabetes are related to the fundamental pathophysiologic devices that increase insulin resistance. When there is a consistent failure in insulin production from the pancreas' beta cells, a genetic failure or concomitant to the aging process occurs. Fasting hyperglycemia follows the emergence of postprandial hyperglycemia. Type 2 diabetes mellitus and glucose intolerance can be prevented by modifying lifestyle, including physical activity and weight loss. Pieces of evidence from various sources have indicated that type 2 diabetes in elderly adults may be influenced by the current rate of digestion of carbohydrates and absorption. According to Lippert et al. (2017), low-income persons with diabetes are likely to have poor health outcomes. Besides, greater self-efficacy and higher levels of apparent family support have been associated with high levels of exercise self-care and reported diet levels, hence reinforcing the necessity of family dynamics in the elderly population. According to Trende (2017), diabetes has the following traits: it is more common in older adults, is associated with significant disease burden and higher cost, and has a relatively higher prevalence in long-term care facilities. The heterogeneity of the more aging population regarding the overall health and comorbidities status is critical in establishing personalized goals and treatments for diabetes (McMacken, & Shah, 2017). The essential factor in determining glycemic goals is the risk of hypoglycemia. This is due to the catastrophic consequences in the elderly population. The sole use of sliding scale insulin should be avoided, while simplified treatment

6 regimes should have opted. The risk of adverse events tends to increase as patients transition from one setting to the other. The epidemic growth of type 2 diabetes in the United States has been found to have disproportionately affected older adults. Across multiple studies, the prevalence of diabetes has ranged from 25 to 34 percent in the long-term care population. The high prevalence of diabetes has contributed to the unsustainable growth of healthcare costs in the United States (Yakaryılmaz, & Öztürk, 2017). Postprandial hyperglycemia is known to be a prominent trait to type 2 diabetes in older adults. This contributes to the observed differences in prevalence depending on the type of diagnostic test that has been used. The type 2 diabetic epidemic is linked to the increasing rates of obesity and overweight in the United States population. However, the Centers for Disease Control and Prevention states that the prevalence of diabetes is likely to double in the next 20 years, even if its incidence is leveling off (Heitkamp et al., 2021). Besides, CDC has also projected that diabetes cases to individuals aged 65 years and above are likely to increase by an approximation of 4.5 fold by 2050. Although both incidences and prevalence of diabetes levels at the age of 65, it usually increases with age (Mahil et al.,2019). Older adults with diabetes are known to be under the highest rates of significant lower extremity amputation, end-stage renal diseases, myocardial infarction, and visual impairment. The mortality rate from hyperglycemic crises has also been found to be significantly higher among older adults. According to Brouns (2018), a vital role is customarily played in evolving care plans for older adults with diabetes by the dietitian occupied with other healthcare team members. Education non-nutrition should be tailored individually by incorporating respect, patience, kindness, understanding, and humor for the variances that make each older person feel

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7 appreciated (Kramer et al., 2018). It is necessary to have skills at a multi-layered valuation to have trials in the nutritious care being pinpointed. Besides, these skills help synthesize all information obtained to have a workable nutritional interference being designed and adapting the instruction tools and techniques for a wide variety of educational abilities and needs. Sincere caring, knowledge, judgment, skill, and experience are attributes to possess a successful outcome (Ghosh et al.,2020). Besides, the qualifications and understanding of the educators who deliver educational components seem to be very important. According to Romero-Gómez, Zelber-Sagi, & Trenell (2017), there has been a greater understanding of senior diabetes care and the fundamental of management due to the increase in the prevalence of diabetes in the elderly population. Even though the pace of aging of population differs in different countries, the ratio of adults who are over 65 years of age compared to those working has been expected to increase by two-fold in 40 years in the world (Hallsworth, & Adams, 2019). The United States is having an increase in the number of diabetic patients. Authors Romero-Gómez, Zelber-Sagi, and Trenell argue that management is needed to increase the rate of individuals with diabetes to help those who fail to accomplish diabetes-related self- care activities such as injection of insulin. Therefore, the aging population is supposed to be associated with the emergence of diabetic management in the elderly. This is because some patients are related to cognitive and physical impairment. There has been a global increase in obesity in older patients with diabetes. Obesity in older patients, especially those with diabetes, has led to cardiovascular diseases. A particular form of attention should always be paid to malnutrition in elderly diabetic patients (Changizi, & Kaveh, 2017). Pieces of evidence from various sources have indicated that elderly diabetic people are at risk of malnutrition at 50 percent more as compared to elderly who are not diabetic.

8 Besides, undernutrition is relatively lower among elderly who are not diabetic compared to the diabetic ones (Romero-Gómez, Zelber-Sagi, & Trenell, 2017). Great attention should be taken since malnutrition in diabetic patients may result in loss of memory. Past studies on diabetic patients in nursing homes have found that sufficient energy intake is required to reduce mortality and frailty in older adults. For instance, nutrition guidelines recommend intake of 30 kcal/kg body weight each day to the elderly population ( Dávalos, & Marazuela, 2020). Elderly diabetic patients are associated with a wide range of complications, including frailty, insulin resistance, mitochondrial dysfunction, arteriosclerosis, oxidative stress, white matter lesions in the brain, and chronic inflammation. Therefore, there should be a shift in dietary strategies to control these complications. According to Garcia-Molina et al. (2020), elderly diabetic patients should work closely with the doctor to manage diabetes. For instance, eating healthy is crucial to all diabetic patients. This is because everything taken affects the blood sugar of the patients. Elderly patients are supposed to take only their body needs and rely entirely on whole grains, vegetables, and fruits (DeLuca et al., 2020). Besides, elderly diabetic patients should limit foods with fats and sugar by choosing non-fatty dairy and lean meat. Although no cure has arrived that can cure type 2 diabetes, pieces of evidence have proved that weight loss and diet maintenance can help the elderly patient come to an average level of blood sugar without necessarily taking medication. However, patients should be known that having or approaching an intermediate blood sugar level does not mean that they are entirely cured since type 2 diabetes is an ongoing disease. According to Spence and Youssef (2021), there is a demand for health care providers to address the unique needs of elderly diabetic patients. Clinicians ought to develop and adopt different strategies to address the most common issues faced by elderly adults. This includes self-

9 management, nutritional, and lifestyle issues (Garcia-Molina et al., 2020). Besides, nutritional assessment to the older adults who have diabetes should be comprehensive regarding each patient's dietary needs. Therefore, a health care plan is necessary for success. Two primary factors are associated with the incidence of type 2 diabetes. These include the change in metabolism and physical activity changes, and weight ( Mattioli et al., 2020). During aging, the development of glucose intolerance has been a recognizable metabolic change. Besides, glucose intolerance becomes normal later in life to both diabetic patients and healthy people. The etiology of glucose intolerance in elderly adults has been multifaceted, where differing factors result in a reduction in glucose utilization. Some of these factors include slower absorption of glucose, reduced lean body mass, altered digestion, etc. Conclusion This section analyzes different written articles that discuss the lack of change in lifestyle and diet to elderly diabetics living in nursing homes. It has been found that although older adults experience an age-related reduction in lean body mass, no recommendations have been made on the modification for the distribution of macronutrients. One significant difference in the nutritional goals of elderly adults concerns the weight of the patient's body. However, aggressive weight loss therapies for elderly patients are not recommended. This is because trusted sources have found that unintentional consequence increases mortality and morbidity in elderly diabetic patients.

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10 References American Diabetes Association. (2017). 4. Lifestyle management. Diabetes care , 40 (Supplement 1), S33-S43. American Diabetes Association. (2018). 4. Lifestyle management: standards of medical care in diabetes—2018. Diabetes care , 41 (Supplement 1), S38-S50. American Diabetes Association. (2019). 5. Lifestyle management: medical care standards in diabetes—2019. Diabetes care , 42 (Supplement 1), S46-S60.

11 Apolzan, J. W., Venditti, E. M., Edelstein, S. L., Knowler, W. C., Dabelea, D., Boyko, E. J., ... & Gadde, K. M. (2019). Long-term weight loss with metformin or lifestyle intervention in the diabetes prevention program outcomes study. Annals of internal medicine , 170 (10), 682-690. Balk-Møller, N. C., Poulsen, S. K., & Larsen, T. M. (2017). Effect of a nine-month web-and app- based workplace intervention to promote a healthy lifestyle and weight loss for employees in the social welfare and health care sector: a randomized controlled trial. Journal of medical Internet research , 19 (4), e108. Brouns, F. (2018). Overweight and diabetes prevention: is a low-carbohydrate–high-fat diet recommendable?. European journal of nutrition , 57 (4), 1301-1312. Changizi, M., & Kaveh, M. H. (2017). Effectiveness of the mHealth technology in improving healthy behaviors in an elderly population—a systematic review. Health , 3 . Chia, C. W., Egan, J. M., & Ferrucci, L. (2018). Age-related changes in glucose metabolism, hyperglycemia, and cardiovascular risk. Circulation Research , 123 (7), 886-904. DeLuca, L., Toro-Ramos, T., Michaelides, A., Seng, E., & Swencionis, C. (2020). Relationship Between Age and Weight Loss in Noom: Quasi-Experimental Study. JMIR Diabetes , 5 (2), e18363. Garcia-Molina, L., Lewis-Mikhael, A. M., Riquelme-Gallego, B., Cano-Ibanez, N., Oliveras- Lopez, M. J., & Bueno-Cavanillas, A. (2020). We are improving type 2 diabetes mellitus glycaemic control through lifestyle modification implementing diet intervention: A systematic review and meta-analysis. European journal of nutrition , 59 (4), 1313-1328.

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13 Kramer, M. K., Vanderwood, K. K., Arena, V. C., Miller, R. G., Meehan, R., Eaglehouse, Y. L., ... & Kriska, A. M. (2018). Evaluation of a diabetes prevention program lifestyle intervention in older adults: a randomized controlled study in three senior/community centers of varying socioeconomic status. The Diabetes Educator , 44 (2), 118-129. Levesque, C. (2017). Therapeutic lifestyle changes for diabetes mellitus. Nursing Clinics , 52 (4), 679-692. Lippert, K., Kedenko, L., Antonielli, L., Kedenko, I., Gemeier, C., Leitner, M., ... & Hackl, E. (2017). Gut microbiota dysbiosis associated with glucose metabolism disorders and metabolic syndrome in older adults. Beneficial microbes , 8 (4), 545-556. Liu, G., Li, Y., Hu, Y., Zong, G., Li, S., Rimm, E. B., ... & Sun, Q. (2018). Influence of lifestyle on incident cardiovascular disease and mortality in patients with diabetes mellitus. Journal of the American College of Cardiology , 71 (25), 2867-2876. Mahil, S. K., McSweeney, S. M., Kloczko, E., McGowan, B., Barker, J. N., & Smith, C. H. (2019). Does weight loss reduce the severity and incidence of psoriasis or psoriatic arthritis? A Critically Appraised Topic. British Journal of Dermatology , 181 (5), 946-953. Mattioli, A. V., Sciomer, S., Cocchi, C., Maffei, S., & Gallina, S. (2020). Quarantine during COVID-19 outbreak: Changes in diet and physical activity increase the risk of cardiovascular disease. Nutrition, Metabolism and Cardiovascular Diseases , 30 (9), 1409- 1417. McMacken, M., & Shah, S. (2017). A plant-based diet for the prevention and treatment of type 2 diabetes. Journal of geriatric cardiology: JGC , 14 (5), 342.

14 Mogre, V., Johnson, N. A., Tzelepis, F., & Paul, C. (2019). Barriers to diabetic self‐care: A qualitative study of patients and healthcare providers' perspectives. Journal of clinical nursing , 28 (11-12), 2296-2308. Rizvi, A. A. (2019). Nutritional challenges in the elderly with diabetes. International journal of diabetes mellitus , 1 (1), 26-31. Romero-Gómez, M., Zelber-Sagi, S., & Trenell, M. (2017). Treatment of NAFLD with diet, physical activity, and exercise. Journal of hepatology , 67 (4), 829-846. Ruiz-Roso, M. B., Knott-Torcal, C., Matilla-Escalante, D. C., Garcimartín, A., Sampedro-Nuñez, M. A., Dávalos, A., & Marazuela, M. (2020). COVID-19 lockdown and changes in dietary pattern and physical activity habits in a cohort of patients with type 2 diabetes mellitus. Nutrients , 12 (8), 2327. Salas-Salvadó, J., Díaz-López, A., Ruiz-Canela, M., Basora, J., Fitó, M., Corella, D., ... & Martínez-González, M. Á. (2019). Effect of a lifestyle intervention program with energy- restricted Mediterranean diet and exercise on weight loss and cardiovascular risk factors: one-year results of the PREDIMED-Plus trial. Diabetes Care , 42 (5), 777-788. Spence, C., & Youssef, J. (2021). Aging and the (Chemical) Senses: Implications for Food Behaviour Amongst Elderly Consumers. Foods , 10 (1), 168. Trends, D. Diabetes Medications in Long-Term Care. Yakaryılmaz, F. D., & Öztürk, Z. A. (2017). Treatment of type 2 diabetes mellitus in the elderly. World journal of diabetes , 8 (6), 278.

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