For Diabetics, Nursing Homes Fall Short
Deficiencies include minimal monitoring of key levels

(HealthDay News) -- People with diabetes who reside in a nursing home may not be getting care that's up to par.

Researchers at the Ohio University College of Osteopathic Medicine examined medical records for 108 people with type 1 or type 2 diabetes at 11 extended-care facilities in the Midwest .

Compared with American Diabetes Association standards, the care of institutionalized adults came up short. Only 38 percent of the nursing home patients met blood glucose goals, 55 percent met blood pressure goals and 31 percent had their annual lipid levels checked, the study found.

Dr. Jay Shubrook, assistant professor of family medicine at the college and one of the study's authors, blames the finding on the absence of comprehensive guidelines for treating people in all types of extended care facilities.

"I think that the first step to address the shortcomings in diabetes care is to have a sense of what are the most important treatments in terms of quality of life and life expectancy," he said.

Shortfalls in quality and continuity of diabetes care are a concern because the disease is so prevalent among older adults.

One in four U.S. nursing home residents aged 65 and older have diabetes, according to a report by the Institute for the Future of Aging Services. The report also found that diabetic residents use more medications than non-diabetic residents, had a higher likelihood of being admitted to a hospital's emergency department and were more likely to suffer from pressure ulcers.

More work is needed to plan for the special needs of institutionalized patients with this disease, the report's authors concluded. "Given the expected increase in the number and complexity of nursing home residents with diabetes in the coming decades and the paucity of clinical research providing guidance for their care, future efforts should focus on filling the knowledge gap by first defining end points that are appropriate for diabetic people in nursing homes and then designing clinical trials around these outcomes," they wrote.

Diabetes care in the nursing home can be "dicey," Shubrook added, because nursing home residents are usually ill and have limited life expectancy.

"So, we realize that treating them like well adults may not be appropriate or even effective," he said. "However, our experience has been that often too much effort is placed on controlling the glucose -- overzealous or non-supervised use of insulin -- and not enough attention is placed on blood pressure and lipids."

Indeed, in a review published in the Annals of Long-Term Care , researchers at Johns Hopkins University School of Medicine acknowledged the challenges of providing diabetes care in nursing homes. Caring for a heterogeneous group of nursing home residents with diabetes "requires individualization of treatment goals based on health status, life expectancy and preferences," they wrote.

To help close gaps in care, Shubrook and his colleagues plan to develop protocols that will be offered to the region's medical directors at extended-care facilities. "If they work, we will publish our findings to share with others," he said.

On the Web

To learn more about diabetes care in nursing homes, check out a report from the Institute for the Future of Aging Services.

SOURCES: HealthDay News ; Jay Shubrook, D.O., FACOFP, diabetologist, director of Diabetes Fellowship and assistant professor of family medicine, Ohio University College of Osteopathic Medicine (OU-COM), Athens, Ohio; OU-COM, news release, May 25, 2007; Institute for the Future of Aging Services, Washington, D.C.; May 2007, Annals of Long-Term Care
Author: Karen Pallarito
Publication Date: May 31, 2008
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