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Caring for Elderly Patients with Type 2 Diabetes Amid a Pandemic

Jun 5, 2021
 
Editor: Steve Freed, R.PH., CDE

Author: Olivia Shenouda, PharmD. Candidate, Florida A&M University School of Pharmacy

Telemedicine provides a vital channel for supporting elderly diabetes patients during a worldwide pandemic, but may also pose some challenges. 

All over the world, patients with type 2 diabetes are at a higher risk of other comorbid conditions, even death, during the current pandemic COVID-19. Those older than 70 are especially at an increased risk of mortality due to COVID-19. Due to the current challenges that we are faced with during the pandemic, it is getting harder to care for the elderly at different levels of multimorbidity, frailty, and complexity. The elderly are not only affected by the pandemic, but they are affected by the charge of their day-to-day life. Their insurance and Medicaid may have changed, which changed the patients’ ability to receive their diabetes medications. Because of the current pandemic, the elderly are presented with challenges, and we need to offer valuable recommendations.   

 

To overcome the difficulty of meeting with doctors during the pandemic, telemedicine became the best option to help patients connect with their providers through multiple platforms. For diabetes patients, companies such as Glooko, Libreview, and Dexcom offer the opportunity to upload the glucose reading from the glucometer or insulin pumps. Using telemedicine is helpful during these times of hardship because the clinician will be informed of the glucometer results and will be able to make the best decision for the patient. One of the downsides of telemedicine is that the elderly population may not be tech-savvy or familiar with the technology.  

The situation may become frustrating for some patients. To overcome this problem, doctors are advised to schedule longer call times so the patients have time to familiarize themselves with the system. Some questions are required to be asked for patients with diabetes, such as: “Did the patient fall or experience severe hypoglycemia? Have they been hospitalized?” 

Patients with type 1 and type 2 diabetes struggle with multiple other syndromes, leading to further complications and even death. Many patients were moved from nursing homes to their family’s home, which protects them from the risk of COVID-19 but puts them at the functional risk of being at homes that are not equipped for their needs. So, as it is essential to talk with the patients during the pandemic, it is also essential to speak with their families.  

Patients during the pandemic may feel brought down because they lost the progress they made before the pandemic. It is the role of the pharmacists and clinicians to make sure that patient profiles and medication plans are up to date. The clinicians also have the role of motivating patients to keep adhering to medications and lifestyle modifications.  

During this challenging time, patients are at risk of becoming socially isolated, alone, or depressed.  Patients with diabetes are already at higher risk of depression than the general population, and depression is often undiagnosed in the elderly. Pandemic isolation can cause massive psychological stress and affect diabetes control. Registration during follow-up and allowing patients to stay in touch with their families using technology, letters, or cards helps them to feel less isolated. Many religious communities also provide virtual and radio services that patients can attend. Screening for depression is essential with tools such as the Geriatric Depression Scale or the Patient-2 Health Questionnaire. For patients suffering from depression, frequent follow-up, and referral to mental health colleagues can be initiated if needed. Also, assisting caregivers with difficulties, improving telephone or email communications, and providing local resources to support caregivers should be an integral part of overall care. 

Older adults who have diabetes are a vulnerable population who may face many problems that affect their daily lives; however, doctors can reduce the burden during this epidemic by providing guidance, encouragement, and support. Many of the recommendations presented in this article are practical and will remain relevant even after COVID-19. When it is all over, patients will remember how we made them feel and kept them safe and healthy. 

Practice Pearls:  

  • Telemedicine is the best current option for patients with type 1 or type 2 diabetes. 
  • Clinicians have to take the role of managing patients’ profiles and motivating them to follow their diet plan. 
  • Psychological health is posing a considerable risk to patients with chronic conditions.   

 


Sy SL, Munshi MN. Caring for Older Adults With Diabetes During the COVID-19 Pandemic.
JAMA Intern, Med. Published online July 13, 2020. doi:10.1001/jamainternmed.2020.2492 

 

Olivia Shenouda, Fourth-year Doctor of Pharmacy Candidate, Florida A&M University 

 

 

See more about the role of telemedicine in treating elderly and other diabetes patient populations.