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Introduction
It is imperative to assert that age advancement and vulnerability to diabetic conditions are inseparable when clinically analyzed. The occurrence of diabetes is not limited to age or sex of an individual but its prevalence in the elderly people raises greater concern due to the risks it poses. Furthermore, old-aged leads to myriads of malfunctions of the body systems. Diabetes is fatal and upon diagnosis, it becomes the patient’s mandate to take utmost responsibility for its management. There are three types of diabetic conditions; namely “types 1, 2, and gestational” of which the elderly people are vulnerable to the type 2 diabetes mellitus (T2DM) (NDEP 2009: 3). In minding this inevitable medical situation, it is apparent that the elderly patients will have difficulties in managing their conditions. Becoming aged refers to slow but steady weakening of physiological activities of the body organs (Uranga et al. 2010: 344).
Diabetes is a lifestyle-allied ailment and is one of the principal roots of death among those above the age of sixties. This risky situation gets enhancement by the fact that at this very age, body has less vigor and few people attend to the diagnostic procedures; which complicates the situation. Under-diagnosis of diabetes in the elderly reveals that there are various aged people, who suffer from condition, and so far are ignorant of their status. These are very considerable figures and their scrutiny discloses the extent of the trouble faced by those who grant care for the elderly. Medics should ensure that the patients possess the necessary knowledge about diabetes and factors that might have led to this illness and its management hiccups. There is also a need to design a training program that elaborates on the pathophysiology of diabetics, its manifestations, complications, and management. Concurrently, elucidation on how the program’s subjection to evaluation is achievable is no exception.
Comprehending diabetes mellitus, hypoglycemic signs, and adherence to medical commendations decline with age of an individual. Elderly diabetic victims should receive an ongoing program of coaching. There exist incidences in the patient’s history that can contribute greatly to the factors that lead to uncontainable hyperglycemic conditions. There is amplification in diabetic conditions with diminishing socioeconomic category. This implies that the affluent are at lower risks as opposed to the underprivileged Contrasted with major urban centers, people living in the rural and remote villages are at higher risks of diabetic occurrence and difficulty in the management programs. Management of this condition is tricky in rural regions owing to the difficulties in accessing comprehensive healthcare. Such impediments comprise cardiovascular ailments like stroke, coronary heart disarrays, eye problems, kidney complications, and nerve injuries (Keen, Clark & Laakso 1999: 187).
There is a considerable linkage amid poor diet, overweight, and poverty. Unfortunate obese individuals can easily get diabetes. Most affected are those individuals who cannot access balanced meals due to limited resources. There is also an absurd understanding of nutrition and health in indigenous and older people. Preventing excessive weight gain in underprivileged indigenous communities is less easy due to strong tie amid scarcity and obesity. People languishing in poverty usually afford low cost meals while compromise their nutritional requirements in return. Healthy diets built on edible meat, cereals, fresh greens, and fruits are more costly. Poverty in Indigenous communities is in connection with high joblessness and dependency. Living set-ups are congested, inadequate public utilities, with limited access to valuable meals (Chang & Johnson 2008: 152). Remote living entails countless of these factors, although successful prevention of obesity in some societies is, achievable through greater physical activity and consuming bush foods.
Patient’s Knowledge Assessment
Reviewing a patient for several medical parameters is vital in the diabetic diagnosis and management. The patient’s knowledge on his/her condition helps in the elucidation of the severity of the disease. The knowledge rests on the signs and symptoms unveiled by the patient. Such an assessment may reveal crucial information, which can eventually be helpful in the prescription parameters (Schottke & Aaos 2010: 198). In this line, it is crucial to have a wider knowledge on the diabetes mellitus, together with pathophysiology. This is important for the aged patients who are sometimes oblivious and cannot describe their conditions explicitly. Reasons of malfunction in blood glucose management encompass development of fundamental pancreatic β-cell dysfunction, and imperfect loyalty to treatment. This is usual in the elderly due to adverse weight gain in instances of obesity, and hypoglycaemia. Lack of enthusiasm on clinicians to augment therapy also contributes considerably.
Diabetes Mellitus (DM) and its Pathophysiology
DM is a persistent health disorder exemplified by the body failure in insulin synthesis or adverse unresponsiveness to insulin effects. On categorization realms, three types exist including “Type 1, 2, and gestational diabetes”. Their ultimate upshot is soaring blood glucose ranges, also referred to as hyperglycemia. Older people are mostly victims of T2DM. In the cases of T2DM, insulin supply is regular, but the body cells are insensitive. As the bodily tissues never respond to the insulin effects, glucose lingers in the blood stream (Sinclair 2009: 169). Its manifestation is common in the adults above the age of forty. Supplying the body with artificial insulin cannot help. Gestational type is rampant during pregnancies. It is a product of imbalanced hormonal levels during pregnancy; nonetheless, the sugar level stabilizes at postpartum.
Pathophysiology considers body deviations from the regular operational properties. This owes to ailment or anomalous disorder of vascular diseases, mainly atherosclerosis, which is a chief source of disability and demise in patients with T2DM Sinclair 2009: 42). Diabetes mellitus considerably augments the risks of emergent coronary, cerebrovascular, and tangential vascular infections. The pathophysiology of vascular disorders in diabetes engrosses abnormalities upon endothelial, vascular muscle units, and platelet activities. The metabolic malfunctions that abreast diabetes, for example, hyperglycemia, elevated free fatty acids, and insulin opposition, may irritate molecular machineries hence donating to vascular dysfunction. There is reduced bioavailability of nitrogenious diabetic drugs, hiked oxidative stress, and abnormalities in intracellular signal transduction (Colagiuri 2010: 465). Furthermore, platelet activities would be under siege. These aberrations contribute to the cellular activities that cause atherosclerosis, which subsequently boost the risks of getting undesirable cardiovascular disorders habitually common in patients with diabetes. A vital understanding of the mechanisms heading to vascular dysfunction might unveil new plans to lessen cardiovascular morbidity together with mortality in diabetic patients.
Historical Factors and Loss of Glycaemic Control
T2DM is an unremitting disease marked by raised blood glucose levels due to insulin unresponsive and relative deficiency. The patient’s history can greatly influence its control and management. Some of the historical elements include obesity, diet, physical activity, smoking, alcohol utilization, socioeconomic status, geographical isolation, and the cultural view on diabetes. The occurrences of T2DM are high and interrelated with the events of obesity. The susceptibility boosts with the increase in the age bracket. For this matter, the fact that a patient is an obese complicates the matter even further. Concurrently, the issue of age is also detrimental in the T2DM effective management arenas. In an obese individual, the fat cells produce a hormone referred to as “resitin” which hinders the affectivity of insulin on tissues (Khanna 2009: 568). This thwarts the efforts exerted to manage the hyperglycemic conditions in the obese patients. The elderly, who are overweight, have complexities in managing their diabetic status. They have to fight two serious conditions: weight and blood sugar. This is not easy for them and such kind of history can be an obstacle in the realms of diabetic management and medication.
Concurrently, a diet lofty in drenched fats, minimal fiber, and less fresh fruits as well as greens, has soaring linkage with obesity and consequently T2DM. The problem is serious in the poverty-stricken rural areas (Ollendick & Schroeder 2003: 176). These places lack the required nutrition for diabetes management but instead can only afford the starch-loaded meals, which further elevates the sugar levels. Patients hailing from the poverty-stricken areas need special attention in monitoring their diet. This is vital to manage their glucose echelons, which if left unattended, may culminate to grave complications thus worsening the situation. On robustness, amplified physical activity is associated with better general health and lessens the threat of obesity and a range of diseases like coronary heart disorders and T2DM. The aged patients can hardly perform any meaningful physical activity and this can augment the hyperglycemic conditions (Greenberg 2009: 194). Socioeconomic activities that deter healthy living prop up the incidences of diabetes.
Designing Education Program (EP) for Diabetic Patients
The drafted outline helps the patients, especially the elderly, and the rest who are interested in knowing more about diabetes. The rationale of this edification schedule is to help diabetic patients with the knowledge on understanding the disease, its impacts, treatment, and management. The program entails four major divisions with learning more on the fundamental facts about the disease as the first one. The second is being conversant with ones own diabetes ABCs, which in this context is the A1C, Blood pressure, as well as Cholesterol. The third line up is the ailment management program. Finally, there is learning how to get everyday care (NDEP 2009: 1). Diabetes is a fatal disease and if not managed with the utmost care required, then its containment might be difficult to achieve. It requires a daily care without relenting.
Considering the elderly and other diabetic patients, the first step in the EP is to help the patient know issues concerning diabetes. It encompasses the elucidation of diabetes pathophysiolgy, its manifestation, impediments, and the effective management practices. This is applicable to both the patients and the entire community for better precautions. Diabetes is a status in which the blood sugar levels are astoundingly high due to in its absorption reduction from the bloodstream. The patients have to get the information about the types of diabetes currently known and which is applicable to him/her. There occur two chief types in this context. Type I diabetes is a condition which occurs owing to extreme scantiness of insulin in the body. Insulin is fundamental in the absorption of sugar from the blood and its absence culminates to increased blood glucose (Niswender 2010: 273). From the program, the patient would understand that everyday dose of insulin is one of the remarkable remedies for this condition.
On the other hand, T2DM is where the body has a dysfunction in either production or utilization of insulin hence a remarkable elevation of blood sugar ranges. The insulin synthesis can be active, but the body hardly responds to its effects. This can be either due to non-functional receptors or due to other intracellular problems. This diabetic condition is the most common among the elderly people and its patients require a prescription, which are either pills, insulin injections or both plus other management practices (Colagiuri 2010: 463). As for the assignment, the patient is definitely a victim of type II. Gestational diabetes is the final classification. It is widespread in the expectant mothers. It hikes the rate and vulnerability of getting T2DM for a life long period. This can also affect the baby leading to the risks of being overweight and a consequent diabetic condition.
The sick should also grasp the information on malady severity, causes, and symptoms. Concurrently, the fact that the ailment is successfully manageable is important and boosts the hope of the patient on confronting the condition. Anybody with diabetes only needs to live healthily by embracing the ideas of vigorous meals, appropriate weight maintenance, and a maintained physical fitness on a daily basis. The rationale behind all these is to assure the patient take appropriate care of his/her health. It is possible to live much longer and healthily with the disease. When the patients are aware of these, their take on the consequences of having the condition significantly changes to the better hence positively tackling the disease (Bamia et al. 2010: 135). It consequently helps them evade co-infections, which may include heart diseases, eye infections, nerve disorders, kidney dysfunctions, and gum diseases. The most encouraging of all is when the patients get the information on the benefits of staying with normal blood glucose ranges. The benefits include having more energy than getting infrequent thirsts, occasional urination, low chances of bladder and dermal ailments, and excellent eye sights (Rudnicka & Birch 2000: 90). Consequently, the patient knows what type of diabetes he/she is suffering from, its seriousness, and the management practices.
Step two of the EP revolves around the patient’s familiarity with his/her ABCs. This is important as they declare the fate of patient’s prescription. The patient is enlightened on his/her blood sugar levels (A1C), blood pressure (B), and cholesterol (C) content. A1C indicates what the patient’s sugar level is for the past few months. The A1C goals for numerous diabetic patiens are below seven (NDEP 2009: 6). Superior glucose contents are detrimental to the heart as well as blood veins, kidneys, foot, and eyes. As for (B), the blood pressure for most diabetic patients arrays below 130/80. Hiked blood pressure always damages blood vessels, causes stroke, heart problems, and kidney ailments. C stands for cholesterol and it is important during diagnosis of diabetes, management, and effective monitoring of the ailment severity. The LDL gauges for individuals with diabetic ailments is below 100, while the HDL is beyond 40. An LDL condition is risky as it depicts the vulnerability of blood vessels obstruction with cholesterol (Sinclair 2009: 169). This might culminate to stroke or heart disorder. HLD goal is better as it aids the cholesterol removal from the veins. This section of the education program should elucidate to the patient his/her ABCs, and recommendations.
The third step in educational program for the aged is the elucidation of diabetes management practices. Observation of good care on the sides of the diabetic patients can protect them from long-term effects of unattended diabetes. This is achievable through targeting to reach the ABC goals. The patient should team up with his/her doctor to obtain good results. In this program, pieces of advice on the diabetes eating habits are explained. A plan drafted indicates diet preferences. Bounty fruits, greens, and lean meat are recommendable. One should take meals, which have little or no lipids and salt. Food with more fiber encompassing whole grains, and cereals are no exception. Elderly, however old, should strive to attend to some physical activities most frequently to achieve the desired physical fitness. Watching of weight fluctuations is imperative, as overweight condition is detrimental.
Education on the mental health is vital for the patient’s well being. Concurrently, smoking should be avoided, embracement of stress management, regular medication, foot examination, tooth brushing, blood glucose and pressure monitoring, and reporting of any unusual health conditions to the doctor are all crucial for better health management. Since the elderly patient always have trouble with the management practices, close monitoring and encouragement is vital on their side (Bamia et al. 2010: 137). Issues of managing their body weight, regular work out, and habitual medication can be daunting to them. It is advisable to prepare for them a plan, which they can successfully manage without any difficulties. The issue of poverty is another challenging problem. Patients with poor background who tend to live in the remote areas are hard to deal with in terms of their daily diet and cultural beliefs. They lack the recommended balanced diet hence tend to consume the cheap starchy foods, which elevate their blood sugar even further. The case of patient in the assignment is complex due to the combined cases of poverty, obesity, and old age. This complicates the prescription and diabetic management practices.
The fourth point in the diabetic education arena is the need to get knowledge on a routine care to evade further problems. The patients undergo teachings on the need to attend the medical check up frequently as advised by the doctor. They should be in touch with their health care team to unveil and get the required therapy for early treatment of the problems. They should capture the steps to take for ABCs achievement. Any patient with diabetes should be aware that whenever they pay a visit to their doctor, their blood pressure, weight, foot, and review of the self-care plan are checked to notice any abnormality deviating from the previous check up results (Colwell 2003: 36-38). The significance of TAG test, dental examination, flu test, urine, and blood examinations to elucidate the presence or absence of kidney problems is equally helpful.
Evaluation of the program
The evaluation of the effectiveness of the education schedule elucidated above is vital as it ensures the efficacy of efforts towards the control of the diabetic condition. This effectiveness assessment is ensuring proper glycaemic management, and self-care skills recommended for the diabetics conditions. Experts evaluate the knowhow concerning facts, types, and diabetic management in two phases. The first phase elucidates the patient’s knowhow concerning the ailment. They undertake it prior to training to elucidate the patient’s previous knowledge concerning the disease. They do this through oral interviews or questionnaires (Feinglos & Bethel 2008: 460). The score is then noted. The second phase is done later after the provision of the education on the ailment. Medics utilize scoreboard to elucidate patient’s novel knowledge. The ultimate difference on the knowledge obviously indicates the knowledge gained by the patient in question. The aged patients also require this assessment to help in drafting the degree of attention he/she will require towards the management of the diabetic condition (Porta 2005: 58). The patient should ultimately have a clear demonstration on the category of diabetes he/she is suffering from and the prescribed management efforts.
Evaluation on the patient’s knowledge on his/her ABCs comes the second. For it to be effective, the patient’s knowhow on the basics and facts about ABC, its significance in the control arena, and the benefits that abreast it, must be enhanced and tested for understanding. The patient, at whichever age, should be able to know the importance checking his/her blood pressure, cholesterol management, and blood sugar control for a healthy living (Khunti & Davies 2010: 476). The evaluation results must clearly illuminate these for it to have a regard as effective. The third step is on appraising the patient’s knowledge and implementation of diabetes management plans. The weight of the patient should be under constant check at intervals to compare the former and the latter weights for any progress. Implementation of the meal plan, body examination for strange facets, evasion of drug addiction, and gradual espousal to the medication complications are evaluated to reveal the progress. Finally, the patient’s adherence to the routine care plans takes an evaluation course to demonstrate whether he/she is following them to the latter. These routine care strategies are to prevent any co infections that might arise.
Conclusion
In conclusion, diabetes is a chronic metabolic mayhem in which the body is unable to metabolize glucose related carbohydrates, fats, and proteins because of lack, or ineffective use of insulin hormone. Among the three, T2DM is the most widespread in the elderly people leading to major complications. Its incidence amplifies with the occurrence of obese conditions. This positively promotes the chances of victimization and hinders the management efforts. The history of the patient is important in the elucidation of the management progress. Other daunting factors like poverty, locality, drug abuse, and unhealthy eating habits contribute greatly to the unmanageable diabetes. It is vital to grant the diabetic patients appropriate education on the issues related to diabetes. This ranges from definition to management. The education program should take a design, which fits each patient exclusively. The aged individuals require much care and attention due to the difficulties might face in the management programs. On the evaluation of the education program, the mission demonstrates that having an ongoing educational set-up grants the patients with realistic understanding. It works effectively as a means of conveying cognitive understanding, escalating psychomotor proficiencies, and instilling self-confidence to patients in the arenas of diabetes self-care training. The long-term outcome of these programs on patients is magnificently helpful. Early and correct detection of any type of diabetes among the aged is essential to curb severe health effects.
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