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Treatment guidelines are difficult to apply to frail geriatric diabetic patients. The primary purpose of this retrospective cross-sectional chart review is to facilitate the generation of a feasible protocol for the care of geriatric diabetics at all inclusive-care day facilities. Objectives for this managed care program are (1) to evaluate how well the care of frail diabetic patients complies with the American Geriatric Society (AGS) Guidelines (2) to identify why frail elders often fail to use certain medications recommended by practice guidelines. (3) to review the impact that diabetes has on the ability of frail elderly patients to reach goals.
Methods:
Plans of care for 70 diabetics were evaluated in compliance with the AGS guidelines. The care environment for these patients is a PACE (Program of All Inclusive Care for the Elderly) program that provides comprehensive health services for frail elderly participants to maintain them in the community, and out of nursing homes and hospitals. Data collection included assessments according to the American Diabetes Association Standards of Care 2011, polypharmacy, and geriatric syndromes. Participants’ care plans were also reviewed for use of specific medications recommended in the AGS guidelines.
Results:
The seventy patients assessed were an average of 73 years old and were prescribed an average of 8.75 medications. Seventy-four percent of participants had a calculated creatinine clearance of less than 50mL/min classified as stage 3-5 chronic kidney disease. Therefore, majority of patients require medication dose adjustments.
Conclusion:
The PACE program allows geriatric diabetics to meet goals established in the American Geriatric Society guidelines. Frail elders often cannot tolerate medications recommended in the guidelines due to poly-pharmacy, co-morbidities, and other contraindications. These problems often affect treatment options in diabetic geriatric patients. Finally, initiation of specific drug therapies requires analysis of patient’s renal function, adverse effects, drug-interactions, and life expectancy.