That the incidence of Type 2 Diabetes increases as bodies age and our organs get less effective is incontrovertible. Also as damage caused by diabetes is cumulative, then the medication regimes used to manage the condition get progressively more complex.
Up to 27% of residents in older people care homes are likely to have diabetes and they will be developing increased levels of damage and requiring increasingly complex regimes. This has an enormous impact on the care sector! For one, CQC require that your staff have condition specific knowledge and access to material and secondly the need is ever more pressing to ensure a good standard of diabetes care for a group of people who are vulnerable, with complex needs.
As an active volunteer with Diabetes UK the national charity, I know that there are concerns about GP’s readiness to pick up the condition and even practice nurses don’t always have a full range of understanding or skills to carry out appropriate health checks. Our local specialist nurses have concerns about levels of knowledge and understanding in care homes and nursing homes and struggle to resource training on the scale required. But there is a lot of information out there, so, here is a round-up of some resources you may find helpful.
Firstly, after it was revealed that ‘masses’ of people had diabetes but not diagnosed, here is some guidance following the recommendation that all care homes screen for diabetes The key recommendations were:
- Patients who self-medicate should be monitored and their ability to self-medicate should be assessed at regular intervals, and if there is a change in their circumstances
- Care homes should establish good communication with primary care, liaising with GPs and community teams to ensure annual reviews and other scheduled checks take place and inform care practice
- All care homes should be aware of the good clinical practice guidelines for care home residents with diabetes and should base their care and policies on the guidelines as far as possible
- Care homes should have a screening for diabetes policy at admission to a care home and at intervals thereafter
- All care homes should have a fully-stocked hypoglycaemia kit
- All care homes should employ a diabetes foot evaluation scheme (risk stratification)
- All care homes should provide opportunities for care staff to participate in diabetes educational and training programmes
There is support out there from various organisations like the Institute of Diabetes in Older People (IDOP) and Diabetes UK, the national charity, plus local initiatives
The IDOP 3-steps assessment is a method for assessing the physical functional status of older people with diabetes. It incorporates a measure of gait speed and a balance test. These have not been developed by IDOP but are well referenced elsewhere. They are simple to use in most clinical settings and require minimal learning by clinical and social care staff. These two tests should be combined with a test of mood level (e.g. The Geriatric Depression Score) and a test of cognitive function such as the Mini-Cog test, both of which are well referenced in the literature.
IDOP also offer training specifically aimed at care homes
The Bristol Community Health Diabetes Education Programme now includes a suite of on-line videos; ideal as bite size information for busy carers.
Diabetes UK have also developed a set of ‘best practice’ resources for use in care home settings.
It’s also worth checking up on what your local DUk support groups are doing.