Posted: August 25, 2020
By: Kathryn Ciamaichelo, Morrison Living Nutrition Care Manager
Diabetes is on the rise in the United States, and adults 60 years and older are no exception to this data. According to the American Diabetes Association, 1 in 4 Americans over 60 years of age has diabetes. Additionally, physiological and cognitive changes of aging put this population at higher risk for developing type 2 diabetes.
While many approaches to treating and managing diabetes expand across all age groups, certain considerations must be made for the older adult. One must factor in the functional, cognitive, and physiological changes that can accompany aging.
In older adults with diabetes, the primary goal is to prevent episodes of hypoglycemia while also preventing complications of hyperglycemia. Low blood sugars can be the cause of falls, which can lead to decreased mobility, decreased quality of life, and even mortality. Therefore, fasting blood sugar and hemoglobin A1C (a measurement of average blood sugar over 2-3 months) goals can be relaxed and a well-balanced diet with focus on timing of meals and consistent carbohydrate intake should be emphasized.
It is important to also monitor for excessively elevated blood sugars, which can contribute to symptoms of dementia and cause other complications. Close monitoring of blood pressure, cholesterol and lipids, kidney function, mouth and skin condition should also be provided to prevent these complications.
Intentional weight loss is often recommended for individuals with diabetes but is not encouraged in seniors as it can worsen sarcopenia (muscle wasting associated with aging), bone mineral density and even contribute to nutrient deficiencies.
As people age, thirst and hunger cues can be decreased. In addition, taste changes related to age and medications can alter desire to eat or satisfaction at meal times. It is important to provide cuing for meals and snacks if necessary.
To avoid falls, people caring for older adults should be able to recognize the symptoms of hypoglycemia, which can closely mimic other conditions in elderly individuals such as tiredness, confusion, irritability, paleness and excessive sweating. Individuals who are not able to communicate these symptoms are at an especially higher risk.
Research has shown that in seniors, the type of carbohydrate intake is less important than the consistency of intake. It is important to provide a steady stream of carbohydrates, which is converted to sugar once digested, to maintain blood sugar levels. Carbohydrate foods like whole grains, legumes, fruits and dairy should be divided up evenly throughout the day. Individualization is of special importance when working with older adults and one should always consider an individual’s culture, food preferences, support system, and lifelong dietary habits when building a meal plan to promote adherence and sustainability. It is also important to consider micronutrient needs. As people age, energy needs decrease while vitamin and mineral needs often stay the same. A close look at overall intake is required to determine if supplementation is necessary to prevent nutrient deficiencies
At Casey’s Pond, independent living residents have a chance to meet with a dietitian for one on one counseling to help them best manage their diabetes. For those living in assisted living and skilled nursing neighborhoods, menus are created to support consistent carbohydrate intake and tailored to the individual by the dietitian as needed. Our menus provide a variety of whole grains, legumes, fresh vegetables, and many fruit offerings to ensure a well-balanced meal.
In summary, managing diabetes in the aging adult can be done with a focused meal plan, liberalized blood sugar goals, examination of micronutrient intake, and close monitoring of symptoms of hypo/hyperglycemia.
Kat Ciamaichelo is a registered dietitian, ski and mountain bike enthusiast and travel junkie. She’s on a mission to prove that healthy eating doesn’t involve restriction or a rocket science degree. When she’s not in the office or on a mountain, you’ll find her cooking without a recipe or working on her crossword skills.