Caring for Elders with Diabetes
November is National Diabetes Month

There will be many walks, bike races, and educational presentations to raise awareness and encourage getting tested for diabetes. Working with clients that have recently been diagnosed is challenging. Elders, in particular, need your support to understand the many facets of diabetes. Diabetes brings changes to nearly every aspect of life: eating, drinking, exercise, work, relationships, and the balance of one's physical, mental, emotional and spiritual being.

Clients may go through various stages following diagnosis including fear, loss, denial, anger, bargaining, depression, withdrawal, and finally – acceptance and adaptation.

When one is confronted with diabetes, many fears will surface. Clients will ponder whether the condition will be passed on to the children and how roles and relationships will be affected. Physical and socio-economic issues, as well as the dietary restrictions, seem insurmountable. In addition, one will witness other diabetics with complications and wonder if these complications are waiting for them down the road. Fear comes from the unknown.

Loss always involves change and comes in many forms; including the loss of control and health. The condition of diabetes is loss of the way one has lived and feelings of personal health.

Denial is a means of “stopping” diabetes from damaging one's image of what the future holds. An individual will use forms of denial to reduce the threat – such as downplaying signs and symptoms, refusing to believe the diagnosis and not following treatment.

Anger embodies questions of "Why me?" Anger is having the sense of intense injustice/wrongdoing and a need to direct these feelings outside. It is a way of controlling an otherwise impossible situation. It is expressed in blaming others or self, in creating one's situation, not following treatment or missing appointments. As a CHR, it is best to recognize that the anger needs expression. Don't respond with anger. And, don't scold, ignore or avoid the client. Focus on what needs to be done and give/get support from them.

Depression and withdrawal is the stage of grief and mourning for loss of the healthy self. It is a period of sadness and uncertainty. Old ways of thinking start to give way to making a new start and finding new solutions. The Elder will need encouragement to take on an interest or activity or join a support group. If the depression continues, a referral to a counselor may be warranted. From this stage, a person moves on to live with diabetes.

With adaptation and acceptance – change comes a little at a time. It is vital to remember that mental, emotional and spiritual support is critical to the acceptance and adaptation to diabetes.

 

• Give relevant information.
  
• Refer clients to a diabetes support group, if your community has one.
  
• Repeat statements such as ‘effective diabetes care will cut down on complications’.
  
• Acknowledge efforts, such as trying to cut down on smoking and alcohol intake.
  
• Acknowledge the past, but steer energies to the present management.
  
• Do not judge or scold if management plans are not followed.
  
• Reinforce teaching on how to detect changes that indicate complications.
  
• Make yourself available, as an advocate for the Elder, as they go through the health care delivery system.

Adapted and used with permission from NIICHRO