Elderly Population With Diabetes
Epidemiology: Definition and Description
Epidemiology is the study of the distribution and factors to health conditions in particular populations and its application to the control of these health conditions (NCCDPHP, 2004). The shortest description of the work of epidemiologists is that they count and compare data of cases of disease or injuries in a given population. Then they compare these data with those of another or other populations. From the comparison, they form inferences on patterns in determining if a certain problem exists. If and when they infer that there is a problem, they use the gathered data to determine the cause, the modes of transmission, probable factors of susceptibility, exposure or risk and other potential environmental factors. What a health care practitioner does to an individual patient, an epidemiologist does to an entire population. Both of them test their respective hypotheses in reaching a conclusion. The health care practitioner conducts additional diagnostic tests in order to arrive at a conclusion. The epidemiologist, on the other hand, conducts analytical studies, such as cohort or case-control studies, in obtaining a conclusion. From there, both take action. The health care practitioner prescribes treatment while the epidemiologist constructs a community intervention plan or initiative to address the health problem and to prevent it from recurring (NCCDPHP).
Epidemiology of Diabetes and Diabetes in the Elderly
Diabetes is condition defined by the level of hyperglycemia, which in turn increases the risk of microvascular damage (WHO, 2006). This damage includes retinopathy, nephropathy and neuropathy. About 171 million people in the world were stricken with diabetes in the year 2000 and estimated to increase to 366 million by 2030. Diabetic complications increase the likelihood of conditions and reduce the quality of life. These conditions include ischemic heart disease, stroke, and peripheral vascular disease. The American Diabetes Association estimated national costs of diabetes in the U.S.A. To rise to US192 billion in 2020 (WHO).
Recent statistics say that 7% of the American population, or 20.8 million Americans, are afflicted with diabetes (Silver Book, 2011). Prevalence increased 60% between 1990 and 2001. Of the current stricken population, roughly 6% have type-2 diabetes, the most common type. Figures also say that 10.9 American men or 10.5% of those aged 20 and older are diabetic. About 1/3 or 6.2 million are unaware that they have the disease. In comparison, 9.7 American women in this age group and 8.8% of all women in this age group have it too. Similarly, about 1/3 of women are unaware of their condition. In addition, about 54 million are pre-diabetic. They have abnormally high blood glucose levels but not high enough to be considered diabetic. Each year, more than 210,000 deaths are traced to diabetes and its complications. At least 1 in every 3 Americans will develop the disease in his or her lifetime. Of the 17.5 diagnosed, 1 million or 5.7% have type-1 diabetes. Those with type 2 represent more than 7% of American adults. They incur and impose large economic and personal burden. It is estimated that both diagnosed and undiagnosed cases will increase from 23.7 to 44.1 million from 2009 to 2034 (Silver Book).
More than 1 of every $10 health care dollars goes to the control of diabetes ((NCCDPHP, 2011). Diabetics use more health care services than others with other medical conditions. Some of them are also less productive than those without the disease. While some of them are able to control their condition and live relatively active lives, they still confront difficulties and disadvantages because of their condition. Diabetics are generally less healthy than those who are not diabetic. They incur more limitations in daily activities than those without it. And they are more subject to depression than non-diabetics (NCCDPHP).
It is also estimated that the Medicare-eligible population with diabetes will increase to 14.6 million in 2034 (Silver Book, 2011). There were 31.3 million Medicare beneficiaries with diabetes in 2004. As of 2007, 12.2 million or 23.1% of Americans 60 years old and older had diabetes. In the same year, about 1.6 million new diagnoses were made of Americans 20 years old or older. Studies revealed that only 35-40% of descendants of those who die of diabetes registered it as the cause in the death certificates as against only 10-15% who did so. This implies that diabetes is quite likely to be under-reported as a cause of death (Silver Book).
Diabetes and Aging
Findings of a recent cross-sectional comparative study suggested that aging, along with diabetes, affects oxidative stress and inflammation (Nunez et al., 2011). The study used 228 subjects, consisting of 56 healthy adults at a mean age of 47, 60 diabetic adults at a mean age of 52, 40 healthy elderly adults at a mean age of 67, and 72 diabetic adults at a mean age of 68. Their glycosylated hemoglobin, plasma lipid peroxides, superoxide dismutase, glutathione peroxidase, total antioxidants and tumor necrosis factor-alpha were measured. Findings showed that diabetes was a risk factor in the volunteers with high serum levels of these items. It was stronger in older patients (Nunez et al.).
Diabetes is a lifelong struggle among many elderly adults stricken (Cadena, 2010). Their condition requires the attention and support of others in maintaining compliance with treatment. Part of the support is dealing with burnout. Most of elderly diabetics go through burnout in following their strict regimen of medications, diet and exercise. Yet strict compliance is necessary to insure their long-term health and prevent further adverse conditions. Burnout, therefore, needs to be recognized early (Cadena).
Non-compliance is the first sign of burnout (Cadena, 2010). Signs that some medications are not taken or administered should be noticed. They can point to greater complications. The help of a healthcare professional should be secured to insure effective management. Burnout of diabetic treatment is especially difficult to manage in the elderly. Their caregivers should work out on options with the healthcare provider to boost the two other forms of treatment when the third reaches burnout levels. This will allow the caregiver the chance to manage both the diabetic condition and overcome burnout without coercing the patient (Cadena).
This is a model developed by scientists to study health problems and how they spread (BAM Classroom, 2011). Its three corners or vertices are agent, host and the environment. The agent or the microbe is the cause of the diseases, which answers the question of what in the triangle. The host is the organism, which has the disease. It answers the question of who in the triangle. When there are more cases than expected of a particular disease in a given area or population at a particular period, an outbreak or epidemic has occurred. The condition is endemic when a high level of the disease exists among the given population all the time. Giardiasis and malaria are examples of endemic diseases in many parts of the world. An epidemiologist aims at breaking at least one corner of these three sides or vertices in the epidemiological triangle. This is done by disrupting the interconnection among the three sides (BAM Classroom).
Agent — this is an organism too small to be seen with the bare eye (BAM Classroom, 2011). Disease agents or microbes are bacteria, viruses, fungi and protozoa, also referred to as germs. Bacteria are one-celled organisms, which are able to reproduce themselves in the body of the host. They are bigger than viruses although still almost invisible to the naked eye. They are filled with fluid and often possess thread-like structure for movement. A virus has a spiny outer layer called an envelope. It possesses a core of genetic material but which it cannot reproduce on its own. It does so by infecting the cells of the host and takes over its reproductive machinery to replicate itself. A fungus is a multi-cellular plant. It is considered a plant because it cannot produce its own food from soil or water. It instead feeds on animals, plants and people. Examples are muschrooms and yeast. A protozoon is a very small microbe, usually living in water. It is a parasite, which thrives on other organisms, especially human beings. Examples of parasitic protozoa are malaria and giardia (BAM Classroom).
Descriptive epidemiology is used for this topic on the elderly as the vulnerable population with diabetes. Descriptive epidemiology evaluates and classifies all the circumstances and inputs pertaining to a person who gets affected by a health phenomenon of public interest (Christensen, 2011). On the other hand, analytical epidemiology uses these gathered inputs to establish patterns as to their cause. Both branches aim at reducing the incidence of disease or health condition by understanding their risk factors. Both provide public health organizations with validated information with which to address disease and reduce its impact and consequences (Christensen).
Descriptive epidemiology is primarily interested and looks for the frequency and pattern of a disease or health phenomenon (Christensen, 2011). Frequency refers to the rate of occurrence of disease while analytical epidemiologists make use of pattern as basis for drawing risk factors. Descriptive epidemiology is confined to the recognition and examination of the affected person, place and time of the disease or health event. The person is described and examined according to certain factors, such as age, education, socio-economic status, availability of health services, race and gender. Also pertinent to the person are information on behavior, such as use or abuse of drugs, shift work, eating and exercise patterns. Place refers to geographic borders or features of a given area. It has direct significance to people in and around the area. Evaluation of place includes worksites, the density of the population and the environment around homes, worksites and schools. And time refers to the season or certain occurrences during a particular hour or day. Flu, for example, is specifically prevalent during the late fall and early winter. Physicians at these times can predict the most suitable time for vaccinations. Time is also a strong factor in the conduct of studies on health events. Drunk driving, for example, tends to heighten during holidays like Christmas. At this time, injuries and deaths from crashes are more likely (Christensen).
Descriptive epidemiology also evaluates the inter-relatedness among person, place and time (Christensen, 2011). High increase of crime rate in a city in a particular year, for example, affects certain health factors. A person in that area at that time confronts a significant risk of falling victim to crime as compared to another time when crime rates are not as high. People in war zones or countries face the greatest risk. The inter-connection of person, place and time provides the content and basis of information on health risks. Patterns of health risks are drawn from this. The more descriptive the person, place and time information and their correlation, the better the chances of drawing these patterns of risk factors for a health condition. These are the precise inputs for the work of an analytical epidemiologist who will, in turn, pass his analysis to public health policymakers (Christensen).
Levels of Prevention of Diabetes in the Elderly Population
The objectives of the Evidence-based Disease and Disability Prevention Program are to enable the older population to form healthy behaviors, improve health status, and manage their conditions more effectively; and to help aging groups deliver evidence-based programs (AoA, 2010). These interventions primarily aim at helping ailing adults maintain health, wellness and independence. Evidence-based programs focus on physical activity, fall prevention, nutrition and diet, depression and/or substance abuse. Programs for physical activity have included Enhance Wellness, Tai Chai or Healthy Moves. These emphasize low-level aerobic activity, minimal strength training and stretching. Fall prevention programs include Matter of Balance and Stepping on. These focus on strength training and behavioral change to reduce or prevent alls and the fear of falling. Nutrition and diet programs include Healthy Eating. Healthy eating teaches older adults the importance of eating only healthy foods and the maintenance of an active lifestyle. Programs to control or prevent depression and/or substance abuse include PEARLS or Healthy Ideas. These screen referred older adults who undergo or are at risk of depression. (AoA).
Recent statistics say that 18% of all Medicare beneficiaries nationwide or 7 million older adults have diabetes (AoA, 2010). They comprise almost 32% of all Medicare expenses. The Administration of Aging is jointly implementing a program in communities to provide outreach, education and treatment to minority older adults with diabetes. The cooperative endeavor will provide access to Medicare beneficiaries to prevention while improving the clinical assistance for the treatment of diabetes among elder Hispanic and African minorities (AoA). #
AoA (2010). Health, prevention and wellness program. Administration on Aging:
Department of Health and Human Services. Retrieved on July 23, 2011 from http://www.aoa.gov/AoARoot/AoA_Programs/HCLTC/Evidence_Based/index/aspx
BAM Classroom (2011). Understanding the epidemiologic triangle through infectious disease. Body and Mind: Centers for Disease Prevention and Control. Retrieved on July 23, 2011 from http://www.bam.gov/teachers/activities/epi_1_triangle.pdf
Cadena, C. (2010). Chronic diabetes in the elderly: the effects of treatment burnout.
Sans Souci Rehabilitation and Nursing Center: Skilled Marketing Solutions.
Retrieved on July 23, 2011 from http://sansoucirehab.com/2010/08/25/chronic-diabetes-in-the-elderly-the-effects-of-treatment-burnout
Christensen, T.E. (2011). What is descriptive epidemiology. Wise Geek: Conjecture
Corporation. Retrieved on July 23, 2011 from http://www.wisegeek.com/what-is-descriptive-epidemiology.htm
NCCDPHP (2011). Diabetes. National Center for Chronic Disease Prevention and Health
Promotion: Centers for Disease Control and Prevention. Retrieved on July 23,
2011 from http://www.cdc.gov/chronicdisease/resources/publications/AAG/ddt.htm
– (2004). Introduction to epidemiology. Excite: Centers for Disease Control
and Prevention. Retrieved on July 23, 2011 from http://www.cdc.gov/excite/classroom/intro_epi.htm#defined
Nunez, V.M.M. et al. (2011). Aging linked to type 2 diabetes increases oxidative stress and chronic inflammation. Rejuvenation Research: Mary Ann Liebert, Inc.
Retrieved on July 23, 2011 from http://www.liebertonline.com/doi/abs/10.1089/rej.2010.1054
Silver Book (2011). Prevalence and incidence of diabetes. Aging Research: Alliance for Aging Research. Retrieved on July 23, 2011 from http://www.silverbook.org/brose.pho?id=42
WHO (2006). Definition and Diagnosis of Diabetes Mellitus and Intermediate
Hyperglycaemia. World Health Organization in consultation with the International
Diabetic Foundation. Retrieved on July 23, 2011 from http://www.who.int/diabetes/publications/Definition%20and%20diagnosis%20of%20diabetes_new.pdf
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