Health Maintenance Issues
Mrs. Gray is an 86-year-old woman who has been diagnosed with Type Two Diabetes. She has lived with the disease for three years. Mrs. Gray is single and lives in the area in a naturally occurring retirement community. Mrs. Gray, though 86, appears much younger than her stated age, which can be largely attributed to her active physical nature. Mrs. Gray boasts an exceedingly active social life, meeting her friends for lunch several times a week, and she strives to keep herself in good physical condition by going to the gym an average of four times a week. Mrs. Gray is further involved in the community through significant work in her church and as a member of the Senior Friends Program, which allows volunteers to interact with shut-ins by visiting with them and bringing them dinner once a week. Mrs. Gray’s last A1C was 6.1%.
Health Maintenance Issues/Concerns
In assessing the issues at hand to assure that Mrs. Gray remains in good health, certain areas of concern rise to the forefront. These areas of concern must be addressed early in terms of treatment and a health promotion plan so that the issues will not yield future health problems for the patient.
Mrs. Gray’s “health triangle” (maintenance and promotion of health in the areas of physical, mental, and social well-being) is evident, but unbalanced in certain areas. While Mrs. Gray remains physically active by going to the gym and moving about town during her volunteer work, her social lunches several times a week raise significant threats in terms of her ability to maintain a healthy diet that will most significantly assist her in terms of her Diabetes maintenance. Mrs. Gray’s single status also poses a minor issue in terms of monitoring her food intake and continued physical activity. Additionally, Mrs. Gray’s age poses a threat to her health maintenance due to the fact that at any instant, her ability to maintain her now lively and energetic weekly routine may be altered in some way, which in terms of her Diabetes, can be detrimental to her health. Should her diet and exercise routines be altered in any significant manner, Mrs. Gray’s blood sugar levels have the capacity to shift significantly, which poses a major issue due to the fact that her A1C levels are already high. Though Mrs. Gray has remained active in her lifestyle, the fact remains that her A1C level, at last measurement, presented at 6.1% which requires assistance in terms of a suggested health promotion plan.
Assessment/Diagnosis
Patient presents with 6.1% A1C/glycatedhemoglobin level, noting a slightly elevated presence of sugar within the blood. While this percentage places Mrs. Gray in a generally accepted “normal” range for A1C measurements, her previous diagnosis of Type 2 Diabetes makes this slight elevation reason enough to attempt an adjustment in diet to lower the percentage level. While Mrs. Gray’s A1C notes good glucose control, her lack of a consistent diet proves problematic in maintaining the aforementioned levels, which causes concern for future testing. With continued diet and exercise, patient presents with the capacity to continually lower her A1C, maintaining a tight control on the issue in hopes of reversal.
Health Promotion Plan
Mrs. Gray’s diagnosis of Type 2 Diabetes and her age of 86 years old present as major risk factors in terms of keeping her Diabetes and blood sugar levels under control. However, there are certain actions that can be taken in order to reduce the risks associated with the disease and alleviate complications. Complications of diabetes including microvascular and macrovascular issues pose a major threat, especially in dealing with the elderly. A recent prospective study indicated that patients with Type 2 Diabetes without a history of prior heart attack [Mrs. Gray] have equal if not greater risks of myocardial infarcation (MI) compared to those without diabetes who have had prior heart attacks (20.2% vs. 18.8% incidence of MI, respectively over 7 years) suggesting that older diabetics specifically should be monitored for cardiovascular risk factors as well as healthy diet and exercise routines (Haffner, Lehto, Ronnemaa, 2008, p.230). In combating such issues, in general, a glycosylated hemoglobin (HbA1c) goal of <7% is reasonable for most patients.; a less-aggressive goal may be considered for patients at high risk of hypoglycemia or high risk of complications from hypoglycemia, as long as acutely symptomatic hyperglycemia is avoided (Fravel, McDanel, Ross, 2011, p. 502). Further, Chlorpropamide, glyburide, and rosiglitazone, which pose a great risk for hypoglycemia, should be avoided in the elderly as in the case of Mrs. Gray.
The management of the elderly patient with Type 2 Diabetes through medical procedures and intervention has different goals and objectives than does that of the younger patient. The patient’s life expectancy, coexisting medical or psychiatric disorders, and the patient’s willingness and ability to comply with the proposed treatment are important considerations (Halter, 2009, p.239). Medical therapy can contribute to the development of complications in older patients.
Exercise and diet have long been attributed to Diabetes maintenance, and both have played a role in Mrs. Gray’s ability to manage the disease. Along with the continuation of a diet rich in fiber, lean meats, fish and poultry, low-fat and fat-free dairy, limited saturated fats and trans-fats, limited sodium, limited alcohol, limited sugars, and increased H2O intake, with significant exercise, Mrs. Gray should may want to include a dietary supplement into the mix to continue management. Physicians have found that the inclusion of fatty acids, Omega 3, Vitamin D, and Vitamin K in supplement form have aided elderly patients with the maintenance of Type 2 Diabetes when used in conjunction with steady exercise (Traustadottir and Tsitouras, 2010, p.22).
In addition to a steady diet rich in the aforementioned food items, physicians have found that an optimal nutritional regimen exists in Western populations, specifically for the elderly with Type 2 Diabetes. As a general rule, a diet should be adhered to that is nutrient-dense, with a low-glycemic index, high in high-dietary fiber foods with possibly lowered carbohydrate intake and higher protein intake (Esfahani, Josse, Panahi, 2008, p.363). Such a diet with the addition of exercise opens the door to easy dietary and lifestyle modifications that will both prevent and control the progression of the disease.
In viewing the research at hand in the maintenance and reduction in severity of Type 2 Diabetes in the elderly, a proposed health plan for Mrs. Gray will follow these general rules in terms of modified diet, increased exercise, addition of dietary supplements, and scanning for cardiovascular issues during medical exams and physicals.
Conclusion
Mrs. Gray has presented as a patient that consistently works to maintain control of her disease, as seen in her lowered A1C levels back to a more “normal” range. In maintaining her current exercise regimen and making slight alterations to her diet, Mrs. Gray should be able to gain a firm control over the disease in hopes of reversing it significantly.
References
Esfahani, A., Josse, A., and Panahi, S. (2008). Nutritional considerations for older adults with type 2 diabetes. Journal of Nutrition for the Elderly, 27.3-4. pp. 363-80. Retrieved from: EBSCOhost Database.
Fravel, M., McDanel, D., and Ross, M. (2011). Special considerations for treatment of type 2 diabetes in the elderly. American Journal of Health-System Pharmacy, 68.6. pp. 500-9. Retrieved from: EBSCOhost Database.
Haffner, S., Lehto, S, and Ronnemaa, T. (2008). Mortality from coronary heart disease in subjects with type w diabetes and in nondiabetic subjects with and without prior myocardial infarction. New England Journal of Medicine, 349:1. pp. 229-234. Retrieved from: EBSCOhost Database.
Halter, J. (2009). Geriatric patients. In: Therapy for Diabetes Millitus and related disorders, 3 ed. Alexandria, VA: American Diabetes Association. pp. 234-240. Retrieved from: EBSCOhost Database.
Traustadottir, T. And Tsitouras, P. (2010). Role of exercise and dietary supplements in the management of prediabetes and type 2 diabetes the seventh in a continuing series on diabetes in the elderly. Clinical Geriatrics, 18.10. pp. 22-7. Retrieved from: EBSCOhost Database.
Health Maintenance Issues
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