Background
Diabetes is caused by problems with the hormone insulin, which affects how an individual’s body turns food into energy. The primary causes of diabetes among older individuals are genetics and diet. The number of people worldwide with diabetes is increasing, particularly the elderly population. The number of adults with diabetes in the United States is estimated to be 20.8 million (Bendor et al., 2020, p. 43). Diabetes severely affects older people’s health, quality of life, and longevity (Bendor et al., 2020, p. 43). Due to an aging population and increasing prevalence of diabetes, it is estimated that there will be at least 8.3 million new cases in the next twenty years (Bendor et al., 2020, p. 43).
The number of Americans 65 and older diagnosed with the condition will rise from 6.3 million in 2005 to 26.7 million by 2050 (Bendor et al., 2020, p. 43). This estimation is to be a 3.2-fold increase, while the percentage of diabetics in this age group may rise from 39% to 55% (Bendor et al., 2020, p. 43). Diabetes affected 25% of nursing home patients in the US in 2004 (Bendor et al., 2020, p. 43). By 2007, 86% of all diabetes-related deaths in the US involved adults 60 years of age or older (Bendor et al., 2020, p. 43). Meaning that the condition is become more prevent in the society and worldwide.
The prevention of diabetes in late adulthood is possible by maintaining a healthy weight, proper diet, and exercise. If not controlled, diabetes can cause serious health problems, including heart disease (the most common diabetes complication) and damage to the eyes, kidneys, nerves, and gums (Bendor et al., 2020, p. 43). The treatment of diabetes in late adulthood is mainly done by issuing them with metformin. Due to its reduced risk of hypoglycemia, metformin is a desirable drug for older persons. Even if the presenting A1C is below the individualized medication-treated target, healthy older persons may be treated with metformin at the time of diabetes diagnosis, compared to younger adults.
Laws/Policies/Programs/Advocacy Organizations/Funding Sources
Georgia’s applicable policy or program on the issue of diabetes in late adulthood is the “Georgia Diabetic Foot Care Program.” The Georgia Department of Community Health established it to address diabetic foot ulcer prevention and healing in persons with diabetes. The program is a cooperative effort between medical and public health professionals, hospitals, healthcare providers, patients, and the community.
The goals are to prevent and heal diabetic foot ulcers among eligible persons living in Georgia. The mission of the Georgia Diabetic Foot Care Program is to make a positive difference in the health of persons living with diabetes. The funding sources of the Georgia Diabetic Foot Care Program are the Georgia Department of Community Health, the Bureau of Disease Control, the Georgia Diabetes Advisory Board, and private donations (Bendor et al., 2020).
Services
The “Diabetic Foot Care Program serves “persons with diabetes” of all ages in Georgia. It is not diagnosed by the program and depends on medical oversight for diagnosis (Jiménez et al., 2018, p. 65). The service assessment of foot ulcers is done through physical examination by a foot care provider trained in diabetes (physician, podiatrist, or nurse practitioner) and a health history review. The Assessment for medical clearance for surgery is done by a physician trained in diabetes and must be certified by Georgia Diabetic Foot Care Program (Jiménez et al., 2018, p. 65).
If an individual is diagnosed with diabetic foot ulcer and has no evidence of infection, he may start the treatment on an outpatient basis after their surgical wounds are clean with no sign of infection. The surgery may be performed in or out of the hospital depending on the patient’s preference, hospitalization cost, and length of stay. After surgery, patients must follow up with their foot care provider for wound culture and antibiotic coverage (Jiménez et al., 2018, p. 65). Healthcare providers are to measure their blood sugar four times daily and provide treatment for a hyperglycemic condition if it occurs.
The Georgia Diabetic Foot Care Program is also responsible for collecting data, information, and reports regarding foot care providers, demographic characteristics of the patient, diabetic foot care activities, and the foot care provider. The Georgia Department of Community Health Bureau of Disease Control may use the data for evaluation purposes (Jiménez et al., 2018, p. 65). The public health department is responsible for reviewing data from utilization review and quality control to identify problem areas, barriers to access, and interventions that may improve the quality of services provided by health care providers. Additional Sources include donations from private individuals or organizations such as the American Diabetes Association or United Health Foundation.
The program provides funding for diabetic foot ulcer prevention and healing therapies not otherwise covered by Medicare or Medicaid for patients with diabetes aged 60 years or older. The program is also responsible for promoting educational programs to the public regarding diabetic foot care activities, such as education and prevention (Jiménez et al., 2018, p. 65). The programs are designed to encourage the use of new technology to improve the services provided by foot care renders to the community.
Healthcare providers are encouraged to utilize new technology, such as World Wide Web-based software or mobile applications that provide patient education and treatment reminders. The program is responsible for ensuring that the rate of foot amputations is reduced. This is the primary mission since foot ulcers are the second most common reason for foot amputation among persons with diabetes, and programs have been established to prevent diabetic foot ulcers. The program is also responsible for training healthcare providers regarding diabetes management and prevention.
References
Jiménez, S., Rubio, J. A., Álvarez, J., & Lázaro-Martínez, J. L. (2018). Analysis of recurrent ulcerations at a multidisciplinary diabetic Foot unit after implementation of a comprehensive Foot care program.Endocrinología, Diabetes y Nutrición (English ed.), 65(8), 438.e1-438.e10.
Bendor C.D., Bardugo A., Zucker I., Cukierman-Yaffe T., Lutski M., Derazne E., Shohat T., Mosenzon O., Tzur D., Sapir A., Pinhas-Hamiel O., Kibbey R.G., Raz I., Afek A., Gerstein H.C., Tirosh A., & Twig G. (2020). Childhood pancreatitis and risk for incident diabetes in adulthood.Diabetes Care, 43(1), 145-151.