Failing to meet the needs of generations of care home residents with diabetes: a review of the literature and a call for action

Abstract

In residential care homes and aged-care facilities globally, between one in three and one in four residents may have diabetes, an often complex highly co-morbid illness that leads to frailty, dependency, disability and reduced life expectancy. Residents with diabetes also have a high risk of hypoglycaemia, avoidable hospital admissions, and represent one of the most difficult challenges to health professionals and care staff in optimizing their diabetes and medical care. This detailed review examines the literature relating to care home diabetes over the last 25 years to assess what has been achieved in characterizing residents with diabetes, and what we know about the various but limited intervention studies that have been carried out internationally. The guidance and guidelines that have been published to assist clinicians in planning effective and safe care for this rather vulnerable group of people with diabetes are also reviewed. The review presents the first diagrammatic representation of a likely physiological cascade depicting the mainly irreversible functional decline a resident with diabetes might experience, provides modern principles of care for each resident with diabetes, and identifies what priority recommendations are required to be implemented if diabetes care is to improve. The review concludes that action is required since diabetes care still remains fragmented, sub-optimal, and in need of investment, otherwise care home residents with diabetes will continue to have their needs unfulfilled.

Evidence‐based diabetes care for older people with Type 2 diabetes: a critical review

“…Initial screening was undertaken by each author to remove studies that were not appropriate or had no relevance to their assigned tasks within the writing group. As documented previously , we used a model of methodology to conduct a comprehensive and detailed narrative review that minimizes selection bias according to the elements given below.…”

“…A comprehensive review of care home diabetes, including an examination of interventions undertaken has been published recently .…”

The challenge of managing Type 1 diabetes in frail older people

“…In contrast to independent adults with Type 1 diabetes, the support for care home residents with Type 1 diabetes is likely to fall on primary and community care services. Residential care of Type 1 diabetes remains an under‐researched area, and specialists should support these services and provide advice for glucose lowering regimens that will minimize hypoglycaemia, with audit of clinical outcomes to advise on future clinical care .…”

Diabetes, Care Homes, and the Influence of Technology on Practice and Care Delivery in Care Homes: Systematic Review and Qualitative Synthesis

“…In turn, this should empower care home staff to contribute to better diabetes management, thus raising the standards of care within the care home setting. Residents living with diabetes represent one of the most difficult challenges to health professionals and care home staff in advancing care [14] and may need to receive care from multiple medical services. Given that the complications of diabetes and the associated comorbidities alongside the aging process [1] make residents potentially more vulnerable, care home staff are challenged in the provision of care to manage the disease effectively and influence outcomes.…”

“…Diabetes UK [16] has recognized the importance of providing standards of care for residents in care homes and published guidance in 2010 setting standards for diabetes care in residential homes, and multiple care home–specific policies, statements, guidelines, and recommendations [5,6,17-20] exist to support this approach. Nevertheless, at least in the Highlands in Scotland, there is currently no mandatory diabetes training for staff in care homes, no defined standards of care for residents living with diabetes, and no clear protocol for accessing specialist services in the care home setting, highlighting the need for tighter regulation to improve care for those living with diabetes in care homes [14].…”