Pharmacologic treatment of diabetes in long-term care

The Role of Nursing Home Admission and Dementia Status on Care for Diabetes Mellitus

“…This study found that individuals with diabetes mellitus and dementia received lower rates of clinical tests for HbA1c, fasting plasma glucose, and serum creatinine and of dilated eye examinations in community and NH settings than those without dementia. Because of a dearth of outcome studies evaluating diabetic treatment for very frail older people, there is controversy over the level of intensity of care for diabetes mellitus that is appropriate for such persons 5,13,25 . For some, the risks and discomfort associated with treatment may not outweigh the benefits, especially given research documenting that several years may be required before clinical improvements in areas such as microvascular complications and renal disease are seen 5 and that tight glycemic control can increase the risks of cardiovascular disease and hypoglycemic episodes, potentially leading to greater falls risk 13 .…”

“…Others argue that, on a case‐by‐case basis, tighter glycemic control and higher insulin use in institutionalized elderly people should be considered because of their positive effects on hypertension, dyslipidemia, microalbuminuria, and cognitive function. Nevertheless, studies consistently find lower rates of treatment with antidiabetic medications for the oldest old and for NH residents who are more cognitively and functionally impaired 13,14 . These controversies primarily address the provision of medications and not the monitoring procedures examined, but whether advisable or not, at the clinical level, looser adherence to recommended monitoring schedules is likely to accompany less‐intensive pharmacological treatment.…”

“…An important question for researchers and clinicians alike pertains to the relationship between NH admission and quality of care for diabetes mellitus. Although the structured care environment of the NH might lead to better care, priority may be given to more‐urgent health concerns in people newly admitted to the NH, or the goals of care for diabetes mellitus may change as the costs and expected benefits of procedures are considered 3,5,11,13,14 . Care may also change as NH physicians, rather than endocrinologists, direct care 15 .…”

Relationship between State Medicaid Policies, Nursing Home Racial Composition, and the Risk of Hospitalization for Black and White Residents

“…Racial disparities in the quality of nursing home (NH) care have been well documented. Black residents are less likely than their white counterparts to receive appropriate pharmacologic management for a myriad of conditions (Bernabei et al 1998; Gambassi et al 1998; Lapane, Fernandez, and Friedman 1999; Won et al 1999; Spooner et al 2001) and less likely to receive physical therapy upon admission (Harada et al 2000). Black residents are also more likely to be hospitalized than are white residents (Culler, Parchman, and Przybylski 1998).…”

Assessment of a United States pharmaceutical care model for nursing homes in the United Kingdom

“…However, it has been recognised that OBRA has resulted in a focus on poor prescribing (primarily psychoactive drugs), while excluding the promotion of evidence-based therapies for a range of prevalent medical conditions in elderly residents [9][10][11][12].…”