By Vaughn DeCoster, PhD, LCSW, and Holly Dabelko-Schoeny, PhD, MSW
Dr. Vaughn DeCoster is Associate Professor of Social Work at the J. William Fulbright College of Arts & Sciences, University of Arkansas, Fayetteville. Dr. DeCoster has over seventeen years of clinical experience in Type 2 Diabetes, behavioral medicine and medical social work. A Hartford Geriatric Social Work Scholar, his funded research focuses on psychosocial interventions in diabetes, health care disparities and gerontology, with multiple publications and national/ international presentations. He has worked with the Centers for Disease Control, Tennessee Department of Health, Arkansas Department of Health and Human Services, and served as chairman of Arkansas State Diabetes Advisory Council. Dr. DeCoster has been an active member of the National Association of Social Workers (NASW) since 1990.
Dr. Holly Dabelko-Schoeny is Assistant Professor in the College of Social Work at the Ohio State University, Columbus. Her practice and research interests focus on in-home and community-based services for older adults. A Hartford Geriatric Social Work Scholar, her funded research focuses on adult day health and subsidized housing with services for seniors. Some recent publications include “Outcomes of adult day health services for participants: A conceptual model:” in the February 2008 edition of the Journal of Applied Gerontology with Zimmerman; “An examination of the adult day services industry using the resource dependence model” in press with the Journal of Aging and Social Policy with Koenig and Danso; and “Diabetes and adult day health services” in the November 2007 edition of Health & Social Work written with DeCoster. Dr. Dabelko-Schoeny is currently on the National Adult Day Services Association Board of Directors.
Q. What Is Diabetes?
Diabetes is a disease in which the body does not produce or properly use insulin. Without adequate insulin, the body is unable to use food for energy. There are three major types of diabetes: Type 1, Type 2 and gestational diabetes.
According to the American Diabetes Association (ADA) approximately 17.5 million people in the United States have diabetes, two-thirds (11.5 million) are 60 years of age or older. Health experts consider diabetes to be at epidemic proportions and a major factor in the rising costs of health care, responsible for an estimated $116 billion in medical expenses in 2007 alone.
Diabetes is the leading cause of cardiovascular disease, stroke, blindness, kidney failure, and non-accident lower-extremity amputations. Ninety-five percent of older adults have Type 2 diabetes. Obesity, inactivity and advanced age are the leading causes of Type 2 diabetes.
Q. How Is Diabetes Controlled (Managed)?
Controlling diabetes is accomplished with life style changes, not through professional medical treatments alone. As a matter of fact, effective diabetes medical care can only be achieved with active patient involvement. It’s easy, though, to procrastinate with diabetes treatment because the disease seems invisible at first, people look and feel fine most of the time while irreversible damage to the arteries, eyes, nerves occurs.
Prevention is the key to diabetes care by keeping blood sugars within normal levels (70-130 mg/dl). Getting blood sugars into this normal range (glycemic control) may require medications or injecting insulin with a syringe, but both can be reduced or even eliminated by changing eating habits, increasing physical activity and reducing emotional stress.
People can learn specifics on how to manage diabetes and make effective lifestyle changes by taking diabetes classes in clinics, hospitals and even some pharmacies, meeting with diabetes educators or registered dieticians as well as reading information in books and on the Internet (see the Web sites below to get started).
When trying to make lifestyle changes, it is easy for a person to feel besieged, as if they’re losing control of their life with everyone telling them what to do! Feeling helpless and out of control can disable their motivation to stick with those healthy behaviors with some elders thinking, “What’s the use, this is all too much!” But there are ways to promote a sense of control over diabetes and help them avoid feeling overwhelmed.
Q. How Can We Empower Elders With Diabetes?
Empowerment is a subjective feeling of control, strength, competence and a capacity for growth. It’s a way of thinking about how personal actions influence a person’s lived experiences and condition, believing that what they do influences their lives. Many factors shape this sense of personal control: a person’s mental outlook on life, problem solving abilities, past accomplishments, the physical environment (home, neighborhood), severity of other health conditions, history of oppression or discrimination and, most importantly, the ongoing relationships that make up our social lives – spouses, family, friends, church members, employers, doctors, social workers. This form of “personal power” is not given but encouraged for others to seize and there are many ways to foster it for elders living with diabetes.
- Accepting the label. Encourage a healthy acceptance of diabetes but with limits. As a senior adult once said, “I’m a diabetic, it’s who I am but it’s not ALL I am.”
- Avoiding diabetic rescuing. No one wants a loved one to be ill but doing too much for someone else makes “you” responsible for “their” habits, creates resentment and ultimately places the power of change into someone else’s hands. Everyone needs help sometimes but avoid constant reminders to check sugars, eat right, take medication or doing everything for them like filling syringes, packing snacks, recording glucose levels. Ask yourself, “Am I doing this so I can feel good about being a good caregiver or am I truly helping them?”
- Utilizing your village. Research across ages and situations shows that people need people. Find a diabetes partner/mentor, another person with good blood sugar control, preferably a non-family member, than can coach the elder diabetic. Have the senior attend a diabetes support group or start their own self-help group; a half-dozen diabetics that attend the same church and can meet 30 minutes each week after services. Elders attending an adult day program, senior center or living in an assisted living facility can start a diabetes support group. No professionals are needed just a list of topics, a willingness to share diabetic challenges, brainstorm answers, listen, and try solutions offered by the group.
- Using praise. As with driving or coaching, when it comes to health habits everyone is a critic and many diabetics just “tune-out” the judgmental noise. In contrast, words of praise, support, offers of unconditional regard, acceptance for who they are not what they’ll become, these forms of supportive cheerleading are readily heard.
- Using the expert within. Many times “good patients” get so used to following doctor’s orders that they forget the remarkable wealth of knowledge and life experiences they possess. Many times they have the correct answers to diabetic challenges and know what will work best for them to achieve a balance between quality of life and good glycemic control. Critical thinking like “how will this meal choice affect my sugars… is it something I really wantâ€¦ is it worth it” and generating other options has a remarkable influence on making better choices.
- Just do it! Do something, do anything, just encourage and celebrate the elder making some attempt at managing his or her diabetes. Sure, a five minute walk may have little impact on reducing blood sugars but as the saying goes, a thousand mile journey begins with the first step! Diabetes management and lifestyle change is all about subtle, gentle movements toward healthy goals. Habits developed this way are typically easy to start and longer lasting.
- Using fear tactics does not work. Being “scared healthy” from reminders of possible diabetic blindness or kidney failure just doesn’t work for the long-term change that’s needed and only damages the relationship between you and the diabetic.
- Taking every moment as an opportunity. You can never be too old or the time too late to physically feel better from improved glycemic control. Discourage throwing in the towel and abandoning oneself to the immediate gratification of food or being a couch potato. As suggested, people have the power to make decisions to control their diabetes whether they do this is up to them not the providers, caregivers or loved ones.
- American Diabetes Association – www.diabetes.org
- American Diabetes Association for Professionals – http://professional.diabetes.org
- American Dietetic Association – www.eatright.org
- Centers for Disease Control & Prevention – www.cdc.gov/diabetes
- National Diabetes Education Program – http://ndep.nih.gov
- National Institute of Diabetes and Digestive and Kidney Diseases – http://www2.niddk.nih.gov/
- U.S. Food & Drug Administration – http://www.fda.gov/diabetes/
- U.S. Department of Agriculture – www.nutrition.gov
- WebMD – http://diabetes.webmd.com