Chronic Illness

Diabetes mellitus

A syndrome of disorders of glucose metabolism that result in hyperglycemia.

Type 1 Diabetes mellitus

Type of diabetes that develops early in life and is a result of autoimmune destruction of the insulin-producing beta cells in the pancreas. Absence of insulin is incompatible with life.

Type 2 Diabetes mellitus

Type of diabetes that develops later in life. Pancreas makes insulin, but not enough to keep up with the needs of the body. Inadequate supply of naturally occurring insulin is combined with insulin resistance. Onset is usually insidious, and may go years without treatment or undiagnosed.

1. General polyphagia, polyuria, polydipsia, and weight loss

2. Recurrent infections that involve skin, intertriginous areas, or genito-urinary tract, and slow healing of sores and wounds.

3. Neurological dysfunction

4. Arterial disease

5. Small vessel disease involving the kidneys and eyes

6. Lesions on the skin

7. Endocrine-metabolic complications

Signs and symptoms of diabetes mellitus in older adults:

1. People of south asian, asian, african, latin american, or indigenous descent

2. increase age (40+)

3. BP> 140/90

4. First-degree relative

5. Obesity (BMI >30)

6. Previous gestational diabetes

7. Undesirable lipid levels

8. Hx of impaired glucose tolerance or impaired fasting plasma glucose

Risk factors for diabetes mellitus: [8]

1. visual problems

2. renal failure

3. delayed wound healing

4. MI, stroke, heart disease

5. Foot problems

6. Erectile dysfunction

Complications of diabetes mellitus over the course of the disease: [6]

1. Major goal: hold back progression of the disease

2. No smoking

3. Blood pressure ≤130/80 mm Hg

4. Cholesterol <5.18 mmol/L (200 mg/dL)

5. Low-density lipoprotein <2.56 mmol/L (100 mg/dL)

6. High-density lipoprotein >1.03 mmol/L (40 mg/dL)

7. Triglycerides <1.69 mmol/L (150 mg/dL)

8. Fasting blood glucose <7 mmol/L (<126 mg/dL)

Treatment and goals for diabetes mellitus in older adults: [8]

Cardiovascular disease (CVD)

Disease that affects the circulatory system, including the heart and blood vessels. Remains the leading cause of death in Canada after cancer.

Older age (>55 years for men; >65 years for women)

■ Family history of premature CHD (<55 years for men; <65 years for women)

■ Microalbuminuria or estimated GFR <60 mL/min

■ Hypertension*

■ Cigarette smoking

■ Central obesity

■ Physical inactivity

■ Dyslipidemia*

■ Diabetes, IGT, or IFG*

Risk factors for CVD: [9]

Hypertension

The most common chronic risk factor for CVD. When diastolic is consistently over 90 or systolic is consistently over 140.

■ Cigarette smoking or tobacco use

■ Excessive alcohol intake

■ Sedentary lifestyle

■ Inadequate stress management, anger management, or both

■ Unhealthy diet (high in sodium, trans fats, or both; low in fibre)

Modifiable risk factors for hypertension: [5]

Coronary heart disease

Caused by a blockage of the vessels of the heart. May be referred to arteriosclerosis or “hardening of arteries.” Develops when cholesterol and other fats are deposited in the layers of the arteries, narrowing the channels and decreasing blood and oxygen to the heart.

1. Angina

2. Myocardial infarction

Coronary heart disease can lead to what? [2]

Silent MI

Discomfort may be mild and localized to the back, abdomen, shoulders, or one or both arms. MI more likely to be in older adults.

Heart valve disease

Early stages: heart valves are monitored. Late stage: may require repair or replacement. Disease of the valves.

Heart Failure

Progressive disorder of the heart muscle in which the muscle is damaged, malfunctions and can no longer pump enough blood to meet the needs of the body. Damage from coronary heart disease can lead to this.

1. previous MI

2. hypertension

3. excessive alcohol and drug use

4. diabetes

5. obesity

6. infection

7. high cholesterol

8. other medical conditions

Common causes of heart failure: [8]

1. fatigue

2. shortness of breath

3. inability to lie flat

4. waking up at night gasping for air

5. weight gain

6. swelling in lower extremities

7. confused/ delirious

8. falling

9. complaining of insomnia or nocturia

10. dizziness or syncope

Common signs and symptoms of heart failure: [10]

1 reduce symptoms

improve quality of life

reduce mortality and morbidity

maximize function

Goals for CVD: [4]

Mortality

Death as a result of a health condition

Morbidity

Disability as a result of a health condition

Exercise programs
 Medications
 Assessing for signs and symptoms of CHF
 Monitoring diet and fluid intake and output
 Auscultating heart and lung sounds
 Monitoring laboratory values
 Educating the patient about all of the above
 Providing comfort

Interventions for CVD [8]

Older adults at higher risk due to normal changes. Higher risk of death when it occurs in older adults.

Why are older adults at higher risk for respiratory disorders?

1. Infectious (either obstructive or restrictive)

2. Acute

3. Chronic

Classifications of respiratory disorders: [3]

Chronic Obstructive Pulmonary Disease (COPD)

A group of conditions that affects airflow. Includes asthma, bronchitis, and emphysema.

COPD

Fourth leading cause of death in older adults:

Cigarette smoking

Underlying cause of most COPD cases in older adults:

1. little sputum production

2. Appear pink because they receive adequate oxygen

Signs and symptoms of emphysema: [2]

1. chronic sputum production

2. frequent cough

3. pale and somewhat cyanotic

Signs and symptoms of bronchitis: [3]

Pneumonia

Bacterial or viral infection of the lower respiratory tract that causes inflammation to the lung tissue. 7th leading cause of death in older adults, who are at higher risk due to normal changes and co-morbidities (COPD, heart disease)

1. LTC homes

2. normal age-related changes

   1. decreased cough reflex

   2. increased residual volume

   3. decreased chest compliance

Factors that increase risk of pneumonia: [4]

1. community acquired

2. Health care-assiciation infection

Two classifications of pneumonia:

1. cough

2. fatigue

3. dysnpea

4. Falling

5. mental status change

6. confusion

7. deterioration

8. weakness

9. anorexia

10. rapid pulse

11. rapid respirations

12. elevated WBC count

13. fever

(symptoms are normally delayed)

signs and symptoms of pneumonia in older adults:

Influenza

Respiratory disorder with the greatest mortality and morbidity rate in older adults

1. Vaccine

2. Hand washing

How can influenza be prevented? [2]