11. Older Adults

Recommendations c Consider the assessment of medical, mental, functional, and social geriatric domains in older adults to provide a framework to determine targets and therapeutic approaches for diabetes management. C c Screening for geriatric syndromes may be appropriate in older adults experiencing limitations in their basic and instrumental activities of daily living, as they may affect diabetes self-management and be related to health-related quality of life. C c Annual screening for early detection ofmild cognitive impairment or dementia is indicated for adults 65 years of age or older. B c Older adults ($65 years of age) with diabetes should be considered a highpriority population for depression screening and treatment. B c Hypoglycemia should be avoided in older adults with diabetes. It should be assessed and managed by adjusting glycemic targets and pharmacologic interventions. B c Older adults who are cognitively and functionally intact and have significant life expectancy may receive diabetes care with goals similar to those developed for younger adults. C c Glycemic goals for some older adults might reasonably be relaxed using individual criteria, but hyperglycemia leading to symptoms or risk of acute hyperglycemic complications should be avoided in all patients. C c Screening for diabetes complications should be individualized in older adults. Particular attention should be paid to complications that would lead to functional impairment. C c Treatment of hypertension to individualized target levels is indicated in most older adults. C c Treatment of other cardiovascular risk factors should be individualized in older adults considering the time frame of benefit. Lipid-lowering therapy and aspirin therapy may benefit those with life expectancies at least equal to the time frame of primary prevention or secondary intervention trials. E c Whenpalliative care is needed in older adultswith diabetes, strict blood pressure control may not be necessary, and withdrawal of therapy may be appropriate. Similarly, the intensity of lipid management can be relaxed, and withdrawal of lipid-lowering therapy may be appropriate. E c Consider diabetes education for the staff of long-term care facilities to improve the management of older adults with diabetes. E c Patients with diabetes residing in long-term care facilities need careful assessment to establish glycemic goals and to make appropriate choices of glucoselowering agents based on their clinical and functional status. E c Overall comfort, prevention of distressing symptoms, and preservation of quality of life and dignity are primary goals for diabetes management at the end of life. E