Table 1

Characteristics of older adults and their diabetes management based on living situation

Community-dwelling patientsAssisted living facilitiesHospitalized inpatientsSkilled nursing facilityNursing facility (long-term)
General characteristics• Independent living
• Medically stable
• Partially ADL/IADL dependent• Acutely ill• Admitted for rehabilitation
• Probable home discharge
• Chronically ill
• ADL dependence
Caregiver support• Variable• Support of IADL
• Variable medication management
• Temporary supervision• Full or partial• Full or partial
Comorbidities• Variable• Moderate• Variable• Variable• Extensive
Ability to perform ADL and/or IADL• Independent or adequate support• Partial dependence• Temporary dependence• Variable with potential for improvement• Dependent
Diabetes self-care• Usually independent• May need assistance• Temporary assistance• Partial assistance• Dependent
Diabetes treatment goals• Best achievable without risk of hypoglycemia• Based on comorbidities and preferences• Optimal control for recuperation• Optimal control for recuperation• Avoid severe hypo- and hyperglycemia
Diabetes self-care education needs• Frequent education and reeducation• Frequent education and reeducation• Education prior to discharge• Education prior to discharge• Ongoing staff education at all levels of care
Major challenges• Acute illnesses cause fluctuations in cognitive and/or physical status• Blood glucose monitoring and/or insulin injection assistance usually not provided
• Inadequate diabetes education for staff
• Failure to switch to prehospitalization regimen at discharge• Need to be able to perform self-care after discharge
• New or complex regimen might be too difficult for home management
• Erratic intake of food and fluids
• Inadequate diabetes education for staff
• Staff turnover
• Time constraints
• Lack of diabetes-specific protocols
• Variation in practitioner practices
• Excessive use of SSI
  • ADL, activities of daily living (such as bathing, toileting, eating, dressing, transferring); IADL, instrumental activities of daily living (such as cooking, taking medications, traveling, using the telephone, shopping, managing finances, housework).