Connections in Senior Care

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Chester McDowell
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Connections in Senior Care Diet in Seniors With Diabetes Many people including family and caregivers may not fully understand what people with diabetes can and cannot eat.

Fact: If eaten as part of a healthy meal plan, or combined with exercise, sweets and desserts can be eaten by people with diabetes.

1 Connections in Senior Care Diet in Seniors With Diabetes Many people including family and caregivers may not fully understand what people with diabetes can and cannot eat. That s why, as you care for residents with diabetes, it s important to be aware of certain myths regarding food and this disease.1 Myth #1 People with diabetes can t eat sweets or chocolate. Fact: If eaten as part of a healthy meal plan, or combined with exercise, sweets and desserts can be eaten by people with diabetes. The key to eating sweets is sticking to very small portions that are saved for special occasions. Myth #2 People with diabetes can t have fruit. Fact: Fruit is a healthy food that contains fiber, vitamins, and minerals. Fruits also contain carbohydrates, so they need to be included in the meal plan of your patients with diabetes. Myth #3 People with diabetes must follow a special diet. Fact: Long-term residents with diabetes benefit from the same healthy diet that is good for everyone else: plenty of whole grains and fruits and vegetables, with a limited amount of fat and refined sugar. Myth #4 People with diabetes should avoid carbohydrates. Fact: Finding the right amount of carbohydrates depends on many things, including how active you are and what medicines you take. A place to start is at about grams of carbohydrates at a meal. The American Diabetes Association recommends designing your dinner plate as follows: ¼ of grains and starchy foods (brown rice, green peas, potatoes, pasta), ½ with nonstarchy vegetables, and the last ¼ with protein (nuts, fish, eggs, cheese, chicken).2

of the gastrointestinal tract If the resident is able to feed him or herself What he/she likes to eat, the preferred food consistency, and eating habits HANDY WAY TO PICTURE SERVING SIZES 4 3 oz of

2 Make a Difference for Seniors with Diabetes For the patient with diabetes, proper nutrition is essential. You can make a difference by assessing 3 : The resident s dental condition Whether he/she can chew and swallow If the resident has pain or discomfort, especially in the mouth, stomach, or other parts of the gastrointestinal tract If the resident is able to feed him or herself What he/she likes to eat, the preferred food consistency, and eating habits HANDY WAY TO PICTURE SERVING SIZES 4 3 oz of meat would fit in the open palm of your hand. 3 oz of fish would cover your open hand. ½ cup of cooked pasta or rice is a handful. 1 ½ ounces of cheese is the size of your pointer finger. A serving of fruit is the size of your fist. References: 1. American Diabetes Association. Diabetes myths American Diabetes Association. Create your plate Munshi MD, Florez H, Huang ES, et al: Management of diabtes in long-term care and skilled nursing facilities: a position statemen to the Amercian Diabetes Association. Diabetes Care. 2016;39: Dairy Council of California. Serving size comparison chart. aspx. Reprinted with permission. This material was developed by Sanofi and distributed by Health Quality Innovators (HQI), the Medicare Quality Innovation Network Quality Improvement Organization for Maryland and Virginia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. HQI/11SOW/10/13/2015/2258 US.NMH

3 Connections in Senior Care Exercise in Seniors With Diabetes Residents may rely on you to help them stay active. To make your job easier and help keep your residents safe, the following guide has been designed to provide important information about the benefits and risks associated with exercise in seniors with diabetes. Never schedule exercises for a resident without the prior approval of the health care provider. Why Should Residents Exercise? Exercise can be a key part of managing diabetes. That s why many older residents with diabetes are encouraged to incorporate some physical activity into their normal daily routine.1 POTENTIAL BENEFITS OF REGULAR EXERCISE FOR RESIDENTS WITH DIABETES1-3 Reducing the risk of falling Improving strength, balance, and flexibility Controlling weight Controlling blood sugar Promoting relaxation; releasing tension and anxiety Scheduling Regular Activity With Your Residents1,2,4,5 If approved by the health care provider, a standard workout for your residents with diabetes should include aerobic exercise and strength training. Aerobic exercise can be done for 30 minutes (or in 10-minute spurts), 3 to 5 days a week; resistance training should be done at least 2 days a week. Start slowly with 5 to 10 minutes a day. Stretching and balance exercises may also be added. Did you know? Muscle strength declines by about 15% per decade with residents who are in their 60s and 70s then declines by about 30% thereafter.6

4 Who to Keep an Eye On Regular activity is not always a good idea for every older adult with diabetes. Just remember to follow the orders of the health care provider and pay special attention to specific at-risk residents, such as those with 1,4,7 : Nerve damage Cardiovascular disease Eye disease High blood pressure Osteoporosis or arthritis Hypoglycemia Help Them Get a Move On Safely 1,8 Don t forget to help your residents stay safe and comfortable during exercise. Be sure to keep the following tips in mind: Have water on hand proper hydration before, during, and after exercise is important. Make sure residents are wearing appropriate shoes and comfortable, loose-fitting clothing that allows free movement, but won t get caught on other objects. Have residents begin slowly with a low-intensity warm-up. Wait at least 2 hours after residents eat a large meal before starting exercise. What Counts as Activity? While there is no one-size-fits-all approach, it s important to help get your residents moving even if they re not working up a sweat. EXERCISE CAN BE ANYTHING THAT GETS THEM MOVING* 1,2,4,5 Walking Swimming Stretching Chair exercises Floor or water aerobics Lifting light weights Taking the stairs or step exercises Balance exercises Yoga or tai chi Other strength or resistance activities * Never schedule exercises for a resident without the prior approval of the health care provider. References: 1. National Institute of Diabetes and Digestive and Kidney Diseases. Guiding principles: Principle 5: encourage regular physical activity American Diabetes Association. Living healthy with diabetes: a guide for adults 55 and up Mayo Clinic. Diabetes and exercise: when to monitor your blood sugar National Institute of Diabetes and Digestive and Kidney Diseases. What I need to know about physical activity and diabetes. health-topics/diabetes/physical-activity-diabetes/pages/physical-activity-diabetes.aspx. 5. American Diabetes Association. What we recommend aerobic exercise Evans W. Functional and Metabolic Consequences of Sarcopenia. J Nutr. 1997;127:998S 1003S. 7. American Diabetes Association. Exercising with diabetes complications NIH Senior Health. Exercise: how to get started. Reprinted with permission. This material was developed by Sanofi and distributed by Health Quality Innovators (HQI), the Medicare Quality Innovation Network Quality Improvement Organization for Maryland and Virginia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. HQI/11SOW/10/13/2015/2258 US.NMH

Preventing Falls in Seniors With Diabetes Many residents have a fear of falling and for good reason. Among older adults 1 : More than 1 out of 4 fall each year. Each year, 2.

5 Preventing Falls in Seniors With Diabetes Many residents have a fear of falling and for good reason. Among older adults 1 : More than 1 out of 4 fall each year. Each year, 2.8 million older people are treated in emergency departments for fall injuries. Falls are the most common cause of traumatic brain injuries. Deaths due to falling have risen sharply over the past decade. You Can Make a Difference... You can play an important role in helping to keep residents safe by understanding how to identify the risks associated with falling as well as ways to help prevent falls. Diabetes may increase the risk for falls because of slower reflexes, vision problems, obesity, medications, and foot problems. 1-3 Risk Factors for Falling 1 3 Medical Risk Factors Arthritis Blood pressure drops too low Chronic pain Dehydration Diabetes Foot disorders Medication side effects Muscle weakness in legs Nighttime bladder problems Vision impairment Vitamin D deficiency Environmental Risk Factors Clutter Inadequate lighting Incorrect use of walking aids Loose carpets No guardrails along stairs or in bathroom Uneven, wet, or slippery flooring Personal Risk Factors History of falling Improper footwear Lack of exercise Not wearing eyeglasses or hearing aids

6 You Can Help Residents Avoid Falls... Although accidents do occur, they can be prevented. Here are a few simple reminders to help keep your senior residents safe. 3-5 IN THE RESIDENT S ROOM, REMIND HIM OR HER TO... Make sure beds are in the lowest position. Keep the path between the bed and bathroom well lit and free of clutter. IN THE BATHROOM, REMIND HIM OR HER TO... Don t Forget... It s always important to keep an eye on the safety of your residents. However, if one of your residents has a history of falling, make an extra effort to watch that person more carefully. Keep the bathroom clear and free of clutter. Be sure there is adequate lighting. Create a toileting schedule to minimize urgent trips to the bathroom. DURING ACTIVITY, REMIND HIM OR HER TO... Rise slowly from a seated or reclining position. Inspect clothing for proper size and fit. Wear nonskid footwear. IN GENERAL... Make sure assistive devices (canes, walkers, etc) are in good working condition and used properly. Encourage residents to keep hearing aids, eyeglasses, and other frequently used items within reach. Be alert to signs of side effects from new medicines, like dizziness or lightheadedness. References: 1. Centers for Disease Control and Prevention. Important facts about falls National Institutes of Health. Falls and older adults HealthinAging.org. Fall prevention Mayo Clinic. Healthy lifestyle healthy living. Remove some hazards US Department of Health & Human Services: Implementation guide to prevention of falls with injury. Reprinted with permission. This material was developed by Sanofi and distributed by Health Quality Innovators (HQI), the Medicare Quality Innovation Network Quality Improvement Organization for Maryland and Virginia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. HQI/11SOW/10/13/2015/2258 US.NMH

Lesson Overview. Teaching Plan. Learning Goals SAFETY GUIDELINES: PREVENTING STAFF AND RESIDENT INJURIES: TEACHING PLAN. Teaching Plan, continued:

Lesson Overview. Teaching Plan. Learning Goals SAFETY GUIDELINES: PREVENTING STAFF AND RESIDENT INJURIES: TEACHING PLAN. Teaching Plan, continued: SAFETY GUIDELINES: PREVENTING STAFF AND RESIDENT INJURIES: TEACHING PLAN Lesson Overview Time: One Hour This lesson covers basic safety practices that facility staff should use in their work to avert accidents.