Headline: Managing Diabetes and Dementia in Long-Term Care: New Insights
Vancouver Forum Challenges Aggressive Treatment for Seniors
VANCOUVER, British Columbia — In a significant presentation at the Family Medicine Forum (FMF) 2024, Dr. Adam Gurau, a family physician from Toronto, urged a reevaluation of how chronic conditions such as diabetes and dementia are managed in long-term care facilities. His findings suggest that aggressive management strategies are not only ineffective but could lead to increased risks, particularly for residents aged 75 and older.
According to Dr. Gurau, extensive research highlights the risks of hypoglycemia—dangerously low blood sugar levels—and the unnecessary use of high-risk medications in older adults residing in long-term care. “We really should try to reduce [this risk] and not use dangerous medications or potentially risky ways of managing diabetes,” he stated.
The Risks Involved with Intensive Glycemic Control
A Canadian study scrutinizing the outcomes associated with intensive glycemic control for older adults revealed concerning statistics. The study indicated minimal benefits and potential harm associated with high-risk diabetes medications, such as insulin or sulfonylureas. Despite their common use, these medications pose substantial risks, including increased emergency department visits and hospitalizations.
Dr. Gurau emphasized the need to shift towards more practical management guidelines. “Current North American recommendations point towards relaxing glycemic targets to prevent hypoglycemia and reduce overtreatment,” he explained. This perspective urges caregivers to focus on sustaining quality of life rather than pursuing aggressive glycemic targets.
Emphasizing Deprescribing Medications
An essential aspect of optimizing healthcare for seniors involves careful medication reviews and deprescribing—removing unnecessary medications rather than adding more. “What we want to do is optimize medications,” noted Dr. Gurau, advocating for a patient-centric approach.
Research supports the idea that many older adults are open to deprescribing, with a survey revealing that 77% of participants aged 79.1 years and older were willing to reduce their medications if advised by healthcare providers. Building trust through open communication is key to initiating this process and enhancing patient outcomes.
Nonpharmacologic Approaches for Dementia Care
With around 62% of seniors in residential care homes diagnosed with Alzheimer’s disease or another form of dementia, Dr. Gurau advocated for nonpharmacologic interventions. Studies show that therapies like massage, touch therapy, and music can significantly alleviate neuropsychiatric symptoms such as aggression and agitation in dementia patients. “We need to exhaust all the nonpharmacologic approaches,” he stated, firmly supporting more holistic care methods in long-term facilities.
Preventing Unnecessary Hospital Transfers
Another critical issue raised was the frequent and often avoidable transfer of long-term care residents to hospital emergency rooms. Dr. Gurau pointed to data illustrating that as many as 25
