Summary of the teaching plan
Health promotion is a vital activity across the lifespan of an individual. Thus, older people are not too old to start exercising, change their diets or stop smoking, etc. This teaching plan is aiming to teach older adults about the prevalence of diabetes, the risk factors, and the available prevention measures. It will focus on the teaching strategies to be adopted by the older adults so as to accommodate for the typical aging changes. This is because chronic illnesses tend to increase after 50 to 60 years old and hence, there is a need for seniors to focus on disease and illness management. Older adults more often are faced with numerous types of loss such as loss of life-long friends, spouse, and personal physical capabilities which increase their vulnerability to diabetes as well as making difficult for them to promote their health. Therefore, it is very crucial to intermingle with each client as a unique being, capable of learning and changing. Apart from the dealing with the treatment proposals or specific disease issue, this teaching plan will also address important matters such as exercise, nutrition, sexuality and aging affecting older adults who need to look at to prevent illness and promote quality of life. Within this teaching plan, it will assess the more elderly patient’s barriers to be independence and find other means to capitalize on strengths and promote freedom. More so, this teaching plan is targeting to help clients to follow medical recommendations through the provision of information, building awareness of community services and considering the patients’ individual needs as well as lessening the social isolation.
Summary of the implementation teaching plan
Day 1: General overview of diabetes for about two hours
Day 2: Blood glucose monitoring and goals of supervising glucose for about 3 hours
Day 3: Medications and insulin injections for about 3 hours
Day 4: Complications from diabetes for about 1 hour
Skin and foot care for about 30 minutes
Exercise and diabetes for about 1 hour 30 minutes
Day 5: Diet and diabetes for about 2 hours
Coping with diabetes for about 1 hour
Day 6: Questions and answers for about 1 hour
Review of particular concepts requested by patients
Epidemiological rationale for the topic
About seventy-eight million adults aged 20 years and older have prediabetes (CDC, 2015). Prediabetes is known to raises the risk of developing type 2 diabetes and cardiovascular diseases. There are about seventeen million people in the United States having diabetes. Out of this, it is approximated that 11.1 million people have been diagnosed while 5.9 million have not been diagnosed (CDC, 2015). Regarding age groups, approximately 151, 000 (0.19%) of people of age, less than 20 years old have diabetes, about 16.9 million (8.6%) people of age 20 years and older have diabetes (CDC, 2015). About 7.0 million (20.1%) of people of age 65 years and older have diabetes. Thus, prevalence and incidences of diabetes in older adults has twice folded in the past 15 years (CDC, 2013). There is increasing concern about creating awareness about the prevalence rate of diabetes among old adults in the United States of American because it is projected that older Americans are continuing to be a larger portion of the population (Suhl, 2015). As such, the increasing aging population is a key factor in the growth of type 2 diabetes. There are age-related factors that are attributed to affecting diabetes control. In old adults there is increased difficulty in preparing and eating food, altered senses, decreased mobility, altered blood circulation, ploypharmacy, social changes, muscle weakness, exhaustion, unintentional weight loss and co-morbidities.
Additionally, there are risk factors for insulin-induced hypoglycemia in elderly patients with diabetes. These includes insulin administration errors such as excessive insulin dose, improper timing of insulin with respect to the timing of food intake and injection of wrong insulin type, for example, rapid-acting instead of long-acting insulin. Another risk factor is decreased glucose influx caused by missed meals, fasting and gastroparesis associated with delayed carbohydrate absorption. Lastly, increased insulin sensitivity is a risk factor for insulin-induced hypoglycemia which is related to weight loss, intensive insulin therapy, and increased physical exercise. The signs associated with diabetes in the frail elderly include confusion, drowsiness, weakness, falls, seizures, myocardial infarction, stroke, coma, poor concentration, and coordination.
Interventions
Management strategies for diabetes in old adults are nearly the same as that are applied to the younger groups. As it is shown by CDC national data and statistics of diabetes, diabetes is a common problem in old adults because of the widespread misconceptions concerning the possible outcomes of the unmonitored blood glucose levels, the rate of diabetic complications development and the role of the multidisciplinary management. The first prerequisite of the Directorate strategies of the diabetes is an assessment. Those individuals with known risk factors for diabetes and symptoms of complications of diabetes should be encouraged to attend screening programs. Thus, all persons with over the age 45 years were considered for screening. Those individuals who were found not having diabetes was recommended to undergo retesting after one year. I was able to inform old adults about the symptoms of diabetes such as anorexia, weight loss, incontinence, falls, pain intolerance and behavioral/cognitive changes which had to be reported to the healthcare professionals once they appear so as to get early intervention.
Besides, old adults were taught on how to engage in physical exercise and the potential benefits of exercise in diabetes. Physical exercise increases the insulin sensitivity, glucose tolerance, sense of well-being, liveliness and improved cardiovascular fitness. Furthermore, physical exercise is important because it helps an individual to develop stronger muscles and bones which subsequently reduces the risks of fractures and falls. There was the need to caution those persons with the history of retinal bleed not to engage in strenuous physical exercise because it may result in bone injury, vitreous hemorrhage, and sudden death. Old adults were also taught to routinely check the blood glucose level before and after exercise to establish blood glucose level response patterns concerning exercise regimen. For instance, if blood glucose is more than 250 mg/dl, the patient need to delay the exercise session and if the blood glucose level is less than 120mg/dl, the patient need to take the snack.
Furthermore, a medical nutrition therapy was intervened. This includes nutrition assessment, goal setting, an institution of intervention and evaluation and problem-solving. The nutrition assessment which was included is diet history to determine patient’s eating patterns and food choices, weight history, use of alcohol, nutrient needs, psychosocial problems, patient’s knowledge pertaining nutrition and diabetes, patient’s willingness and ability to change. Individuals who were having overweight were encouraged to moderate diet and increase physical exercise rather than restricting calorie intake. After nutrition assessment, the diet plan was individualized so as to minimize barriers in food management and smooth the progress of eating behavior that will give rise to improved function, clinical outcomes and quality of life. Patients were encouraged to take foods with high fiber content with at least 50 grams per day in their diets. Determination of the caloric needs was varied according to the present weight and level energy among individuals. The recommended calories were ranging from 20kcal/lb to 40 kcal/lb per day to those adults with normal activity patterns. They were educated on maintaining a day-to-day carbohydrate intake at snacks and meals. Patients were advised on abstaining from alcohol for those with the history of alcohol abuse.
Patients were taught on the medications and insulin. First, patients were reminded that it was not their fault to have diabetes because of failing to adhere to diet management to overcome depression because many tend to become depressed one start to talk about oral hyperglycemic or insulin administration. Under the teaching plan, we had to review different types of oral diabetic agents, various types of insulin and how to mix that insulin together. Patients were taught on how to self-administer oral hyperglycemic and insulin medications exactly as prescribed. Alongside that, patients were provided with lists of signs and symptoms diabetes and actions to take in each situation.
Patients had an opportunity to be taught on how to prevent complications of diabetes. Patients were educated on the importance of management of cholesterol and lipids, smoking cessation and blood pressure monitoring. They were also educated on the important of managing other disease processes such as skin and foot care. Patients were instructed on the benefits of washing their feet daily, drying them, inspecting for corns, swelling, bruises, blisters, redness, calluses, and breaks in the skins. There were encouraged to report any changes immediately they appear to their health care provider. Additionally, patients were advised to avoid walking barefoot and to wear non-constricting shoes.
Patients were educated on how to cope up with diabetes since it is a lifelong disease process which calls for lifetime lifestyle changes and commitment. To manage the disease process, they need to minimize or eliminate cardiovascular risk factors which include lipid control, smoke cessation and blood pressure control. They were instructed on treat other minor illness such as flu, cold and gastrointestinal virus as quickly as possible.
Evaluation of the teaching experience
The best assessment to be used at the end of the educational plan is an assessment tool in which the patient will give the feedback based on the teaching plan program sessions. This evaluation tool is used to evaluate each session the patient attended, and he/she is welcome to add any comment. The evaluation will take the format as outlined below and the respondent is required to circle his/her response.
Day 1: General overview of diabetes
The message was easy to comprehend: 1. Agree 2. Neutral 3. Disagree.
My anticipation for attending class was met: 1. Agree 2. Neutral 3. Disagree.
Do you have any comment to add? If any please indicate.
Day 2: blood glucose checking and goals of glucose supervising
The message was easy to comprehend: 1. Agree 2. Neutral 3. Disagree.
My anticipation for attending class was met: 1. Agree 2. Neutral 3. Disagree.
Do you have any comment to add? If any please indicate.
Day 3: medications and insulin injections
The message was easy to comprehend: 1. Agree 2. Neutral 3. Disagree.
My anticipation for attending class was met: 1. Agree 2. Neutral 3. Disagree.
Do you have any comment to add? If any please indicate.
Day 4: complications from diabetes, skin and foot care and exercise and diabetes
The message was easy to comprehend: 1. Agree 2. Neutral 3. Disagree.
My anticipation for attending class was met: 1. Agree 2. Neutral 3. Disagree.
Do you have any comment to add? If any please indicate.
Day 5: Diet, diabetes and coping with diabetes
The message was easy to comprehend: 1. Agree 2. Neutral 3. Disagree.
My anticipation for attending class was met: 1. Agree 2. Neutral 3. Disagree.
Do you have any comment to add? If any please indicate.
The outcome of the evaluation from the patients’ perspective demonstrated that majority of them were able to understand the contents pass. I had also to evaluate my progress regarding the meeting of the budget plus covering all the areas I had in the plan. The time and budget allocated for this community teaching plan were not enough to access all population of the people living with diabetes within my intended location.
Community response to teaching
Areas of strengths and areas of improvement
After the teaching plan, patients were able to demonstrate strong strength in testing blood glucose levels both before the meals and after the meals that greatly assist them to make enhanced food choices concerning how their bodies were responding to certain foods. Patients were in the better position to perform self-blood glucose monitoring on habitual basis because they were able to use their meters and interpret the data after receiving the education. Unfortunately, some patients were not able to use the device properly because of other internal challenges. These were some patients who were having poor visual acuity and dexterity. To provide the remedy to those problems, there is the need to conduct the assessment by health care provider before selecting appropriate glucose monitoring device that will make it comfortable and convenient to the a particular patient.
Furthermore, patients were able to demonstrate self-administration of the oral or insulin as prescribe and to see the sense of taking the medications exactly on time as well as the appropriate dosage as it was prescribed. They were able to interpret the actions to take based on the signs and symptoms of hyperglycemia and hypoglycemia. On a contrary, the health care provider needs to put more emphasize for the patient to remind to record blood glucose values on the log sheet alongside with time and date as well as the associated symptoms and signs the patient was experiencing at that point.
Additionally, the patient showed strong adherence to skin and foot care as it was evidenced by patient caring for their feet by washing them on a daily basis, drying them vigilantly in particular between the toes, and regular inspection for redness, calluses, swelling, blisters, corns, bruises and breaks in their skin. Nevertheless, patients need to be further encouraged to regularly report any alterations to the health care provider as soon as they appear.
Lastly, there is a need to increase the budget and time for the subsequent community teaching. This is because the budget and time I allocated for the community education did not enable me to access adequately all the areas I intended to cover. Hence, there is a need to allocate more funds and more time so as to cover considerable wider community for the next community teaching plan.
References
CDC. (2013). Addressing the Unique Needs of Older Adults with Diabetes. Retrieved from http://www.niddk.nih.gov/health-information/health-communication-programs/ndep/health-care-professionals/webinars/older-adults/Documents/ndep-older-adults-webinar-may-2013-508.pdf
CDC. (2015). National Data | Data & Statistics | Diabetes | CDC. Retrieved from http://www.cdc.gov/diabetes/data/national.html
Suhl, E. (2015). Diabetes Self-Management Education for Older Adults: General Principles and Practical Application. Retrieved from http://spectrum.diabetesjournals.org/content/19/4/234.full
