PRACTICE IMPROVEMENT PROJECT

Practice Improvement Project

Abstract

The intent of this project was to analyze variables of cardiac risk from older adults in long-term care with complications of diabetes. More specifically, the intent was to identify how to improve geriatric practice by adopting geriatric guidelines for the management of diabetes in a long- term care facility. This project involved a quantitative retrospective chart review of electronic medical records from 85 patients. The average patient age was 75. Statistical analysis yielded a significance (0.694) that establishes controlling cardiac risk and controlling hypoglycemia as independent variables. Further analysis with logistic regression statistics poses that this model is a favorable model to predict myocardial infarction when controlling both diabetes and cardiovascular risk factors. Establishing protocols that document standards of care for this population will have a potential to improve practice outcomes by identifying early complications of diabetes, establish earlier treatment potential and improve quality of life.

Introduction

Diabetes mellitus is a chronic disease more prevalent in older people, having a large increase in recent years due primarily to increased expectations of life of the general population, increased patient survival with diabetes and a higher incidence of diabetes as a result of changes in lifestyles.

Excess

The purpose of this project was to review the current geriatric practice guidelines to the potential of improving the practice and care for the geriatric diabetic patient age 65 years old, in a long- term care setting. This project evaluated a long-term care practice and facility to determine whether interventions were in place for diabetes control of cardiovascular risk factors and hypoglycemia of the older adult with diabetes mellitus consistent with the American Geriatric Society (AGS) practice guidelines.

After review of the AGS guidelines, we proposed that older persons with diabetes mellitus have higher rates of premature death, functional disability, and coexisting illnesses such as hypertension, coronary heart disease and stroke than those without diabetes. The AGS Guidelines show benefit of treating hypertension, hyperlipidemia, and hypoglycemia as well as utilizing aspirin therapy as a part of diabetes care and management. The AGS guidelines state that only two to three years of such therapy is required to see benefits from better control of blood pressure and lipids. For this reason, this guideline places special emphasis on “domains" particularly important to the reduction of complications for persons with diabetes mellitus (DM) such as high blood pressure, hypercholesterolemia and establishes a need for aspirin therapy. Our review of the electronic medical records (EMR) established a need for further protocols to provide accurate documentation of cardiac risk factors as well as documentation of glycemic control. The American Diabetic Association (ADA, 2004) provided further support of the significance for evaluating current geriatric practice guidelines, noting the chronic nature of the disease which warrants continued medical care and patient education to prevent or minimize both acute and long term complications and management of complex issues beyond glycemic control.

Older adults with Diabetes are at increased risk for developing what is commonly termed “Geriatric ...