Palliative Care: A Holistic Approach to Caring for Older People with Diabetes

As a result of the major achievements of modern civilization, people are now living longer than at any other time in history. In a pre-modern world, our ancestors lived for approximately 30 years. Since 1900, the global average life expectancy has more than doubled and is now above 70 years. Among the older population, life expectancy rates have been improving for many decades now.

But does living longer equate to a better quality of life? What about older adults with chronic conditions who need care? Adding years to life is more meaningful when it is supplemented by adding life to years. An article published by Podiatry Today, entitled “When Patients with Diabetes Need Hospice Care” links the rising numbers of older people with diabetes to an increased need for end-of-life care. Contrary to popular opinion, people do not have to be actively dying to qualify for palliative or hospice care. Palliative care is an interdisciplinary speciality that focuses on preventing and alleviating suffering and supporting the best possible quality of life for patients who are facing a serious and/or life-threatening illness.

As the older person with diabetes approaches the end of their life, there comes a time when rigorous glycemic control can not only prove to be of questionable benefit but also has the likelihood to cause harm.

Many clinicians do not converse with their patients on advance care planning because they are either not familiar with palliative care or are reluctant to discuss the issue. However, comprehensive diabetes management includes palliative care and advance care planning. With comorbidities that shorten life-expectancy, the focus then expands from tight glucose control to encompass informed consent, comfort, religious and cultural values, mental, spiritual, and emotional needs.

In a paper published in the American Diabetes Association journal Diabetes Spectrum, the authors explain that many older adults with diabetes experience frailty, and cognitive changes or dementia. They are prone to the unpleasant symptoms associated with these conditions, and consequently often have unmet psychological needs that compound pain and other symptoms.

Advance care planning goes hand in hand with palliative care. It is essential that the older person with diabetes together with the diabetes health care team and family members share perspectives and options to enable informed decisions about future care. This brings value and control into the life of the older adult, where they feel seen and heard, and can make their priorities clear such as, dancing at a grandchild’s wedding or attending a graduation.

The UN Decade of Healthy Ageing focuses on changing how we think, feel and act towards age and ageing, developing communities that foster the abilities of older people, delivering integrated care, and providing older people with access to long-term care. Palliative care ensures a holistic approach to care that considers the older person’s wants and needs. Ensuring quality of life does not stop at a certain age, it continues until the end.

To learn more about end-of-life care for older people with diabetes, contact Prof. Trisha Dunning, Chair in Nursing and Director Centre for Nursing and Allied health Research at Deakin University and Barwon Health in Victoria, Australia, and former Vice President of the International Diabetes Federation, at the IFA Expert Centre, which is an invaluable resource for those interested or involved in the areas of ageing, vision health, human rights, vaccination and more. To learn more about how to contribute to the vital conversation on diabetes and the older person, connect with Dr. Supriya Venigalla (svenigalla@ifa.ngo), and join the DR Barometer community.