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Health Promotion Final Paper: Diabetes Among Elderly Delawareans

Ashley Buccio

RN to BSN Nursing Program, Delaware Technical Community College

NUR 330: Population and Community Health

Dr. Wagamon

April 3, 2023
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Health Promotion Final Paper: Diabetes Among Elderly Delawareans

Delaware has a large elderly population. Diabetes is especially an issue among elderly

Delawareians. A major problem with diabetes especially among older adults is diabetes can often

go undiagnosed in the geriatric population. The symptoms of diabetes can be brushed off as

being “just a normal part of aging”. Some of the symptoms of type two diabetes include skin

infections and injuries that take longer to heal, constant fatigue, unexplained weight loss,

frequent urination, and blurred vision all of these are common in older adults (Case, 2021).

Because the signs of prediabetes usually go undiagnosed it is often not caught until bigger issues

of diabetes arise.

Seniors can also be more susceptible to type two diabetes due to inactivity, sleep

deprivation, and metabolic syndrome (Case, 2021). Seniors might be less likely to exercise due

to the fear of getting hurt or the inability to get to a place where they can safely exercise.

Exercise can result in more stable blood sugar levels. Older adults are more prone to sleep

deprivation with their changes in sleeping habits as they age. “Decreased or poor quality sleep,

along with elevated blood sugar levels and obesity, can lead to diabetes” (case, 2021). People

with metabolic syndrome tend to have higher blood pressure, a larger waistline, and elevated

cholesterol levels (case, 2021). Getting the proper amount of physical activity and eating healthy

are two main ways to prevent and manage diabetes. Among Delaware adults in a 2019 survey,

“27%” said they “did not participate in any physical activities in the past month” (DHSS, 2021,

p. 14). Overall diabetes is a major issue, especially among older Delawareans. Another major

issue is that many older Delaware residents might not even know that they have diabetes and

they are not doing much to prevent it either.

Review of the Data

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Delaware has a relatively large senior population. According to the US census from 2021

Delaware has approximately “201,551” people over the age of 65 which is about “20.1%” of all

Delawareans (U.S. Census Bureau, 2021). Comparatively the entire united states people aged

“65 years and over” only make up about “16.8%” (U.S. Census Bureau, 2021). Delaware also

has a relatively large number of people with diabetes or prediabetes. In Delaware in 2020 a mere

“3.7 percent” of 18-44 year olds had diabetes, but as the age range rises to 45-54 the prevalence

more than doubled to “10.4 percent”, and that percent almost doubled again for adults aged 55-

64 to “19.41 percent”, and for adults aged 65 and older “23.4 percent” of them had diabetes

(DHSS, 2020).

The percentage of people 65 and older with diabetes is probably higher. “1 in 3 adults” in

the nation has prediabetes, “which puts them at a higher risk for developing type 2 diabetes”, but

“90 percent” of adults do not know they have prediabetes (National Association of Chronic

Disease Directors, 2021). “This suggests there are more than 230,000 adults in Delaware who

have prediabetes but do not know it” and a large percentage of them are seniors (National

Association of Chronic Disease Directors, 2021).

Disparities and Barriers

A barrier for an older adult with a chronic condition might be learning, traveling, and

accessing medications. It takes an old person a longer time to learn something new than it does a

younger adult. If an older adult has type one or two diabetes and has had it their entire life they

won't have to learn anything new and shouldn't have too many problems managing it.

Unfortunately, many people are diagnosed with diabetes later in life. People develop diabetes at

an older age it can be more difficult to learn how to manage it and create a new routine in their
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life. They also have difficulty remembering things which might make it difficult for them to

remember to take their medication or check their blood sugar.

Another barrier for older adults might be getting to and from their doctor's appointments.

Age can also affect someone's ability to drive. According to the U.S. Department of Health and

Human Services (HHS) and the National Institute on Aging (NIA), there are some common

health conditions and medication side effects that may influence a persons driving ability (2022).

Elderly peoples driving ability may be influenced by stiff joints and muscles, trouble seeing,

trouble hearing, medications, slower reaction times, and some medical conditions. According to

the Delaware DMV “Diabetics who take insulin should not drive when there is any chance of an

insulin reaction, blackout, convulsion, or shock. This could result from skipping a meal or snack,

or from taking the wrong amount of insulin” (Delaware Division of Motor Vehicles, n.d., para.

1). The Delaware DMV also recommends having someone else drive the person with diabetes

while the “doctor is adjusting [their] insulin dosage” (Delaware Division of Motor Vehicles,

n.d.).

“If you have diabetes, you should have your eyes checked regularly for possible night

blindness or other vision problems” (Delaware Division of Motor Vehicles, n.d.). U.S. An older

adult's ability to access their medication may be affected by their driving ability as well as their

ability to pay for the medications.

Many seniors rely on their caregivers for transportation to and from places. Today many

people get around using Uber or Lyft but both of those require a person to use their mobile

device or computer to request a ride although Lyft does have a number you can call to request a

ride not many people know about it. Delaware also offers public transit and even reduced fare to

those 65 and older. Many older Americans have difficulty using technology.
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The older population is no longer working and getting the income and health benefits that

they were getting from their job.

SMART Goal #1 Education:

The first goal is to educate the Delaware population on diabetes including the signs and

symptoms of diabetes so that 20% of Delawareans can list some of the signs and symptoms of

diabetes or how to prevent or manage diabetes.

SMART Goal #2 Prices:

The goal in Delaware is to lower the cost of diabetes supplies by the end of the month.

SMART Goal #3 Transportation:

The goal is to be able to have every older Delawarean with diabetes be able to attend

their appointments and get the necessary supplies for their condition by 2024.

Role of the Nurse

A potential role of a nurse is as a health educator. The health educator's job is to inform

the public specifically the higher-risk populations such as the elderly population in DE. The role

of a health educator is important because "education is the cornerstone of healthcare” (Boulton,

2020, para 4). Educating the patients so that they can be self-sufficient at home on their own. The

nurse is not constantly around to be able to check their blood sugar before every meal and at

night. The patient has to know how and when to check their blood sugar for themselves.

One of the roles of a public health nurse (PHN) is advocacy. “Advocacy refers to the

responsibility of PHNs to speak for populations and communities that lack the resources to be

heard” (Savage, 2020, p. 15). If a nurse sees signs or symptoms of diabetes they should get their

patients tested. This is especially important because “some people with type 2 diabetes may not

realize they have it because symptoms often develop slowly and go unnoticed” (U.S. Department
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of Health and Human Services, 2019, para. 8). It is especially important to advocate for the older

adults because “sometimes older adults dismiss [diabetes] symptoms as “getting old,” but they

can be signs of a serious problem” (U.S. Department of Health and Human Services, 2019, para

8).

All types of nurses have many roles which are all important. Education is one of the most

important roles of a nurse. Educating our patients is what keeps our patients from multiple visits

for the same issue and keeps our patients healthy. The nurse can become a diabetes educator or

just educate their patients in the setting that they usually work in. The nurse can also make home

visits to people who have difficulty driving. The nurse can also educate their patients that use

caregivers for transportation that there are alternative means of transportation if they are ever

having difficulty finding a ride to an appointment. The nurse can also inform the patient if they

are able to schedule home visits or telehealth visits. Nurses can collaborate with social workers

and case managers to provide the patient with information on cheaper options.

Interventions and Resources

Resource #1 Education:

There are many resources on diabetes information available to the public for free or at

little cost. Public Health offers two “workshops to help people manage their chronic diseases

more effectively: Diabetes Self-Management Program (DSMP) — for Delawareans with type 2

diabetes, and Chronic Disease Self-Management Program (CDSMP) — for Delawareans with

other chronic diseases” which can include diabetes (Delaware Health and Social Services., n.d.).

These resources can help people with diabetes safely manage their condition on their own.
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Most of the well-known hospitals in Delaware have nationally recognized diabetes self-

management education programs. There are also virtual workshops on self-management of

diabetes. There are also social media campaigns to educate the public on diabetes.

Benefits and Outcomes: Increased proportion of adults who are aware of diabetes risk factors,

signs and symptoms, and resource availability can lead to early identification of individuals with

prediabetes or diabetes. With education on prediabetes and diabetes, there will be improved

disease management; improved quality of life; improved health outcomes; and reduced

healthcare costs.

Resource #2 Costs:

By educating the general public health costs can be reduced. If the public is informed

about prediabetes and how to prevent diabetes or even prediabetes then it'll improve health

outcomes and reduce healthcare costs. A major local policy that affects people with diabetes in

Delaware is a new policy that should be implemented soon. Delaware Governor John Carney

signed a senate bill to “cap the monthly cost of diabetes supplies and equipment at $35 for those

on state insurance plans” (Sainz, 2022). The bill was created due to the large population of

people living in Delaware with diabetes. This policy will go into effect next month on April 26th,

2023 (Delaware General Assembly, n.d.). The cap on the price of diabetes equipment could be

essential for Delawareans who are struggling with the costs of living with the chronic disease.

One role of the public health nurse is to inform the public that this law exists and how to take

advantage of this law. Another role of the nurse is to continue to do all we can to push

lawmakers to make more laws like this which would allow our patients to be able to afford

lifesaving supplies.
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“Overall in 2020, 13.2 percent of Delaware adults age 18 - 64 reported not having health

insurance” (Delaware Health and Social Services, 2020, para.3). That means “about 73,324

Delaware adults did not have health insurance during 2020” (Delaware Health and Social

Services, 2020, para.3). Anyone 65 or older should be covered by Medicare. “In 2017, 94.2

percent of adults 65 and older said they were getting their health insurance through Medicare”

(Delaware Health and Social Services, 2020, para. 9). Therefore the majority of older Delaware

residents have health insurance. Even though they have health insurance it still costs a lot for

supplies for their diabetes. A diabetic who uses insulin “typically spends $4,882 a year on

treatment if they have insurance” (Lee, 2023, para. 8). Over “80% of the annual” amount spent

on treatment is “spent on supplies” that amounts to “$3,992” per year with insurance to manage

their disease (Lee, 2023, para. 8). Some people that can't afford to pay this much might cut back

on their insulin dose or skip a dose. They also might reuse their own needles which can be

unsanitary or share them which can be dangerous. They also might reuse lances which can lead

to inaccurate blood glucose measurements.

Resources #3 Transportation:

Many seniors rely on their caregivers for transportation to and from places. There are

many resources for older people to get lower-cost or free rides to and from doctor's

appointments. Today many people get around using Uber or Lyft but both of those require a

person to use their mobile device or computer to request a ride although Lyft does have a number

you can call to request a ride not many people know about it. Delaware also offers public transit

and even reduced fare to those 65 and older. Many older Americans have difficulty using

technology. Some medications and supplies can be mail ordered. Mail order companies. As well

as home health and telehealth doctor visits.

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Health Promotion Plan

SMART Goal #1 Education Interventions:

Educating the elderly on the signs and symptoms of diabetes is the main intervention that

should be implemented. Education on hypoglycemia and hyperglycemia can be done by an

endocrinologist. Most of the well-known hospitals in Delaware have nationally recognized

diabetes self-management education programs.

SMART Goal #2 Costs Interventions:

To lower the cost of diabetes Delaware residents can ensure that the Senate bill passes so

that diabetes supply costs will be limited in Delaware. Diabetics can also be provided with

information and resources as to how to lower their costs.

SMART Goal #3 Transportation Interventions:

Another way to spread information is to have information on resources for transportation

available to all the patients coming into the office or hospital. Offices and hospitals could offer

telehealth visits or home health visits.

Evaluation

To get diabetes information out to the public healthcare professionals can promote

awareness through online resources and community outreach and collaboration with other

companies such as hospitals and health facilities like gyms. Delaware can put out a questionnaire

asking people about diabetes and if they do not know the answers or get the questions wrong

they can be given the correct information. Professionals can also provide diabetics with

information and resources as to how to lower their costs. The diabetes costs should be evaluated

yearly to determine if they are going down. The transportation can be addressed by determining
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how many older people in Delaware miss their doctor’s appointments because they do not have

transportation.
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References

Boulton, A. (2020, November 14). The nurse and diabetes care. Independent Nurse.

Retrieved from https://www.independentnurse.co.uk/blogs-article/the-nurse-and-

diabetes-care/232170/

Case, A. (2021, August 6). Why are seniors at elevated risk for diabetes?: West Hartford

Health. West Hartford Health & Rehabilitation Center.

https://westhartfordhealth.com/news/senior-health/elevated-risk-diabetes/

Delaware Department of Health and Social Services (DHSS). (2021, June). The Impact

of Diabetes in Delaware 2021.

https://dhss.delaware.gov/dph/dpc/files/diabetesburdenreport2021.pdf

Delaware Division of Motor Vehicles. (n.d.). Senior driving. Division of Motor Vehicles.

Retrieved from https://www.dmv.de.gov/DriverServices/senior/index.shtml?

dc=health_diabetes

Delaware General Assembly. Bill Detail - Delaware General Assembly. (n.d.). Retrieved

from https://legis.delaware.gov/BillDetail/119641

Delaware Health and Social Services. (n.d.). Delaware self-management programs.

Diabetes: Self Management Program. Retrieved from

https://www.dhss.delaware.gov/dhss/dph/dpc/diabetesselfmgt.html

Delaware Health and Social Services. (2020). Prevalence of health care coverage among

Delaware adults, 2020. Health Insurance Coverage. Retrieved from

https://dhss.delaware.gov/dph/dpc/healthinsurance2017.html
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Department of Health and Human Services. (2022). Safe driving for older adults.

National Institute on Aging. Retrieved from https://www.nia.nih.gov/health/older-

drivers#:~:text=As%20you%20age%2C%20your%20joints,wheel%20quickly%2C%20or

%20brake%20safely.

Lee, M. (2023). Diabetes treatment can be incredibly costly. but the biggest cost is

(surprisingly) not insulin. USA Today. Retrieved from

https://www.usatoday.com/story/money/personalfinance/2023/03/19/cost-diabetes-

supplies-worse-than-insulin/11472381002/

National Association of Chronic Disease Directors. (2021, December 20). Delaware

boosts diabetes prevention referrals using EHR and academic detail. Retrieved from

https://chronicdisease.org/success-story/delaware-boosts-diabetes-prevention-referrals-

using-ehr-and-academic-detail/

Sainz, N. (2022, November 14). Delaware caps monthly cost of diabetes supplies at $35.

diaTribe. Retrieved from https://diatribe.org/delaware-caps-monthly-cost-diabetes-

supplies-35

Savage, C. L. (2020). Public/Community Health and Nursing Practice: Caring for

populations. F.A. Davis Company.

U.S. Census Bureau. (2021). Explore census data. https://data.census.gov/table?q=United

%2BStates&t=Older%2BPopulation&g=0400000US10
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U.S. Department of Health and Human Services. (2019, May). Diabetes in older people.

National Institute on Aging. Retrieved from https://www.nia.nih.gov/health/diabetes-

older-people#:~:text=Be%20active.,health%20care%20team%20can%20help.