Educating Older People with Diabetes

Professor Trisha Dunning AMChair in Nursing and Director Centre for Nursing and Allied

Health Deakin University and Barwon Health, Australia

Common misconceptions about older people’s capacity to learn

o Older people with diabetes are not a homogenous group but they are adult learners and have considerable life experience and often significant experience living with diabeteso Older people do use technologyo You can ‘teach an old dog new tricks’ and, in the process, can often Learn new tricks from old dogs

Some key considerations

Lecture contento Older people with diabetes often do not receive adequate

or appropriate diabetes education

o Teaching styles are often not appropriate to older people’s learning needs or learning styles

o Learning can be compromised by multimorbidities, sensory and functional changes and environmental issues

o Most existing diabetes education guidelines do not encompass the specific education needs of older people

o Inconsistent information from the range of health professionals who manage the individual is confusing and disempowering

o Older people may not regard diabetes as a significant life priority

Teaching and learning

Teaching and learning is an inter-related process

The process should reflect an approach where information is cogenerated between the health professional and the individual older person and in some cases their family/carers

Teaching

The actual aim of a skilled educator is to create an environment in which the person can learnTeaching is an art and a science as well as a creative endeavour

LearningLearning is a complex cognitive process that involves processing information to construct neural pathways and making neural connections with information already stored and consolidated in memoryInformation in store is retrieved when needed but many factors affect memory and the ability to retrieve and use information

Personalise teaching

Teaching must be personalised to make sure it is relevant to the individual:

• Ask the individual what they want to learn/know• Individual’s literacy and numeracy level, learning style and physical

and cognitive capabilities• Learning goals and outcomes considering family/carers if relevant• Can apply the learning • Receives the information in an appropriate format and in an

environment conducive to learning

In addition, the teaching must be appropriately documented and communicated to relevant care providers so everybody ‘sings from the same hymn book’

Survival education

Dietary advice, which must be tailored to the individual rather than ‘standard diet education’Older people often have nutritional deficits that need to be consideredExercise/activity suitable to their functional ability and that is safe e.g. tai chi and progressive weight lifting build muscle strength and help reduce falls riskMedicines self-management including how to recognise and manage hypoglycaemia, other medicine side effects and adverse eventsRecognising and managing hyperglycaemia/sick days to prevent HHS/DKA

Ongoing education

Ongoing education may be planned or opportunistic - teach at the teachable momentOngoing education might encompass eating out, travel, new technologiesThe importance of regular health checks in addition to regular diabetes complication assessmentsCould encompass discussion about what the individual learned experientially, from friends and relatives and on the InternetInformation about planning to stop drivingInformation about end of life e.g. advance care plans and directives and living wills

Characteristics of older learners

Have established beliefs, attitudes and decision- making and problem-solving processesHave a great deal of life and often diabetes-related experienceLike to know what information will be provided so they can decide whether it is relevant to their needsLearn by sharing (peer education)Like to receive information in a range of formats

Factors that affect older people’s learning capacity

Several inter-related factors affect an older person’s ability to learn; these include:Beliefs, attitudes and culture and health statusCognitive, physical and environmental factorsHealth professionals knowledge and skills as well as their beliefs about what older people can and cannot do and what they should and should not do – sadly ageist attitudes are still prevalentThe health professional-older person relationship

Cognitive

Short term memory deficits and other sensory deficits including social isolationReduced reaction time (approximately 20%) that affects information processing and decision-making especially when:

• Complex decisions are needed• The stimulus or cue to action is not relevant to the person• The motor sequence needed to complete a task is complex• Reduced ability to understand concepts• Unwillingness to change• Cognitive reserve is exhausted from long teaching sessions requiring

extended concentration time or repeated tasks

Physical/sensory

Decline in simple and complex motor skills such as eye hand coordination and fine motor skillsUnrelieved painHearing and vision deficits – ensure the person has their glasses and hearing aid with them and the hearing aid is switched onHyper- or hypoglycaemia, which affect memory and concentration in the short and longer term

EnvironmentA quiet environment free from unnecessary distractions such as noise, busy posters and pictures, passers by and loud music is more conducive to learningAdequate lightingComfortable temperatureThe teaching materials are suitable to older people e.g.

• Adequate contrast between text and background• Appropriate font type and font size• Sufficient white space and breaks in the text to rest the eye and reduce the effort

involved in reading• Appropriate illustrations in context rather than disembodied body parts

The education session does not conflict with other activities important to the individualAccess for people in wheel chairs, and walking frames

Health professionals

Teaching competence and communication skillsHealth status when teachingKnowledge about diabetes in particular, and diabetes in older peopleBeliefs and attitudes about:

• Older people’s capacity and willingness to learn• What older people need to know

Effective education

Education is more likely to be effective if the person believes they:

• Need the information i.e. it is relevant to them• Can use the information in their particular situation and

the task is within their physical and cognitive capabilities• Will benefit from the education i.e. it will make a difference• Is able to practise key tasks/skills

Effective education

Proceeds from simple to more complex information Does not provide too much information at once Uses practical examples relevant to the individualUses a variety of teaching stylesAllows the person time to absorb the information and practice new skillsUses clear concise handouts relevant to the individual, the information provided, and culture and literacy level to optimise knowledge retention and provide cues to action

Summary

Educating older people is a joy and a challengeIt involves adopting an holistic, personalised approach to the teaching-learning processPhysical and cognitive capacity need to be considered and family/carers involved when indicated and the individual agreesOlder people might need information outside the ‘standard diabetes’ education usually provided Older people living in aged care homes can benefit from diabetes education