With November being Diabetes Month, and World Diabetes Day having taken place on 14th November, we wanted to explore get into the nutritional challenges of catering for older people with diabetes in care homes. Here we’ll be looking at:
- Diabetes prevalence
- Complex health conditions and diabetes
- Dementia, nutrition and diabetes
- Hypoglycaemia and nutrition
- Frailty, nutrition and diabetes
- Advice and guidance for catering for older people with diabetes in care homes
- How can software help
With the launch of our new product for the care industry, Saffron Care Catering, we discussed some of the key functionality in our Introduction to Care Catering. We also rounded up the current care industry statistics and what they mean for caterers in Providing nutrition to older people – what is the state of the industry‘ However, our software can help care home caterers manage the specific complexities of diabetes and its complications too, so we wanted to explain how that works in more detail against the backdrop of the diabetes problem in the UK.
Most diabetic people in the UK have Type 1 diabetes, so are often dependent on insulin or other medication. Nobody knows why Type 1 diabetes develops. Type 2 diabetes is associated with poor diet, and sometimes being overweight or obese. However, you can also be genetically pre-disposed to Type 2 diabetes. Type 2 can be managed with dietary and lifestyle changes but may require some drug therapy too.
General UK population
In the general population:
- There are around 3.5 million people currently living with a diagnosis of diabetes (most of them Type 1), but Diabetes UK estimates that there at least a further 500,000 who are undiagnosed.
- This total of people living with diagnosed and undiagnosed diabetes represents 6% of whole UK population.
- It’s predicted that diabetes prevalence will rise to 5 million by 2025.
Clearly, as the UK’s population increases and we all live longer, this will mean more people with diabetes going into care homes in the future.
In older people within care homes
The England-Wide Care Home Diabetes Audit, conducted in 2012-13 and published 2014, revealed that, in the 23% who actually responded:
- There are round 37,625 people living in care homes with a form of diabetes mellitus.
- The audit reports that 10.4% of all care home residents have diabetes, although this sample audit contrasts to Sinclair’s 2001 research and the Care Quality Commission’s report in 2015 – which suggests that more than 25% of care home residents have diabetes. This disparity could be poor record keeping or a failure to recognise diabetes in residents.
- 17% of care homes didn’t have any policy for checking whether residents took their medication.
- 63% of care homes didn’t have a staff member that is designated to have responsibility for managing residents’ diabetes.
- 37% of homes didn’t have a policy for screening their residents for type 2 diabetes.
Complex health conditions and diabetes
Frailty, chronic pain, dementia and other illnesses can all contribute to the poor care of older people with diabetes in care homes. Their clinical presentation can be problematic: they may have no obvious symptoms of diabetes, or symptoms that can be misinterpreted or attributed to other illnesses associated with ageing. Increased disability and general susceptibility to illness associated with ageing may also make self-management of diabetes much harder, requiring more intervention from medical and dietetic staff – and so more consideration from the care home catering team.
As a result, complications stemming from diabetes can happen more often, and require more detailed management. Nutrition has some interplay with both the causes and the effects of these symptoms. Recognised complications can all impact one another, making a vicious cycle. Poor nutritional management may cause or exacerbate hypoglycaemia, affect carb counting for residents that use dietary management, contribute to malnutrition and frailty, and play a role in the dietary management of Type 2 diabetes.
Care plans and information exchange between the catering team and medical and nursing staff, dietetic advisers, healthcare assistants and other care/support workers is absolutely key to the successful nutritional care of diabetic residents.
Dementia, nutrition and diabetes
Diabetes increases the risk of dementia in older people – and within care homes it is further compounded. More of Professor Alan Sinclair’s research suggests that:
- In care homes, the prevalence of cognitive impairment is higher (compared to older people in the community with diabetes): reaching up to 56% of those with diabetes.
- On the other hand, diabetes affects about 13% to 20% of people with dementia.
- The number of cases of people diagnosed with diabetes and dementia is expected to double over the next few decades.
Dementia in older people can complicate basic nutrition, even for those without diabetes. For older people with diabetes and dementia, eating can be a problem on a physical and psychological level. Dementia can cause:
- dysphagia – problems with chewing and swallowing, so reducing food intake and requiring adaptation
- decreased ability and motivation to self-medicate due to cognitive impairment, from carb counting to administering medicine
- changes in the individual’s cognitive relationship to meals – they may forget to eat, forget to communicate hunger or preferences, and so become increasingly at risk of malnutrition (which in turn can further compound diabetes complications)
This will mean that the individual’s holistic nutritional requirements – from physical formats (pureed diets, thickeners and so on) need to be assessed, recorded, and a nutritional care plan then designed and adhered to. Saffron Care Catering can do this: read our product guide and Introduction to Saffron Care Catering.
Hypoglycaemia and nutrition
As well as the fundamental long-term management of diabetes, medical emergencies such as hypoglycaemia need careful attention in care home residents.
- The annual incidence of hypoglycaemia in older people with diabetes reaches 42% in care homes because of the increased additional illnesses a resident may have.
Nutrition and diet obviously play a key part in prevention of ‘hypos’ – residents may need to know exact nutritional information to administer the correct insulin therapy. In addition, malnourished older people with diabetes are at greater risk of hypoglycaemia, so they will need a meal plan that has the correct calorific value, as well as the correct carbohydrate profile.
Frailty, nutrition and diabetes
Muscle mass loss (sacropenia) is accelerated in people with diabetes. Diabetes can lead to increased frailty and so excess disability. Older people with diabetes in care homes will need nutrition that takes into account their carbohydrate (and sometimes fats) intake, as we’ve discussed in relation to hypos, but also nutrition that combats frailty: whether this is increased calories or supplements. Care home caterers need a system to manage this.
Advice and guidance for catering for older people with diabetes in care homes
Although diabetes is a huge problem for the UK, there are worrying deficiencies in joined-up care for diabetic older people in care homes. Here is some of the guidance and advice to help inform care caterers:
From Diabetes UK:
- Diabetes care for older people resident in care homes
- Good clinical practice guidelines for care home residents with diabetes 2010
- Diabetes in care homes – awareness, screening training 2010
Care Quality Commission:
- Guidance for CQC staff: Inspecting the quality of care for residents with diabetes mellitus living in care homes
- Type 2 diabetes in adults: management (link to chaper on patient centred care)
How can software help
Managing diabetes in the long term requires a multi-faceted approach from caterers. That’s why using our Saffron Care Catering in tandem with modules from our main Saffron product can help provide, and evidence, a person-centred approach. Here’s how you can approach the cross-section of needs associated with diabetes in older people:
|Challenge||How Saffron software can help|
|Helping with self-management||Saffron’s recipe and menu module can help design appealing, low carb diet plans, with different menu cycles according to the varying dietary needs of residents. Read more on recipe and menu planning here. The nutritional analysis module provides useful nutritional information for those needing to carb count. Read more on nutritional analysis here.|
|Hypoglycaemia||Saffron’s nutritional analysis module can analyse nutritional profiles to provide information on the correct insulin dosage.|
|Dementia||Saffron Care Catering can record and disseminate an individual’s care needs on a social level, from how they like their food served to where they want to eat and who with. If residents have lost the ability to self-manage, Saffron’s nutritional analysis module can assist care home staff (medical and dietitians) with carb counting and calculating insulin dosage.|
|Dysphagia||Saffron Care Catering can record and disseminate an individual’s specific dietary needs, such as pureed food or thickeners.|
|Frailty and malnutrition||Saffron Care Catering can help record any supplements the individual needs to reduce risk of weight or muscle loss. Saffron’s recipe and menu module can help caterers set guidelines, and design and adapt recipes with high calorific value as needed.|
|Joined-up care||Saffron’s documents module can help share information across all of your teams, making sure every staff member is on the same page, from procurement to chefs to care-workers serving meals.|
With the burden of diabetes and our ageing population set to only increase further, care home caterers need systems in place to ensure better management. To see how our Saffron software can help, call us on 0114 281 6060, email us at firstname.lastname@example.org, or fill out our contact form.