Abstract
BackgroundHome care services plays an important role in diabetes management, and to enable older adults remain home-dwellers. Adequate follow-up and systematic nursing documentation are necessary elements in high quality diabetes care. Therefore, the purpose of this study was to examine the diabetes treatment and management for older persons with diabetes receiving home care services.MethodsA cross-sectional study was used to assess the diabetes treatment and management in a Norwegian municipality. Demographic (age, sex, living situation) and clinical data (diabetes diagnose, type of glucose lowering treatment, diabetes-related comorbidities, functional status) were collected from electronic home care records. Also, information on diabetes management; i.e. follow-up routines on glycated haemoglobin (HbA1c), self-monitoring of blood glucose, insulin administration and risk factors (blood pressure, body mass index and nutritional status) were registered. HbA1c was measured upon inclusion. Descriptive and inferential statistics were applied in the data analysis.ResultsA total of 92 home care records from older home-dwelling persons with diabetes, aged 66–99 years were assessed. Only 52 (57 %) of the individuals had the diabetes diagnosis documented in the home care record. A routine for self-monitoring of blood glucose was documented for 27 (29 %) of the individuals. Only 2 (2 %) had individual target for HbA1c documented and only 3 (3 %) had a documented routine for measuring HbA1c as recommended in international guidelines. Among 30 insulin treated older individuals, a description of the insulin regimen lacked in 4 (13 %) of the home care records. Also, documentation on who performed self-monitoring of blood glucose was unclear or lacking for 5 (17 %) individuals.ConclusionsThe study demonstrates lack of documentation in home care records with respect to diagnosis, treatment goals and routines for monitoring of blood glucose, as well as insufficient documentation on responsibilities of diabetes management among older home-dwelling adults living with diabetes. This indicates that home care services may be suboptimal and a potential threat to patient safety.
Highlights
Home care services plays an important role in diabetes management, and to enable older adults remain home-dwellers
Delivery, and monitoring of care, we investigated what information was documented in electronic home care records, and further evaluated to what degree the documentation of these aspects was in accordance with guideline recommendations
The aim of this study was to explore what information was documented with regards to diabetes treatment and management in home care records for older people living at home, and to assess if planning and delivery of diabetes care was in accordance with international guidelines
Summary
Home care services plays an important role in diabetes management, and to enable older adults remain home-dwellers. People with diabetes in general have a risk for developing diabetes related complications, and they are in need of careful follow-up to prevent severe complications such as cardiovascular events, falls, pain, depression, infections and lower limb amputations [2]. Self-management refers to activities and behaviours individuals undertake to control and treat their condition [7]. To avoid diabetes-related complications, people with diabetes need to undertake continuous self-management, which include both lifestyle interventions (healthy diet, regular physical activity and maintaining a healthy body weight) and pharmacologic interventions (oral medicines, insulin, to control blood glucose level) [1, 2]. Blood glucose monitoring, recommended for anyone treated with insulin, is a complex task which takes place in the home [2, 8]. Several of the self-management tasks may be challenging to carry out by frail, older individuals, and older home-dwellers with diabetes often need assistance from their next-of-kins or professional health care providers to achieve proper self- management [9]
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