After Hurricane Irma that displaced thousands of people and left them without power many elderly patients find it hard to “bounce back” from the stress. The sudden and overwhelming nature of natural disasters can leave many shocked, emotional and uncertain about their future. The constant warning and 24/7 news coverage of destructive weather this year can take a major toll on anyone’s mental health. People can develop PTSD (post-traumatic stress disorder” at any time after experiencing a traumatic event, but 30 days is the minimum to receive a diagnosis. After Hurricane Harvey and the catastrophic flooding, many people are suffering acute symptoms such as depression, anxiety, panic disorder and fear of the unknown. For the elderly and those who have a history of mental illness or dementia they are at a greater risk for developing PTSD. Signs of PTSD include flashbacks and nightmares, avoidance of situations that bring them back to the trauma, heart pounding, trouble breathing. The condition can also lead to feelings of depression and anxiety as well as insomnia. Being displaced during a storm, staying with other people (even family) needing to throw away damaged items, having to buy a refrigerator’s food, dealing with blocked streets and downed trees are stressful for healthy adults and even more so for an elderly person. PTSD in the elderly does
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Question: Sliding Scale orders for insulin is time consuming and sometimes confusing. Is there a better way to prescribe insulin for elderly patients? Answer: According to recent guidelines published in February 2017 by the American Diabetes Association sliding-scales are NOT RECOMMENDED in long-term care. Diabetes affects up to 33% of patients in long-term care facilities The most commonly prescribed insulin therapy for patients in long-term care is sliding-scale insulin (SSI), the use of finger-stick blood glucose testing to assess the need for insulin administration based on current blood glucose levels. Its sole use for long-term treatment is specifically not recommended Recent updates to several published guidelines, including CMS, the Beers criteria, the American Medical Directors Association, and the American Diabetes Association regarding the use of SSI-only insulin regimens for elderly patients in long-term care all advise simplified treatment regimens and avoidance of “sliding-scale” regimens. Below is a summary of the recommendations: Hypoglycemia risk is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred and better tolerated. Sole use of SSI should be avoided. Liberal diet plans have been associated with improvement in food and beverage intake in this population. To avoid dehydration and unintentional weight loss, restrictive therapeutic diets should be minimized. Physical activity and exercise are
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