Julius LeBlanc Stewart: 65+ American Paintings

Julius LeBlanc Stewart

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The pharmacological management of diabetes in older people is complex and challenging. It requires a comprehensive understanding of the individual beyond the diabetes itself. Through the ageing years, the older individual presents with diabetes -related and non-related comorbidities and complications, develops functional limitations and psychological issues, and may lack social support and access to care. A disturbance in these categories, known as the four geriatric domains, will negatively affect diabetes self-management and self-efficacy, leading to poor outcomes and complications.

Furthermore, older people with diabetes may be more interested in the management of other chronic conditions such as pain or impaired mobility, and diabetes may be lower in their list of priorities. Proper education must be provided to the older individual and caregivers, with continuous monitoring and counselling, especially when pharmacological interventions offer risks of side effects, adverse reactions and interactions with other medications.

Informed shared medical decisions will help to improve adherence to the regimen; however, such discussions ought to be based on the best evidence available, which is unfortunately limited in this age group. We performed a review focused on pharmacological agents and summarize current evidence on their use for the treatment of diabetes in older people. We encourage clinicians to investigate and incorporate the four geriatrics domains in the selection and monitoring of these agents.

The prevalence of diabetes increases with age. The approach in this age group is influenced by the coexistence of comorbidities and geriatric syndromes, as well as by the polypharmacy found in these patients. All the clinical practice guidelines recommend that glycemic control be individually tailored according to such factors as disease duration, the presence of complications, functional status, life expectancy, and the patient's environment, among other elements. In general, the therapeutic approach in older persons does not differ from that recommended in the younger population: The main limitation is hypoglycemia, which is the most common and severe factor in this age group.

Therapeutic recommendations in elderly persons with diabetes are based on expert opinion, since these patients are usually excluded from clinical trials. Consequently, clinical judgment is required to optimize the treatment of diabetes , with an emphasis on interventions to prevent symptoms and improve quality of life.

DPP-4 inhibitors can be used, due to their low risk of hypoglycemias and safety. Depression among older adults with diabetes mellitus. Older adults with Diabetes Mellitus DM experience greater risk for comorbid depression compared to those who do not have DM.

Julius LeBlanc Stewart

Undetected, untreated or under-treated depression impinges an individual's ability to manage their DM successfully, hinders their adherence to treatment regime, and undermines provider-patient relationships. Thus, in the context of caring for older adults with DM, comorbid depression presents special challenges and opportunities for clinicians. In this article, we summarize the clinical presentation of late-life depression, potential mechanisms of comorbidity of depression and DM, importance of depression in the successful management of DM, and available best practice models for depression treatment.

Diabetes and cardiovascular disease in older adults: The prevalence of diabetes increases with age, driven in part by an absolute increase in incidence among adults aged 65 years and older. Individuals with diabetes are at higher risk for cardiovascular disease, and age strongly predicts cardiovascular complications. Inflammation and oxidative stress appear to play some role in the mechanisms underlying aging, diabetes , cardiovascular disease, and other complications of diabetes.

However, the mechanisms underlying the age-associated increase in risk for diabetes and diabetes -related cardiovascular disease remain poorly understood. Moreover, because of the heterogeneity of the older population, a lack of understanding of the biology of aging, and inadequate study of the effects of treatments on traditional complications and geriatric conditions associated with diabetes , no consensus exists on the optimal interventions for older diabetic adults. The Association of Specialty Professors, along with the National Institute on Aging, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Heart, Lung, and Blood Institute, and the American Diabetes Association, held a workshop, summarized in this Perspective, to discuss current knowledge regarding diabetes and cardiovascular disease in older adults, identify gaps, and propose questions to guide future research.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. Diabetes and Cardiovascular Disease in Older Adults: Current Status and Future Directions. Drug treatment of hypertension in older patients with diabetes mellitus. Both diabetes mellitus DM and hypertension are independent risk factors for cardiovascular CV related morbidity and mortality. Optimal BP targets were not identified in elderly patients with DM and hypertension.

In this review article, the authors briefly discuss the pathophysiology of hypertension in elderly diabetics , present evidence with various antihypertensive drug classes supporting the treatment of hypertension to reduce CV events in older diabetics , and then discuss the optimal target BP goals in these patients. When medications are required for optimal BP control in addition to lifestyle measures, either thiazide diuretics, angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers, or calcium channel blockers should be considered as initial therapy.

Combinations of medications are usually required in these patients because BP control is more difficult to achieve in diabetics than those without DM. Mobile application for diabetes self-management in China: Do they fit for older adults?

Despite the exponential proliferation of Chinese diabetes applications, none are designed to meet the needs of the largest potential user population. The purpose of this study is to examine the features and contents of Chinese diabetes mobile applications in terms of their suitability for use by older adults with diabetes. A search of the Apple application store and the Mobile Assistant was conducted to identify Chinese diabetes applications. Next, we compared the features and contents of all the included and most popular diabetes applications with both the International Diabetes Federation IDF clinical guideline and recommended usability criteria for older adults respectively.

Seventy-one diabetes apps were randomly selected from a pool of diabetes apps and reviewed. The features of most apps failed to include content areas of known importance for managing diabetes in older adults. Usability of all tested applications was rated moderate to good. Designing maximally effective medical applications would benefit from attention to both usability and content guidelines targeted for the largest potential user population.

Despite the preponderance of older adults in the potential user group, failing to consider the relevance of content, in addition to usability for the specific population will ultimately limit the usefulness of the app. Diabetes Self-Care and the Older Adult. The prevalence of diabetes is highest in older adults, a population that is increasing. Diabetes self-care is complex with important recommendations for nutrition, physical activity, checking glucose levels, and taking medication.

Older adults with diabetes have unique issues which impact self-care. As people age, their health status, support systems, physical and mental abilities, and nutritional requirements change. Furthermore, comorbidities, complications, and polypharmacy complicate diabetes self-care. Depression is also more common among the elderly and may lead to deterioration in self-care behaviors.

Because of concerns about cognitive deficits and multiple comorbidities, adults older than 65 years are often excluded from research trials. This review summarizes the current literature, research findings, and expert and consensus recommendations with their rationales. Salivary function and glycemic control in older persons with diabetes. There is no consensus on the possible association between diabetes and salivary dysfunction in older persons with diabetes. This study's purpose was to investigate the effect of diabetes and glycemic control on salivary function in an older population.

Twenty nine persons with type 2 diabetes and 23 nondiabetic control subjects participated age range, years. Diabetic status was determined by a glycosylated hemoglobin HbA 1c test and a 2-hour glucose tolerance test. Unstimulated whole saliva, unstimulated parotid, and stimulated parotid flow rates were measured, and subjects completed a standardized xerostomia questionnaire.

There were no significant differences in xerostomic complaints based on diabetic or glycemic control status or salivary flow rates. These results provide some evidence that poorly controlled diabetes may be associated with salivary dysfunction in older adults who have no concomitant complaints of xerostomia.

Glycemic targets and medication limitations for type 2 diabetes mellitus in the older adult. To review the optimal management of type 2 diabetes mellitus T2DM in the older adult. A PubMed search was completed to identify publications in the English language from to using combinations of the search terms: References of articles were also reviewed for inclusion if not identified in the PubMed search. Original studies, clinical reviews, and guidelines were identified and evaluated for clinical relevance. Although the number of older adults with T2DM is growing, evidence for the treatment of T2DM in this population is lacking.

Barriers such as polypharmacy, comorbid conditions, economic limitations, cognitive impairment, and increased risk of hypoglycemia may limit optimal glycemic control in older adults. Several organizations provide recommendations for glycemic targets and recommend using standard glycemic goals in most healthy older adults. However, less stringent goals are necessary in certain older populations such as those patients with limited life expectancy and severe hypoglycemia.

In general, glycemic goals should be individualized in older patients. Age-related pharmacokinetic and pharmacodynamic changes, comorbid conditions, adverse drug reactions, ease of medication administration, and cost of medications necessitate the need to individualize pharmacologic therapy. Glycemic targets and medication use for T2DM should be individualized in older adults. Excessive loss of skeletal muscle mass in older adults with type 2 diabetes. A loss of skeletal muscle mass is frequently observed in older adults. The aim of the study was to investigate the impact of type 2 diabetes on the changes in body composition, with particular interest in the skeletal muscle mass.

We examined total body composition with dual-energy X-ray absorptiometry annually for 6 years in 2, older adults. We also measured mid-thigh muscle cross-sectional area CSA with computed tomography in year 1 and year 6. At baseline, g oral glucose challenge tests were performed. Longitudinal regression models were fit to examine the effect of diabetes on the changes in body composition variables. Older adults with either diagnosed or undiagnosed type 2 diabetes showed excessive loss of appendicular lean mass and trunk fat mass compared with nondiabetic subjects.

Thigh muscle CSA declined two times faster in older women with diabetes than their nondiabetic counterparts. These findings remained significant after adjusting for age, sex, race, clinic site, baseline BMI, weight change intention, and actual weight changes over time. Type 2 diabetes is associated with excessive loss of skeletal muscle and trunk fat mass in community-dwelling older adults. Older women with type 2 diabetes are at especially high risk for loss of skeletal muscle mass.

Clinically significant cognitive impairment in older adults with type 1 diabetes. Little is known about cognition in older adults with type 1 diabetes. The aim of this study was to identify correlates of clinically significant cognitive impairment. Diabetes duration, diagnosis age, daytime CGM, and lifetime severe hypoglycemic events were not related to cognitive impairment status.

Clinically significant cognitive impairment was common in older adults with type 1 diabetes. Diabetes -related correlates of cognitive impairment were identified , including hypoglycemia unawareness, recent severe hypoglycemic events, and CGM variables. Longitudinal research is needed to determine if these variables predict cognitive decline and if their modification alters outcomes.

Rowe and Kahn's concept of successful aging remains an important model of well-being; additional research is needed, however, to identify how economically and socially disadvantaged older adults experience well-being, including the role of life events. Data were coded using an inductively derived codebook. Codes related to aging, disease prognosis, and "worldview" were thematically analyzed to identify constructions of well-being. Participants evaluate their well-being through comparisons to the past and to the illnesses of friends and family.

Diabetes self-care motivates social engagement and care of others. At times, distrust of medical institutions means well-being also is established through nonadherence to suggested biomedical treatment. Hardship and illness in participants' lives frame their diabetes experience and notions of well-being. Providers need to be aware of the social, economic, and political lenses shaping diabetes self-management and subjective well-being. For permissions, please e-mail: To review the epidemiology, pathophysiology, screening and diagnosis, and optimal treatment of diabetic autonomic neuropathy DAN and its implications in older adults.

A search of PubMed using the Mesh terms " diabetes ," "type 1," "insulin-dependent," "T1DM," and " diabetic autonomic neuropathy" was performed to find relevant primary literature. Additional search terms "epidemiology," "geriatric," and "risk" were employed. All English-language articles from to appearing in these searches were reviewed for relevance.

Related articles suggested in the PubMed search and clinical guidelines from the American Diabetes Association and the American Association of Clinical Endocrinologists were reviewed. These uncovered further resources for risk stratification, pathophysiology, diagnosis, and treatment of DAN.

DAN is highly prevalent in the diabetes population and increases the risk of morbidity and mortality in older adults, yet, often goes undiagnosed and untreated. Treatment of DAN is complex in the older adult because of poor tolerability of many pharmacologic treatment options; therefore, great care must be taken when selecting therapy as to avoid unwanted adverse effects.

With increasing life-expectancy of patients with diabetes mellitus, awareness of DAN and its implications to older adults is needed in primary care. Consistent screening and appropriate treatment of DAN in older adults with diabetes mellitus is essential in helping to maintain functional status and avoid adverse events. This analysis describes physical activity levels and factors associated with physical activity in an ethnically diverse African American, Native American, white sample of rural older adults with diabetes.

Data were collected using a population-based, cross-sectional stratified random sample survey of community-dwelling…. Objectives To explore factors associated with the provision of diabetes -monitoring practices among older Latinos with type 2 diabetes. Multivariate logistic regression modeled the relationship between health status and sociodemographic factors and the receipt of semiannual HbA1c tests, annual foot exams, and annual retinal exams.

Higher English-language proficiency and health insurance coverage were associated with the provision of HbA1c tests and foot exams, but not retinal exams. Insulin therapy was positively associated with semiannual HbA1c testing, but negatively associated with foot exams. Discussion There are considerable missed opportunities in the provision of diabetes monitoring for older Latinos, particularly those with limited English proficiency, less comprehensive insurance, and noninsulin therapy. Laiteerapong, Neda; Karter, Andrew J. Administrative records were used to ascertain diagnoses of geriatric syndromes, diabetes complications, and hypoglycemia.

Associations were estimated between HRQL and exposures in exposure-specific and combined exposure models any syndrome, any complication, or hypoglycemia. The lowest physical HRQL was associated with amputation. Addressing geriatric syndromes and avoiding hypoglycemia should be given as high a priority as preventing diabetes complications in older adults with diabetes. Dietary screening tool identifies nutritional risk in older adults No rapid methods exist for screening overall dietary intakes in older adults.

The purpose of this study was to develop and evaluate a scoring system for a diet screening tool to identify nutritional risk in community-dwelling older adults. The dietary screening tool was able to characterize 3 levels of nutritional risk: Individuals classified as at nutritional risk had significantly lower indicators of diet quality Healthy Eating Index and Mean Adequacy Ratio and intakes of protein, most micronutrients, dietary fiber, fruit, and vegetables.

The at-risk group had higher intakes of fats and oils and refined grains. The dietary screening tool is a simple and practical tool that can help to detect nutritional risk in older adults. Synopsis Depression is among the leading causes of decreased disability-adjusted life years in the world1 and a serious public health problem. Conversely, history of depression increases the risk for new onset DM. Moreover, recent studies have suggested that co-occurring depression and DM may accelerate cognitive decline, highlighting the importance of treating depression and DM.

Several treatment modalities are available, which can be used to treat and manage depression in primary care settings: An evidence-based health care delivery model is also available for treating depression in primary care settings. However, most of these data are not specific to elderly patients, and none are specific to individuals age 80 or older. Almost all of these older patients have type II diabetes.

Elderly patients are still at risk for the long term The efficacy of lowering isolated systolic hypertension among diabetic patients age 60 or older was established by a subgroup analysis of the Systolic. Obesity and diabetes are known risk factors for the development of physical disability among older adults. With the number of seniors with these conditions rising worldwide, the prevention and treatment of physical disability in these persons has become a major public health challenge.

Sarcopenia, the progressive loss of muscle mass and strength, has been identified as a common pathway associated with the initial onset and progression of physical disability among older adults. A growing body of evidence suggests that metabolic dysregulation associated with obesity and diabetes accelerates the progression of sarcopenia, and subsequently functional decline in older adults.

The focus of this brief review is on the contributions of obesity and diabetes in accelerating sarcopenia and functional decline among older adults. We also briefly discuss the underexplored interaction between obesity and diabetes that may further accelerate sarcopenia and place obese older adults with diabetes at particularly high risk of disability. Self-reported diabetes education among Chinese middle-aged and older adults with diabetes.

To compare self-reported diabetes education among Chinese middle-aged and older adults with diabetes in three population groups: The sample included participants age 45 and older who reported having diabetes diagnosed from a health professional. We performed multilevel regressions performed to examine the associations between characteristics and different aspects of diabetes education received. Our study shows that Among those who received information, After controlling socioeconomic factors, life style, number of comorbidities and community factors, we found that compared with migrant population and rural residents, urban residents were more likely to receive diabetes education on diet.

Urban residents were also more likely to obtain diabetes education and more aspects of diabetes education comparison with migrants and rural residents. Our study suggests diabetes education is a serious concern in China, and a significant proportion of the participants did not receive advice on smoking control and foot care.

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Rural residents and migrants from rural areas received much less diabetes education compared with urban residents. Efforts to improve diabetes educations are urgently needed in China. Diabetes Management and Education in Older Adults: Diabetes in older adults is increasing in its prevalence and complexity. To date, little research has been done to inform current diabetes management, including education and support, in older adults in Canada. The objective of this interactive national workshop was to develop key research priorities for future research related to diabetes in older adults.

Workshop participants comprised interprofessional healthcare providers, decision makers and policy makers from across Canada. Approximately 30 individuals attended an interactive 2-day meeting that included expert presentations and group consensus building using an electronic meeting system as well as nominal group techniques. The results of the 2-day meeting found more than 50 ideas that were summarized into 5 overall themes, with 14 subquestions, reflecting areas such as 1 identifying relevant outcomes for patients, providers and decision makers; 2 diabetes prevention; 3 the impact of diabetes on older adults and informal caregivers; 4 risk assessment tools and 5 effective models of care across a variety of healthcare settings.

To date, this workshop is the first of its kind and follows suit with other international working groups and associations. The research priorities developed through consensus from this workshop set forward a research agenda for diabetes in older adults in Canada. Published by Elsevier Inc. Purpose The purpose of this systematic review was to describe what is known about the diabetes disparity affecting Puerto Rican identified adults living in the continental United States as well as illuminate areas that merit further investigation.

Search limits included identified Hispanic subgroup is disproportionately affected by diabetes -the diabetes disparity. Puerto Rican identified Hispanic adults are less affected by citizenship status, may be less affected by English proficiency, use health care services differently, and have contextually different fatalistic views of diabetes compared with other Hispanic identified people. Conclusion Ambiguous use of the term Hispanic should be avoided when describing Hispanic subgroups. Stronger, more robust studies are needed to understand the unique cultural forces influencing the poor diabetes outcomes and individual behaviors that contribute to generally suboptimal diabetes self-care for Puerto Rican adults with type 2 diabetes.

An interactive resistance chair RC exercise system has been designed to support patients at home in following their individualized strengthening exercise plan. The aim of this study was 1 to introduce a computer-assisted home-based resistance exercise for older adults and 2 to demonstrate feasibility of the proposed system in older adults with diabetes.

The RC exercise system was well accepted by older adults with diabetes regardless of education level, race or gender. The post-task questionnaires demonstrated ease of system use and satisfaction with the system. The attitudinal survey results showed positive seniors' attitudes towards the RC exercise system. The system usability SUS scale score was From the qualitative interviews, individualized feedback yielded important system upgrade solutions that can be useful in tailoring patient needs, values and preferences specific for seniors with diabetes.

Further research is warranted to assess impact of RC exercise system in home setting with a larger sample size in a randomized trial. Identifying countermeasure strategies to increase safety of older pedestrians. The increase in the older population as well as its increased frailty has led the National Highway Traffic Safety Administration NHTSA to conduct research initiatives examining the safety and mobility of older adults. Although older adults are stru Diabetes and Cognitive Decline in Older Adults: The Ginkgo Evaluation of Memory Study.

Previous studies have shown that individuals with diabetes exhibit accelerated cognitive decline. However, methodological limitations have limited the quality of this evidence. Heterogeneity in study design, cognitive test administration, and methods of analysis of cognitive data have made it difficult to synthesize and translate findings to practice. We analyzed longitudinal data from the Ginkgo Evaluation of Memory Study to test our hypothesis that older adults with diabetes have greater test-specific and domain-specific cognitive declines compared to older adults without diabetes.

Tests of memory, visuo-spatial construction, language, psychomotor speed, and executive function were administered. Test scores were standardized to z-scores and averaged to yield domain scores. Linear random effects models were used to compare baseline differences and changes over time in test and domain scores among individuals with and without diabetes. Among the 3, adults, aged years, 9. Over a median follow-up of 6. For the composite cognitive domain scores, participants with diabetes exhibited lower baseline executive function and global cognition domain scores, but no significant differences in the rate of decline.

Identifying cognitive domains most affected by diabetes can lead to targeted risk modification, possibly in the form of lifestyle interventions such as diet and physical activity, which we know to be beneficial for improving vascular risk factors, such as diabetes , and therefore may reduce the risk of executive dysfunction and possible dementia. The purpose of this study of adults with type 1 diabetes was to analyze patterns of diabetes self-management behaviors and predictors of glycemic control across the adult life span.

This study was a secondary cross-sectional analysis of data from of 7, adults enrolled in the Type 1 Diabetes Exchange clinic registry who were divided into four developmental stages emerging, young, middle-aged, and older adults. Data were collected by questionnaire and medical record review at enrollment.

Statistical analyses compared sociodemographic, clinical, and diabetes -related factors across groups. The sample was divided according to adult developmental stage: Emerging adults had the highest mean hemoglobin A 1c level 8. Identifying groups of nonparticipants in type 2 diabetes mellitus education. Patient education is a compulsory element of the nationwide disease management program DMP for type 2 diabetes mellitus in Germany. However, a considerable proportion of patients do not attend diabetes self-management education courses.

Therefore, the purpose of this study was to describe patient-reported reasons for nonparticipation and to identify typical subgroups of nonparticipants in order to improve recruitment strategies. The authors performed a cross-sectional observational study on participants and nonparticipants in diabetes education using a postal survey and chart review. Nonparticipants were grouped by cluster analysis based on the reasons for nonparticipation. The authors identified 4 typical subgroups of nonparticipants: Also, differentiating barriers of nonparticipants can be determined by the degree of feeling informed and responsible for diabetes management.

Physicians should more clearly explore patients' perception of their knowledge of diabetes and their attribution of responsibility for diabetes management. Starting from this patient perspective might help physicians motivate patients to participate in diabetes education. Screening and identifying diabetes in optometric practice: Unconventional settings, outside general medical practice, are an underutilised resource in the attempt to identify the large numbers of people with undiagnosed diabetes worldwide. The study investigated the feasibility of using optometry practices opticians as a setting for a diabetes screening service.

Adults attending high street optometry practices in northern England who self-reported at least one risk factor for diabetes were offered a random capillary blood glucose rCBG test. Of adults attending practices for sight tests, Of these, Screening in optometric practices provides an efficient opportunity to screen at-risk individuals who do not present to conventional medical services, and is acceptable and appropriate.

Optometrists represent a skilled worldwide resource that could provide a screening service. This service could be transferable to other settings. Prevalence and correlates of diagnosed and undiagnosed type 2 diabetes mellitus and pre- diabetes in older adults: The prevalence of type 2 diabetes and pre- diabetes has increased rapidly in recent decades and this trend will continue as the global population ages. This study investigates the prevalence of, and factors associated with, diagnosed and undiagnosed type 2 diabetes mellitus and pre- diabetes in older adults in Ireland.

Diagnosed diabetes was defined using self-reported doctors' diagnosis and medications data. Glycated haemoglobin HbA1c analysis was used to identify undiagnosed and pre- diabetes. Age and sex-specific prevalence estimates were generated. Logistic regression was used to investigate the association between diabetes classification and the demographic, health and lifestyle characteristics of the population. The prevalence of diagnosed and undiagnosed type 2 diabetes was 8. Diabetes was more prevalent in men than women and increased with age.

The prevalence of pre- diabetes was 5. Diabetes and pre- diabetes were independently associated with male sex, central obesity and a history of hypertension, while undiagnosed diabetes was associated with geographic location and medical costs cover. Despite high rates of obesity and other undiagnosed health conditions, the prevalence of undiagnosed and pre- diabetes is relatively low in community-dwelling older adults in Ireland. Addressing lifestyle factors in this population may help to further reduce the prevalence of pre- diabetes and improve outcomes for those with a previous diagnosis.

Diabetes mellitus and risk of falls in older adults: However, studies on diabetes mellitus and the risk of falls have yielded conflicting results. Our objective was to investigate the effect of diabetes mellitus on the risk of falls in older adults by conducting a systematic review and meta-analysis. Only prospective cohort studies reporting at least age-adjusted risk estimate of falls compared diabetic to non- diabetic individuals were selected. Diabetes mellitus was ascertained by a combination of medical history and laboratory tests or use of anti- diabetic drugs.

The number of falls in diabetic and non- diabetic individuals was of 1, For Permissions, please email: A Prospective Cohort Study. Background Older adults with type 2 Diabetes Mellitus are at increased risk of falling. The current study aims to identify risk factors that mediate the relationship between diabetes and falls.

Methods older adults with diabetes and 95 healthy controls underwent a medical screening. Falls were prospectively recorded during a month follow-up period using monthly calendars. Results Compared to controls, diabetes participants scored worse on all physical and cognitive measures. Sixty-four participants 42 diabetes vs. Univariate logistic regression identified diabetes as a risk factor for future falls Odds Ratio 2. Stepwise multiple regressions defined diabetes and poor balance as independent risk factors for falling. Taking more medications, slower walking speed, shorter stride length and poor cognitive performance were mediators that reduced the Odds Ratio of the relationship between diabetes and faller status relationship the most followed by reduced grip strength and increased stride length variability.

Conclusions Diabetes is a major risk factor for falling, even after controlling for poor balance. Taking more medications, poorer walking performance and reduced cognitive functioning were mediators of the relationship between diabetes and falls. Tailored preventive programs including systematic medication reviews, specific balance exercises and cognitive training might be beneficial in reducing fall risk in older adults suffering from diabetes. Research regarding older adults and, in particular, those with diabetes , lags far In this study, patients over age 70 with diabetes will be randomized to care by either geriatric diabetes intervention team GDT or attention Diabetes Management in the Elderly: Metabolic parameters and cognitive function in a cohort of older diabetic patients.

Dementia is one of the most disabling conditions associated with old age. With increasing life expectancy, prevalence of both dementia and diabetes is rising. The complex pathological relationship between diabetes mellitus DM and dementia has been studied, but is not yet fully understood. The main objective of this study was to investigate the relationship between metabolic parameters and the cognitive function in older diabetics. By employing a multivariate linear regression analysis, several significant relationships have been identified: The close detailed monitoring of the cognitive function and a rigorous metabolic control are important, especially in the very early stages of DM.

Addressing factors such as weight control in older diabetic patients could contribute to better cognitive outcomes. The association between environmental quality and uncontrolled diabetes among older adults in the U. From to , the diagnosed diabetes rate in the U. Recent studies have suggested factors such as air quality, neighborhood characteristics, and the social environment are associated with diabetes in older adu Balance training reduces falls risk in older individuals with type 2 diabetes.

Sixteen individuals with type 2 diabetes and 21 age-matched control subjects aged years participated. Postural stability and falls risk was assessed before and after a 6-week exercise program. Diabetic individuals had significantly higher falls risk score compared with control subjects.

The diabetic group also exhibited evidence of mild-to-moderate neuropathy, slower reaction times, and increased postural sway. Following exercise, the diabetic group showed significant improvements in leg strength, faster reaction times, decreased sway, and, consequently, reduced falls risk.

Older individuals with diabetes had impaired balance, slower reactions, and consequently a higher falls risk than age-matched control subjects. Together these results demonstrate that structured exercise has wide-spread positive effects on physiological function for older individuals with type 2 diabetes. Diabetes is associated with subclinical functional limitation in nondisabled older individuals: The aim of this study was to examine the role of comorbid conditions and body composition in the association between diabetes and subclinical functional limitation, an indication of early functional decline, in well-functioning older individuals.

This was a cross-sectional analysis of 3, well-functioning black and white men and women aged years, enrolled in the Health, Aging, and Body Composition study. Subclinical functional limitation was defined using self-report of capacity and objective performance measures. Comorbid conditions were identified by self-reported diagnoses, medication use, and clinical measures. Body composition measures included anthropometry and total fat dual X-ray absorptiometry. Of 2, participants, 1, This association remained significant when adjusted for body composition measures OR 1.

In a well-functioning older population, diabetes is associated with early indicators of functional decline, even after accounting for body composition and diabetes -related comorbidities. Poor glycemic control contributes to this relationship. Whether improvement in glycemic control in older people with diabetes would change this association should be tested.

Multifactorial intervention for diabetes control among older users of insulin. To evaluate if the closer follow-up with the supply of insulin pens and the measurement of capillary blood glucose improve the management of older patients with type 2 diabetes without adequate glycemic control despite extensive therapy. This is a prospective, non-randomized, quasi-experimental study. The intervention consisted of monthly medical visits, with the provision of insulin pens and strips for blood glucose measurement.

Treatment was adjusted with the same endocrinologist monthly for six months. Glycated hemoglobin was measured at baseline and 12 and 24 weeks after intervention. Glycated hemoglobin at baseline was The association between cognitive decline and incident depressive symptoms in a sample of older Puerto Rican adults with diabetes.

Older Puerto Rican adults have particularly high risk of diabetes compared to the general US population. Diabetes is associated with both higher depressive symptoms and cognitive decline, but less is known about the longitudinal relationship between cognitive decline and incident depressive symptoms in those with diabetes. This study investigated the association between cognitive decline and incident depressive symptoms in older Puerto Rican adults with diabetes over a four-year period.

Households across Puerto Rico were visited to identify a population-based sample of adults aged 60 years and over for the Puerto Rican Elderly: Health Conditions study PREHCO ; participants with diabetes at baseline and no baseline cognitive impairment were included in analyses. In a covariate-adjusted logistic regression model, cognitive decline, female gender, and greater diabetes -related complications were each significantly associated with increased odds of incident depressive symptoms p older age were associated with greater cognitive decline, and higher education was related to less cognitive decline p older Puerto Ricans with diabetes who also experienced cognitive decline.

Efforts are needed to optimize diabetes management and monitor for depression and cognitive decline in this population. Residents in rural communities in the United States, especially ethnic minority group members, have limited access to primary and specialty health care that is critical for diabetes management. This study examines primary and specialty medical care utilization among a rural, ethnically diverse, older adult population with diabetes.

In-home interviews, observed medications, and A1C were used to stratify by diagnosed diabetes , undiagnosed diabetes , or no diabetes. Logistic regression was used to model associations between diabetes conditions and sexual characteristics, separately by gender. Women with diagnosed diabetes were less likely than men with diagnosed diabetes adjusted odds ratio 0. Partnered sexual behaviors did not differ by gender or diabetes status.

The prevalence of orgasm problems was similarly elevated among men with diagnosed and undiagnosed diabetes compared with that for other men, but erectile difficulties were elevated only among men with diagnosed diabetes 2. Women with diabetes were more likely than men to cease all sexual activity. Older women with diabetes are as likely to have sexual problems but are significantly less likely than men to discuss them.

Factors associated with fear of falling in community-dwelling older adults with and without diabetes mellitus: This study aimed to investigate the associated factors with fear of falling in community-dwelling older adults with and without diabetes mellitus. The potential factors associated with fear of falling included sociodemographic data, chronic diseases, health-related variables and functional capacity measures. Logistic regression analysis was performed to identify the factors associated with fear of falling.

Female gender, arthritis or rheumatism, negative health self-perception, frailty, lower Lawton Scale score and reduced gait speed were independently associated with fear of falling in both groups. Factors associated with fear of falling specific to non- diabetic older adults were depression, visual impairment, falls in the previous 12months, obesity, depressive symptoms, higher Katz Index score and decreased handgrip strength.

Lower Mini-Mental State Examination score was an associated factor with fear of falling only in those with diabetes. The factors associated with fear of falling did differ between non- diabetic and diabetic older adults. Health care professionals should consider such differences when planning their therapeutic approaches for a successful management of fear of falling in these older populations. The most common and clinically significant neuropathies of T2DM include uremic neuropathy, peripheral neuropathy, and cardiac autonomic neuropathy.

Although advances in gene sequencing technologies have identified several genetic variants that may regulate the development and progression of T2DM, little is known about whether or not the variants are involved in disease progression and how these genetic variants are associated with diabetic neuropathy specifically. Significant missing heritability data and complex disease etiologies remain to be explained. This article is the first to provide a review of the genetic risk variants implicated in the diabetic neuropathies and to highlight potential commonalities.

Identifying needs and barriers to diabetes education in patients with diabetes. To assess the needs, awareness and barriers to diabetes education for self management and to facilitate the initiation of an education programme promoting self care among diabetics and their families. A qualitative study was conducted among adult diabetics attending outpatient clinics in a tertiary care teaching hospital in Karachi, Pakistan.

Semi-structured interviews were conducted on 27 subjects 11 men; 16 women to identify dominant themes and priority issues. Participants displayed great deal of variation with respect to level of knowledge and motivation for education. Most believed that diabetes was caused by stress. Family was perceived to be a source of positive support.

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Relative ease of adherence to pharmacological regimens as compared to diet and exercise was reported. Participants expressed frustration at chronicity of disease and fear of developing certain specific complications and inheritance by their children. Barriers to enhancing knowledge included 'No need for further information', distance from training institutions and other priorities. Knowledge, beliefs and fears about diabetes , family influence and accessibility of healthcare, affects management behaviours and learning.

Understanding needs and expectations of people with diabetes is essential in initiating and improving the outcomes of education programme for diabetes self care. Although most children with type 1 diabetes do not achieve optimal glycemic control, no systematic method exists to identify and address self-management barriers. HbA1c was abstracted from the electronic health record.

Factor analyses of adolescent and parent data yielded well-fitting models of self-management barriers, reflecting the following domains: Results Factor analyses of adolescent and parent data yielded well-fitting models of self-management barriers, reflecting the following domains: All models exhibited good fit, with X2 ratios 0.

The prevalence of diabetes and associated coronary risk factors in urban and rural older Mexican populations. To determine the prevalence of diabetes and examine its association with food intake, anthropometric and metabolic variables, and other coronary risk factors in urban and rural older Mexican populations. Three Mexican communities urban areas of medium and low income and a rural area.

A total of men and women aged 60 years and older and 93 men and women aged 35 to 59 years were selected randomly for inclusion in the survey, which was derived from the CRONOS study Cross-Cultural Research on Nutrition in the Older Adult Study Group promoted by the European Economic Community. A personal interview assessed demographic information, personal medical history, and functional status, and a hour diet recall was obtained. A physical examination included anthropometric and blood pressure measurements.

A fasting blood sample was obtained for measurements of lipids, insulin, and glucose. Diabetes prevalence was higher in men than in women for all age groups: For all age groups, diabetes was more highly prevalent in urban communities.

Using a multivariate stepwise logistic regression, variables associated independently with diabetes in older individuals were: Diabetes in older people was associated significantly with hypertriglyceridemia, impaired functional status, and an increased prevalence of ischemic heart disease; in younger adults diabetes was associated with low density lipoprotein LDL hypercholesterolemia, hypertriglyceridemia, and a proportionally higher.

The purpose of the study was to identify factors influencing physical activity among community-dwelling older adults with type 2 diabetes. The study design was based on the Theory of Triadic Influence. A total of older adults with type 2 diabetes participated in this study. Six variables related to physical activity in older adults, including self-efficacy, social normative belief, attitudes, intention, experience, and level of physical activity, were measured using reliable instruments. Data were analyzed using descriptive statistics, Pearson's correlation analyses, and a path analysis.

The mean physical activity score was The path analysis showed that self-efficacy had the greatest total effect on physical activity. Also, experience had direct and total effects on physical activity as well as mediated the paths of social normative beliefs to attitudes and intention to physical activity. The findings of the study reveal the important role of self-efficacy and past experience in physical activity in older adults with type 2 diabetes. The impact of depression and diabetes mellitus on older workers' functioning.

Using the International Classification of Functioning, Disability and Health as a framework, this study investigates the impact of depression and diabetes mellitus on older workers' functioning problems with concentration, physical functioning, need for recovery and work and social participation restrictions. The study focuses on how these chronic conditions, in their interaction with the work context, affect older workers' functioning, which may be an important precursor of early retirement.

The interaction with participants' working conditions psychological job demands, decision latitude and strenuous work was also analysed. Compared to the reference group, depression and diabetes mellitus were over time positively related with need for recovery caseness and restrictions in social participation but not with restrictions in work participation. Depression was positively related with concentration problems and need for recovery, whereas diabetes mellitus was negatively related with physical functioning.

Finally, the relationship between functioning and depression and diabetes mellitus depends on working conditions. Older workers with depression or diabetes mellitus are vulnerable to losses in specific domains of functioning. The impact on functioning varies across working conditions, providing insight for disease-tailored preventive measures. Use of short-acting insulin aspart in managing older people with diabetes.

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Type 2 diabetes mellitus affects 5. Treatment of older people with diabetes differs in many ways from that in younger adults since the majority have type 2 disease and are at particular risk of macrovascular rather than disabling microvascular disease. Insulin therapy, the most effective of diabetes medications, can reduce any level of elevated HBA1c if used in adequate doses. However, some clinicians are often reluctant to initiate insulin therapy in older people with diabetes mainly out of their concerns about adverse reactions to insulin, particularly hypoglycemia.

There is evidence suggesting that insulin aspart appears to act similarly to regular human insulin in older people with type 2 diabetes mellitus. Insulin aspart can be used in the treatment of older people with diabetes , but this should be individualized. There is evidence that it improves postprandial glucose control, improves long-term metabolic control, reduces risk of major nocturnal hypoglycemia and increases patient satisfaction compared with soluble insulin.

Diabetes may affect intracranial aneurysm stabilization in older patients: Analysis based on intraoperative findings. Only a small proportion of aneurysms progress to rupture. Previous studies have focused on predicting the rupture risk of intracranial aneurysms. Atherosclerotic aneurysm wall appears resistant to rupture. The purpose of this study was to evaluate clinical and morphological factors affecting atherosclerosis of an aneurysm and identify the parameters that predict aneurysm stabilization.

The meerkats are very popular with visitors young and old to the Aquarium. Their Aquarium exhibit offers lots of opportunities for climbing, digging and exploring. For young Aquarium visitors, a special viewing bubble lets children pop up right among the meerkats. Click on it at www.

From the Desert to the Sea. October 17, October 17, Participants will enjoy a fun-filled day of music, puppet shows, and hands-on art activities at this free outdoor event.

This high-energy, contagiously exuberant band will perform originals, mixed with a classic brass band repertoire of spirituals, blues, gospel and funk. Howard Fishman is a critically acclaimed singer, guitarist, composer and bandleader. Fishman has headlined in some of the most prestigious venues in the U.

Fairfield County – Page 23 – Connecticut Travel

Once upon a time, there was a brave knight and a beautiful princess who bravely saved the Kingdom of Lockheart! This medieval adventure includes lots of laughter and a cast of hilarious characters. Chad Williams is a filmmaker turned puppeteer, and has shot and edited two puppetry documentaries. WonderSpark Puppets present the sweet, funny puppet shows that engage the imaginations of kids and adults alike!

Other happenings of the day will include a variety of hands-on activities for children and adults led by the distinguished faculty of the School of Art. And, of course, there is the opportunity to see the end of summer exhibits in the Silvermine Galleries that will run through September 16th.

For more information about ArtsFest, call , ext. For area information visit www. The center also provides innovative arts education in Norwalk and Stamford schools through its outreach program, Art Partners, and hosts a lecture series and special programs throughout the year.

Silvermine Arts Center is a nonprofit organization. Grounded in the belief that art is vital to the spirit, creativity and wholeness of human beings, the mission of Silvermine Arts Center is to cultivate, promote and encourage growth through the arts; to showcase and serve artists; and to foster arts education and appreciation opportunities for the greater community.

Silvermine Galleries are open Wednesday through Saturday, 12p. For more information, call ext. September 15, August 21, Fun for families and friends from nine to ninety, the 35th annual Norwalk Seaport Association Oyster Festival will be held this year from Friday, September 7 through Sunday, September 9. Festivalgoers will enjoy a wide variety of rides, cooking competitions, arts and crafts and a diverse assortment of attractions and entertainment that promise unforgettable fun.

New this year the festival will feature the action packed Paul Bunyan Lumberjack Festival that will feature world champion lumberjacks demonstrating their log rolling, axe throwing, chopping, sawing, tree climbing and dragster chainsaw skills. Another new event venue will offer hands on interactive race-themed attractions by nationally recognized Fast Action Motorsports Entertainment. These dynamic additions to the Oyster Festival are awe inspiring and unforgettable.

Here, kids can meet real life pirates and look for booty in treasure hunts, hear storytelling and join in other fun-filled activities. This interactive pirate encampment gives kids a taste of what seafaring was like during the golden age of piracy from In addition, there will be an action-packed performance by Marvel Super Heroes.

The festival offers a wide array of attractions the whole family will enjoy, including continuous entertainment by local musicians and national acts. A multitude of fine artists and crafters display whimsical as well as practical items that appeal to all tastes, budgets and ages. For on the water fun, head to the festival docks to tour historic vessels and to cruise the scenic and historic Norwalk Harbor. Food demonstrations and competitions, including the always-popular chowder and chili cook-offs will take place throughout the fesitval.

A highlight of the Festival is the wide variety of great food from around the world that is available at the International Food Court. This culinary fare is prepared by dozens of local nonprofit organizations allowing them to raise vital funds for their charitable causes. Children under 5 and U. Sunday is Family Day with special pricing on that day only — 1 child age free with each paid adult admission.

Tickets can be purchased at http: Free Parking and Free Shuttle Bus service is provided from four 4 local parking lots, just follow the signs to Oyster Festival Parking. Packages are available at all ticket offices and ticket machines except South Norwalk Station or by visiting www. The Seaport Association and its volunteers are solely responsible for organizing and financing the Oyster Festival. In addition to the Oyster Festival, the Norwalk Seaport Association owns Sheffield Lighthouse and its volunteers maintain the lighthouse and grounds as a museum and nature preserve.

For more information, visit www. August 3, August 21, Share a memorable boat ride with crabs, fish, lobsters and other creatures brought up right out of Long Island Sound right before your eyes during daily study cruises this summer with The Maritime Aquarium at Norwalk. In June, they push off at 1 p.

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