老年人糖尿病的预防和护理

糖尿病的患病率正随着人们生活水平的提高,人口老化,生活方式的改变而迅速增加。据世界卫生组织（WHO）估计,全球目有超过1.5亿糖尿病患者,到2025年将增加1倍。估计我国现有糖尿病患者约3千万,居世界第2位（第1位为印度,第3位为美国）[1]。由于糖尿病是一个慢性、伴随终生的疾病,是严重威胁人类健康的世界性公共卫生问题,因而糖尿病的预防和护理就显得非常重要,而老年人群虽然易患糖尿病,但如果能进行积极的预防,其发病率能够得到一定控制。本文就老年人糖尿病的预防和护理方面的体会,进行归纳总结如下。     

2型糖尿病的预防与控制

<正>糖尿病是一种常见的内分泌代谢疾病。《中国糖尿病防治指南》(2010年版)将之定义为:糖尿病是一组有遗传倾向的、由于胰岛素分泌及(或)作用缺陷引起的以血糖升高为特征的代谢病群。在我国,随着生活方式的改变和老龄化的进程加速,我国糖尿病的患病率正在呈快速上升的趋势,成     

非传染性慢性病预防方法的思索

1984年,天津市卫生防病中心在全国率先开展了非传染性慢性病的预防工作,当时开展的病种有高血压、冠心病、恶性肿瘤和脑卒中.     

糖尿病视网膜病变早期预防宣教的临床分析

目的 探讨糖尿病视网膜病变(DR)早期预防与宣教的防治方法.方法 对109例DR患者进行回顾性分析总结.结果 109例DR患者中70例经过早期预防与宣教并坚持正规治疗,DR病理演变发生缓慢,对早期治疗,防止眼盲,提高生活质量取得明显效果.39例患者未按照早期预防、宣教及坚持正规治疗措施,DR病理演变发生较重.结论 早期预防与宣教并坚持正规治疗措施,可以较好地控制血糖达标,减慢DR病理演变过程,提高患者生活质量,减轻降低医疗费用,特别在基层医院,是一个不可忽视的问题.     

糖尿病并发症的防治及护理

［摘要］ 目的探讨糖尿病并发症的防治及护理方法。方法回顾分析１０４例２型糖尿病病人并发症的 护理资料。结果糖尿病患者并发高血压、冠心病、脑梗塞很常见,并发酮症酸中毒１例、白内障失明１例、肾衰 竭１例、糖尿病周围神经病变９例、低血糖５例、糖尿病足７例,其中有２例经抗炎治疗、换药无效,疼痛难忍、不能 行走转入骨科行截肢手术。结论治疗糖尿病单纯的药物治疗已达不到理想的效果,要采取综合性措施。最终 治疗目标是通过纠正病人不良生活方式和代谢紊乱,防止急性并发症的发生和减低慢性并发症的风险,提高病人 生活质量。     

东海县农村老年人高血压社区规范化管理效果评价

目的评价东海县农村老年高血压患者的社区规范化管理效果,探讨农村老年高血压防治模式。方法 2009年对东海县农村的老年高血压患者落实由经过培训的社区医生进行规范化管理(健康教育、行为干预、药物治疗和定期随访等),2年后评价其效果。结果参加社区高血压规范化的老年高血压患者4 149例,其中男性1 862例,女性2 287例,规范化管理后平均收缩压和舒张压分别降低了16.56和8.97 mmHg,知晓率、治疗率、血压控制率由管理前的22.99%,15.77%,2.55%分别上升至82.31%,99.40%,38.73%,差别均有统计学意义(P<0.05)。结论针对农村老年人的特点,社区规范化管理能有效改变老年高血压患者不良生活方式,提高药物依从性,良好控制血压,提高生命质量,是防治农村老人高血压的一种行之有效的方法。     

社区老年人跌倒的预防与控制

跌倒是老年人常见的问题,而且是老年人群伤残、失能和死亡的重要原因之一[1]。随着人口老龄化进程加快和期望寿命延长,为保持老年人较高生活质量,降低医疗费用支出,减轻社会疾病负担,老年跌倒的预防控制已成为公共卫生问题和健康问题。随着社区卫生服务的发展,如何有效预防社区老年人发生跌倒已成为社区卫生服务的重要内容。国外对老年人跌倒的相关问题研究较多,国内的研究多集中于护理机构中老年人的跌倒,针对社区老年人跌倒的预防与控制研究尚处于起步阶段。为借鉴国内外经验,做简要介绍。1跌倒的流行病学跌倒是指出现突发的、不自主、非…     

门诊口腔科感染的预防与控制

目的 分析口腔科感染的原因,采取系统化护理管理措施,预防与控制口腔科交叉感染.方法 严格规范医、护人员职责,加强临床各个环节的消毒与各项预防工作,对口腔门诊的交叉感染进行了系统化的控制与管理.结果 系统化护理管理措施大大提高了医务人员对交叉感染的认识,有效地降低了医院感染,保证口腔科诊疗质量和医务人员的安全.结论 系统化护理管理方案的实施可以使口腔门诊的交叉感染预防控制工作走向规范化、程序化和完善化,从而最大限度地防止口腔门诊交叉感染发生.     

Prevention of diabetes mellitus type 2

Diabetes mellitus type II is a major clinical and public health problem and is therefore a candidate for several primary and secondary preventive strategies. Further research on the effects and side effects of both types of prevention is required before it is possible to accurately determine which prevention strategy is most suitable. Research into primary prevention should not only focus on the effect of the strategy on diabetes itself, but also on its complications. With respect to diabetic screening, it is advisable to investigate the cost-effectiveness of several screening strategies. As opportunistic screening is becoming the predominant current practice, a cost-effectiveness study of screening strategies should be started in the short term due to increasing difficulties in selecting a control group.     

Hypoglycemia in the elderly with diabetes mellitus

Aging is associated with an increasing prevalence of chronic diseases, including type 2 diabetes mellitus and its chronic and acute complications. With changes observed in diabetes mellitus treatment goals and the lower levels of glycosylated hemoglobin recommended, the prevalence of hypoglycemia especially in patients treated with insulin has increased. Aging and changes in the physiologic reserves generate a decreased perception of symptoms associated with hypoglycemia, increasing the risk of unawareness or severe episodes. Traditionally, age was a risk factor for hypoglycemia, but in the population over 60 years, multiple comorbidities like chronic heart failure, malnutrition and renal failure are associated with increased risk of developing this acute complication. It is necessary to train doctors and nurses from all levels of care to recognize the specific clinical manifestation of low blood glucose that allow early detection and treatment, because this complication is associated with an increased hospital and 1-year after discharge mortality, with falls and cognitive impairment that directly affect the independence and functionality of older persons.     

老年糖尿病患者的心理干预护理效果

目的：了解老年糖尿病病人的抑郁和焦虑状态,探讨实施心理干预护理的效果。方法：采用自评抑郁量表、自评焦虑量表评定出50例存在不同程度抑郁、焦虑老年糖尿病患者,对他们进行干预式心理护理。结果：老年糖尿病患者护理干预前后焦虑和抑郁程度比较,焦虑、抑郁症状明显好转。结论：老年糖尿病患者抑郁、焦虑状态发生率较高,必须予以高度重视;干预式心理护理可有效减轻病人抑郁、焦虑状态,有利于患者的治疗与康复。     

老年糖尿病患者的社区管理

目的:探讨某辖区老年糖尿病患者的社区管理。方法:对某辖区50位老年糖尿病人进行科学管理,定期体检,合理指导生活和用药。结果:观察和监督其生活和用药,体检指标,锻炼情况,有效控制血糖水平,减少并发症,改善生活质量。结论:通过科学合理指导用药,按时定量用餐,适度锻炼,提高其对疾病认识,坚持科学、系统治疗,提高生活质量,增强生活自信心。     

Specific needs in the care of elderly with diabetes mellitus

The management of diabetes mellitus (DM) in the elderly is a complex process. In the perspective of improving glycemic control and postponing complications, lifestyle changes (diet and exercise) are often prescribed. Pharmacologic intervention is common and must be accompanied with adequate teaching on drug and hypoglycaemia management. Ideally, this process is multidisciplinary and objectives must be shared by all members of the diabetic team. The transmission and application of diabetic management strategies must be adapted to each individual in the context of his limits and capacities. Even in presence of interventions to control glycaemia, blood pressure and lipids, the micro and macro vascular complications are still very frequent in elderly patients with DM. Vascular interventions such as percutaneous arterial angioplasty and/or arterial bypass are frequently proposed even in very old diabetic patients. These patients are still at high risk of lower limb amputation with subsequent dramatic alteration in functional status and mortality. We will attempt to make a brief overview of the very diverse needs observed in older diabetic patients.     

Prevalence of hypothyroidism and diabetes mellitus in elderly kibbutz members

The aim of this study was to determine the prevalence of hypothyroidism and diabetes mellitus (DM) in elderly (aged 65–92 years) kibbutz members in Northern Israel. Method: The medical records of 1096 elderly (642 females and 454 males) residing in 11 kibbutzim were reviewed for data regarding thyroid function tests (TSH and FT4) and fasting blood glucose. Fasting blood glucose levels above 7.8 mmol/l was considered diagnostic for diabetes mellitus. Results: The prevalence of hypothyroidism was 14% (9.7% in males and 18.2% in females) and that of DM was 11.5% (12.1% in males and 11.1% in females). In 74% of the diabetics the diagnosis was made after the age of 60 years. Distribution of treatment modalities in diabetics was as follows: diet only 42%, oral hypoglycemic agents 52% and Insulin 6%. Subclinical hypothyroidism (serum TSH levels above 4.5 mU/L with normal FT4 levels) was detected in 38% of all the hypothyroid subjects. Conclusion: The data suggest that diabetes mellitus and primary hypothyroidism are common disorders in elderly subjects. DM in the elderly can usually be handled with diet and oral hypoglycemic drugs. Since the clinical features of hypothyroidism in the elderly are often atypical, we suggest that elderly subjects should be screened for hypothyroidism.     

Cognitive and motor perturbations in elderly with longstanding diabetes mellitus

Type 2 diabetes mellitus is a chronic disease characterized by insulin resistance; inflammation; oxidative stress; vascular damage; and dysfunction of glucose, protein, and lipid metabolisms. However, comparatively less attention has been paid to neurologic alterations seen in elderly individuals with type 2 diabetes. We review clinical, metabolic, and biochemical aspects of diabetic encephalopathy (DE) and propose that quality of dietary lipids is closely linked to DE. This implies that preventive nutritional interventions may be designed to improve DE.     

Excess mortality related to diabetes mellitus in elderly Medicare beneficiaries

PURPOSE: To determine whether diabetes remains an important contributor to mortality among the elderly. METHODS: A 5% national sample of Medicare claims was utilized to create a retrospective cohort study. Participants were 148,562 persons with at least one hospitalization or two outpatient visits for diabetes in 1994, who were alive on January 1, 1995, were > or =65 years old, and were not in managed care in 1994; and 148,562 age, gender, and race matched controls without diabetes. Deaths were ascertained through 1999. Survival and proportional hazards analysis were used to calculate rates and relative risks. RESULTS: The mortality rate was 100.2/1000 person years (PY) among seniors with diabetes compared with 60.6/1000 PY without diabetes (age adjusted relative risk (RR)=1.83, 95% CI: 1.81-1.86). Non-white minorities had a similar RR associated with diabetes (Hispanic 2.37, Asian 1.95, Native American 2.38, blacks 1.64) as whites (1.86). The mortality risk associated with diabetes decreased with increasing age, but remained significantly elevated even among those aged 85 years and older. In contrast, the absolute excess mortality attributed to diabetes increased with age. CONCLUSION: The excess mortality associated with diabetes amongst all older ages suggests that greater attention to optimal diabetes treatment and prevention is needed.     

老年高血压合并糖尿病患者药物重整效益分析

目的对老年高血压合并糖尿病患者进行药物重整并分析效益。方法选择2015年7—9月真如社区全科门诊就诊的老年高血压合并糖尿病患者作为研究对象,对入组患者进行药物重整干预,干预前后进行问卷调查评估药物重整指导效果。计量资料采用配对t检验,P0.05为差异有统计学意义。结果干预后长期用药品种、每月药费总金额和每月药费自付金额分别为(7.77±1.29)种、(1 151.50±468.50)、(393.67±148.22)元,均显著较干预前的(9.48±2.05)种、(1 340.00±530.57)、(436.83±179.21)元降低,干预后患者满意度评分及健康自评分分别为(86.70±2.98)、(71.81±11.48)分,均较干预前的(85.63±3.69)、(69.08±14.55)分有所上升,差异均有统计学意义(均P0.05)。结论药物重整显著提高老年高血压合并糖尿病患者生活质量,具有多方面效益,有必要开展药物重整工作。     

容桂社区老年人糖尿病现况调查

目的了解顺德容桂地区老年人糖尿病现况。方法对顺德区容桂街道整群随机抽样,随机抽取2个村。对村中60岁以上的常住人口全部进行调查。总人数1503人,资料完整的1400人（60—93岁,68．15±6．66岁）其中男性578人,女性822人;60～69岁865人（占61．8％）,70～79岁430人（占30．7％）,80岁～105（占7．5％）。调查的项目有年龄、性别、空腹血糖（FG）、总胆固醇（TC）、甘油三酯（TG）、身高、体重、腰围（WC）、臀围（HC）、血压、既往史,并计算出体重指数（BMI）、腰臀围比（WHR）和腰围身高比（WHtR）。结果①1400例社区老人糖尿病总现患率12．4％;男性现患率12．8％,女性现患率12．2％。60—69岁组现患率12．8％,70～79岁组现患率12．3％,80岁以上组现患率9．5％。男女之间差异无统计学意义（P〉0．05）,不同年龄组间差异有统计学意义（P〈0．01）;②与非糖尿病者相比,糖尿病者BMI、SBP、DBP、WC、WHR、WHtR、TG更高,差异有统计学意义（P〈0．05）,年龄与TC差别不明显,无统计学意义（P〉0．05）;③Pearson相关性分析发现,糖尿病与BMI、WC、WHR、WHtR、SBP、DBP、TG明显相关,差异有统计学意义（P〈0．01）,与TC不相关。结论①1400例顺德容桂社区老人糖尿病现患率12．4％;②糖尿病患者与BMI、WC、WHR、WHtR、SBP、DBP、TG升高明显相关。