Although we are living in a high tech world, when it comes to the elderly, we often think to simplify regimens and use low tech products. This is especially true when an elderly person has a cognitive impairment. However, there are times in which high tech devices, such as insulin pumps, are particularly useful in an older population. With the assistance of another person (family, friends, home health nurse, etc.), I have seen dozens of cognitively impaired older adults (both type 1 and type 2) benefit from the use of insulin pump therapy. In a few cases, I have seen mildly impaired older adults learn to manage their pump independently (with exception of adjusting settings in which family members assist), after multiple in-home trainings.
As someone who has ordered a fair number of insulin pumps for older adults in the state of Utah, here are a few recommendations.
1. Do a pump trial using saline. Make sure the older adult won’t become confused by the pump and pull the pump site out. I have found that waist bands are sometimes helpful in keeping the pump discreet.
2. Plan for multiple pump trainings. If you are relying on others to assist with button pushing to navigate the pump, you will need to train back-up individuals that can manage the pump if the primary caregiver(s) are away.
3. Plan a dosing schedule. Assure that it is realistic for the family member, friend, or home health nurse to assist with bolusing and pump site changes.
Is it worth all the work? Yes! When blood sugars become more stable, older adults often feel much better. Clinically, I have witnessed some cognitive improvement in older adults who started insulin pump therapy. I believe this is directly related to fewer episodes of hypoglycemia and overall excursions. Insulin pumps for the cognitively impaired elderly is possible, but it does take work!
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