DPCA2-2_issue_v2

29.03.2017 Views
Falls prevention in older adults with diabetes “All primary care practitioners should have access to education about falls prevention, and every attempt should be made to provide comprehensive and individualised education about falls to older adults with diabetes and where appropriate, their caregivers and family.” Authors Anna Chapman, Research Fellow, School of Primary Health Care, Monash University, Melbourne, Vic; Claudia Meyer, Research Fellow, Centre for Health Communication, School of Public Health and Human Biosciences, La Trobe University, Melbourne, Vic. Both are at the RDNS Institute, St Kilda, Vic. appropriate preventive strategies. A diagnosis of diabetes in an older adult should trigger to primary care practitioners the potential for increased falls risk. Systems need to be established in the diabetes care pathway to enable falls risk screening to be performed annually. All primary care practitioners should have access to education about falls prevention, and every attempt should be made to provide comprehensive and individualised education about falls to older adults with diabetes and where appropriate, their caregivers and family. n Al-Rubeaan K, Al Derwish M, Ouizi S et al (2015) Diabetic foot complications and their risk factors from a large retrospective cohort study. PLoS ONE 10: e0124446 Allan L, Ballard C, Rowan E, Kenny R (2009) Incidence and prediction of falls in dementia: A prospective study in older people. PLoS ONE 4: e5521 American Geriatrics Society & British Geriatrics Society (2010) Prevention of Falls in Older Persons: AGS/BGS Clinical Practice Guideline. AGS/BGS Australian Commission On Safety And Quality In Healthcare (2009) Preventing falls and harm from falls in older people: Best practice guidelines for Australian community care. ACSQHC, Canberra, ACT Berlie HD, Garwood CL (2010) Diabetes medications related to an increased risk of falls and fall-related morbidity in the elderly. Ann Pharmacother 44: 712–7 Boulton AJ (2004) The diabetic foot: from art to science. The 18th Camillo Golgi lecture. Diabetologia 47: 1343–53 Bradley C (2012) Hospitalisations due to falls in older people, Australia 2008-09. Australian Institute for Health and Welfare, Canberra, ACT. Available at: http://bit.ly/2mlESXq (accessed 08.03.17) Brown SJ, Handsaker JC, Bowling FL et al (2015) Diabetic peripheral neuropathy compromises balance during daily activities. Diabetes Care 38: 1116–22 Chapman A, Meyer C, Renehan E et al (2016) Exercise interventions for the improvement of falls-related outcomes among older adults with diabetes mellitus: A systematic review and meta-analyses. J Diabetes Complications 31: 631–45 Clemson L, Donaldson A, Hill K, Day L (2014) Implementing personenvironment approaches to prevent falls: a qualitative inquiry in applying the Westmead approach to occupational therapy home visits. Aust Occup Ther J 61: 325–34 Crews R, Yalla S, Fleischer A, Wu S (2013) A growing troubling triad: diabetes, aging, and falls. J Aging Res 2013: 342650 Delbaere K, Kochan NA, Close JC et al (2012) Mild cognitive impairment as a predictor of falls in community-dwelling older people. Am J Geriatr Psychiatry 20: 845–53 Dirani M (2013) Out of sight: A report into diabetic eye disease in Australia. Baker IDI Heart and Diabetes Institute and Centre for Eye Research Australia, Australia Drootin M (2011) Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 59: 148–57 Ganz D, Bao Y, Shekelle P, Rubenstein L (2007) Will my patient fall? JAMA 297: 77–86 Gillespie L, Robertson M, Gillespie W et al (2012) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 12: CD007146 Haran MJ, Cameron ID, Ivers RQ et al (2010) Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial. BMJ 340: c2265 Hill K, Wee R (2012) Psychotropic drug-induced falls in older people: A review of interventions aimed at reducing the problem. Drugs Aging 29: 15–30 Huang ES, Karter AJ, Danielson KK et al (2010) the association between the number of prescription medications and incident falls in a multi-ethnic population of adult type-2 diabetes patients: The Diabetes and Aging Study. J Gen Intern Med 25: 141–6 International Diabetes Federation (2013) IDF Global Guideline for Managing Older People with Type 2 Diabetes. International Diabetes Federation, Brussels, Belgium Jafari B, Britton ME (2015) Hypoglycaemia in elderly patients with type 2 diabetes mellitus: a review of risk factors, consequences and prevention. J Pharmacy Practice Research 45: 459–69 Karinkanta S, Piirtola M, Sievanen H et al (2010) Physical therapy approaches to reduce fall and fracture risk among older adults. Nature Reviews Endocrinology 6: 396–407 Kirkman MS, Briscoe VJ, Clark N et al (2012) Diabetes in older adults. Diabetes Care 35: 2650–64 Liu-Ambrose T, Ahamed Y, Graf P et al (2008) Older fallers with poor working memory overestimate their postural limits. Arch Phys Med Rehabil 89: 1335–40 Lord SR, Menz HB, Tiedemann A (2003) A physiological profile approach to falls risk assessment and prevention. Phys Ther 83: 237–52 Lord SR, Smith ST, Menant JC (2010) Vision and falls in older people: Risk factors and intervention strategies. Clinics Geriatr Med 26: 569–81 Meijer JW, Smit AJ, Sonderen EV et al (2002) Symptom scoring systems to diagnose distal polyneuropathy in diabetes: the Diabetic Neuropathy Symptom score. Diabet Med 19: 962–5 Menz G, Morris M, Lord S (2006) Foot and ankle risk factors for falls in older people: a prospective study. J Gerontol A Biol Sci Med Sci 61: 866–70 Meyer C, Hill S, Dow B et al (2013) Translating falls prevention knowledge to community-dwelling older PLWD: A mixed-method systematic review. Gerontologist 55: 560–74 Moyer VA (2012) Prevention of falls in community-dwelling older adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 157: 197–204 Palma F, Antigual D, Martinez S et al (2013) Static balance in patients presenting diabetes mellitus type 2 with and without diabetic polyneuropathy. Arch Endocrinol Metab 57: 722–6 Pijpers E, Ferreira I, De Jongh R et al (2012) Older individuals with diabetes have an increased risk of recurrent falls: analysis of potential mediating factors: the Longitudinal Ageing Study Amsterdam. Age Ageing 41: 358–65 Podsiadlo D, Richardson S (1991) The Timed “Up & Go”: A test of basic functional mobility for frail elderly persons. J Amer Geriatr Soc 39: 142–8 Roman De Mettelinge T, Cambier D, Calders P et al (2013) Understanding the relationship between type 2 diabetes mellitus and falls in older adults: A Prospective Cohort Study. PLoS ONE 8: e67055 Royal Australian College Of General Practitioners (2016) General practice management of type 2 diabetes: 2016-18. RACGP, East Melbourne, Vic Russell MA, Hill KD, Blackberry I et al (2008) The reliability and predictive accuracy of the falls risk for older people in the community assessment (FROP-Com) tool. Age Ageing 37: 634–9 Russell MA, Hill KD, Day L et al (2009) Development of the Falls Risk for Older People in the Community (FROP-Com) screening tool. Age Ageing 38: 40–6 Shaw F, Bond J, Richardson D et al (2003) Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: Randomised controlled trial. BMJ 326: Sherrington C, Tiedemann A, Fairhall N et al (2011) Exercise to prevent falls in older adults: An updated meta-analysis and best practice recommendations. N S W Public Health Bull 22: 78–83 Sinclair A, Dunning T, Rodriguez-Mañas L (2015) Diabetes in older people: new insights and remaining challenges. Lancet Diabetes Endocrinol 3: 275–85 Tiedemann A, Shimada H, Sherrington C et al (2008) The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people. Age Ageing 37: 430–5 Tinetti ME, Franklin Williams T, Mayewski R (1986) Fall risk index for elderly patients based on number of chronic disabilities. Am J Med 80: 429–34 van Deursen, R (2008) Footwear for the neuropathic patient: offloading and stability. Diabetes Metab Res Rev 24: S96–S100 Zijlstra GAR, Van Haastregt JC, Van Rossum E et al (2007) Interventions to reduce fear of falling in community-living older people: A systematic review. J Am Geriatr Soc 55: 603–15 74 Diabetes & Primary Care Australia Vol 2 No 2 2017

Article The effect of diabetes on the skin before and after ulceration Lesley Weaving, Roy Rasalam Diabetes affects the skin in many different ways at a microcirculatory level, making it more prone to injury and ulceration. These changes not only have an impact on healing but also on the resulting scar tissue, which is not as strong as the skin was prior to injury. Eight-five percent of amputations are preceded by ulceration, with re-ulceration rates reported to be as high as 70% after 5 years. This article looks at the changes that occur in the skin of people with diabetes and the importance of skin care before and after ulceration. A history of ulceration is considered to be a significant risk factor for re-ulceration, and as such, people with diabetes are classed as high risk if they have a history of foot ulceration (National Institute for Health and Care Excellence, 2015). Australia’s amputation rate as a result of diabetes appears to have increased in the last decade and is a major contributor to the national burden of condition (Lazzarini et al, 2012). Eighty-five per cent of amputations are preceded by ulcers (International Diabetes Federation, 2016); therefore, the prevention of re-ulceration is an important consideration in reducing amputation rates. Varying rates of reulceration have been reported in the literature, but the rate of re-ulceration is known to increase over time from initial ulceration; Miller et al (2014) reported 34% re-ulceration at 1 year, 61% at 3 years and 70% at 5 years. A critical triad of neuropathy, minor foot trauma and foot deformity is present in >63% of patients’ causal pathways to foot ulceration (Reiber et al, 1999). There are many reasons that determine whether people with diabetes develop ulcers, including their vascular status, nutritional status and compliance with preventative therapies, such as custom-made shoes or insoles (Miller et al, 2014). Despite these interventions, one study has reported a 30% re-ulceration rate over a 2-year period, during which individuals received regular podiatric review (Westphal et al, 2011). With this in mind, do we need to consider other factors, such as the health of the skin? What is the effect of ulceration on the skin during and after healing, and does it play a role in the risk of re-ulceration? The skin The skin is the largest organ of the body. Its main functions are to act as a barrier to substances entering the body and in the prevention of moisture loss. It helps to regulate temperature and provides sensory information (e.g. pain, touch and temperature). It has three layers: the epidermis, the dermis and a fat (subcutaneous) layer (see Figure 1). The epidermis is the thin outer layer, made of five layers. The outermost layer is the stratum corneum, which consists of dead cells and is the major barrier to chemical and bacterial transfer through the skin. The epidermis is thicker on the plantar aspect of the foot and is relatively waterproof. The second layer of the skin is the dermis, which contains nerve endings, sweat glands, oil (sebaceous) glands, hair follicles and blood vessels. It consists of a thick layer of fibrous and elastic tissue, giving the skin its flexibility and strength. Below the dermis is a Citation: Weaving L, Rasalam R (2017) The effect of diabetes on the skin before and after ulceration. Diabetes & Primary Care Australia 2: 75–9 Article points 1. People with diabetes are more prone to skin injury and ulceration. 2. Diabetes impairs the skin’s ability to heal. 3. Scar tissue is not as strong as the tissue was before injury. 4. Skin should be kept in the best condition possible to prevent re-ulceration. Key words – Healing – Re-ulceration – Scar tissue – Skin Authors Lesley Weaving is diabetes specialist podiatrist, Leicestershire Partnership Trust, Coalville Community Hospital, Coalville, Leicestershire, UK; Roy Rasalam is Director of Clinical Studies, College of Medicine, James Cook University, Qld, Australia. Diabetes & Primary Care Australia Vol 2 No 2 2017 75

Page 1 and 2: Diabetes & Primary Care Australia V

Page 3 and 4: Contents Diabetes & Primary Care Au

Page 5 and 6: Editorial Diabetes and pregnancy It

Page 7 and 8: From the other side of the desk Fro

Page 9 and 10: 2017 NATIONAL CONFERENCE Saturday 6

Page 11 and 12: Resources to support preconception

Page 13 and 14: Resources to support preconception

Page 15 and 16: Optimising pregnancy outcomes for w



Page 21 and 22: Article Diabetes and bone health Vi

Page 23 and 24: Diabetes and bone health Secondary

Page 25 and 26: Diabetes and bone health Page point

Page 27 and 28: Diabetes and bone health increase i

Page 29 and 30: Article Falls prevention in older a

Page 31 and 32: Falls prevention in older adults wi

Page 33: Falls prevention in older adults wi

Page 37 and 38: The effect of diabetes on the skin

Page 39 and 40: The effect of diabetes on the skin

diabetes

primary

australia

increased

assessment

preconception

fracture

diabetic

osteoporosis

prevention

DPCA2-2_issue_v2

Delete template?

Save as template ?