Elsevier

Diabetes & Metabolism

Volume 31, Supplement 1, December 2005, Pages 5S13-5S19
Diabetes & Metabolism

Article
Caring the elderly diabetic patient with respect to concepts of successful aging and frailtyLe patient diabétique âgé, entre vieillissement réussi et fragilité

https://doi.org/10.1016/S1262-3636(05)73647-8Get rights and content

Summary

Successful aging and frailty are emerging constructs becoming necessary to define prevention and treatment goals in elderly subjects. Frailty corresponds to the stages between full autonomy or successful aging and irreversible functional dependency or pathological aging. However its definition is imprecise and potential clinical criteria are numerous and interrelated. Diabetes decreases the likelihood for successful aging and particularly increases the risk for functional dependency. One major end-point in the care of elderly diabetic subjects is to investigate the impact of blood glucose control on progression of disability. Geriatric intervention based on comprehensive geriatric assessment (CGA) in the frail elderly population has been shown effective to prevent the loss of autonomy and to improve quality of life, but seems ineffective on mortality. It is now recommended to screen elderly diabetic patients for frailty criteria. The effect of combined individualized diabetes care and CGA on the aging profile should be investigated.

Résumé

Dans le domaine du vieillissement, les concepts de vieillissement réussi, de fragilité émergent en réponse au besoin de construire des stratégies de prévention et de traitement chez les personnes âgées. La fragilité représente les états intermédiaires entre vieillissement réussi avec autonomie fonctionnelle complète et dépendance irréversible ou encore vieillissement pathologique. Cependant, les critères utilisés sont nombreux, le plus souvent reliés entre eux et ne permettent pas d’aboutir à une définition univoque de la fragilité. Le diabète diminue les chances de vieillissement réussi et en particulier augmente les limitations fonctionnelles. Un objectif majeur de la prise en charge des patients diabétiques âgés serait d’étudier l’impact du contrôle glycémique sur la progression du handicap. Une intervention gériatrique bâtie sur la base de l’évaluation gérontoiogique standardisée (EGS) chez des personnes fragiles a montré son efficacité dans la prévention de la perte d’autonomie et l’amélioration de la qualité de vie, mais semble sans effet sur la mortalité. Il est maintenant recommandé de dépister les critères cliniques de fragilité chez les personnes âgées diabétiques. Les effets de la prise en charge individualisée du diabète, combinée à celle de l’EGS sur le profil de vieillissement des diabétiques, devraient être étudiés.

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