Table 2.

Comprehensive geriatric assessment for older people with diabetes [39]

A. Microvascular complications

Retinopathy Screening for diabetic retinopathy as well as other ocular diseases common in older people, such as cataract, glaucoma, and macular degeneration. Preservation of vision is important to prevent social isolation, reduce incidence of falls, and maintain independence especially for self-medication with insulin

Nephropathy Chronic kidney disease is common in older people. Monitoring of renal function is essential for adjustment of medications. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers should be used in patients with persistent microalbuminuria

Neuropathy Regular feet inspection and access to diabetic foot care is essential in older people with diabetes as many may not be able to care for their feet due to physical disability

B. Cardiovascular risk factors

Cardiovascular disease is the most common cause of mortality in patients with diabetes regardless of age. Life style modification, such as weight reduction, regular exercise, and smoking cessation, is recommended. Achieving blood pressure and blood glucose control is essential along with dyslipidemia treatment and the use of antiplatelets as a secondary prevention

C. Geriatric syndromes

Screening for the following geriatric syndromes should be addressed on the initial assessment:

Cognition: cognitive impairment should be suspected if difficulties in self-care develop

Physical function: mobility, gait, balance, and ability to perform activities of daily living

Nutrition: oral health, chewing, swallowing, and hydration

Depression: suspected if noncompliance with medication develops

Comorbidity burden

Polypharmacy: medication review to reduce medication burden

Pain: assessment for neuropathic and nonneuropathic pain

Urinary incontinence: could be the first manifestation of diabetes

Social status: the need for help in self-care especially for those on insulin