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Mental Health Aspects of Diabetes in Elders from Diverse Ethnic Backgrounds Sensory Loss and Emergency Preparedness Strategies with Elders with Diabetes Prepared and work done by Melen McBride, RN, PhD Stanford GEC Copyright © 2005 Background: Sensory Loss Vascular and neurologic complication of diabetes may result in vision and hearing impairment Vision: retinopathy, retinal hemorrhage, retinal detachment, macular degeneration, cataract, glaucoma, refractive errors Hearing: sensorineural loss, decrease acuity for pure tones, speech, and ability to understand speech Hearing: cortical changes, difficult speech and language Hearing: age-related, structural changes and presbycussis (Sources: Kane, et, al, 1994; Kakarlapudi, et al, 2003) Stanford GEC Copyright © 2005 Background: Vulnerability Sensory deprivation impedes ability to respond and navigate environment in event of emergency Low vision: difficult to observe signs of infection (i.e., skin changes) Hearing loss: difficult to report by phone or absence of electricity, non-functioning TDD (Source: Kane, et al, 1997; Kakarlapudi, et al, 2003) Stanford GEC Copyright © 2005 Background: Vulnerability (cont.) Compromised immune system in diabetes at risk with infection Delayed access by ethnic seniors: Sensory loss, limited English proficiency, lack of knowledge, distrust (Sources McBride & Lewis, 2004; McBride, Morioka-Douglas, & Yeo, 1996) Stanford GEC Copyright © 2005 Implications for Service Providers: Public Health Emergency Preparedness Ethnic elder with diabetes, unrecognized depression and changes in memory and sensory function: at risk of falling through the crack Older adults most vulnerable to emerging infectious agents (Ashford, et al, 2003) Evacuation may trigger disorientation and confusion in sensory impaired older person Power blackout impact assistive technology Stanford GEC Copyright © 2005 Implications for Service Providers: Public Health Emergency Preparedness (cont.) Encourage/guide older ethnic clients to have a personal emergency plan Ensure back up supply of insulin and supplies with someone out of neighborhood (useful in event of quarantine) Emergency shelter: avoid social isolation of older person, maintain flow of communication Community education in ethnic minority communities Stanford GEC Copyright © 2005 Education of Service Providers Resources for training Reference document developed by CDC and APIC BTEPA Curricula developed by 6 GECs (Gateway GEC, OVARGEC, NYGEC, SGEC, Texas GEC, Western Reserve GEC Bio-Terrorism & Emergency Preparedness in Aging Sources: www.apic.org http://bt.cdc.gov/training/index.asp#intro Stanford GEC Copyright © 2005 Ethnogeriatric Curriculum Framework E.T.H.N.I.C. E.L.D.E.R.S. E, evaluate risk to elder T, translate technical info to simple, indigenous terms H, help elder communicate special needs N, negotiate/navigate pathways to trust relationship I, intervene with culturally appropriate plans C, collaborate with family, community, ethnic media Stanford GEC Copyright © 2005 Ethnogeriatric Curriculum Framework E.T.H.N.I.C. E.L.D.E.R.S. E, explain access to local resources L, label survival items in English & other languages D, differentiate stress-anxiety and language difficulty E, educate senior, family, community leaders R, respect traditional healing practices and rituals S, support with non-verbal behaviors Stanford GEC Copyright © 2005 Information from Interviews Emergency Preparedness Informant interviews Establish effective modes of communication during a crisis Provide language interpreters Develop readiness plan Educate family on how to provide guidance in a disaster Clarify payment for emergency services Have a central place to go to in the community Stanford GEC Copyright © 2005 Information from Interviews Emergency Preparedness (cont.) Consultation with Community Agency Staff Create well organized emergency response system Enable agency to facilitate access to resources Educate staff and responders to special needs Target training to workers in emergency shelters Supplement community education Stanford GEC Copyright © 2005 Information from Interviews Emergency Preparedness (cont.) Consultation with Ethnic Minority Elders Ensure availability of language interpreters Educate emergency workers and volunteers on combined effects of diabetes, depression, cognitive changes, sensory loss, and infectious agents Educate seniors on a comprehensive approach to personal safety at home in presence of infectious agent Provide information on community emergency resources Stanford GEC Copyright © 2005 Case Vignette - A Mrs. Garcia, age 72 yrs, Mexican American, 10 yrs noninsulin diabetes Irregular with medication due to finances Overweight, believes it is normal for women who had children to be rotund Recently informed of retinal changes Employed: sews children’s clothes at home Takes care of grandchildren Stanford GEC Copyright © 2005 Case Vignette Questions – A What additional assessment would you do to build trust? What would you include in a teaching plan for her and the family on emergency preparedness? What strategies would you use to help her adapt an effective self-management plan? Stanford GEC Copyright © 2005 Case Vignette – B Mr. Magat, age 68 yrs, Filipino American, 17 yrs with diabetes, quadruple by-pass 5 yrs ago Insulin for 17yrs, uses physical symptoms to adjust dosage and food intake instead of blood test Heavy teaching schedule as reason for risky behavior On laser treatment every 3-4 months for retinal hemorrhage Visits grandchildren in daytime due to severe vision loss Since getting widowed, rents part of house to a middleaged couple Daughters call often, they get frustrated when he does not wear hearing aid Stanford GEC Copyright © 2005 Case Vignette Questions – B What makes him vulnerable in the event of an emergency exposure to an infectious agent? What would you include in your cultural assessment to understand his attitude about self-care? What resources would you offer his and his daughters to improve communication? Stanford GEC Copyright © 2005 Resources: Emergency Preparedness American Red Cross National Headquarters www.redcross.org/services/disaster Independent Living Resource Center www.ilrcsf.org/Publications/prepared/HTM/Emergen cy_Prepa edness01.html Web Resources http://www.lighthouse-SF.org http://www.hearingsocietey.org http://ucbcidp.org Stanford GEC Copyright © 2005