From the Guidelines
Endocrine conditions commonly encountered in nursing home settings include diabetes mellitus, thyroid disorders, and osteoporosis, with diabetes being particularly prevalent, as noted in a 2016 position statement by the American Diabetes Association 1.
Common Endocrine Conditions
- Diabetes mellitus: requires careful monitoring of blood glucose levels, medication management, and dietary control.
- Thyroid disorders: especially hypothyroidism, managed with levothyroxine replacement therapy, typically starting at 25-50mcg daily in elderly patients with dose adjustments based on TSH levels.
- Osteoporosis: management includes calcium supplementation, vitamin D, and possibly bisphosphonates like alendronate.
Management Considerations
- Age-related changes in metabolism, multiple comorbidities, and polypharmacy concerns require special consideration in nursing home residents.
- Regular monitoring through laboratory testing, medication reviews, and assessment of symptoms is essential for effective management, as emphasized in the context of managing adults with complex conditions like 22q11.2 deletion syndrome 1.
- Staff education regarding recognition of acute complications like hypoglycemia, thyroid storm, or adrenal crisis is crucial, as these conditions can present atypically in elderly patients.
Key Recommendations
- Diabetes management should prioritize personalized goals and treatments, considering the risk of hypoglycemia and the importance of simplified treatment regimens 1.
- Regular review and adjustment of medications, including insulin regimens and glucose-lowering agents, are necessary to minimize risks and improve quality of life.
- Interprofessional team approaches and administrative support are essential for integrating effective endocrine condition management into nursing home care.
From the Research
Common Endocrine Conditions in Nursing Homes
- Thyroid disorders, including hypothyroidism and hyperthyroidism, are common in older adults, with a higher prevalence in older-old frail residents in nursing homes 2
- Subclinical hyperthyroidism and hypothyroidism are also frequently seen in older populations and have been linked to increased total and cardiovascular mortality 2
- Diabetes mellitus, including type 1 and type 2, is a significant concern in nursing homes, with a high prevalence of diabetes among residents 3, 4
- Hyperparathyroidism is another common endocrine disorder that can affect older adults in nursing homes, resulting in elevated levels of parathyroid hormone and subsequent hypercalcaemia 5
- Other endocrine disorders, such as pituitary disorders, hypoglycemia, and disorders of the adrenal cortex, may also be present in nursing home residents, although less is known about their prevalence in this population 6
Prevalence and Management of Endocrine Conditions
- The prevalence of diabetes in nursing home residents is high, with approximately 35.4% of residents having diabetes 4
- Insulin is the mainstay of treatment for diabetes in nursing home residents, followed by oral agents 4
- The management of diabetes in nursing homes can be challenging, with considerations such as polypharmacy, comorbidities, and cognitive impairment affecting treatment decisions 3, 4
- Nurses play a crucial role in the support, education, and care of older adults with endocrine disorders, including thyroid disorders, diabetes, and hyperparathyroidism 2, 3, 5