title: Review of Hypoglycemia in the Older Adult: Clinical Implications and Management.
abstract: The aging of the population is a worldwide phenomenon. The prevalence of diabetes rises with increasing age, so the personal and financial costs of diabetes in the aging population have become significant burdens. In 2012, 104 billion (59%) of the estimated $176 billion in United States healthcare expenditures attributable to diabetes were utilized by patients older than 65 years of age [American Diabetes Association (1)]. With improvement in diabetes management and better glycemic control in the general population, there is an increase in the prevalence of hypoglycemia, which is the complication of the treatment of diabetes. Older adults with diabetes have a higher risk for hypoglycemia due to altered adaptive physiologic responses to low glucose levels. These patients also have comorbidities, such as cognitive and functional loss, that interfere with prompt identification and/or appropriate treatment of hypoglycemia. Older adults who suffer from hypoglycemia also have increased risk for falls, fall-related fractures, seizures and comas and exacerbation of chronic conditions, such as cognitive dysfunction and cardiac events. Thus, hypoglycemia in the older adult must be proactively avoided to decrease significant morbidity and mortality. Education of the patients and caregivers is important in prevention and treatment of hypoglycemia. In this article, we discuss the important aspects and unique challenges pertaining to hypoglycemia in older population. We also highlight the risks, consequences and prevention and management strategies for hypoglycemia that can be used by healthcare providers caring for older populations.
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Mousumi
authors.initials: M
authors.lastname: Sircar
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ashmeet
authors.initials: A
authors.lastname: Bhatia
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Joslin Diabetes Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA. Electronic address: mmunshi@bidmc.harvard.edu.
authors.forename: Medha
authors.initials: M
authors.lastname: Munshi
mesh_terms: D000222:Adaptation, Physiological; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D003131:Combined Modality Therapy / Q000009:adverse effects; D017281:Cost of Illness; D048909:Diabetes Complications / Q000453:epidemiology / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000097:blood / Q000178:diet therapy / Q000188:drug therapy / Q000628:therapy*; D003927:Diet, Diabetic; D058620:Elder Nutritional Physiological Phenomena; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D009043:Motor Activity; D064686:Nutritionists; D010349:Patient Compliance; D010353:Patient Education as Topic; D010819:Physician's Role; D015995:Prevalence; D024382:Professional Role; D012306:Risk; D012648:Self Care; D000078329:Workforce
chemical_list: D007004:Hypoglycemic Agents
keywords: diabetes; diabète; geriatric; gériatrique; hypoglycemia; hypoglycémie; older adult; patient safety; personne âgée; sécurité des patients