Assessment
4
Overall Health Assessment of Older Patients With Diabetes
➤ In patients aged 65 and older with diabetes, we advise assessing the
patient's overall health (see Tables 2–5) and personal values prior to the
determination of treatment goals and strategies. (UGPS)
➤ In patients aged 65 years and older with diabetes, ES suggests that
periodic cognitive screening should be performed to identify undiagnosed
cognitive impairment. (2|⊕⊕
)
Technical Remarks:
▶ Use of validated self-administered tests is an efficient and cost-effective way to
implement screening (see full text guideline). Alternative screening test options, such
as the Mini-Mental State Examination or Montreal Cognitive Assessment, are
widely used.
▶ An initial screening should be performed at the time of diagnosis or when a patient
enters a care program.
▶ Screening should be repeated every 2–3 years after a normal screening test result for
patients without cognitive complaints or repeated one year after a borderline normal
test result.
▶ Always evaluate cognitive complaints and assess cognition in patients with complaints.
➤ In patients aged 65 years and older with diabetes and a diagnosis of
cognitive impairment (i.e., mild cognitive impairment or dementia), ES
suggests that medication regimens should be simplified and glycemic
targets tailored (i.e., be more lenient) to improve compliance and prevent
treatment-related complications. (2|⊕⊕
)
Technical Remarks:
▶ Medical and nonmedical treatment and care for cognitive symptoms in people with
diabetes and cognitive impairment is no different from those in people without
diabetes and cognitive impairment.
▶ Depending on the situation and preferences of the patient, a primary caregiver can be
involved in decision-making and management of medication.
