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
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Background: Sensory Loss
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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)
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Background: Vulnerability
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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)
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Background: Vulnerability (cont.)
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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)
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Implications for Service Providers:
Public Health Emergency Preparedness
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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
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Implications for Service Providers:
Public Health Emergency Preparedness (cont.)
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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
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Education of Service Providers
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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
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Ethnogeriatric Curriculum Framework
E.T.H.N.I.C. E.L.D.E.R.S.
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E, evaluate risk to elder
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T, translate technical info to simple, indigenous
terms
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H, help elder communicate special needs
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N, negotiate/navigate pathways to trust relationship
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I, intervene with culturally appropriate plans
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C, collaborate with family, community, ethnic media
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Ethnogeriatric Curriculum Framework
E.T.H.N.I.C. E.L.D.E.R.S.
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E, explain access to local resources
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L, label survival items in English & other languages
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D, differentiate stress-anxiety and language
difficulty
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E, educate senior, family, community leaders
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R, respect traditional healing practices and rituals
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S, support with non-verbal behaviors
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Information from Interviews
Emergency Preparedness
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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
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Information from Interviews
Emergency Preparedness (cont.)
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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
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Information from Interviews
Emergency Preparedness (cont.)
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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
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Case Vignette - A
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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
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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?
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Case Vignette – B
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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
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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?
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Resources: Emergency Preparedness
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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
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