Prevalence of Foot Problems in Nursing Home Residents With Diabetes Stratified by Dementia Diagnosis

Tewary S, Pandya N, Cook N. Prevalence of foot problems in nursing home residents with diabetes stratified by dementia diagnosis.  Annals of Long-Term Care: Clinical Care and Aging. 2013;21(8): 30-4.

Prevalence of foot problems in nursing home residents with diabetes stratified by dementia diagnosis is an open-access article that examines foot problems in the diabetic nursing home population.  The article includes an overview and implications for practice.

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ABSTRACT

The systemic and chronic nature of diabetes places frail older adults at higher risk of foot problems, including ulceration, gangrene, osteomyelitis, and amputation. Early detection and treatment of foot problems can prevent more serious problems that could otherwise lead to reduced quality of life and costly hospitalizations. Residents of nursing homes are at high risk of developing foot problems because they are more likely to have multiple comorbidities, complex pharmacologic regimens, limited caregiver support, and cognitive impairment. Few studies document the prevalence and assessment of foot problems in nursing homes. The authors conducted a retrospective chart review that included three nursing homes in southern Florida to determine the prevalence of foot problems among persons with diabetes at these facilities and to learn how nursing home staff assessed these problems. The medical charts were stratified by dementia diagnosis to examine whether cognitive status impacted foot evaluations and care. The authors found that almost 70% of the total patient population had some type of foot problem, with 38% of patients with concomitant dementia having significant foot problems, including calluses, edema, and amputations. The authors found that the assessment of foot problems and follow-up treatment was inconsistently documented in patient charts. Results of this study indicate a need for interprofessional training programs that focus on foot assessment and foot care, tailored patient education, better protocols for regularly evaluating and managing foot problems, and adoption of better documentation systems, like electronic health records.