Insulin Therapy in Elderly Patients: a Qualitative Study on Patient Care

Background: Around 80% of type 2 diabetes patients aged over 65 are treated by their family doctors. This study looks into the implementation of primary care therapy in the daily life of elderly patients as well as collaboration between primary and nursing care. Methods: We collected primary data from the exploratory qualitative study using 38 expert interviews with: family doctors (n=20), nurses (n=6 ambulant mobile care, n=6 residential home for the elderly), and medical technical assistants (n=6); and applied a narrative analysis method based on extempore biographical narration. Results: Complex insulin therapy involves the risk of confusion and overburden in elderly patients. The main risk to primary care treatment by family doetors arises from unevenly distributed skills among nurses in assessing critical metabolic situations, and shortcomings in interdisciplinary communication. Conclusion: We recommend that family doctors planning insulin therapy for elderly patients consider existing patient skills in using the therapy as well as everyday routine and expectations on quality of life. A standardized method of information exchange, such as by fax, would improve communication between primary care and nurses. Regular quality-assured training for diabetes care professionals would improve the situation and risk assessment.