Some of America’s seniors are suffering from type 2 diabetes, yet find themselves stretching one meal into multiple servings on a regular basis. This food insecurity combined with a lack of support, makes for formidable daily challenges. Melissa McGuire MS, RD, LD, CDE is a home health professional who works with these seniors trying to help them balance their nutritional needs with their diabetes management so they can maximize their limited resources.   

By: John Parkinson, Clinical Content Coordinator, DiabetesCare.net

The elderly man slowly shuffles across the parking lot to the big box store. SUVs and other family vehicles speed by this man who is frail, thin, and his clothes hang off him. He is tired from walking and a bit nervous navigating the parking lot trying to avoid cars. As he steps into the behemoth store, his stomach growls and he fights the hunger pangs he struggles with everyday.

He is going to this big box store to get his prescriptions and get a few simple snack foods that he doesn’t have to prepare and he can afford. In addition, to struggling to get to the store for medicines and food, this man may be stretching out pre-made meals provided to him by a public or governmental feeding program. And one more thing: he has type 2 diabetes.

This struggling senior who is food insufficient and living on a fixed income is not the image of what many Americans think of when they envision people with type 2 diabetes today. Rather many people associate type 2 diabetes with young people who may be suffering from obesity.

This irony is not lost on Melissa McGuire, MS, RD, LD, CDE. McGuire (pictured, lower left) is a home healthcare professional who works for Shawnee Mission Home Healthcare in Merriam, KS  (metropolitan Kansas City area) who sees patients like this aforementioned senior every day.

One of the bigger daily challenges McGuire is seeing are homecare patients who may or may not get enough calories, face malnutrition and struggle with their diabetes. McGuire uses the term confounding to describe the situations these seniors face as they try to balance their food intake, medicines, diabetes supplies, and try to remain healthy at the same time.

McGuire has a wide expanse of experience and before she was involved in home healthcare, she worked in a clinic associated with a community hospital in delivering outpatient nutrition counseling.   

DiabetesCare.net talked with McGuire about the challenges home healthcare professionals are seeing, provides some insights into this patient population, and talks about some of  the resources available that seniors and their providers can utilize in the quest to stay ahead of diabetes and help them manage their lives.

DiabetesCare.net: Can you explain what you are seeing with seniors who have type 2 diabetes but who are struggling to make ends meet?

McGuire: The longer people live the more likely they are going to outlive their income, especially with increasing costs. Add into this scenario, a senior widower living on his own, and his grown kids live out of the area. This senior is suffering from a lack of both emotional and financial support.

A lot of the 65 and older age group grew up remembering their parents and grandparents in nursing homes from a different era. Today, there are qualified nursing homes with skilled medical professionals, yet that fear may remain for these seniors who don’t want to be taken to a nursing home facility, because they do not want to lose their independence and their quality of life. However, in keeping their independence, they are faced with numerous challenges they must address on their own. 

DiabetesCare.net: For these folks who might be on a limited income and food insufficient, they may have one daily meal delivered to them through a public or government program. Can you explain the specific challenges these people are seeing?

McGuire: Part of the Older Americans Nutrition Act covers congregate eating sites where if you are still independent, you can go to a public site and have a meal, or if people qualify, and there are sufficient staff and volunteers in their area, they can have a meal delivered to their homes. These are warm meals delivered once daily five days a week.  

 
Financial Resources and Support Organizations:

However, the meal is the size of a standard frozen entrée that people heat up. It may be a couple of ounces of protein with a little starch, vegetable, fruit, and bread, and a half pint of milk. It will cover the needed food groups and nutrients but it is designed to be one meal during the day to meet a percentage of a person’s needs, like a school lunch does.

These meals are delivered usually at 11 to 11:30 in the morning, and we have some patients where this meal is the majority of what they are eating all day. They might split the meal and eat part of it for lunch and the other half for dinner. It really shouldn’t be made into two meals. 

Patients in these scenarios are eating easy-to-prepare foods. They are eating chips, crackers, cookies—all foods with a lot of carbohydrates—but what is missing in this population is protein.

Meats require cooking, and for men who are widowers and had wives who cooked for them their wholes lives, or for some patients who are dealing with some form of senility and may have had an incident where they forgot to turn off the stove, these people may choose not to use their ovens altogether.

And meats can be expensive. What I try to do is help them in looking at easier proteins to prepare, like eggs, cottage cheese, and peanut butter. If the patient can chew well, then you can also suggest nuts to them.

What I try to do is offer patients some things that will give a little more nutrition and fill in some of the protein deficiency gaps.  

DiabetesCare.net: Some of the most inexpensive food items we have are processed snacks, which are loaded with carbohydrates. What do you do for people with diabetes who subside on them?

McGuire: Yes, we do have a problem as the cheaper foods are the carbohydrates, but carbohydrates always have a place. We rely on them for nutrients that protein and fat don’t give, and they are also a short-term energy supply. Carbs certainly have a major impact in blood sugars in that they hit the system quickly. In these people who are eating more carbs, they need to be doing so in smaller amounts. Some of this fits into this older population who cannot eat like they used to and are eating smaller portions anyhow.

Nonetheless, we need to offset this with a little protein. However, even with simple proteins like milk, some people may not tolerate milk or there is an issue with having to go out to the store to get it. 

DiabetesCare.net: What are the most frustrating aspects of caring for these patients who are struggling?

McGuire: It is wishing we could do more for them and a little bit of wishing they had assertiveness training. This is a generation of people where they accepted what was happening to them. For example, with medical care, they don’t really question their doctors. These senior patients need to ask for things.

At the same time, they don’t want to burden anybody. They don’t want to bother their adult children who might be taking care of their own kids.

DiabetesCare.net: What are some of the other challenges you see?

McGuire: For seniors who don’t have family or friends, getting to the store can be problematic. You are not talking about people going to little grocery stores around the corner from where they live. You are talking about these people having to take cabs to the big box stores. These stores are not easy to get around in either. Yet, at the same time, people can make their food dollar go further in these big box stores.

It is a bit of a gotcha. If people are looking to get as much as possible for their limited resources, these are the places where it helps, but some people may struggle to get there.  

Also, more of us are getting older, and this will create an increased portion of the population that could be vulnerable to these health issues combined with the possibility of limited social services and government programs in the future. This is a big part of the overall picture—an aging society with decreasing resources.

For anybody right now, our healthcare system is a very complicated process of getting the services you need. With Medicare, a lot of seniors don’t have anyone advocating for them. The fact that there are preventative Medicare programs that people either don’t know of or utilize is problematic.

DiabetesCare.net: What are some of the helpful resources that are out there to help patients who are struggling financially?

McGuire: There are senior aging programs that may have resources. We have a center in the Kansas City area that offers lunches and meetings for seniors, but county and local governments may be of help. For example, people can look to their local Department of Aging to see what they offer.

For those who can, volunteer to shop for seniors. For anyone who can carve out an hour a week to go to the grocery store for somebody, it is things like that, which can really help seniors who could not go there on their own. This could be a lifeline for them.