Vivir Healthcare acknowledges the Traditional Owners of Country. We pay our respects to the Aboriginal and Torres Strait Islander cultures, and to elders past and present, whose land we stand upon today.
Diabetes in Aged Care
Jane McQualter - Clinical Specialist, Dietetics - Vivir Healthcare • Apr 15, 2021
an Diabetes is a growing concern in the aged care setting. It is now estimated that up to 25% of residents in an aged care setting can have diabetes and this number is likely to grow due to our ageing population.
What is Diabetes?
Diabetes occurs when the body can no longer control the amount of glucose in the blood which leads to high blood glucose levels. Glucose is classified as a carbohydrate. Examples of carbohydrate foods are breads and cereals, rice, pasta, potato, dairy foods, fruit, cakes, biscuits, soft drinks and juices. Over a long period of time, uncontrolled diabetes can cause complications such as heart disease, foot ulcers, kidney failure and vision loss.
There are two types of Diabetes. Type 1 diabetes is an autoimmune disease where the body destroys the cells that produce insulin. This is a less common form of diabetes and only 10–15% of people with diabetes have this type. Type 2 diabetes is the more common type and affects 85–90% of all people with diabetes.
Diabetes in an aged care setting
It can be challenging to manage diabetes in an aged care setting as it can be a balancing act between controlling blood glucose levels, optimising quality of life and preventing malnutrition or unwanted weight loss amongst residents. Unnecessary dietary restrictions that can result in a decreased food and fluid intake and place the resident at an increased risk of malnutrition is not recommended. The main goal should be on meeting the individual’s dietary requirements and promoting enjoyment of meals instead of focusing on tight control of blood glucose levels.
Diabetes and diet myths in aged care
‘People with diabetes can’t eat sugar’ – False.
It is a common misconception that diabetic residents should avoid sugar. However, residents should be able to enjoy sugar in moderate amounts, such as having jam on their toast, a glass of orange juice with breakfast, sugar in their tea or coffee, and their desserts.
‘Residents with diabetes should be provided with a diabetic diet’ – False.
A well planned and balanced menu should be provided to all aged care residents. Residents with diabetes do not need to have special foods such as artificial sweetener or sugar-free lollies, jams or drinks. Research has now shown that residents with diabetes should enjoy a balanced and liberal diet and do not need to follow a separate ‘diabetic diet’.
Diet tips for Residents with Diabetes:
Ensure there is an even distribution of carbohydrate containing foods at each meal and snacks. This should be consistent with the regular menu that is offered to all residents.
- Avoid hypoglycaemia. Hypoglycaemia occurs when blood glucose levels fall too low and can arise in residents who take some oral hypoglycaemic medications or are receiving insulin. Common dietary causes of hypoglycaemia can include missing a meal or snack, long periods of time without eating or a low intake of carbohydrate foods. Hypoglycaemia can occur overnight but a way to help avoid it occurring can be to ensure a suitable snack before bed is provided, such as a milk drink, sandwich or yoghurt and fruit.
- Ordinary jam, honey, regular ice-cream, sugar with tea/coffee, the main dessert, cakes and muffins should all be offered to residents with diabetes. Diet products are not necessary.
- Fresh fruit should always be available.
- Keep hydrated. Drinking adequate amounts of water is important for residents with diabetes as being dehydrated can negatively impact on blood glucose levels.
It is always important to get individualised dietary advice for residents with diabetes from an Accredited Practising
Dietitian.
To talk to one of our friendly representatives about our dietetic services please contact us today.
Nourishing our bodies by eating a nutritious diet is one of many things we can do to live happy and healthy lives. Our passionate and food loving team of Dietitians are highly trained in the dietetics space and provide tailored dietary advice and support care plans for each client of all ages across Australia to ensure that they have a good relationship with food no matter their age or disability. We sat down with Jane, one of our Dietitians based in Melbourne to answer frequently asked questions they often get from clients and their families about nutrition and how to promote healthy eating habits for our children.
In Australia, it is reported that 1.2 million Australians have a communication disability. And with communication a fundamental human right, we feel that it is important to raise awareness of the communication challenges people in our community face and how our dedicated team of speech pathologists at Vivir Healthcare empower people to ‘communicate their way’! To celebrate Speech Pathology week coming up this August, our Speech Pathologists have provided fascinating insights on the role of a speech pathologist and how they support their clients and their families with their communication challenges – no matter their age. The role of a Speech Pathologist in supporting people with communication challenges is important. Speech Pathologists, also known as Speech-Language Pathologists (SLPs) or Speech Therapists, are skilled allied health professionals who specialise in the assessment, diagnosis, and treatment of communication and swallowing disorders. They work with individuals across all age groups to address a wide range of issues, from speech and language development in children to communication challenges following stroke or injury in adults. Their goal is to help individuals improve their ability to communicate effectively, which is crucial for social interaction, education, independence and overall quality of life. There are some common misconceptions about speech pathology: “Speech Pathologists only work with speech problems.” - In reality, Speech Pathologists address a wide range of issues, including language, cognitive-communication, and swallowing disorders. “Only children need speech therapy.” - People of all ages can benefit from speech pathology services. “Speech Therapy is just about talking.” - Speech Therapy encompasses a wide range of areas, including listening, understanding, reading, writing, and using language effectively. “Once therapy starts, progress will be quick.” - Therapy is a process that takes time, patience and consistent effort from both the client and the Speech Pathologist. Speech Pathology interventions differ between children, adults, and the elderly. Across different age groups, communication challenges vary significantly and speech pathology interventions as a result are tailored to the specific needs of each age group. In children, the common issues our speech pathologists address include speech delays, articulation disorders, stuttering, and language development disorders. Children might struggle with forming words correctly, using language appropriately, or understanding others. Their therapy sessions often involve play-based activities and interactive exercises to engage them and make learning fun. Early intervention is key for this age group, focusing on developing foundational speech and language skills. Adults can face communication difficulties due to health conditions or injury like stroke, traumatic brain injury, or progressive neurological disorders such as Parkinson's disease. These can result in aphasia (difficulty with language), dysarthria (difficulty with speech), and cognitive-communication disorders. Age-related conditions such as dementia and hearing loss can also impact communication. Interventions for adults might include more structured speech exercises aimed at relearning skills or compensatory strategies to manage communication challenges. Therapy is often more intensive and specific to the type of communication disorder they are experiencing. For elderly people, speech therapy may focus on maintaining their current abilities and slowing the progression of the disorder. Techniques often include memory aids, cognitive exercises, and strategies to enhance communication despite physical limitations. Family support plays a key role in supporting the speech pathology interventions for their loved ones. Family members play a crucial role in supporting speech pathologists and the overall success of speech therapy on their loved ones. Their involvement can provide emotional support, reinforce strategies learned during therapy sessions, and create a supportive environment for practice. For adults and the elderly, family members can assist with therapy exercises and help apply communication strategies in real-life situations, ensuring continuity and effectiveness of treatment. For children especially who participate in speech therapy sessions, parents can integrate language-building activities into daily routines. Our speech pathologists recommend that following five strategies for parents to support their children's communication skills: Read Aloud: Reading to your child regularly helps build vocabulary and language comprehension. Engage in Conversations: Encourage your child to express themselves, ask questions, and describe their experiences. Play Together: Use playtime to introduce new words and concepts in a fun, relaxed setting. Model Good Communication: Demonstrate clear and effective communication by speaking slowly, clearly, and using proper grammar. Use Positive Reinforcement: Praise your child’s efforts and successes to build their confidence and motivation. Speech pathologists work with other allied healthcare professions to provide the best care to their clients. Speech Pathologists often collaborate with a multidisciplinary team to provide holistic care. For instance, they may work with Dietitians to address issues related to swallowing disorders, such as dysphagia . Dietitians can recommend appropriate dietary modifications and nutritional supplements while Speech Pathologists focus on improving swallowing function. This teamwork ensures that clients receive comprehensive care that addresses all aspects of their health and well-being. Speech Pathologists and Occupational Therapists (OTs) also often team up to provide comprehensive care for children, especially those with complex needs. Speech Pathologists assess communication skills, speech, language and swallowing, whilst OTs evaluate motor skills, sensory processing, and daily functional abilities. Together, they get a full picture of the child’s needs. They set shared goals, like improving social communication and sensory regulation to ensure the child’s therapy session addresses multiple developmental areas. By working together, they provide well-rounded support that enhances their development and empowers families to support their progress and growth. Progress in Speech Pathology is measured through regular assessments and observations. Success is often determined by achieving specific, individualised goals set at the beginning of therapy. These might include improvements in speech clarity, language usage, or swallowing function. The timeline for improvement varies greatly depending on the nature and severity of the disorder, the age of the client, and their level of engagement in therapy. Generally, clients can expect to see gradual improvements, with milestones being deservingly celebrated along the way! Our Speech Pathologists love what they do One of our Speech Pathologists has shared their client success story which demonstrates the integral work Speech Pathologists around the world do. “A referral was received to see a woman with “swallowing changes” due to her Parkinson’s disease . On initial assessment, the client spoke of rapid change to her voice, she had developed stutter like speech behaviours. She was finding it was getting increasingly difficult to communicate, and people had difficulty understanding her. When eating, she felt like foods took a long time to go down. On our initial appointment, I talked through simple diet modifications that would improve her swallow safety. Knowing the importance of food and quality of life, I talked her through how we can modify her favourite foods – for example using slow cooking techniques, ensuring foods are well sauced, eating lots of fish. In our second appointment I introduced her to techniques that aimed to improve her fluency (stutter free speech) and her voice strength. By the end of our third session, the client was able to apply these strategies for up to 30 second speaking tasks. I played her a recording of her voice at initial assessment, and a recording of her voice at the third session. The look on her face as she listened and heard the difference – it made me heart sing. I knew she felt moved by the change. It is why I love what I do.” If you are looking for a Speech Pathologist to support you or your loved ones, please get in touch with us today by filling out our referral form ! Our Speech Pathology team can be reached all around Australia through our telehealth service – so no matter where you call home or if you have trouble travelling to visit a Speech Pathologist in person, our Speech Pathologists will be available to come to you.
In part two of our Physiotherapy for Pain Management blog series, we take a deeper dive how physiotherapists approach pain assessment and treatment and whey they may often take an interdisciplinary approach to support a client in managing their pain. We again sat down with Vivir Healthcare’s Clinical Coordinator for Physiotherapy, Jyoti Chatla to explore the important role physiotherapy plays in pain management where she also shares one of her client success stories! If you have not ready part one of Physiotherapy for Pain Management blog series, you can read it here. Vivir Healthcare: What role does client education play in physiotherapy for pain relief and prevention? Jyoti: Client education is one of the major components and an integral part of chronic pain management. Pain is a complex, unpleasant feeling and is highly subjective in nature and has strong emotional response associated with it. Due to our experiences with pain with day-to-day living, we form ideas and concepts in our mind which can be dependent on our beliefs, upbringing, or our surroundings and our past experiences. Clients suffering with chronic pain have several questions related to their condition and need reassurance and education to address their concerns. It is also not uncommon to see clients with chronic pain having ideas or misconceptions such as exercise is harmful, or physical activity is going to aggravate pain, pain is not treatable with exercises, and their condition is not treatable and will need surgery. At times, clients with chronic pain learn to associate pain with movement as being harmful to their body and develop avoidance behaviours in anticipation of pain or risk of reinjury. This in turn leads to a vicious cycle where a client due to their fear of pain with movement avoid movements and activities leading to inactivity and ultimately risk of greater level of disability. This has an impact on their physical state, and it also affects their mental health, sleep, and lead to chronic fatigue. Client education starts from explaining to the client about the complex nature of chronic pain which extends beyond the timeline of normal tissue healing and is not generally associated with a physical injury or illness. Education and information about why pain with movement is not always damaging or harming their body and does not mean further risk of reinjury or increase in pain is a crucial step for clients with chronic pain. With education, we aim to impart the knowledge to the client that it is ok to move and gradually increase their tolerance of pain to movement by gradually exposing their body to more movement with time to avoid the downward spiral of inactivity. Gradually with exercise and activities, their threshold for pain improves and they will be able to move more with less pain. Certainly, client education is important to develop the client’s positive attitude towards exercise and physical activity. In addition, education about the importance of activity pacing, self-management strategies such as use of heat and cold packs, relaxation, use of proper body mechanics can improve confidence of the client to help them manage their pain. Vivir Healthcare: Can you share a specific success story where physiotherapy has made a significant difference in pain management for one of your clients? Jyoti: One of my clients, a 50-year-old lady, used to work as an admin staff and generally led a sedentary lifestyle. She had been experiencing chronic lower back pain for several years. The pain was affecting her ability to perform daily living activities, including work and leisure activities. She had tried various treatments, including medications and chiropractic adjustments, but she never experienced any long-term relief. She eventually decided to see a Physiotherapist after her friend recommended her to try this treatment because of her own positive experience.On subjective examination, her pain was localised in the ow back area. There was no radiation of pain to her extremities. She didn’t have pain with rest but sitting for more than 15 minutes or standing and walking more than 10 mins were painful for her. On examination, we identified that the client had muscular imbalances, poor posture, and lack of core strength. She had asymmetric tightness in the muscles in both her extremities and had weakness in her posterior chain muscles. Her treatment was a combination of manual therapy techniques such as soft tissue massage, joint mobilisations to alleviate muscle tension and to improve joint mobility. Additionally, we prescribed her specific exercises to strengthen her core muscles, posterior chain muscles and exercises to improve flexibility in her tight muscles. We started the strengthening programme at a very low intensity as much as she could tolerate and progressed to body weight exercises in a functional pattern. As her pain levels improved, we commenced the client on a walking programme. We requested her to maintain a diary and record her daily walks, distance/ time she could manage to walk, symptoms that she experienced and how long the symptoms lasted. We educated her with self-management strategies such as bracing her core muscles, taking rest pauses to recover from pain. She was given a home exercise programme that she could complete at home focusing on strengthening and flexibility exercises. Her walking duration improved gradually as her confidence and motivation levels improved and she was able to walk 45 minutes to 1 hour without any complaints of pain. We also checked her desk and seating set up at work and gave her some recommendations to make the setup ergonomically sound . She was educated about the importance of avoiding prolonged static postures since our muscles and joints are designed to move and not to stay in one position for long duration. We gave her a handout with pictures of exercises that she could do when she was in her office, which were easy and could be performed in an office setup without specific equipment required. The client continued to maintain her regular walking programme and all the exercises that were given to her. She was not experiencing pain anymore and was happy with the overall outcome she had. She was also looking forward to engaging in activities that she has previously avoided due to fear of discomfort. Vivir Healthcare: How important is interdisciplinary collaboration (e.g., with Occupational Therapists, Dietitians) in managing pain through physiotherapy? Jyoti: For the best outcome for clients, it is important for a Physiotherapist working with clients with chronic pain to collaborate with other allied health professionals such as Occupational Therapists and Dietitians for overall holistic approach to treatment. Chronic pain has a strong impact on clients’ lives and their well-being. Due to complexities associated with pain, clients can experience difficulties with their daily living activities, their participation in the community and even their occupations and leisure activities. Occupational Therapists can complete a thorough assessment of a client’s activities, their occupational demands, and the impact of their surroundings and environment on their experience of pain. Due to their expertise and knowledge about adaptive equipment and assistive technologies, Occupational Therapists can work closely with the clients suffering with chronic pain and identify any modifications or adaptive equipment that can make day to day tasks easier for the client. They can also recommend assistive devices / technologies and suggest and make changes to their environment to enable the client to engage in their activities of daily living (ADLS) which promotes independence and therefore feelings of satisfaction amongst clients. There is a growing body of scientific evidence which has shown that poor nutrition, unhealthy dietary behaviours, and sub optimal nutrition play a strong role in occurrence, development, and prognosis of chronic pain. Clients with chronic pain have several challenges due to their mobility and strength, mental health, irregular sleep habits due to which access to healthy nutritious meals can be a challenge. A well-balanced diet is important for a client with chronic pain to gain benefits from physical activity and exercises. In addition, clients with chronic pain are at risk of various lifestyles diseases and comorbidities associated with reduced mobility, due to which diet is important. Dietitians can work closely with the client, understand their challenges, their requirements and recommend strategies and dietary recommendation personalised to their needs. Vivir Healthcare: How does Vivir Healthcare approach pain assessment and treatment planning during initial client consultations? Jyoti: Vivir Healthcare Physios complete a comprehensive assessment on their initial appointments. The initial client consultation starts with subjective examination where the clinician asks the client questions about the difficulties they are experiencing in their day-to-day activities, their occupation and leisure. Physiotherapists will collect in depth information from their client about their pain such as the location of pain, severity, type of pain, the aggravating and relieving factors, and changes in levels of pain with time of the day and if the pain is associated with any other kinds of symptoms. Baseline level of pain is documented using pain scales which is used to monitor during follow-up sessions to understand how the treatment planned for the client is helping them. Subjective assessment also includes understanding how pain is affecting the clients’ ADLS and their participation in the community in their occupation, hobbies, and leisure. This information helps the us physiotherapists to get a better understanding of their client’s problem. The next step in the initial consultation includes completing a thorough physical examination, where we will assess client’s range of motion, strength, balance, their gait. Physiotherapist will also complete some special tests to identify musculoskeletal causes of pain. Standardised outcome measures are recorded at baseline which are re-assessed periodically by the physiotherapist to ensure that the treatment plan designed by the physiotherapist is effective at bringing about some change in client’s symptoms and their function. Finally, Physiotherapists sets goals in collaboration with the client. Based on the above information and examination, Physiotherapists then develops a personalised treatment plan for the client which includes patient education, manual therapy, exercises. Treatment plans are individualised as per the clients’ goals, their baseline levels of function and exercise capacity and are reviewed and monitored periodically, are adjusted as required to ensure client is progressing safely and has the best possible outcome. Physiotherapist will also give you self-management strategies and a tailor-made home exercise programme with pictures and instructions to help client in between the sessions with physiotherapists. The physiotherapist will guide you through a graded approach of return to activities. Vivir Healthcare: What advice do you have for individuals seeking physiotherapy to manage their pain but are unsure about where to start? Jyoti: If you are suffering with chronic pain, you should consider seeing a Physiotherapist. In Australia, Physiotherapists are first contact practitioners and therefore you do not usually need a referral from a GP before you see a Physiotherapist. However, if you would like to claim Medicare rebate, you will need to consult a GP to get a referral via Chronic disease management plan (CDM) or Enhanced Primary care programs (EPCs). CDMs or EPCs is a Medicare rebate system to help refund part of the cost of attending a private allied health service. Each eligible individual can claim 5 sessions per calendar year. If you have private health insurance, check your policy if it covers Physiotherapy treatments. If you are over 65 years of age you may be eligible for government funded aged care services, you need an assessment to find out if you are eligible for these fundings. Using this funding you can have access to Physiotherapy services. If you are already on some form of aged care funding, speak to your case manager who can arrange Physiotherapy services for you. The next step is to find a Physiotherapy service provider that you would like to use. Vivir Healthcare offers mobile Physiotherapy services and come to your home for all sessions . The first session is an initial consultation during which the physiotherapist will talk to you and take full history of your condition to understand your condition, complete a physical examination and set goals in collaboration with you. Based on this information, they will design treatment plan that will be individualised to you as per your circumstances and goals. The subsequent sessions will be follow-up sessions with your Physiotherapist focussing on the treatment, who will closely work with you and monitor your symptoms and adjust your treatment if required to ensure you get the best possible outcome. If you would like to book in one of our physiotherapists to help you manage your pain, fill out our referral form here .
