Diabetes mellitus and the elderly: special considerations for foot ulcer prevention and care

The risk of lower extremity amputation in persons with diabetes mellitus increases with advanced age, necessitating clinical vigilance. Individualized and comprehensive prevention efforts are required to address the complicated and diverse nature of the diabetic foot in the elderly patient, including promotion of lifestyle changes to offset diabetes, attention to cognitive deficits and economic limitations, and provision of foot care education and management (eg, emphasizing the need for appropriate foot wear). If an ulcer develops, physiologic and socioeconomic factors may influence its clinical presentation, assessment, diagnosis, and treatment. To help ulcer-related complications and prevent lower leg amputations, clinicians must address diabetes management; the cost of supplies; the importance of offloading, nutrition, and exercise; and challenges inherent to impaired eyesight, dexterity, and ability to self-care. A multidisciplinary approach is recommended. Additional research to enhance understanding of practice parameters in this population is needed to help clinicians manage the increasing numbers of older adults with diabetes mellitus.