elderly
Elderly Israelis at a community center in Jerusalem. An estimated 200,000 Israelis have diabetes but have not been diagnosed. Photo by Gil Cohen-Magen
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We will live a long time, far longer than our parents and grandparents. According to forecasts, by 2050 around 25 percent of the world's population will be 60 years old and up. Time, humanity's most precious resource, will be plentiful. The question is how to make the best of it.

The first, and most important, challenge facing older people is staying healthy. That is the basis for quality of life.

In recent years medicine has been shifting from a focus on disease to a focus on health and preventive measures that begin at an early age. The idea is to find the factors that contribute to so-called successful aging; in other words, how to get more people to reach the age of 80 as independent, clear-thinking and fully functioning individuals.

Diabetes, a chronic disease characterized by high blood-sugar levels, affects many older people. There are two main forms of the disease (in additional to gestational diabetes, which affects pregnant women): Type 1, formerly called juvenile diabetes, results from the inability of the pancreas to produce sufficient levels of insulin, the hormone responsible for moving sugar into the cells. As a result, the sugar  remains in the bloodstream. Type 2 diabetes, formerly known as adult-onset diabetes, results from insulin resistance, in which larger quantities of insulin are needed in order to move the same amounts of glucose into the cells. As a result, the pancreas steps up its production of insulin until it fails to make enough of the hormone. At that stage, blood-sugar levels rise because not all of the glucose can be taken into the body's cells.

Type 2 diabetes can be present in childhood but typically does not develop before age 30, after which the risk of developing the disease continues to rise. As a result of dietary changes and rising levels of obesity, the prevalence of Type 2 diabetes is on the increase worldwide.

Half a million Israeli diabetics

Israel is no exception. According to the International Diabetes Federation, Israel is in ninth place among the 20 Organisation for Economic Co-operation and Development member states for the prevalence of diabetes in the 20-79 age group. According to the Ministry of Health, approximately half a million Israelis, or 7 percent of the population, has diabetes. An estimated 200,000 more Israelis have the disease but have not been diagnosed. Around 4.2 percent of Israelis take medication for diabetes.

Recent studies suggest that diabetes accelerates the aging process. Individuals with diabetes have up to double the risk of developing dementia, of experiencing accelerated cognitive decline and of incurring damage to their learning, memory and cognitive abilities. They are also at greater risk for muscle atrophy, physical disability and the need for outside assistance.

As a chronic disease, diabetes requires monitoring by a health professional and changes in eating and exercise habits, and it is crucial for the person with diabetes to comply with all of these demands for the remainder of his or her life. This is very difficult to achieve, in part because people tend to make decisions about their health based on their present-day symptoms and difficulties rather than on the basis of future risk.

Sheba Medical Center at Tel Hashomer accepted the challenge, establishing a center that is unique not only in Israel but throughout the world: the Center for Successful Aging with Diabetes. The center's purpose is to help individuals with diabetes to maintain optimal health and physical function. Its staff is multidisciplinary, consisting of a doctor, a neuropsychologist, a physical therapist, an occupational therapist and a nutritionist. People with diabetes aged 60 and up are invited to a one-day, comprehensive examination, beginning with a thorough physical by a doctor who specializes in diabetes. She evaluates the patient's medical condition and the drugs that he takes. The neuropsychologist performs a comprehensive evaluation, which gives a picture of the patient's cognitive functioning - focus and memory as well as executive, learning and problem-solving abilities. She also evaluates the patient's emotional status and quality of life. The physical therapist and the occupational therapist examine aspects affecting the patient's everyday functioning, including physical strength, balance and endurance. Also taken into consideration is the patient's diet and the extent to which his or her eating habits support the demands of treating diabetes.

The one-day, comprehensive evaluation format is particularly helpful for older individuals, eliminating as it does the need to make and keep multiple appointments in different places. The staff discusses each patient in a holistic, integrative manner and reaches conclusions that are based on all aspects of patient care - physical, cognitive and emotional.

The unique contribution of the center is expressed in three important areas. The first is the creation of a personal database that allows each patient to monitor their condition in all areas and to identify any problems early on so that they can be addressed before they deteriorate further. Second, the patient receives integrative recommendations. So, for example, a patient who is assessed as having difficulties with balance will be given recommendations regarding physical therapy and coping techniques. Third, the center allows for the rapid implementation of new research findings, to the benefit of the patients. So, for example, the results of the cognitive portion of the trial, which was presented at the most recent conference of the American Diabetes Association and which assessed the affect of the use of Lantus long-acting insulin on the rate of cognitive decline in people with diabetes, will be implemented in the recommendations for patient care.

To sum up, a person with diabetes can reduce the disease's effects on the aging process. We look forward to living at least 20 years after age 60, and we wish for ourselves years of health, activity and quality of life. Regular monitoring of the functional areas liable to be affected by diabetes is the foundation for prevention and proper treatment.

For more information, call 03-530-5470 or 052-484-4525, or write to the center at sawd.diabetes@sheba.health.gov.il

Dr. Tali Yafe-Cukierman is in charge of the Center for Successful Aging with Diabetes, a senior physician at the Institute for Endocrinology and a researcher at the Gertner Institute for Epidemiology and Health Research (at Sheba) and at Tel Aviv University.

Rachel Natovich is a rehabilitation psychologist and is in charge of the area of neuropsychology at Sheba.