Diabetes and cognitive impairment bring special challenges to senior living communities.

By Susan Saldibar

Here’s a challenging combination: diabetes and cognitive impairment. Neither is easy, but together they bring special challenges to senior living communities.

Here’s the problem:

Many senior care providers, in efforts to be safe and efficient, take everything — from insulin checks to skin care — completely out of the hands of residents. “It’s understandable, given that the main concern is for the health and safety of diabetic residents,” says Angela Edney, Occupational Therapist and National Clinical Director for Aegis Therapies, a Senior Housing Forum partner. “But if you can allow some level of control by higher functioning residents, you’ll be rewarded downstream,” she adds.

How much intervention is really needed?

Perhaps less than you think, especially for residents with higher cognitive awareness. Aegis recommends pairing each diabetic ailment with a) the level of care needed and b) the ability of each resident to self-administer. Aegis uses the Allen Cognitive Levels to help make this determination. Facility staff should consult rehab therapists who are trained to use the Allen Cognitive Disability Model to better understand each patient’s cognitive status and its potential impact on care.

Here are some guidelines, based on the Allen Cognitive Levels:

  • <4.6:       Will require some assistance or cueing from caregivers for most diabetic self-management.

  • 4.6-4.7:  May be able to continue to handle previously learned medication management activities.

  • 4.8:         May be able to learn new medication management activities with extensive training/repetition and the use of a checklist.  

  • >4.8:       May be able to handle a varying range of self-management, such as insulin injections and glucose monitoring, based on past history and motor skills.

The above are general guidelines. Aegis recommends that you sit down with your residents and caregivers and go over the guidelines for each level of care, using the Allen scale, so that residents understand what they are capable of today and when it may become time to have a nurse assist or take full control of care.

Below are five common issues associated with diabetes and self-monitoring and care specifics:


   Assessing cognitive ability to complete self-care:

  1. High Glucose Levels

  • Can they conduct their own accu-checks daily?

  • Will they advise staff when levels are outside normal range?

  • Can they take medications according to schedule?

  • Do they have awareness of proper nutrition?

  • Are they able to monitor carbohydrate intake?

  1. Diabetic Retinopathy

  • Will they advise staff when vision changes?

  • Can they take medications according to schedule?

  • Do they need special adaptive equipment and/or low vision aids to facilitate independence and ensure safety?

  1. Diabetic Neuropathy

  • Can they use techniques to improve circulation?

  • Will they advise staff of increased numbness and pain?

  • Are they able to make adjustments to compensate for numbness and pain?

  • Can they properly use devices and mobility aids?

  • Can they take medications according to schedule?

  1. Foot Issues

  • Can they conduct their own regular foot-checks?

  • Are they able to advise staff when new sores and ulcers appear?

  • Can they apply medications according to schedule?

  • Are they able to keep their feet clean?

  • Will they wear proper shoes?

  1. Skin Issues (Xerosis)

  • Can they conduct their own regular skin-checks?

  • Will they advise staff when new lesions, sores or rashes appear?

  • Can they apply medications according to schedule?

  • Are they able to keep their skin clean and hydrated?


Enabling residents to contribute to their own care will give them a better understanding of their condition and greater control over their health and wellbeing. As cognitive abilities decline, the degree of self-care assistance required needs to be re-evaluated. This should occur at 90 day intervals or less, depending on the individual.

“If you stay on top of issues associated with diabetes, you can possibly avoid additional side effects, altogether,” says Angela. “So many senior care providers don’t keep up as well as they should and they find themselves managing a growing number of issues that could have been avoided.”

For more information on diabetic self-management using the Allen Cognitive scale, please contact Aegis Therapies. Their trained therapists will be happy to answer your questions and help you provide a higher quality of life to your residents with diabetes.