Diabetes care: Take two betta fish and call me in a week
Eleanor Feldman Barbera, Ph.D.
More than 25% of the US population over the age of 65 years has diabetes1 and the numbers are far higher for those in long-term care. (Approximately one third of nursing home residents have diabetes.2)
Diabetics often need to track their blood sugar level multiple times daily and administer medication. Uncontrolled diabetes can lead to a host of medical problems, including heart disease, neuropathy, and impaired vision and falls, and can result in hospitalizations and rehospitalizations.
While guidelines suggest that elders with comorbid health problems need less intensive glucose control than younger healthier people (who are more likely to benefit from years of strict control), many residents in our communities still need to keep track of their blood sugar daily.
We can borrow an idea from a recent study of children with diabetes to help empower our elders toward better self-care in our senior communities and more successful transitions home from skilled nursing care.
In an effort to test pairing twice daily glucose checks with pet care, researcher Olga T. Gupta, MD gave betta fish and tanks to children ages 10 to 17 years. The children were asked to feed their fish and check their blood sugar at the same time, and to review their glucose logs with their parents when they cleaned the fish tank each week. The results of this pilot study showed a small but significant improvement in glucose control.
We can adapt this study to seniors and simultaneously take advantage of the health benefits of pet ownership. Caring for a pet has been linked to fewer doctor visits, improvement in activities of daily living, reduced depression and better heart health, among other rewards. 3
While not as cuddly as dogs and cats, fish nevertheless offer the opportunity for elders to be responsible for another creature and this can contribute to a sense of wellbeing.
For those elders who are unable to take care of a dog or cat, fish can be a better option than birds, which have a long lifespan. (When researching pigeons, or “rock doves,” as I preferred to call the family that established a nest outside my New York City apartment window, I discovered they have a twenty-year lifespan! A rock dove living today could have been born during the Clinton administration.)
Linking pet ownership and diabetes care for seniors
Appropriate seniors (short-term stay residents and those who live in settings where they're responsible for glucose control) can be encouraged to consider taking on a pet to help them with their health management.
These days, when organizations are being penalized for rehospitalizations and closely monitored on clinical outcomes, it's likely to be a worthwhile study to provide a group of elders with the fish, some food and a tank along with their self-care training before discharge or after diagnosis.
Elders can be coached to take care of their pets and monitor their glucose levels at the same times each day. Instead of reporting to parents weekly as did the children in the research, other options can be offered: a weekly check-in with a nurse, an electronically submitted log that triggers additional care as needed, or even a review by a loved one (flipping the script of the research study and having the kids monitor how the parents are doing).
The authors of the research describe it as “a novel behavioral intervention.” We could use more of those in long-term care.
Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.