Nursing Care for Older Adults with Uncontrolled Type 2 Diabetes Mellitus and Dementia: A Two-Case Study.
Keywords:
older adults, type 2 diabetes mellitus, dementia, nursing process, evidence-based nursing practice; multidisciplinary careAbstract
This comparative case study aimed to examine the nursing process in older adults with uncontrolled type 2 diabetes mellitus and dementia by applying Gordon's 11 Functional Health Patterns in conjunction with evidence-based nursing practice. The study was conducted at the Geriatric Clinic, Phon Hospital, Khon Kaen Province, Thailand, between October 2024 and June 2025. Two older adults diagnosed with uncontrolled type 2 diabetes mellitus and moderate dementia were included. Data were collected from patient records, medical charts, laboratory investigations, direct observation, and interviews with patients and their caregivers. Standardized assessment tools included the Mini-Mental State Examination Thai 2002 (TMSE), Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), the Two-Question Depression Screening Test (2Q), and the Thai Geriatric Depression Scale (TGDS). The collected data were used to identify nursing diagnoses, develop individualized nursing care plans, implement nursing interventions, and evaluate nursing outcomes.
The findings revealed that both patients had uncontrolled type 2 diabetes mellitus with moderate dementia and multiple comorbidities, including hypertension, dyslipidemia, and stage 3 chronic kidney disease, resulting in impaired self-management and poor glycemic control. Case 1 also presented with depressive symptoms (positive 2Q screening and a TGDS score of 15). Following the implementation of the nursing process, comprehensive health assessment based on Gordon's Functional Health Patterns, evidence-based nursing interventions, continuous follow-up, caregiver education, and multidisciplinary care, Case 1 achieved substantial improvement in glycemic control, with HbA1c decreasing from 8.1% to 5.5%, allowing discontinuation of insulin therapy. In Case 2, fasting blood glucose levels progressively improved; however, HbA1c remained above the target level because of persistent limitations in self-management and dietary adherence.
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