Care of the elderly patient by ambulant nursing care in the Heinsberg region of Germany

Objective: The number of elderly people with chronic diseases receiving amb ulant nursing care in the German population is continually increasing. Howe ver, little information is available on the quality of care of elderly diab etic patients. The aim of this study was to investigate the pattern of care provided for this group by such ambulatory nursing services. Patients and methods: All ambulant nursing services in the county of Heinsb erg, North-Rhine-Westphalia, were contacted and asked to answer a standardi zed questionnaire. 23 of the 24 services participated in the study and prov ided suitable answers. The study was conducted between October 1998 and Mar ch 1999. Results: All services together took care of 337 persons with known diabetes mellitus, of whom 79.6% were female and 20.4% were male. The total diabete s prevalence among all patients was 27.2%. 231 diabetic persons (68,5%) wer e treated with insulin. Nurses administered insulin to 84.8% of the patient s. As expected many diabetics had severe late complications (7.4% amputatio n, 20.8% blindness, 4.2% renal failure). In the majority of patients, blood glucose was monitored, but only occasionally, whereas urinary glucose was checked in only a few cases. Foot inspection and care were provided regular ly. 115 diabetics (34.1%) had at least one hospital stay during the previou s 12-months period. Conclusion: The results of this study indicate that ambulatory nursing serv ices care mainly for insulin-treated diabetic patients in late stages of th e disease. The current organisational structure not meet the requirements o f modern diabetes management.