The prevalence of diabetes is growing significantly. Based on projected population growth, increases in diabetes incidence, and decreases in relative risk of death for individuals who have diabetes, the Centers for Disease Control and Prevention conservatively estimates that 12% of Americans will have diabetes by 2050.¹ This figure represents > 48 million people.

The elderly are at highest risk. In the group aged 65–74 years, it is projected that the number with diabetes will triple. In the group aged >_ 75 years, the number of diabetes patients will increase to five times its present level. Elderly diabetes patients often have multiple medical problems (e.g., physical disabilities and mental and emotional problems) that complicate the illness. Furthermore, increased life expectancy means that more of the elderly will suffer impaired quality of life (e.g., pain and depression) because of diabetes-related complications.

There has been a growing call to understand the medical and psychosocial challenges that elderly diabetes patients confront. The 2003 publication “Guidelines for Improving the Care of the Older Person with Diabetes Mellitus”² highlighted the importance of individualizing the medical management of older diabetes patients and avoiding a one-size-fits-all approach. For example, the guidelines recommend targeting cardiovascular risks rather than aggressively treating hyperglycemia for many elderly patients.

The Elderly and Depression

The statistics concerning mental health of the elderly are also alarming. Approximately 20% of the elderly experience diagnosable mental disorders (i.e., anxiety, severe cognitive impairment, and depression) that cannot be attributed to normal aging.³ Depression is a major concern. Estimates suggest that 8–20% of community-dwelling elderly people can be diagnosed with major depression, with an aging-associated increase in depressive symptoms. Older adults have the highest rate of suicide of any age-group, and individuals > 85 years of age are most likely to commit suicide (twice the national rate).³ Depression is …