**Acknowledgements**

*Palliative Care*

dementia in the longer term.

**4.5 Nutrition and hydration**

interdisciplinary care.

provide counseling and support.

**4.6 Family carers**

**5. Summary**

the medicine regimen and care needs.

**4.4 Managing medicines: Pharmacovigilance**

symptomatology and can become chronic. Hypoglycaemia is a risk factor for frailty [69] and cardiovascular disease [70] and leads to short-term cognitive changes and

T2DM is associated with brain aging and cognitive changes that affect memory and learning and contribute to depression in the longer term. Thus, blood glucose monitoring in a suitable regimen tailored to the medicine regimen and hypo-hyperglycaemia risk profile can provide important information about glucose variability,

Pharmacovigilance is important and includes regular medicine reviews, stopping medicines and using non-medicine options where possible and selecting the lowest effective dose when medicines are indicated. Insulin might be a safer option than some other glucose-lowering medicines and can be used with a palliative intent, that is, to improve comfort by managing unpleasant symptoms associated with hyperglycaemia. Some medicines are diabetogenic, and it is important to diagnose hyperglycaemia caused by medicines such as glucocorticoids and manage it appropriately.

Undernutrition can contribute to frailty, hypoglycaemia, slow wound healing and falls and can be present in overweight individuals. Eating disorders, depression, difficulty swallowing and other causes can be present. Likewise cancer, thyroid disease and other diseases can cause weight changes. These factors highlight the value of comprehensive geriatric assessments and collaborative

Family carers play a vital role in the care of children and older people with diabetes by helping with diabetes self-care and other activities of daily living. They are at risk of sleep deprivation, reduced immunity, depression and unresolved bereavement after their relative dies [68]. It is important to monitor their health and

Long-standing diabetes and associated complications significantly increase the risk of disability and frailty and reduce life expectancy. Palliative care can be used with usual diabetes care. Proactively planning for diabetes palliative care is important. Diabetes reduces life expectancy and can cause significant suffering. Considering the indicators of reducing life expectancy and implementing palliative care early into the diabetes care plan has many benefits, including reducing the suffering and the burden on the individual and family carers. Atypical symptoms associated with older age can

People admitted to hospital near their end of life are more likely to receive burdensome treatment such as admission to intensive care, resuscitation, dialysis and blood transfusions that are often futile [45, 46] and distressing for the individual and their families. Health professionals have an important role in helping older people with diabetes to plan for predictable changes in health status and to initiate timely palliative and EOL care to prevent unnecessary admissions to hospital and/or

make it difficult to recognize deterioration and underlying causes.

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The authors acknowledge the older people with diabetes and their families and health professionals who served on research advisory groups for their research. The Diabetes Australia Research Program funded the research that enabled them to develop a suite of information to help older people with diabetes, family members and clinicians initiate discussions about palliative and end-of-life care. It is referenced in the chapter.
