Improving diabetes care for older adults

New report calls for changes to support older Canadians living with diabetes and their caregivers.

In a country where nearly four million people are affected by diabetes, a significant portion of the population grappling with the illness are older adults. Statistics show that over half of all cases of diabetes in Canada are among individuals aged 65 and above. With more and more Canadians living longer than in the past, it has become increasingly crucial to better understand and support older adults living with both Type 1 and Type 2 diabetes.

A report published by the National Institute on Ageing, which highlights research from multiple McMaster School of Nursing faculty, explores some of the current issues with older adults managing diabetes and provides suggestions on how to better support them.

Older adults face unique concerns and challenges in managing diabetes. Their treatment plans must be tailored to consider other health conditions, functional abilities, and cognitive status. Factors such as dementia, frailty, and disabilities significantly impact the care required for older adults with diabetes, often resulting in increased hospitalization rates or relocation to long-term care facilities. These individuals face an elevated risk of falls, urinary incontinence, cardiovascular diseases, and other complications associated with diabetes. Adequate care for this population demands access to primary care, specialist care, long-term care services, and the support of unpaid caregivers. Regular foot and eye care are also essential to prevent and manage diabetes-related complications.

However, navigating the existing health and social care systems can be a daunting task for many older adults living with diabetes. The integration of multidisciplinary, person-centered care across various sectors remains a challenge, leading to limited access to the care they require. Additionally, the social determinants of health, such as affordability and access to nutritious diets, out-of-pocket expenses, and medical appointments, further aggravate the situation. While some provinces cover a portion of diabetes medications and supplies, the financial burden on individuals living with diabetes remains substantial.

The current health and social care systems in Canada do not adequately cater to the needs of older adults living with diabetes. Timely access to primary, specialty, mental health, and long-term care services remains a challenge. Identifying those in need of eye exams or foot assessments to prevent complications from diabetes is often lacking. Furthermore, interventions to support older adults with multiple chronic conditions are still poorly understood, including those aimed at improving care coordination. The potential of health technologies to aid older adults living with diabetes is an under-explored area, and unpaid caregivers require support in managing diabetes-related complications.

To address these issues, local and national advocacy efforts have been mobilized to improve diabetes care. The report proposes four recommendations to better support older Canadians living with diabetes:

1.     Recognition and Engagement: The Canadian federal, provincial, and territorial governments must ensure that diabetes health strategies and research include a specific focus on addressing the unique issues and needs of older Canadians living with diabetes and their caregivers.

2.     Information Systems: National health information systems should be developed to enhance understanding of the prevalence and incidence of diabetes and its complications among older Canadians. Additionally, reporting and screening mechanisms through provincial and territorial registries need improvement.

3.     Care System Improvements: Governments at all levels must prioritize enhancements in health and social care system navigation, care integration, and transitions of care for older adults living with diabetes and their caregivers. Comprehensive primary care-led support, clinical pathways, and interprofessional and specialist supports should be considered while centering efforts around the needs and perspectives of older adults and their caregivers.

4.     Social Determinants of Health: Diabetes prevention and ongoing care must be approached from a social determinants of health perspective. Provincial and territorial governments need to ensure that publicly funded healthcare and social systems appropriately cover and support diabetes care and prevention measures.

Efforts to improve diabetes care for older adults must address the unique challenges faced by this population. By implementing these recommendations, we can strive toward better care for older adults with diabetes.

To read the full report, click here: National Institute on Ageing