By Krista Lamb
For older Canadians, diabetes is often one of multiple conditions they are trying to manage—all while encountering barriers that are specific to their age. This is why a research team at Diabetes Action Canada is dedicated to working together with older adults with multiple chronic conditions and their caregivers to promote optimal aging at home.
This Diabetes Community Partnership Program (CPP), developed by the Aging, Community and Health Research Unit at the School of Nursing, McMaster University in Hamilton, ON involves a six-month self-management intervention that is designed to improve the quality of care and health outcomes in adults over 65 with diabetes and other chronic conditions who are living in the community. The Diabetes CPP is delivered through a partnership between primary care and community partner organizations and consists of care coordination, home or virtual visits, wellness sessions, and team case conferencing in addition to usual diabetes care. The Diabetes CPP is currently being evaluated in six diverse settings across three provinces (Ontario, Quebec, PEI).
For Dr. Jenny Ploeg, the need to focus on an older adult population is key. “We fully recognize the vulnerability of older adults in terms of their multiple chronic conditions,” she says. “They’re high users of the health system, their quality of life is often affected by the presence of chronic conditions. And also, they’re heavily reliant on their family caregivers for support.”
Dr. Maureen Markle-Reid agrees. “This is a population that is underserved, in that they face a lot of inequities and have difficulty, for example, accessing services, and are often difficult to reach because they have low income or they have low social support. There’s lots of factors that influence their health outside of the health care system,” she says. “And a large piece of this puzzle is the fact that they’re under studied. When we started this project, we found that a lot of the research looking at different models of community-based care had actually excluded older adults who had multiple chronic conditions.”
Older adults with diabetes and other chronic conditions often receive care from multiple providers who do not communicate directly with each other. This can mean their care is fragmented. The CPP was designed to improve communication and coordination across providers, settings and sectors so that older adults and their caregivers can feel better supported and improve health outcomes.
The team are also studying the barriers and facilitators to implementing the CPP in specific communities so that the program can be tailored appropriately. They recognize that elements like geography and individual cultural safety should be considered when implementing the program in diverse settings. For example, in a community like the suburb of Scarborough, ON, older adults may struggle to find transportation to get to the grocery store and purchase healthy groceries, or to find resources available in their native language. When considering these factors, what may work well in one population may be completely wrong for another. Being aware of this allows for a much more holistic and evidence-based approach.
For the Patient Partners involved in this project, much of the appeal of this project was in better understanding the needs of older adults from diverse backgrounds and, therefore, being able to provide programming and support that would improve their lives.
Frank Tang experienced many of the barriers the program has observed when he was caring for his aging parents, including a mother with diabetes and dementia. He had to navigate multiple doctors and specialists and translate to his parents what was needed and why. Now, as he grows older and manages his own diagnosis of type 2 diabetes, he is very aware of the need for research to focus on meeting the specific needs of communities. “I think that what I bring to this project is the lived experience, especially when language is a major factor,” says Tang. “As people get older, their hearing is not as good. And you get a specialist that talks quickly to them and they don’t have a clue what the details are. You need someone who has some good comprehension of the English language or the French language who could help them break it down in a way that they can understand.”
Patient Research Partner Ron Beleno agrees. He is also helping his parents manage diabetes and other chronic conditions. He sees clearly the challenges of having older adults from an immigrant population trying to navigate the health care system, and the need for research programs to study their needs and create programs that meet them. “This is about understanding that community piece and being willing to adapt,” he says. Researchers have been learning from the Patient Partners about the very different concerns faced by each individual and how research must meet the needs of everyone. “You have to have some flexibility based on the community.”
Moving forward, the program aims to continue to focus on collaboration with Patient Research Partners and community resources to improve on outcomes. “I’m so proud of the changes that we’ve seen as we move forward with this study,” says Markle-Reid. “We often say that we were changing practice as we study it. And we’re seeing changes in terms of how providers are caring for older adults with multimorbidity, how they’re paying attention to the social determinants of health, how they’re now working with a patient-centered lens, working collaboratively with patients and families, including family caregivers or friends, and really bringing those people in as part of their care.”