Education Program for Diabetic Older Adults
Education Program for the Diabetic Older Adults in Kimberley
Despite the acknowledgement that the Aboriginal and Torres Strait Islander are the oldest living cultures in Australia and that they play an essential role in maintaining cultural diversity in the country, the people in the culture continue to face political, economic, social and cultural injustices that deprive them the privileges enjoyed by other populations. The aboriginal populations in Australia a generally oppressed, a trend that has inhibited their development in all sectors (Waterworth, Dimmock, Braham, Pescud, & Rosenberg, 2015). The decreased levels of development among the aboriginal communities have adversely impacted their health and general wellbeing. The Aboriginal populations in Australia lack the political capacity and will to push for or initiate transformative health policies, the economic power to fund health promotion programs, and the social will to fight for equal health rights. As a result, the Aboriginals suffer high morbidity and mortality rates compared to the rest of the populations in Australia (AIHW, 2016). The most prevalent health conditions among the indigenous populations in Australia include respiratory diseases, mental illnesses, cardiovascular disease, diabetes and chronic kidney disease (AIHW, 2016). The prevailing circumstances in the health status of the Aboriginal populations can systematically be transformed by initiating and implementing promotional health programs at different triers of the population.
Population and health issue
Kimberly is a remote region in Western Australia that hosts a significant percentage (40 per cent) of the entire Aboriginal population in Western Australia (Diabetes WA, 2019). The region is classified by the Accessibility/Remoteness Index of Australia (ARIA) as 97 per cent very remote (Government of Western Australia, 2018). The remoteness of the region blocks its residents from access to reliable health services. It also impacts the economic and social aspects of life, which are key health determinants. Kimberley’s population is relatively young compared to the population of other regions in Australia. According to the 2016 census data, the population above 50 years old in Kimberley only makes up 23 per cent of the total population (ABS, 2017). In Western Australia, older adults represent only 14 per cent of the entire population. However, projected statistics indicate that the population of older adults will rise significantly due to the increasing rates of life expectancy and reduced fertility levels. By 2055, people above 65 years are expected to form 22.6 per cent of the Australian population compared to the 2016 census 15 per cent (ABS, 2017).Indigenous populations in Australia experience a higher disease burden of 2.3 per cent compared to the non-indigenous population (AIHW, 2016). Chronic illnesses cumulatively contribute to 70 per cent of the gap experienced in the disease burden between the Indigenous and non-Indigenous populations in Australia. The diseases that contribute largely to this gap are cardiovascular diseases (19 per cent), mental disorders (14 per cent), cancer (9 per cent) and diabetes (7 per cent) (Al-Yaman, 2017). More than 75 per cent of the disease burden among the Aboriginal populations is preventable through the elimination of the risk factors such as smoking, drug addiction, obesity, high blood pressure and physical inactivity (Al-Yaman, 2017). Similarly, the mortality rates contributed to by the high disease burden can be reduced by proper management of the diseases, especially the chronic conditions.
Diabetes is a major health condition affecting older Aboriginal adults in Kimberley. In 2007, the mortality rates resulting from diabetes in Kimberley were 39.8 times compared to the entire Western Australia population (Government of Western Australia: Department of Health, 2013). The prevalence of type 2 diabetes has been growing in Australia, making it a top chronic condition in the country. The Indigenous populations are 38 times more likely to have a major leg amputation compared to the non-Indigenous populations (Sesti, Incalzi, & Bonora, 2018). Close to 98 per cent of all the amputations performed on the Aboriginal populations are linked to diabetes (Diabetes WA, 2019). Amputations are major implications of diabetes and reduce the quality of life of the patients. Mortality rates linked to diabetes are also a major implication of the condition. The Indigenous people living in Kimberley present a higher possibility of dying from diabetes compared to their counterparts living in non-remote areas and the entire Australian population (Hyde, 2018). These deaths account for 23 per cent of all the deaths among the older Aboriginals living in Kimberley.
The prevalence of diabetes among older adults in Kimberley is largely as a result of their sedentary lifestyle. Majority of the deaths and deterioration caused by diabetes is controllable through the application of primary and secondary health interventions. This revelation highlights the necessity of interventions such as screening and public health programs. These interventions should specifically target the diabetes risk factors such as physical inactivity, smoking, alcohol use, poor nutritional choices and excessive weight.
An estimate of 1.8 million people are living with diabetes in Australia. This figure includes both the patients who have been screened and those who have undiagnosed type 2 diabetes (Australian Indigenous HealthInfoNet, n.d.). Diabetes is ranked the seventh most common cause of mortality in Australia and costs the Australian economy approximately $14 billion annually (Diabetes NSW & ACT., n.d.). The fast-rising implications of diabetes can be managed through the engagement of an education program to address the needs of the patients by promoting their health and general wellbeing. The remoteness of Kimberley limits the patients from access to the educational programs which are available in most non-remote areas. Thus the diabetic people in Kimberley are at risk developing the devastating complications of diabetes, which occasionally lead to amputation or death. The quality of life of diabetic people living in Kimberley is relatively lower compared to that of patients living in other parts of Australia. The diabetic Aboriginal older adults living in Kimberley are doubly challenged. Despite living in very remote conditions, they face economic, social, political and cultural challenges that further hinder their access to information that is essential for the management of their conditions (Welch, Königsberg, Rochecouste, & Collard, 2015). In 2016, only 28 per cent of the Aboriginal population reported having attended the highest education, against 58 per cent of the non-indigenous population (ABS, 2017). Education is a key health determinant and contributes positively to health outcomes at all ages. Education helps people in making informed health decisions that help in maintaining their quality of life. Most of the Aboriginal older adults in Kimberley lack any form of education which exposes them to greater diabetic health implications.
Implementing an education program for the older adults living in Kimberly is likely to boost their understanding of the condition and consequently, their health outcomes. For the educational program to have far-reaching impacts, it would be necessary to incorporate not only diabetic patients but also their families and caregivers (Herman, 2019). Kimberley lacks major chronic diseases management centres and specially trained experts. General physicians are, therefore tasked with the role of taking care of diabetic patients. Lack of the capacity to offer specialized care limits the achievement of the desired health outcomes. The families of diabetic patients have a vital role in managing the condition, especially in offering support and other care-related duties. The age and vulnerability of the Aboriginal older adults in Kimberley coupled with the health implications of diabetes in most occasions, leave them incapacitated to perform their daily chores (American Diabetes Association, 2019). Among the older adults, diabetes is accompanied by various comorbidities, functional disabilities and premature mortality (Sesti, Incalzi, & Bonora, 2018). Thus the family members are left with the bigger share of managing the lifestyles of the patients. Diabetes self-management (DSM)is a complex issue among older adults due to the prevalence of debilitation and comorbidities. It is, however, an integral component of diabetes management for anyone desiring to attain good health outcomes regardless of their age. Medical care is hardly adequate and effective in the management of diabetes if the patient does not practice self-care (Suhl, 2016).Objectives
1. Help the Aboriginal older adults living in Kimberley to achieve relevant goals in the management of diabetes: DSM education is likely to help the diabetic Aboriginal adults living in Kimberley to set and attain goals relevant in achieving the best health outcomes. Lifestyle choices have major implications in the management of diabetes. The patients, at times, lack awareness on the best practices that they need to adopt to manage their conditions. Those who know that they need to change their lifestyle may not understand the implications that the changes will have on their health. This project seeks to hold classes for the diabetic Aboriginal older adults living in Kimberley and help them learn major self-management skills that will help in mitigating the health implications that decrease the quality of their lives. Some of the successful management goals that will be explored in the classes include maintaining physical activity, healthy eating, monitoring blood sugar, taking medicine consistently, risk reduction and weight reduction.
2. To boost family support for the diabetic Aboriginal older adults living in Kimberley: Families play an essential role in the management of chronic conditions. Older adults who suffer chronic conditions may be physically incapacitated and may need help in doing some of the most basic needs. Family plays a role in helping the patients attend to their daily routines and improve their quality of life. Emotional distress due to societal stigma is a major factor that influences diabetic patients, consequently reducing their quality of life. Generally, the Aboriginals face stigma, which may be doubled by suffering a chronic condition. Educating family members improves the patient’s lifestyle choices, their quality of life and control health-related problems such as emotional distress.
3. To improve the care practices engaged by the general physicians in Kimberley in the treatment of diabetic Aboriginal older adults: The concept of health is interpreted differently by both the Aboriginal and non-Aboriginal Australians. The Aboriginals view health in a holistic manner which encompasses the physical, emotional, social and cultural wellbeing(Australian Indigenous HealthInfoNet, n.d.). The general physicians should, therefore, handle the patients of the Aboriginal descent with consistency to their beliefs. Apart from creating awareness around the Aboriginal health perspectives among the general physicians, this project will also push for continuing medical education to cater for the care needs for the diabetic Aboriginal older adults. The general physicians in Kimberley treat over 90 per cent of the patients in the region (Fogelman, Goldfracht , & Karkabi , 2015). The project will fund efforts to make continuing medical education accessible for the general physicians in Kimberley. These efforts will equip the physicians will knowledge necessary for the management of diabetes among the older adults of the Aboriginal descent.
Working in partnerships
Diabetes is a complex health condition, and its management requires various partnerships at different levels. Most of the people living with diabetes have to make major adjustments in their lives to enable them to maintain quality of life. This project will establish various partnerships to improve its effectiveness. The partners for the program will include:
a. Public health departments
b. Religious/ Culture-based organizations
c. Nutrition experts
d. Fitness and wellness centres
e. Social service organizations
The program will make a huge contribution to the management of diabetes among Aboriginal older adults. It will equip the patients, their families and caregivers with relevant information and consequently reduce major health implications such as amputation and mortality. To ensure the sustainability of the program, the initiated partnerships will be maintained to ensure that the support offer is not terminated. The partners will be empowered to support the program’s sustainability strategies. Those who will have benefitted from the program will be encouraged to take part in the running of the program either at the administrative or non-administrative levels. Members of the public will also be encouraged to volunteer and commit to the program’s goals for the communal good. To make the sustainability of the program more achievable, a sustainability plan will be developed. In the future, a similar program will be developed to help in the management of other health issues among the Aboriginal populations living in Kimberley.
ABS. (2017, October 31). Census of Population and Housing: Reflecting Australia – Stories from the Census, 2016. Retrieved from ABS: https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0~2016~Main%20Features~Aboriginal%20and%20Torres%20Strait%20islander%20Population%20Article~12
AIHW. (2016). Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011.
Al-Yaman, F. (2017). The Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people, 2011. Public Health Research and Practice, 27(4), 1-44.
American Diabetes Association. (2019). Older Adults: Standards of Medical Care in Diabetes 2019. Diabetes Care, 42(1), 139–147.
Australian Indigenous HealthInfoNet. (n.d.). Aboriginal and Torres Strait Islander concept of health. Retrieved from Australian Indigenous HealthInfoNet: https://healthinfonet.ecu.edu.au/learn/cultural-ways/aboriginal-and-torres-strait-islander-concept-of-health/
Diabetes NSW & ACT. (n.d.). Diabetes facts and figures. Retrieved from Diabetes NSW & ACT.: https://diabetesnsw.com.au/about-diabetes/what-is-diabetes/facts-and-figures/
Diabetes WA. (2019, October 16). Diabetes WA funds technology to reduce amputations in the Kimberley. Retrieved from diabetes WA: https://www.diabeteswa.com.au/diabetes-wa-is-delivering-world-class-technology-to-reduce-amputation-rates-and-improve-patient-care-across-wa/
Fogelman, Y., Goldfracht , M., & Karkabi, K. (2015). Managing Diabetes Mellitus: A Survey of Attitudes and Practices Among Family Physicians. Journal of Community Health, 40, 1002–1007.
Government of Western Australia. (2018). Kimberley Health Profile. Department of Health.
Government of Western Australia: Department of Health. (2013). Diabetes in Western Australia: Prevalence and Services in 2012. KPMG.
Herman, O. (2019). Guidelines Issued on Managing Diabetes in Older Adults. Journal Watch. Retrieved from https://www.jwatch.org/fw115193/2019/03/25/guidelines-issued-managing-diabetes-older-adults
Hyde, Z. (2018). Mortality in a cohort of remote-living Aboriginal Australians and associated factors. PLoS ONE, 13(4), 1-42.
Sesti, G., Incalzi, A. R., & Bonora, E. (2018). Management of diabetes in older adults. Nutrition, Metabolism and Cardiovascular Diseases, 28(3), 206-218.
Suhl, E. (2016). Diabetes Self-Management Education for Older Adults: General Principles and Practical Application. Diabetes Spectrum, 19(4), 234-240.
Waterworth, P., Dimmock, J., Braham, R., Pescud, R., & Rosenberg, M. (2015). Factors Influencing the Health Behaviour of Indigenous Australians: Perspectives from Support People. PLoS ONE, 10(11).
Welch, A. R., Königsberg, P., Rochecouste, J., & Collard, G. (2015). Aboriginal Education in Australia: Policies, Problems, Prospects.