Last Blog for #MHST 601 -Diabetes Amongst Older Adults

To complete my first course in the Master of Health Studies program at Athabasca University, I was tasked with reflecting on the material I have studied over the past 13 weeks, and apply this learning to analyze a health issue that is affecting Canadians. As a manager working in long term care, I wanted to explore a health concern that affects many of the residents I care for. One of the more prevalent diseases amongst nursing home residents is diabetes, especially Type 2 diabetes. The following chart by Statistics Canada (2023) shows the prevalence of diabetes, and it shows that older adults (65+) are more likely to have a diagnosis of diabetes.    

When looking at nursing home residents, authors Lega et al., (2020), stated that “over 25% of nursing home residents have diabetes.” Since the year 2000, the rate of diabetes has increased an average of 3.3% per year (LeBlanc et al., 2019). Those rates are alarming, especially when you consider the fact that our population is ageing!  So, my question is, how are we addressing diabetes in our healthcare system, and what can we do individually and collectively to reduce the prevalence of this chronic disease? 

The Definition of Health

At the beginning of the course, we looked at the definition of health.  The World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” (World Health Organization, n.d.). There has been criticism around this outdated definition. In an article published in the British Medical Journal by Huber et al., (2011), it was argued that the WHO definition of health was no longer appropriate due to the rise of chronic disease. The authors suggested changing the emphasis of the definition of health towards “the ability to adapt and self-manage in the face of social, physical, and emotional challenges.” (Huber et al., 2011). Take, for example, an older adult with diabetes. According to the WHO definition of health, this person would be considered "unhealthy" because they are not in a state of complete physical well-being. However, if you ask the individual if they are healthy, they might respond “yes” because they are effectively managing their condition and therefore do not perceive themselves to be “unhealthy”.  With this broader definition of health, can a person who has diabetes really be considered “healthy”? And what are the implications if they perceive themselves to be “healthy”?  A research study by Kugbey et al. (2017) looked at the correlation between illness perception and self-care practices amongst persons living with Type 2 diabetes.  They found that a person’s perception of their diabetes heavily influenced whether they changed their dietary or exercise routines (Kugbey et al., 2017).  This study shows that healthcare workers must understand an individual’s perception of health, because it can affect whether an individual adheres to treatment plans and/or self-care practices to manage diabetes.   

Determinants of Health

In Unit 3 of course MHST 601, we looked at the social determinants of health – the “personal, social, economic, and environmental factors that determine individual and population health” (Public Health Agency of Canada, 2023). In relation to diabetes, I wanted to determine which factor was the largest predictor of an individual being diagnosed with Type 2 diabetes. An article by LeBlanc et al., (2019) showed that in 2016/17, the number of Canadians living with Type 2 diabetes was approximately “1 in 11 adults and 1 in 333 children youth.” This demonstrates that age is a risk factor, but in Canada, we also see that Type 2 diabetes is higher amongst Indigenous communities. Diabetes Canada has a webpage that speaks to the prevalence of Type 2 diabetes amongst Indigenous peoples, but they state that identifying the causes of diabetes is complex (Diabetes Canada, n.d.). Diabetes Canada suggests that “learning about the medical, social and cultural contributions to diabetes is key to diabetes prevention.” (Diabetes Canada, n.d.). For instance, they recommend looking more in-depth at the correlation between family history of colonization when looking at the current high rates of diabetes amongst Indigenous peoples (Diabetes Canada, n.d.). Older adults might be reluctant, for instance, to seek medical care or participate in regular health screening, due to their negative experience in the residential school system. So, there are multiple systems at play, some that are within our control, and others that are systemic and out of our control. 

Chronic Disease Prevention

In Unit 4, we evaluated our healthcare system in terms of preventing and/or managing chronic disease. The Centers for Disease Control and Prevention defines chronic diseases as “conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both” (CDC, n.d.). The Public Health Agency of Canada (2021) has published a document specifically looking at chronic diseases amongst older adults. Not surprisingly, diabetes was mentioned as one of Canada’s more prevalent chronic diseases, with over 1.7 million Canadian seniors (65+) diagnosed with Type 2 diabetes in 2016/2017 (Public Health Agency of Canada, 2021).  In terms of prevention strategies, common suggestions are to remain active as we age, monitor our body weight, and consume a healthy diet. However, in a recent article by Rodrigues et al. (2022), it was stated that “as many as 88% of Canadian adults 65 years and older are not meeting the exercise guidelines.” So, what does that mean for our healthcare system?  With an aging population, I have concerns that we will continue to see increasing numbers of older adults living with multiple chronic conditions. I hope that more targeted health promotion programs can be developed, to prevent overuse and potential collapse of our healthcare system. 

Vulnerable Populations

In Unit 6, we looked at marginalized populations, and I created a blog speaking about the opioid crisis within the Indigenous community. I used the social-ecological framework to identify the levels of influence in determining the risk of illegal use of opioids. The framework has 4 levels: individual, relationship, community and societal (The Social-Ecological Model: A Framework for Prevention, CDC, n.d.). The overlapping rings in the model (pictured below) illustrate “how factors at one level influence factors at another level” (The Social-Ecological Model: A Framework for Prevention, CDC, n.d.).

When time permits, I would love to explore how this model applies to the disproportionate rates of Type 2 diabetes among Indigenous peoples compared to non-Indigenous peoples. Diabetes Canada has identified several barriers that affect the health care that Indigenous peoples receive when it comes to diabetes, and this includes “fragmented healthcare, a lack of culturally appropriate care, poor chronic disease management, high health-care staff turnover, chronic underfunding of health services for Indigenous communities, and limited tracking of new diabetes cases.” (Diabetes Canada, n.d.). Certainly, these barriers touch on every “ring” in the social-ecological model, and applying this model can generate useful information to help design effective prevention programs.

Final Thoughts

This exercise, looking at diabetes amongst older adults, allowed me to dissect and think about the topics that I have studied in this course. I have gained knowledge on the Canadian healthcare system and looked at various factors affecting individual and population health. I have explored the multiple spheres of influence and the social determinants of health, and critically examined how the healthcare system meets the needs of vulnerable people or marginalized groups. Taking this course has also prompted me to consider my own perception of health and my professional career in supporting chronic disease prevention, especially given that this population is aging.  I look forward to continuing my studies in the second course of the Master of Health Studies Program!  Thanks for your support!

WORKS CITED

Centers for Disease Control and Prevention (n.d.).  About chronic diseases. https://www.cdc.gov/chronicdisease/about/index.htm

Centers for Disease Control and Prevention (n.d.). The Social-Ecological Model: A Framework for Prevention. https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html

Diabetes Canada (n.d.). Indigenous communities and diabetes - Diabetes Canada. (n.d.). Diabetes Canada Website. https://www.diabetes.ca/resources/tools---resources/indigenous-communities-and-diabetes

Government of Canada, Statistics Canada. (2023, November 6). Diabetes, by age group. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310009607

Huber, M., Knottnerus, J. A., Green, L., Horst, H. v., Jadad, A. R., Kromhout, D., Leonard, B., Lorig, K., Loureiro, M. I., Meer, J. W., Schnabel, P., Smith, R., Weel, C. v., & Smid, H. (2011). How should we define health? BMJ, Vol. 343, pp. d4163–d4163. https://doi.org/10.1136/bmj.d4163   

Kugbey, N., Asante, K. O., & Adulai, K. (2017). Illness perception, diabetes knowledge and self-care practices among type-2 diabetes patients: a cross-sectional study. BMC Research Notes, 10(1). https://doi.org/10.1186/s13104-017-2707-5 

LeBlanc, A. G., Gao, Y. J., McRae, L., & Pelletier, C. (2019). At-a-glance - Twenty years of diabetes surveillance using the Canadian Chronic Disease Surveillance System. Health Promotion and Chronic Disease Prevention in Canada, 39(11), 306–309. https://doi.org/10.24095/hpcdp.39.11.03 

Lega, I. C., Kapur, A., Leung, F., & Zahedi, A. (2020). Type 2 Diabetes in Older Adults in Long-Term Care Homes: An Educational intervention to improve Diabetes care. Canadian Journal of Diabetes, 44(5), 407-413.e3. https://doi.org/10.1016/j.jcjd.2020.01.009 

Public Health Agency of Canada. (2023, June 1). Social determinants of health and health inequalities. Canada.ca. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Public Health Agency of Canada. (2021, July 20). Aging and chronic diseases: A profile of Canadian seniors. Canada.ca. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/aging-chronic-diseases-profile-canadian-seniors-report.html

Rodrigues, I. B., Wagler, J. B., Keller, H., Thabane, L., Weston, Z. J., Straus, S. E., Παπαϊωάννου, Α., Mourtzakis, M., Milligan, J., Isaranuwatchai, W., Loong, D., Jain, R., Funnell, L., Cheung, A. M., Brien, S., Ashe, M. C., & Giangregorio, L. (2022). Encouraging older adults with pre-frailty and frailty to “MoveStrong”: an analysis of secondary outcomes for a pilot randomized controlled trial. Health Promotion and Chronic Disease Prevention in Canada, 42(6), 238–251. https://doi.org/10.24095/hpcdp.42.6.02

World Health Organization (n.d.). “Constitution of the World Health Organization.” World Health Organization. www.who.int/about/accountability/governance/constitution