Type 1 diabetes

Grey nomads at risk of medical mishap on the road


Grey nomads with diabetes are endangering their health by failing to prepare before setting out on the road, a conference has been told.

New research taps into the experience of diabetes educators and GPs in remote and rural South Australia who have looked after the so-called grey nomads, the colloquial term describes people aged  65 or older who travel for extended periods around Australia by road, typically in a caravans or motorhomes.

The unpublished research, by a team from Flinders University and Country Health South Australia, finds this cohort lacks information on how handle unexpected health-related difficulties or where to go for help when they arise, and is often unprepared for challenges that can crop up when travelling in remote locations where services are scarce.

This could be as simple as a traveller with type 2 diabetes knowing when a blister on their foot requires medical attention, says Dr Pauline Hill (PhD), from the College of Nursing and Health Sciences at Flinders University in Adelaide, who presented the abstract findings to ADC 2018 on Thursday (August 23).

But the variety of problems that confront grey nomads can arise from myriad factors: sudden lifestyle changes from a desk job to camping and hiking lead to musculoskeletal pain or injury, while change to routines can disrupt medicine regimens, Dr Hill told the limbic.

Then there are the unexpected events – from flat tyres to illness – that strike in remote locations, where help is hard to access. Some begin their travels with a new diagnosis of diabetes, adding another layer of complexity.

Grey nomads – and their treating clinicians – should be considering these possibilities before the caravan is packed.

“We tend to forget we can’t just pick up a phone and go to a GP, they could be quite isolated,” she said. “What happens if the car breaks down, have you got food to take with your medication?”

“It’s about thinking am I prepared and able to manage the unexpected?

The research suggests retail pharmacists are the most likely of all health professionals to interact with this cohort, and this highlights the need for those working in regional and rural Australia to be cognizant of diabetes-related complications and risk factors, so they can be on the front foot.

“A classic example for someone with type 2 diabetes is they’re now doing more walking than they normally would they may or may not have prepared physically and may or may not have quality shoes. They may be getting blisters and typically they would go to the nearest store or pharmacy and get something to manage that foot care is a significant issue for people with type 2 diabetes and if it’s not managed properly it can turn really serious really fast.

“If they talk to the pharmacist and the pharmacist is alert to the potential difficulties, they can advise them and refer them to a podiatrist or diabetes educator – but if the pharmacist does not have that level of knowledge or skill they won’t necessarily refer them on.”

The findings point to an urgent need for grey nomads to be better prepared before they commence travel, and clinicians must take the lead to ensure this happens, Dr Hill said.

They will need information on location of diabetes specific support centres, what health documentation they should carry and detailed planning for self-management whilst travelling, including ‘what if’ scenarios.

“That really about the individual knowing to raise that with their diabetes health professionals before they venture off on their traveling, so they can get some ideas about what services are available and what things to look out for. So, a little bit of a risk management, creating a checklist that says ‘if this happens you need to do that’.

“For endocrinologists, if you have people in these age groups and they’re talking about travelling, tell them they need to see a diabetes educator to make sure they have the education to self-manage while they are away and understand the limited resources that might be available.”

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