Grey nomads with diabetes self-management on the road - a scoping review

Abstract

Introduction: This scoping literature review explored the characteristics and behaviours of a subset of Australia's older population: 'grey nomads', many who live and travel with type 1 or 2 diabetes mellitus. Grey nomads are people aged more than 55 years, who travel in caravans or motorhomes for extended periods of time around rural and remote areas of Australia. Grey nomads are challenging the established view of ageing in Australia by their lifestyle choices, which include social and economic contribution, independence and furthering of personal fulfilment.However, some evidence suggests that grey nomads experience health issues while in rural locations, which exerts a significant burden on already under-resourced Australian rural health services. This review seeks knowledge on grey nomads' selfmanagement of diabetes while travelling, with the aim of understanding their experiences and identifying support services and strategies that would facilitate improved self-management. Furthermore, this review seeks knowledge of how Australia's rural and remote health services support the nomads with diabetes and the influence of this burgeoning population on such services. Methods: A scoping review methodology provided the methods to map the current evidence concerned with this broad and complex topic. A systematic six-step framework was adopted: identifying the research question; identifying relevant literature; selecting studies; charting the findings; collating, summarising and reporting results; and a final consultation. Results: The grey nomads in this review travelled long distances through the often-harsh Australian countryside where they sought, privacy, isolation, self-sufficiency and a closeness with nature.Although their motivations included life-and health-enhancing experiences, most grey nomads travelled with at least one chronic health condition, which they did not consider as a barrier to adopting a grey nomad lifestyle. However, many were underprepared for their health needs when in rural or remote Australia. Specific literature concerning grey nomads and self-management of diabetes was not found but salient aspects of diabetes selfmanagement were identified and included a well-developed relationship with their diabetes healthcare provider; a relationship that relied on ongoing communication and support. When travelling, the ability to form or sustain supportive relationships with local health care providers was limited due to sparseness of rural services and the perceived transient nature of the relationship. Increasingly, grey nomads utilised digital technology via telemedicine or social media sites for information and advice on health issues. The local pharmacies in rural and remote locations were also identified as sources of support and services. Conclusion:The literature showed that the grey nomad population had a similar distribution of chronic illness, including diabetes, to that of the general Australian population, but very little was published about how they self-manage conditions when in re...

Understanding the planning and preparation for diabetes self‐management of grey nomads when travelling in rural and remote Australia: An exploratory survey

“…Thus, grey nomads must fully embrace self‐management of their diabetes for successful long‐term travelling. Whilst over 77% of survey participants believed that they managed their diabetes well, there were some concerning findings in this current study that supported previous evidence that this population of travellers was not well‐prepared 8,10,11,13 …”

“…The impact of border restrictions and international travel bans in response to the COVID‐19 pandemic has seen the independent travelling population fluctuate from an early and sharp decline to a more recent rapid increase once restrictions were eased 16 . Regardless, this and other studies 8,11,13,17 have found little preparedness by grey nomads with chronic conditions including diabetes, fragmented or ad hoc health services, and a strong need for self‐management of chronic conditions on the road.…”

“…This exploratory survey of the diabetes self‐management of grey nomads has shed light on the health‐related travel planning activities of this older group of travellers who frequently seek to follow long‐held dreams of independent travel in remote areas of Australia. Understanding the specific needs of this rapidly expanding population is vital as previous research found that grey nomads have an unrealistic expectation of health‐care services available in remote areas of Australia 10 and have mixed levels of preparedness 11 . Furthermore, the transitory residential patterns and corresponding service requirements of this burgeoning population are not captured in current census data and are thus underrepresented in the planning of services and infrastructure at all levels of government 12 .…”

“…Understanding the specific needs of this rapidly expanding population is vital as previous research found that grey nomads have an unrealistic expectation of health-care services available in remote areas of Australia 10 and have mixed levels of preparedness. 11 Furthermore, the transitory residential patterns and corresponding service requirements of this burgeoning population are not captured in current census data and are thus underrepresented in the planning of services and infrastructure at all levels of government. 12 Thus, grey nomads must fully embrace self-management of their diabetes for successful long-term travelling.…”

Travel with Diabetes: A Comprehensive Review for Clinicians

“…The rural pharmacy was the first post they contacted for help, while the overburdened rural clinics could not accommodate them. Seeing different practitioners fragmented health care [53, 54].…”