Appendix A: Small Group Work – Suggested Strategies

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In the small group sessions, participants were asked to suggest five priority activities for a senior-specific plan to prevent diabetes or the further complications of diabetes.

A.1 Group 1

Priority: Collect and write human-interest stories under theme of "living with diabetes." Gather stories from people across Canada and prepare them in various formats (written texts, video, CD) for dissemination through the media, such as magazines like Canadian Living, or even for nurses and homecare workers to take to seniors' homes on video. The stories could be testimonials, tips, tricks and strategies for coping with diabetes, and would be popularized by focusing more on human interest than science. They could cover everything from first-hand stories about early warning signs and symptoms to coping with difficulties of modern travel as a diabetic.

Objective: to raise awareness of prevention and coping mechanisms among diabetics and others.

Partners: seniors organizations (national and provincial), Victorian Order of Nurses, Inuit nurses, Canadian Diabetes Association, media, professional associations.

Activity: Improve promotion of current list of early warning signs of diabetes. This could be accomplished by tailoring it more toward specific audiences, such as seniors and others, presenting it in formats that are easier to give away (e.g. fridge magnets), and placing it in highvisibility public areas (e.g. on buses, in bus shelters) or making it available in places with a link to the issue of diabetes (e.g. pharmacies, optometrists, seniors' conferences).

Objective: to raise early awareness of warning signs, and therefore to assist in early detection of diabetes.

Partners: Shoppers Drug Mart, pharmacists, pharmacies, optometrists, Canadian Association on Gerontology, Canadian Health Network, Canadian Diabetes Association, national and provincial seniors organizations, Web sites.

Priority: Influence hotels, restaurants, trains, planes, conferences, etc., to offer healthy food choices for diabetics. Launch a Government of Canada policy to offer healthy meals at all events; if hotel cannot accommodate, then go somewhere else. There is a need to think more about who to approach to achieve this over broader range.

Objective: to make it easier for diabetics to manage their diabetes.

Partners: Canadian Diabetes Association, Heart and Stroke Foundation, Conference Board of Canada.

Other priority areas:

• Screening: assess costs, ethical concerns, logistics and other factors. Education: examine ways to raise awareness of early warning signs, prevention, coping mechanisms, etc. - include children, who can influence family behaviour.
• Gaps in post-diagnosis service: develop information packages, create model for training trainers, develop self-help groups.
• Physical activity: promote physical activity among seniors (e.g. by strengthening connection between diabetes association and community walking clubs).
• Food security: ensuring access to healthy foods by all parts of society.
• Smoking cessation among seniors.

A.2 Group 2

Priority: Identify best practices. What are the provinces doing? What is working? What can be transferred across provinces/communities to make national campaigns? Produce a resource database with the results.

Goals:

• to share successful solutions and programs across Canada
• identify effective practices and programs
• identify barriers to programming (e.g. financial, access in rural communities).

Outcome: Produce and compile models that be applied in various situations (e.g. geographic, age, ability, modes of presentation). Complete a database on where this information is available across the country.

Potential players (leads/partners): National Advisory Council on Aging, Canadian Pensioners Concerned, Canadian Public Health Association.

Priority: Research and policy on nutrition.

• Revise Canada's Food Guide to Healthy Eating specifically for seniors.
• Determine seniors' standards for healthy weight standards (BMI only applicable for 20- to 65-year-olds), nutrition requirements (RDIs of vitamins and minerals), dosage and absorption issues.
• Develop a database resource with this information.

Goal: Provide information to seniors (and general population) that is specific to their needs/requirements and culturally specific. This is also important information for health care professionals, caregivers, family members, etc.

Outcome: Seniors are provided with information relevant to their needs.

Potential players (leads/partners): Health Canada (lead), Canadian Diabetes Association, Dieticians of Canada, pharmacists.

Priority: An interactive play of diabetes information for seniors.

Goals:

• to raise awareness and involve seniors in delivering information on diabetes and relationships to the determinants of health (e.g. physical activity, healthy eating)
• entertain while educating.

Outcome: Develop a training manual with:

• script about diabetes issues
• background information on issues
• comprehensive instructions on how to organize the presentations at conferences, meetings with seniors' groups by seniors' groups, etc.
• suggested provision of meals, transportation, etc., for seniors when presenting the program (breaking down barriers)
• combine with other diabetes information activities (e.g. discuss diabetes and healthy eating with a cooking demo, discuss physical activity with a tai chi demonstration).

Potential players (leads/partners): Canadian National Institute for the Blind, Canadian Diabetes Association, Canadian Mental Health Association, Dieticians of Canada, National Congress of Volunteers, Volunteers Association of Toronto.

Other discussion/ideas:

• Education and awareness for early detection. Organize a conference through an organization like ALCOA. Invite seniors' advocacy groups, which can take the information back to seniors in their communities.
• Attempt to get the Canadian Mental Health Association together with seniors' groups to promote information and education for physicians, including incorporation in the medical curriculum. Make use of nurse practitioners and nutritionists to help physicians educate patients.
• Establish peer support groups for diabetes and a clear referral program to these groups.
• Clarify what works, what is portable and can be used across varied communities (e.g. best practices in diabetes education, physical activity, healthy eating, medication).
• Consolidate efforts and provide consistent messages about diabetes and its care/management. More research on the interaction with physical activity needs for seniors is required.
• Conduct more research on the interaction with physical activity.
• Develop tools that are clear and easy to use and understand (e.g. exchange system for diabetes adapted for seniors in large print).
• Develop senior-specific guidelines for healthy body weights (diabetics as a subgroup).
• Develop prescreening tools based on weight, lifestyle, etc., to predict risk factors before it is a problem (screening).
• Community-based programming: Combine education programs with, for example, free meal and transportation in order to work on multiple problems - healthy eating, social isolation, misinformation, etc.
• Use "entertainment" not just education.

A.3 Group 3

Priority: To build upon the Active Living Coalition for Older Adults (ALCOA) project "train the trainer" focused on physical activity and nutrition for adults 55 years of age or older.

Target audiences:

• Rural/remote, frail, old-old, residential, nursing home seniors
• 75 to 85 years of age or older
• Families and caregivers of targeted seniors. Caution: children of seniors often do not live near their parents.

Project: Adapt the content from ALCOA "train the trainer" project on physical activity and healthy eating use with:

• rural/remote seniors
• residential/nursing home seniors
• seniors 75 to 85 years of age or older.

There is the possibility of developing strategies in incremental pieces to deal with multiple settings:

• ALCOA could look into community-based action.
• Rural/isolated communities contain many diabetics, but may not be represented by "train the trainer."
• Rural/isolated communities with a library, a computer and someone who knows how to use the computer can run the "train the trainer" course on-line.

Potential partners: Lead: Canadian Public Health Association (lead) in conjunction with ALCOA:

• There is a need to work together to disseminate information.
• Community care must also be a partner.
• Associations for residential care must also be included.

The two lead groups could work with provincial seniors organizations that have links with government and seniors groups (e.g. National Advisory Council on Aging, Veterans Affairs Canada).

Rationale: There is no national membership organization of seniors. The Canadian Public Health Association has both national structure and grassroots access:

• large enough to take the lead if funded
• approximately 3,500 members, 8% of whom are interested in gerontology
• experienced with "train the trainer" program
• rural emphasis
• already dealing with diabetes issue
• good at information dissemination
• linked to Canadian Association on Gerontology and other seniors organizations
• old, frail adults are not targeted by ALCOA.

Spin-off research: Implications of complications of diabetes:

• cognitive changes re: maintenance/control of disease
• stress management
• pairing seniors with gerontology and social work students
• include seniors as researchers.

Evaluation:

• need to partner with university or universities to ensure that a thorough evaluation isintegral to project.
• 15% of funding to be spent on evaluation
• need active input in evaluation from the start
• need to look at sustainability
• "train the trainer" important as it provides viability.

Outcomes:

• healthier living among frail elderly and inclusionary capacity of residential care
• nationally and provincially supported.

A.4 Group 4

Priority: Develop a needs assessment for 10 ethnic communities of adults 45 years of age or older and health professionals.

The activity would include:

• determining incidence of diabetes
• determining cultural practices (eating and physical activity)
• determining changes to cultural practices after immigration
• determining preference of receiving information
• identifying current resources available
• identifying what priorities need to be addressed
• identifying acceptable eating habits and activities for their culture.

A pilot test of Hispanic, Black and Asian communities is under way.

Overall objective: to increase the knowledge development and information available regarding cultural needs and the incidence of disease by population.

Key partners: Main stream and ethnic media, ethnocultural organizations, health care agencies, Canadian Ethnocultural Council, College of Family Physicians of Canada, Canadian Nurses Association, Victorian Order of Nurses, Canadian Diabetes Association, Association Diabetic Quebec, Canadian Medical Association, Metropolis, universities, Canadian Association on Gerontology.

Other comments: The group discussed the need to identify what types of materials should be disseminated and what vehicles would be most effective. One member suggested that information should be short and in point form but it should get distributed more often. Another member suggested that one vehicle for dissemination could be the monthly pension cheque received by most seniors. The group discussed having more resources that are based on graphics and pictures instead of text-laden brochures. The group also briefly discussed the attitude of denial and the "it won't happen to me" thought process that seniors tend to have.

It is important to include health professionals in the needs assessment as they gather a lot of information from varied cultural communities.

Priority: Develop and disseminate culturally appropriate resources on diabetes and risk factors (including healthy eating, physical activity and medication use).

The activity would include:

• review of current resources available
• determine resources to be adapted (user-friendly, plain language for low literacy, different formats, translation)*
• develop new resources if required
• focus test any adapted or newly developed resources.

* Link to needs assessment

Overall objective: to increase awareness of diabetes, the symptoms, the risk factors and how to help prevent the development of the disease.

Key partners: Workplaces, ALCOA, Dieticians of Canada, National Institute of Nutrition, Canadian Pharmacists Association, Canadian Diabetes Association, Canadian Ethnocultural Council, Canadian National Institute for the Blind, Canadian Colleges Athletic Association, Canadian Centre for Exercise Physiology.

Other comments: The group discussed the possibility of developing a guide for each culture, identifying its specific needs.

Priority: Annual screening for at-risk individuals 45 years of age or older for diabetes.

The activity would include:

• look at current assessment tools available to health professionals
• develop a tool if required
• advocate use of the tool and follow-up care of patients diagnosed with diabetes or those at risk for developing diabetes Healthy Aging 16 Diabetes and Seniors
• look into adopting screening clinics to capture a broader target group than those who go to a physician for an annual check-up

Definition: At risk may include those who have a family history, high BMI, cultural predisposition.

Overall objective: to identify seniors with diabetes as soon as possible.

Key partners: Health Canada (lead), stakeholder federal/provincial/territorial committees, College of Family Physicians of Canada, Canadian Periodic Health Examination Task Force, diabetes educators.

Other comments: The group discussed the need for better tracking methods. Often the cause of death, injury and disability is related to diabetes complications; however, this is not tracked. It was also mentioned that the Canadian Diabetes Strategy is leading up to capturing such information.

Priority: Engage seniors to advocate on behalf of other seniors.

This activity would include:

• involving seniors in the entire process (e.g. creating legislation, resource development, prevention activities)
• involving community groups (e.g. support groups, spiritual leaders) in dialogue.

 

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