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

Background: This scoping literature review explored the characteristics and behaviours of a subset of Australia’s older population - the grey nomad, many of whom live and travel with diabetes. Grey nomads are people over the age of 55, 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 that include social and economic contribution, independence and furthering of personal fulfilment. However, some evidence suggests that grey nomads experience health issues whilst in rural locations which exerts a significant burden on an already under resourced Australian rural health services
Aims: This review seeks knowledge on grey nomads self-management of diabetes whilst 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 grey nomad with diabetes and the influence this burgeoning population has 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 that included: Identifying the research question, Identifying, and selecting relevant studies, charting the findings and then collating, summarising, and reporting the results was adopted in this review.
Findings: Australia’s grey nomads journey long distances through the often-harsh Australian countryside where they sought, privacy, isolation, self- sufficiency, and a closeness with nature. Whilst their motivation included life and health enhancing experiences, most grey nomads travelled with at least one chronic health which was not considered as a barrier to adopting a grey nomad lifestyle. However, at times their capacity to manage health needs was exceeded, as 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 self-management were identified and included a well-developed relationship with their diabetes health care 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 pharmacy in rural and remote locations were also identified as sources of support and services.
Conclusions: The literature determined the grey nomad population had a similar distribution of chronic illness, including diabetes to the general Australian population, but very little was known about how they self-manage their condition when in remote locations where health care services were limited. The emerging roles of digital technology and the Australian Medical Benefits Scheme of Extended Practice for Pharmacists offer new and innovative avenues to support grey nomads with diabetes whilst travelling in rural and remote Australia.