Psychology Group Sessions in Residential Care

As a registered psychologist, my long-term passion and objective is achieving better mental health outcomes in residential care. This area is often overlooked by other psychologists due to limited training and employment opportunities in the field, neglected by federal government and funding bodies and underestimated by general population. Research indicates that depression, anxiety and adjustment disorder are highly prevalent in residential care and exacerbated by poor physical health, social isolation and limited support network.

In 2010 I commenced delivering individual therapy for older people living in residential care. I soon learned that connecting residents to one another had better therapeutic outcomes than individual therapy alone. Connecting individuals is important and powerful for their self-esteem, sense of belonging and mental stimulation. Soon after, I developed content for psychology groups sessions in residential care [RESIST™ Resident Program]. Both old and new residents responded exceptionally well to the program, which has been recognised by NSW Health, Mental Health Commission and won a Positive Living in Aged Care Award. Last year, undergraduate and postgraduate psychology students assisted in co-facilitating the program and learning more about the emotional needs of older adults in residential care. The students reported the value of attendance and noted that their university training has not sufficiently prepared them to work with this population.

Yesterday the sessions resumed across three facilities in Sydney. I walked into the room of 93 year old Marion* and invited her to come to the session. Marion* said “I am miserable”. However, after I said that the session was about to commence she quickly got changed, put on her lipstick and soon enough was reading an exercise in the group session. She later commented “the group is interesting, it opens up your brain, as it has been down the drain a bit”. In yesterday’s sessions participants discussed the impact of memory loss, loss of independence and the importance of setting a goal. As Ron* said “I still have goals, my goal is to get on that bus next week for lunch outing – as they say never ventured, never gained”. A number of residents have formed friendships and connected with one another outside of the sessions, which was the overall objective of the groups.

The RESIST™ Resident Program is now available for licensing. It can be delivered at any aged care facility in Australia, with adequate support and training offered to the licensee. The program has been written so that it can be delivered by other allied health professionals and RACF personnel who do not necessarily need to have psychology training. Contact me to find out more.

Why should we engage with families of those in residential care?

I WILL never forget entering an aged care facility in Sydney some years ago and observing several relatives in the lounge room making cups of tea or coffee for themselves and sitting quietly alone deep in their thoughts. I note some did this before the visits, others after. It would have been difficult observing a loved one’s health declining and feeling helpless and unable to improve the circumstance. It is not necessarily something that you would want to talk to a stranger about. Often those emotions are private. Being a carer of a loved one who is in residential care can be rewarding but at times it could be frightening, overwhelming, sad and frustrating. Last week at a Carer Information Session, attended by over 30 relatives from various facilities throughout Sydney, each was asked to write a word on the board to describe how they felt about being a carer. The written words were not dissimilar to the emotions mentioned above. One elderly gentleman whose wife is in a dementia specific unit wrote ALL OF THE ABOVE. Clearly, with the declining health in their loved ones who are no longer able to live independently, families have great need for support in dealing with their own emotions and understanding how best they can help.

It is only in the recent years that action has been taken towards improved awareness of the importance of family support in residential care. This has been demonstrated with an increased interest and requests for training programs educating staff on how to best support families as well as holding information sessions for relatives. Distressed relatives can present additional challenges for aged care staff, whose training is limited to ensuring personal care needs are met. As the preliminary findings from my PhD research from Macquarie University suggests, aged care workers do not have skills in mental health or understanding when someone may need support from mental health experts. Many aged care workers reported using life skills in those situations. Early researchers (Bates, 1968 and Blum, 1960) reported that the family members were found as interfering, disruptive, and critical of professional policies, staff, and the overall facility environment. These results may suggest that families are advocating for their loved ones and that perhaps families may need additional education about the condition which their loved one has (such as muscular dystrophy or dementia). These results may further suggest that families are grieving the loss of the relationship with their loved one. Family members may need additional support to assist them at this difficult time in their lives. Knowing where they can find support is paramount.

The value of family cannot be understated. As human beings our family is our primary social unit. Family may include all individuals who are part of the central core in the support network of individuals including non-family carers. There are many reasons why it is important for facilities to support families. These include better understanding of the resident and their needs, provision of socio-emotional care and to deliver advocacy and encouragement or assistance with the provision of personal care. Families are particularly integral in reducing resident isolation, which is a significant problem for the elderly. Elderly with poor mental health are particularly prone to isolation and present as an additional risk of suicide. A recently longitudinal study from the UK  indicates that isolation kills more elderly people than smoking and obesity (Victor & Bowling, 2012).

Unfortunately not all facilities engage well with families. This can be due to poor communication within the family unit, poor communication between staff members, lack of documentation around the family system, family could be living interstate or overseas, staff may not be comfortable and reluctant in discussing behavioural issues or increased care needs with the family and the health status and age of the family member. These are just some of the factors which could contribute towards the breakdown in the communication between families and aged care facilities. Families need aged care staff to acknowledge their journey and the difficulties, personalise the information wherever possible and encourage families to speak with staff about any issues sooner rather than later. Encouraging families to attend meetings and opportunities to meet other families as well as to take residents out of their rooms is important and may improve the overall care of the care recipient.

Finally, it is very important to encourage families to take good care of themselves and practice self-care strategies which includes spending time away from the facilities to rest and recuperate. Where possible, acknowledge the emotional and physical burden on the family and on individual family members of caring for a resident, recognise and allow for different coping styles between individual family members, allow family members the opportunity and privacy to express their concerns and the difficulties they are experiencing, provide reassurance if they are feeling guilty about issues that could include relationship issues, the nature of the admission to facility and offer an intervention such as pastoral care. Chaplains offer wonderful support for families and are integral part of care delivered in residential care setting.

Involving the family is an important component of any care plan and it can have significant effects on the family and the resident’s ability to accept what is happening. Some of the advantages of involving the family include trust in the aged care team, recognition that family members have contributed significantly to the resident’s wellbeing prior to admission, a positive partnership is developed between the care team and the family members and finally the family are better able to cope with separation anxiety and can provide positive benefits for all family members.

The best outcomes in the aged care system are achieved by collaboration within the facility, engaging external providers and most importantly families.

If you are interested in coming along to the next Carer Information Session in Sydney please sign up to our Newsletter (click here) and we will email you about the upcoming events.

Reference

 

Bates RC. Medical Economics Book Division; Oradell, New Jersey: 1968. The fine art of understanding patients.

Blum RH. Management of the doctor-patient relationships. McGraw Hill; New York: 1960.

Victor, C. R., & Bowling, A. (2012). A Longitudinal Analysis of Loneliness Among Older People in Great Britain. The Journal of Psychology, 146(3), 313-331

 

Recognising anxiety in older people

Phyllis often complains about problems with indigestion, stating the food she was given in the residential hostel was not sitting right with her. She even diagnosed herself with Irritable Bowel Syndrome (IBS) and has her own supply of Gaviscon, which she takes regularly.  Phyllis is determined the only way overcome her IBS is to stop eating all foods other than plain toast. Phyllis appears stressed when we met yet denied any symptoms “no, nothing is wrong with me. It is their food”.

Unfortunately, there is a lot of stigma associated with mental health, particularly in older adults. Many are reluctant to discuss their emotional wellbeing with their families, relatives, friends or doctors in fear that they are burdening them. Mental health conditions, such as anxiety, are still perceived as a sign of weakness and many, particularly the elderly will not admit to it. This does not solve the problem, it only exacerbates it.

Importantly, mental health conditions are treatable. In most instances individuals require 6-10 sessions with a qualified professional (usually registered psychologist) and at times medication. Psychologists are trained in empowering individuals to overcome their symptoms with psycho-education through Cognitive Behavioural Therapy, skills building and quick to learn relaxation techniques. Once the therapy is completed individuals are encouraged to keep practicing the exercises discussed during the therapy to deal with setbacks, relapse or difficult periods. Just like with physical exercise, cognitive exercises have the best results when regularly completed.

An anxiety disorder is different to our normal everyday responses to feeling under pressure, stressed or worried. For a person experiencing an anxiety disorder, anxious feelings cannot be brought under control easily. Imagine crossing a busy road in downtown New York with traffic coming in all directions, no pedestrian crossing and the only way for you to cross and meet your friend is to carefully time your move against the traffic. Sweaty palms, palpitations, tense muscles, inability to concentrate. What would happen after you cross that road? Feelings of anxiety would dissipate. People with anxiety disorder however carry those feelings around with them all the time.

There are many different types of anxiety disorders with a range of signs and symptoms. The most common types include:

• Generalised Anxiety Disorder (GAD)
• Specific Phobias
• Post-Traumatic Distress Disorder (PTSD)
• Obsessive Compulsive Disorder (OCD)
• Social Phobia
• Panic Disorder

The common types of anxiety disorders can be grouped into four categories: physical, behavioural, thinking and feeling.

Physical: muscle pain; restless and on the edge; difficulty sleeping and sweating
Behavioural: avoidance; poor concentration; alcohol and drug use
Thinking: constant worry; recurring and/or obsessive thoughts
Feeling: fearful; irritable; overwhelmed; sudden and intense panic

People with anxiety may present with a variety of physical symptoms. Muscle pain is common, as individuals with an anxiety disorder often hold their bodies very tightly. Many are not aware of this. Similarly, difficulty in switching off at night can bring on insomnia.

Did you know?

Older people often experience more physical symptoms than symptoms from other categories. If an individual complains of sleep disturbances, changes in their appetite, difficulty concentrating and poor memory, these could be signs of an anxiety disorder, or depression, which warrant further investigation.

In general, older people with anxiety disorders have a history of anxiety disorders. Relatives and friends are a great source to find out about the person’s history and whether they experienced an anxiety disorder earlier in life.

Treatment

Treating anxiety disorders is not difficult. The main barrier is identifying which individuals have anxiety and how to create a seamless team effort including: personal care attendants, recreational staff, registered staff, GPs, allied health providers. The GP in collaboration with the psychologist would assess, monitor and advise on treatment. Aged-care providers can assist with the process by offering mental health training to their staff in understanding how to recognise symptoms of depression and anxiety in the elderly.

Caring is Sharing – Dementia: Supporting Relatives and Friends

Every quarter in affiliation with a large aged-care provider, I run a free carer’s workshop. This is invaluable for carers to better understand their needs, offer support and effective tips on late life changes. What is normal part of ageing? What is the progression of dementia, other neurological conditions and declining physical health? When I come to the nursing home why is it that some visits are great and others not so great? These are all the questions we get asked on a regular basis.

Last night the topic was Coping with the Long Goodbye

We covered some important domains when discussing dementia including:

• understanding different types of dementia
• understanding the needs of people with dementia
• offered improved tips on how to communicate with the person diagnosed with dementia
• understanding the emotions that carers experience
• the importance of self-care and good health

Practical exercises included:

• writing a card to a loved one with dementia and giving it to them on next visit
• writing a letter to yourself (as a carer) which we will post in a month (see below)

Letter to Someone Special

Dear….

I hope you are looking after yourself. May I suggest you…..

I also want to say……..

Thanks for being such a wonderful carer!

Love…..

It was an excellent evening and although the session was advertised to run from 4.30-6 pm most participants stayed well after 7 pm! Our next workshop is on Wednesday 5 March 2014.

Lets together beat the myth that depression and dementia are normal part of ageing!

Depression in late life is not normal ageing

“Every man has his secret sorrows which the world knows not; and often times we call a man cold when he is only sad.” Henry Wadsworth Longfellow

 

Sadness is a normal human emotion and must not be mixed with depression, which consists of persistent impairment in functioning. Depression in older people is widespread, often undiagnosed, and usually untreated and is not a normal part of ageing.

Depression comes in many types and some of the most common include:

• Minor Depressive Disorder
• Major Depressive Disorder
• Depression Without Saddness
• Mixed Depression and Anxiety Disorder
• Adjustment Disorder (with/without Depression)
• Dysthymia

Depression is perhaps the most frequent cause of emotional suffering in later life. The latest findings from the Australian Institute of Health and Wellbeing (2012) indicates that 52% of residents in supported accommodation had symptoms of depression. Unfortunately, many of those individuals are not treated for this condition by a psychologist or a psychiatrist.

Individuals who are alone or require additional support to stay at home are more likely to be depressed than those who have independent life free from cognitive and emotional disturbances. There is a lot of stigma associated with receiving support for mental health and older people often report that they do not discuss their emotional wellbeing with their families, as they don’t want to burden them, or their GPs. Untreated depression can become more complex to manage and may cause decline in other life domains.

The overall long-term prognosis for elderly depression is good. Most individuals would benefit from approximately 6 to 10 counselling consultations and antidepressant medication, if deemed appropriate by their GP or psychiatrist. Research shows the best outcomes are in those individuals who take medication (therefore regulate the chemicals within their brain) and engage in psychotherapy (learn new coping skills and behavioural strategies).

Depression can be difficult to identify and diagnose in older people. This is due to several barriers which include:

• it is harder to identify
• More somatically focused
• Often related to other illnesses (comorbidities)
• More impariment on psychological testing
• Higher rate of dementia on follow-up

Risk factors for depression in elderly include:

• Being female
• Single (divorced; separated; widowed)
• Lower socioeconomic level
• Poor social support
• Stressful life events
• Impaired medical health
• Disability

How can we help older adults who have depression ?

Teach staff on how to recognise symptoms of depression and anxiety. Julie and her team of psychologists nationally deliver beyondblue Professional Education in Aged Care to staff working in community and residential care setting. Contact us today for more details

Encourage older adults to seek support we get many requests for our psychotherapy service from aged care staff, families and doctors and visit a number of aged care facilities.  The sooner we can help someone the better it is for the individual and the less likely they are to require prolonged treatment. We do not charge extra for home visits.

Be there for them and spend 1:1 time we can all fall into the trap of thinking we are helping someone by doing many things for them. Sometimes we just need to take a few minutes and spend the time with the person, they do not necessarily need us to “fix” anything for them. Just listen

Mental Health Week: time to look out for seniors

Mental Health Week 6 to 12 October 2013 – Celebrate, Connect, Grow

This week marks national Mental Health Week and it coincides with World Mental Health Day on Thursday 10 October. The theme for this year’s Mental Health Week is Celebrate, Connect, Grow. This theme encourages all of us to act on the big and small things we can do to increase our own wellbeing as well as the wellbeing of those around us by celebrating the positive events in our lives and connecting with others.

Good mental health is important for all Australians, particularly older adults. Research shows that most older Australians are in good health until their health deteriorates and they are likely to require more support to stay at home or move into residential care. Individuals with high level of support needs are likely to develop a mental health condition which may include: depression, anxiety and adjustment disorder. It is important to provide older Australians with skills and education on self-care and empower them to maintain their independence into their twilight years.

Here are my top five tips for building resilience:

1. Self-care
Self-care is personal self maintenance. How we look after ourselves determines how we lead our lives. Older adults who look after themselves physically, spiritually and emotionally usually keep their independence in late life. Self-care includes a wide range of activities such as being aware of physical changes in the body, understanding the importance of good nutrition and regular physical activity.

2. Engage in Meaningful Activities
After we retire and grow out of the 9-5 routine, it can become more difficult to initiate and engage in meaningful activities. Regardless of our health and life stage it is important to find an activity that to us is meaningful and different from mundane everyday tasks. Individuals who engage in meaningful activities report higher life satisfaction and better mental health.  Meaningful activities very and it is about growing: expanding your horizons and trying something new that creates meaning and purpose for you. This can include picking up a new language, joining in a craft activity, volunteering time through your church or charity or  knitting blankets for hospital patients.

3. Acknowledge your emotions
As we get older we are likely to face many losses. These can include: loss of independence, loss of driver’s licence, loss of financial security, loss of roles and responsibilities and death of a loved one. It is important to acknowledge your emotions and deal with them in time. Poor mental health is not something that can be “shaken off” or forgotten. The longer the symptoms are ignored the more difficult and expensive it is to treat them. Early and preventative measures are best in ensuring comfort and life satisfaction in late life.

4. Stay Connected
Isolation is a big issue for many Australians, particularly those with poor health and reduced mobility. Whilst we all enjoy spending some time alone prolonged isolation is detrimental for physical and mental health. Stay connected with your local community, look out for free events such as those offered by your library, spend some time sitting out in the sun and absorbing vitamin D which is good for you and your body. Go out and have a coffee, you never know, you might just meet a new friend!

5. Relax and Rejuvenate
Unfortunately many people associate relaxation with sleeping. Relaxation assists us to deal with life stressors and take control of our emotions. By developing  new habits we can assist in keeping anxiety at bay and reduce our distress. Relaxation techniques include: breathing exercises, visualisation and mindfulness. Being mindful of thoughts that enter our head and the impact they have on our overall health is very beneficial and can help us understand of the impact that they have on our physical body.

Growing old is a privilege denied to many – enjoy and make most of it! If you require assistance in improving your resilience and building skills contact us on 1300 78 51 10.