 Hello everyone and good evening. My name is Stephen Ginsberg and I'm your facilitator for tonight. Welcome to our webinar, Age, Frailty, Loneliness and Suicide. We've got about 2,700 people registered for the webinar tonight. Not all of them will come. But there will also be a possibility to view the recording when it gets sent out to you. And please share with your friends and colleagues. So I'd like to start by acknowledging that this nationwide webinar is held on Aboriginal and Torres Strait Islander land. Always was and always will be. And also acknowledging all First Nations people who are attending tonight and paying my respects to elders past, present and emerging. We have much to learn from you and your elders about the care of older people. The theme of Reconciliation Week was Be Brave, Make Change. And the theme of next week's NAIDOC Week is Get Up, Stand Up, Show Up. I'd also like to pay my respects to the elders of the many cultures of these lands and thank carers for their support of older people. I'm speaking from Gamma Regal land and perhaps some of you would like to share and enter into the chat room on which land you are tonight. I'd also like to say a special welcome to the members of the Sydney North Older Persons Mental Health Network, of which I'm a co-coordinator, and to other networks around Australia who are meeting tonight to watch this broadcast. MHPN currently supports six older persons mental health networks across the country, and details of these networks and how to join them will be listed in the closing slides. This webinar is the result of a unique partnership between the 31 primary health networks and the mental health professionals network. And in a first in their history, the 31 PHNs have formed a consortium and engaged MHPN to plan, produce and broadcast webinars focusing on older Australians and mental health. I have been facilitating all of these and tonight's webinar is the fifth of the series and there is one more to come later in the year. All of the previous webinars are in the library on the MHPN website. Now all the panelists bios were sent out to you in the invitation, so I won't go through their bios one by one, but we'll put them up on the screen briefly, and they all have their names tagged to their images. By way of registration, you were asked to submit a question that you'd like the panel to consider. There were about, well there were over 200 questions submitted, so we've distilled some of these, and we've tried to distill most of them and you will have some of these questions put by me to our panellists. Quite a few people in their questions have asked about the effects of previous trauma for both women and men and how this trauma is expressed in older life. Our last webinar was on this topic, so it's really worthwhile going into the library on the website of the past webinars and having a look at that webinar if that's an area of your interest. Trauma certainly, previous trauma lies behind many of the behaviours of us older people. I include myself in that at 74, us older people in our later life. So you're an amazing audience with all of the number of who've registered and the number of questions you've sent in and I can't imagine what it would be like if you were all putting up your hands while we were talking. So let's get started. Some elders have shared that they've forgotten who they are, whether through the trauma of colonisation, refugee or migrant displacement from homelands or the familiar loss of the community that many may once have had. And they say that sometimes they feel invisible. Can I start by asking you, Sandhya, someone who welcomes such people into your RACS, residential aged care facilities, how we can help these older people? Thank you, Stephen. I think no one wants to enter a residential aged care facility, but it's important to keep the older person and their families informed and demystified that they're not just the place where you go to die and that it can become their home. And the way we do that is they develop a sense of community when they come into the home facility and they meet other people with similar life stories, similar ages and stages. Perhaps they've been isolated in the community and the only people that visit them are their families or maybe the neighbour pops in. And then they come in and suddenly there's 20, 30, 40, however many people around them where they can reminisce, they can share their life stories. The staff who are looking after them also know some of that background as well. So I think in a lot of ways there perhaps have been a little bit more lost in the community where their world has shrunk and now when they come into us, their world opens up again. So I think that's probably one of the key messages that I over many years have been speaking to families and to residents to help them understand that we're not the baddies if they do need that extra support and care. Probably no one's asked them for their life history in a long time. I love their life stories. They're amazing. They've got so much to offer and I think for the young generation who are looking after them I think that makes it more meaningful for them as well. Yeah. So Viviana or Viv, in your experience, what does the research tell us about the most effective interventions and protective factors that we can offer to support someone who's very sad and maybe at risk of suicide and may have forgotten who they are? Yeah. I guess we know the research tells us that the first problem here is that we're not very good at recognizing and acknowledging when an older person is actually experiencing sadness or depression. So unfortunately as a community, as professionals, but also as family members and friends, the research tells us we do tend to dismiss these symptoms. We tend to normalize it as being a part of being older. So they're just grumpy because they're a grumpy old man. That's what men do when they get old. She's worrying and nervy but that's because she's frail. That's because she just spends all the time at home. We forget that actually when we see an older person who is sad, who is nervy, that it actually probably signifies distress, emotional distress and we actually need to do something about it. That's the first message, right? Let's make sure we do something about this when we notice it. And so in the resources, I believe you've been given access to. There are some links there to some helpful resources that have been developed by the Australian Association for Gerontology about how to talk to someone who you think might be sad. And there are some other resources from the Centre for Aging, Cognition and Well-Being there. So check those out. And of course, we have to remember that older men are the highest completed suicide rates in Australia. So again, if we see an old man or an older lady who's looking a bit sad, we have to really take care to check it out. We have to ask and say, are you okay? What's going on? Tell me about that. And we do need to say, are you at risk? Are you thinking about hurting yourself? How are you looking forward to the future? Because we do know that for older people, when they make intents for self-harm, unfortunately, those intents can be pretty significant and they are more likely to follow through. Now, in terms of evidence for how we might help these people, the good news is that the evidence suggests that older people can benefit from interventions for depression just as well as younger people can. So that includes older people who might have physical health conditions. That includes people who might be living in residential aged care. And again, I think the message I really want to get across is that we just need to go in and aggressively treat depression or sadness or loneliness in an older person in the same way that we might with a younger person. We know psychological interventions and particularly behavioral interventions are very effective in this population, just as effective as in young people as well as medications if antidepressants in particular. So I've gone a little bit more about that. I'll go a little bit later. I just want to make one more comment here and that is that we know that keeping older people connected socially and this really comes back to that point you were talking about before Stephen and also you, Sandy. Helping older people stay part of a community, making sure we maintain those connections with other people, their social groups is a really important way that we can both treat depression but also starve off depression for 90 years. That's great. That really primes it up for us. I'm just wondering what came to my mind was there are, I know, in all of these audiences of these programs some younger practitioners, healthcare workers and the question that I sometimes ask is how do I get consent to ask these kinds of questions? We know we give consent in surgery briefly, piece of paper shoved under our face but people can be very, I'm not telling you anything or anyone, anything they don't know very touchy about their emotions and we're usually not very good at sharing them. Sandy, have you found any resistance or do when people, you're concerned about someone, they go straight for it? I think it's about developing trust for them and in the residential setting it's their home and we're working in their home so I think it's less threatening perhaps and going to a doctor's surgery or the hospital to discuss your emotions but when they're in their own home I think you certainly don't ask those questions in the first 48 hours that they arrive on the doorstep but give them time to settle in, get to know stuff and develop a rapport with them and I haven't found resistance. I think people do, they do want someone to listen to them. Yeah. So is that what you find because you would obviously see quite a lot of people in the consulting room and... Yeah, I think the disadvantage that I have compared to Sandy is if it's the first time it's quite hard, you've really got to build that rapport and I think you do it and you do it with your body language and by giving examples of how they might be feeling and hopefully they open up but sometimes it's the second or the third time you see them because that relationship that you develop is just so important. I know when our panel was speaking about trauma they emphasised the importance of listening. Listening, listening, listening. So Sue, you've become famous since your programs on the ABC showing the benefits of intergenerational care with your four year olds. How can we provide compassionate care to frail and sad elders in our communities? Look, Viv's partly answered this I think but what we need to remember is no matter what age we are humans are pack animals. We need to stay connected. We need to belong. We need to belong whether it's to a family or a church or a community club or a football club. We need to belong and as people get older it is a time of loss. You lose your partner. You lose friends. You lose your health quite often. Yeah, your independence exactly Sandy. You lose your identity often when you stop working. So it really is a time of loss and people do tend to become very isolated and I think it is really, really important to keep older people connected and I use that same word that Viv did. Clearly as we showed in the TV series with four year olds and hopefully soon you will see the series with teenagers with old people's home for teenagers. Intergenerational programs really can offer a great solution but they are just one of the solutions and let's face it we have to get them up and running again with COVID but we know bringing older people together for activities that they are interested in is really, really important and there is lots of work going on in this area and Stephen you would be aware of the village hub concept so Sydney North Health Network has combined with Hornsby Council to develop what is called a village hub and that is where people come together for social, physical, educational, arts cultural activities that they are interested in and across diverse backgrounds but it is bringing them together and I think that concept is really important in today's society and we have become very isolated and the whole concept of compassionate care I would make one observation COVID has really improved compassionate care in communities I have seen it both where I work down the south coast of New South Wales also I do some telehealth to Armadale in Northwest New South Wales as well as my work in Sydney the development of the community in the neighbourhood has been amazing it is like we needed to be given permission to talk to our neighbours particularly our older neighbours and we have one neighbour who says he will never finish the store of toilet paper because people, neighbours were leaving toilet paper on his front door step because they were worried he might not have had enough but that sort of concept of enable-ness I think one of the positives maybe one of the few positives of COVID is that that has brought it back to a degree and people have really pulled together so I give that as one example of a compassionate community wouldn't it be... don't understand it I think that has very much been a positive for elderly people in the community it wasn't such a positive experience for all living in residential aged care because we had so many rules and regulations that we had to it eased up eventually but in those early months it was not good for the elderly at all I hope we don't ever go down that path again you know it's interesting isn't it that COVID brought that upon us an infectious disease but we hear so much about the chronic diseases of older life as we get older and live longer that we don't prepare for having someone to watch our back as it were at difficult times that's one of the killers of the compassionate communities concept is that you have an inner circle of people who you identify in advance as you get older to be your supporters and that you do it neutrally so it's caring with each other not for someone so that that sense of cohesion and you mentioned the importance of kinship and I hadn't realized that the word kind comes from kin it's something you show your kith and kin that's an important aspect of care that we're going to probably come back to and it comes up in the next question that Olive asked before the webinar started Olive asked the question how well are we prepared for people who want to remain at home despite their frailty and that's open to any of you who wants to jump in someone will have to be brave I'll have a first go it's also how well are the people themselves prepared to live at home when they're frail because there's a limit to what I think we as service providers can do and I think one of my big messages tonight talking about the very negative and it is a really negative title aging learning the suicide and frailty gosh we couldn't have picked a more depressing title in a lot of ways but the thing about frailty is you can do something about it in many different cases and I think that's something that's really important that we have to be thinking ourselves but for our patients our clients how do we keep them as fit as we possibly can and it's interesting Sandy said that people come into residential care they don't want to go into residential care nobody or very few people do but once in there they get their medication regularly they're getting regular food they're getting the social interaction and quite often they're getting the exercise and it's amazing how people can do well so we know both in residential care but we're not prepared for frail older people who live at home just have a look at our hospitals our acute hospitals at the moment they are full of older people whose medical problem is now being managed but they can't go home because they're too frail they can't get out of bed they can't take themselves to the toilet so yeah we've got a bit of a problem and we don't have enough services there so there's a lot of rethinking I think that has to be done in terms of how we prepare for all of us who want to stay at home and get carried out in a box we need to prepare ourselves as patients or clients or older people as well as preparing our patients and encouraging them to be independent and do their physical exercise and eat properly is so important yeah and that's where that little group of five or however many it is doing it together and all seeing that perhaps aging is it's got a stigma to it but it doesn't have to proud of our one's age proud of being an elder frailty you've shown how clearly that can be turned around to something strong a loneliness if we didn't have loneliness if we'd have no trigger to find someone else to be with or other people to be with so these are all when I came up with that title I thought it does sound it does sound negative but if we try and without polyannering it see that these all need solutions suicide another matter that's certainly an area you've had researched anything to say on that last I mean all these things are connected together right so we know that when someone is lonely it increases their likelihood of developing depression and then of course with depression increase likelihood of suicidal ideation we start to have people who are then socially withdrawing because of their depression or their isolation exercising as much risk for frailty these things can't be thought of singly these things come as a package not necessarily altogether in the beginning but over time we see this complexity building where people develop more and more conditions and it becomes harder and harder to treat if we want to think about keeping people in their own homes we need to make some changes about the way we provide services because it is hard sometimes to get psychologists or social workers or physios into people's homes to help them right so we definitely need to change that but we also need to just get better identifying these issues much earlier on because all of these things don't all just start suddenly all at once in this really severe way I mean it can sometimes with a hospitalization or a fall it can suddenly set off this cascade of conditions but often these things start to emerge over time I think as you know health professionals if we can be better at identifying these early warning signs we start to see the depression creeping in we start to see the socialization building and we do something about then we really can then set people up to have much more independence living alone living at home but I just that's something we don't do very well I see that as the big challenge for sustainability because there's so much power in the community and as we saw from Covid willingness and the evidence is there that if you help someone and you care with them your own health improves so the loneliness and disconnection sandy yes I did grow up in the country very fond memories of growing up on a rural property out in the bush but I do think that the rural communities do it a whole lot better than those of us in Metro you can move suburbs and it might take you 6 or 12 months to find someone else that lives in the street that's going to say hello to you where I do think rural communities do that extremely well is that what you found in all of your work the difference between remote and metro country and metro me you I think yeah I think it is in some ways easier to grow old in the more rural areas but of course they do lack a lot of services like geriatricians which is why I guess I'm involved and we're trying to encourage some of our young ones out there but it is I think the sense of community is there and I guess if you're living in the bush you're pulling together more we saw it I think down the south coast around the fires because of course they got them there was so much damage and I know there are people listening tonight who lost quite a lot in that in those fires then we had COVID and there was a bit of a loss of community and then down the south coast they then had the floods and Mogo and Maroo, Bateman's Bay were flooded and people pulled together it was just amazing it is a one it's an amazing way to get to know your your neighbours although perhaps not the nicest but yeah that sense of community that sense of belonging I think is a little bit stronger I wouldn't say it's across the board but it is certainly stronger in the regional and rural areas so that is a challenge isn't it yeah well I was just going to jump in and say I mean we're sort of talking as though you know when older people have these networks that they can lean on right but I guess we have to remember so for some older people it's easy to activate these connections these networks these supports and encourage them to get together with other people to exercise or to socialise but certainly in our research we found that some of these people feel like they have nobody like actually have nobody like they just don't have family maybe they've moved away or they just don't want anything to do with them and they don't have friends and they're not sure how to go about actually making friends and so I think it's important for us to also remember how hard it can be even though socialising is really good it can be really hard for an older person to socialise to older people when we think about mental disorders social phobia is still the most prevalent other than specific phobias of the mental disorders that an older person will have so we still have older people who are shy and worry about meeting new people and afraid of conversations and so I think as mental health professionals we need to remember that that it's not as easy just to say to an older person we'll go on join a social group we'll go on start to talk to your neighbours we also need to think about what are the barriers to them doing that and what can we do to try and solve some of those barriers can they start by talking to the neighbour is there actually a neighbour down the street who is the neighbour that says hello when they've been out can we start with a little bit more of a conversation there can we find out about what local community groups are happening and can we try and match them to one that matches their interests at least their interests might get them there rather than meeting people and I always have this rule of thumb when I'm talking to an older person about joining a new group and I say you have to go three times before you decide whether you don't want to go back and that's because it takes a little while to become familiar with people it takes a little while for someone to recognise that there are a lot of warm and friendly interactions to happen so I think yes we definitely need to encourage older people but we need to think about what barriers are they facing and what can we do that are just practical and simple and straightforward that might help to break down some of those barriers can I butt in and say a common interest will bring people together I have watched older men who did not want to go to the men's shed there's a few that still won't go to the men's shed but you get them to the men's shed and they have a common interest so it's not like they have to be social but suddenly there's something that they're interested in and quite often that they're good at and I often think that's why football clubs are so popular because you go you're all wearing the same coloured scarfs or sweaters so there's that sort of sense of identity it may not be a true sense but I think that sort of thing is quite important so having that activity that does bring them together because I agree with you it's very hard to get people it's like taking children to school those first few times and your rule of threes is probably a good one you know we always try and make sure that there's something of interest whether it's art or you've got to find something to hold the older person and give them a link so that they can then develop those friendships because yeah there are people who have nobody social work I'm just so excited by what Sue was saying I just want to add one more thing so there's this really cool research I wish it was mine but it's not mine that's been done from the University of Queensland that have actually really shown the benefit of social groups being better for mental health better for physical health and better for cognitive health then individual social interactions so something special about helping people connect with groups and it's about how they feel valued within groups that seems important and the cool research they've done is it depends on how many social groups you have how good your cognitive or how slow your cognitive decline will be so you want older people to not just have one social activity but three or four social activities yeah Sue I mean you showed that so clearly in your ABC program those older people who were so brave to show their their reticence to come to your yeah and yet when they got there it was wonderful and I think that's that will be clear in series three as well there were people who really did not want to be there but when you got an activity that engaged them often with the teenagers they were doing it and further to Div's comments we know that to stave off dementia or prevent it or slow its decline social interaction is just so important and mental activity and it's one of those 12 risk factors that we we need to look at and I just want to mention loneliness we've talked about loneliness loneliness is as bad as smoking for your health and I think that's a fact a lot of people don't realise but loneliness contributes to depression and you know ongoing the possible risk of suicide but it's also a risk factor for heart disease for stroke and for dementia equal to smoking and this time making sure people don't smoke but we should be thinking about the effects of loneliness as well so there's lots and lots of really good reasons to address it I did want to make that point Sandy I mean you said before the benefit of coming into an aged care facility you're muted yes sorry as both Viv and Sue talking I was busting to say that there are some good things about residential aged care because we do provide that sense of community as they're heading down the corridor to go to the dining room they pick up Mary and Fred on the way and they've got an instant group of friends that they take with them at a home I commissioned Steven you will know this one when we were setting up the home we were new in the community and and when we're trying to work out activities programs we you know the old bingo came out well no one was going to play bingo and I can tell you within a very short period of time they were killing each other to get to the bingo game because it was competitive I've never played they tell me it's competitive it's competitive it's a challenge for them they have to think and they walk away with it knowing that they got the freddo frog or whatever it was that won the game of bingo so I do think and I keep going back to this because it's something that I've heard so many times about the negativity of of residential care but there are some positives I'm all for keeping people out in the community for as long as possible but when it's not possible any longer we we're not all that bad and also one of the functions in aged care facilities sometimes whether they like or not there is a culturally and linguistically diverse environment one of the comments I always get is that the place is full of old people and I say well actually I've got more young stuff looking after you than there are actually elderly people so they back to the kindergarten or the impact of young children on the elderly the fact that they're being looked after by predominantly 20 to 30 year olds and they're hearing about what they did on the weekend it's not all bad so questions are coming in and prior to the webinar Susan and Julia brought up the issue and the evening Julian brings up the same issue what psychological and other treatment services are there for people with poor mental health in aged care facilities I know that some or all of the PHNs have been federally funded to commission mental health services into aged care facilities for individuals groups and families one in our PHN is called emotional well being for older people and of course GPs can provide services themselves or refer to other mental health professionals both in the aged care facilities at the moment under the COVID rules and into the community by a better access but do any of you see another avenue that I see you wanting to I've actually had the emotional well being for older people program in a couple of the nursing homes that I've looked after and families love it and the actual residents really have benefited enormously from having that support and they do it as a one-on-one or they might do it as a group men quite often get lost in nursing homes because it's predominantly women so having that program in the facility has been a fantastic support great yeah that's been my experience and it's so good to have something that we can offer it's really been a gap a gap that you can get services if you're out of an aged care facility but not if you're in one so that's been a big move anything to add to that yeah I mean I think there's a bit of a change some of the facilities do actually contract psychologists or people to be there on the site alright so but not all of them infact very few of them there are some private psychologists that might come in through the better access mental health plans not a lot we're working very very hard as psychologists in terms of trying to up skill and train psychologists to go and work more with this particular population the older adult mental health services will sometimes go and see people in residential aged care facilities but there is a there is a telehealth service which some of you may not know about so Swinburne University down in Victoria actually have a national telehealth program where for free they will do counselling for older people in aged care facilities it's actually run by the students so the psychology registrars under supervision are very very experienced people down there so look them up because that is definitely an option and I know it was a very important option for a lot of residents during the COVID pandemic but the problems we have getting older people to have access to services in residential aged care is actually not all that dissimilar it's harder but not that dissimilar for older people in the community so it's also pretty hard to find somewhere for an older person in the community and it's really the same avenue so there are private psychologists the older adult mental health service and actually at Macquarie Uni we actually have a national service which is a telehealth or face-to-face service that we do through the Centre for Emotional Health there as well so I'm hoping we're going to have more and more of these sorts of services where people can access it it's a huge gap and I think it's partly about embedding new services but partly about just upskilling the whole range of professionals we already have out there who are more than capable with a few little skills learning how that they can go into these facilities or into community settings and use the knowledge they already have in this age group because we know those psychological strategies are just as helpful in this group mental health first aid how one can also train up people in community to be aware of what you were saying earlier about you see someone they're looking glum and if you can with consent reach out to that person that's a great help absolutely and in terms of what skills work we know that some really simple behavioural stuff goes a really long way so someone doesn't become a clinical psychologist to help an older person with depression so I mean one of the skills that has the most evidence for it is what we call activity scheduling you know in lay person's terms it's getting people back involved in doing activities that they find pleasurable right and so any of us can help somebody else to do that you know help them remember what their favourite music is and how to put it on what's their favourite movies getting them to go for a nice little walk giving themselves time to have a cup of tea or make their favourite cake or calling up a friend and they sound ridiculous in terms of its simplicity but we know they're incredibly effective and I know during COVID I did a webinar and journalists were saying to me oh my goodness we're all glum we've all got that COVID downer and you might have all forgotten this but I remember it and I said these really simple things where we give ourselves a moment to do the little picnic arts and there's stuff that anyone can do now I remember a social worker saying to me when you go into someone's home or you speak to someone and they say I've got no friends and I've got nothing I want to do and she made the nice metaphor of you think the larder is empty but actually let's go in and have a look at what's in the larder and sometimes you find quite enough to make a good meal or to make a move towards some recovery from that sad state it's back to giving them a voice and for us to listen to what they're saying very much so so I'm sure some of the more medicalised participants might want an answer that Sue put in the questions beforehand and we've had lots of questions beforehand on this what is the link between chronic physical ill health and mental health or vice versa so it's a huge topic and you basically all got about five minutes to answer it I'll take less look we know that chronic illness and associated physical frailty can lead to social isolation and loneliness and I've already raveted on about how important loneliness is a risk factor for lots of things so you've got those so it increases your chance of depression anxiety and then you socially withdraw and so you don't move as much so you become more frail and it's this vicious cycle and our job is to break that so people don't withdraw from society and become physically isolated and there's so much out there now for chronic and complex disease management a lot of it is self management and coaching there's a bit of that there as well but there is a lot we can do but I think the important thing is to reassure our patients that just because they've got a chronic illness it's not the end of the line it's for many many years and it's seeing the positive side rather than the negative and teaching them the good things that they can do it's how we spin it and Viv's probably got a much more official name for it but it's really getting them to see the positive side you know it's the glass half full hey you know you're still alive this is what you can do so yeah I think we all have a role to play there in our own little ways to encourage people because you mentioned medicalising things Steven and we do tend to reach for the scoop pad because it's easy and quick but it's not usually effective certainly not like some of these other strategies we've been hearing about thanks and that would probably include seeing as you're a geriatrician unless we forget the the kinds of medication it's very much after a royal commission on everyone's mind the kinds of medications that are used to alter behaviour now it's a huge topic I'm sure Sandy's faced this we all know that non-pharmaceutical remedies are better but it is a problem isn't it can I just say there are some people for whom a pharmacological solution is the right one for those people who are very depressed or who really are psychotic I think you know I will reach for the scoop pad but they're not the majority I don't feel and I think we have to try all and non-pharmacological measures first and I know Sandy's very good at that Sandy share a passion where we tried everything and I would bring you Sue and say I've tried every little trick in my book and it's not working just give us a few tricks Sandy just give us an overview the kinds of things because I think they probably would be helpful for people who are in the community as well whose behaviour might be challenging to family or the similar sorts of strategies might be helpful so when one strategy doesn't work you've got to try another one and then you try another one so you have to I don't think there's any one strategy but it's trying different things looking at how that person reacts to it and then when it's not being effective trying something else I could give you many examples some of the things the person who came down into my office every single day probably two or three times a day swearing about their relative that put them in this terrible place and where's my suitcase because I'm going home now every day twice a day or more often we would discuss the suitcase and I'd be looking for it and then I found that she went to and there was so then I could talk to her about her schooling which is probably where she was sitting and then that created a diversion for her so if I was to be irritated by those multiple visits into my office perhaps we would have gone down the pharmacological pathway so there are and certainly in the residential setting we actually have to look at every option before we pick up that phone and say hey Sue, can you give me a hand here we have to be able to demonstrate that we have tried all these other little tricks or strategies not tricks, their strategies to help people can I jump in with the concept of therapeutic fibbing now this is something and I speak from both my professional experience but my mum had dementia, my grandmother had dementia, she lived with us so I've lived with dementia most of my life both professionally and personally therapeutic fibbing is wonderful and it actually has a literature around it so when mum would say now I don't know where your father is and dad had been dead for a while I would say mum you know what dad was like always at meetings and she'd say yes, yes you're right but what was interesting was when the staff at the facility would say to her when she asked that question always probably at Bunnings she'd look at them and say rubbish she's never been to a hardware store in his life so you have to be careful and therapeutic fibbing is where you actually go into the person's situation you see it from their point of view so we don't call it therapeutic lying because it's more white lies and I was thinking about it and I thought we do it all the time professionally we're not going to tell someone who's got a really bad prognosis you're going to be dead by Christmas you couch it slightly differently so I think that concept of therapeutic fibbing you distracted which is wonderful and I think we've all learnt to do that but it's all the different ways and I have to say where mum was they were very good at that and I think that's something that residential care staff do excel at and that's why we don't use perhaps as much medication as might happen otherwise but I think we need to say therapeutic fibbing is okay and I say that to my patients who say no I have to correct her and I say no you don't have to correct her for her it's Wednesday Saturday that doesn't matter it's not fatal and I think that's where we it's important to say that we can bend the truth a little bit if it reduces distress and anxiety but I'll stop there you've made my day Sue I'm going to hang on to that no it's a very important strategy I'm very keen to get this question in for many reasons what are the challenges of pre-existing disability for ageing people and their mental health I just say that's it's a double whammy ageing with a disability is a double whammy and we need to make sure we take that underlying disability into account because I won't have to think like that because I won't have seen the person when they were younger but we're seeing them now so you really need to think about what that is and I think about people with polio they've actually lived with that disability or their life it's getting maybe a little worse or they've developed something else but they know their own issues well and I think Sandy and Viveve both said this we need to listen to the person and ask them how they are managing it really is an interesting situation and people with disabilities like spinal cord injury I know it's not common but they age faster their systems age faster after a spinal cord injury than someone of the same age who didn't have a spinal cord injury so it's kind of having a little bit of knowledge of how the underlying disability will affect the ageing process it's an issue at the moment isn't it Sandy in terms of people with disability being looked after in aged care facilities young people in aged care facilities it's not easy and they're not with their peers so the all the 80 and 90 year olds with people with common stories and life experiences and then suddenly put a 30 year old in there it's not the best spot for them and we hope it's about to change but we'll see Viveve have you had any experience in this area of disability to see my internet is a bit dodgy I'll see if I can answer that question yes I agree really with what the others have said but also just to say that it's not a given though we have to remember that all older people are not the same they all come with their own personalities and some are just more resilient than others in the same as younger people are so there are lots of older people who can just get on with it despite pre-existing disabilities get on with it probably better than most of us do so I just wanted to be mindful of the fact that I think we do have to be careful of the assumptions about older people and how they will cope given different sorts of life circumstances as well as different sorts of health very much so we've had a question come in about frailty and acute care and this comes back to all of our discussions I think and probably it's been answered to some degree how do you think acute hospital staff can help older people with frailty that they can take the steps to reduce their frailty speaking from experience we are doing that study at the moment and it is very interesting we're screening for frailty in people in their acute wards after they're admitted and the number of older people that don't want to be called frail when they clearly are very frail and we're taking a very positive attitude if they've lost weight we look at dietary interventions if they can't walk up a flight of stairs or even two stairs we look at physio interventions if there are lots of medication as unfortunately a lot of them are we look at a pharmacist having a look at their medication so we're actually actively treating their frailty as much as possible but what is interesting is the number of older people that actually aren't all that interested in being treated it's not a lot but it is a few and I do think that's going to be an issue mind you if you're in an acute hospital bed you're probably reasonably unwell and even if you're getting better because you've spent a few days in bed you are going to be a lot worse than you were when you came in from a functional point of view so it is hard but we are very much addressing frailty now it's top of mind because it underpins falls it underpins long length of stay and it contributes to so many other unpleasant outcomes so I think watch this space as far as frailty goes Has anyone got a better word for frailty? one that doesn't have the stigma attached to it I know it's really hard I hope it's going to come to me one day in the shower this is the word but it's hard to get it into one or two words but I think it is a stigma we're building perhaps with the best of intentions because we want to identify these people and yet it does have a stigma for some people it is a diagnosis and that's always hard to take a diagnosis so I'm wondering if as it were one by one you could take a few minutes we've got slightly longer than just a couple of minutes just to sum up the learnings as it were for you from the title of the webinar what the main challenges may be and how hopeful you are that things are going to improve even with the workforce challenges who'd like to go first Sandy very keen to jump in there you'll have to unmute though I don't know how keen I am if I'm still on mute I think we've covered it really well in terms of we're all looking at keeping the older person socialised, not isolated in the community can be the key to delaying their entry into residential care and that as Sue was saying linking them with their neighbours with community groups with the hub that Sue was talking about I think definitely those sort of links I do see that people who have been well linked in the community are coming into residential care a lot later than the 70-year-old that's isolated themselves or the 75-year-old that's isolated themselves because of their perception that they're too frail to do this or perhaps they're too depressed to do something they will enter residential aged care a lot faster in terms of when they come into care what we have to offer to open their worlds up for them when was the last time a 92-year-old went to a concert we bring the concert to them Tai Chi art therapy we bring the kindergarten into the nursing home so as much as they can't get out we try and bring those socialising aspects of life to them and I think we do that well yeah you certainly do is there any possibility do you think in the future of doing aged care facilities so well that people will return to their lives in community how much do you see that I think I'd love to say it happened but I think we're doing that out in the community we're keeping them out in the community longer so by the time they get to us 25-30 years ago you saw 60-year-olds in a nursing home thank heavens you don't do that anymore so if you've stopped laughing we don't see the 60-year-olds in nursing homes anymore because we've got a lot of supports out in the community we're now seeing the mid to late 80s and early 90s coming into a nursing home so I think that's a good thing but we do get them out it's more about getting the community into them as much as I'd love to say it for them to have the physical ability to go back to Bowles at the local bowling club I think might be difficult but would you like to sum up I guess my final thoughts we just have to not give up on older people at any point whether they're in the community or in the aged care facility or whether they have comorbid conditions and frailty and depression and loneliness and suicide all rolled in together I think we need to be looking for these symptoms early on and treating them preventatively and giving them the best quality evidence and evidence-based intervention rather than making sure we don't give up we give them the best that we can I think there's going to be a move to a lot more prevention I really hope we do because quite a few of the issues we're talking about unfortunately start in the 40s and 50s the health, the lack of exercise the shrinking social networks these are all the things that happen in midlife that actually set people up not to have great time in later life so I think yeah let's not be complacent let's just jump in and try and keep people as well as they can be right to the end and just a word on suicide because it is in our title and again if there's a stigma around it's the stigma we're not talking about suicide which you know that's why I thought it was keen to put it in there and what are the statistics are they this is the rate of suicide going up in older people I don't know about them going up I don't think it's necessarily changed that much but we still know that the highest suicide rates in Australia for men now in around their 30s used to be younger men and now men age 75 and above and it's not necessarily that older men are more suicidal that there are more of them walking around feeling like they want to commit suicide it seems most likely that they're just much more successful that when an older person decides they are feeling suicidal they will follow through and they will do it successfully so I just think yeah we have to take depression seriously because when they look back at the research successful suicides in older men something like 80% of their medical records will indicate that this person had symptoms of depression again depression is just one of those clues social isolation is one of those clues that says we need to screen we need to check in if they're okay and we need to ask what it is we can do to help and we need to treat it aggressively yeah absolutely have the conversation so by the way someone in the audience wanted to know when your teenage version of intergenerational care is coming up old people's home for teenagers it goes to where we think it'll be later this year it's in post production at the moment so hopefully later this year Steven I think Sandy and Viv have said almost everything I wanted to say or I've already said it about loneliness about the fact we can do something and I think Viv made the comment about we need to get people when they're younger my comment was going to be start now we know that even at 85 you can improve your strength and balance with exercise in fact you probably improve more than younger people so it's never too late to start and I think that's the message and Viv used the word aggressive I think that's what we've got to be really pushy when we do this and because the results are there if you do this the evidence shows us you can improve older people's lives and it's making sure they know that it's back to public health isn't it and the social determinants of health it's the same old messages and the savings if we go to the economics of good prevention and being aware of things like transport and education and literacy and community really are the cornerstones of what certainly if you read the press sounds like a very depressing situation but I think everyone's expressed the same motto look at what's strong not what's wrong certainly acknowledge what's wrong but try and develop an attitude of what's strong which is why frail is such a challenging word so thank you all I'm going to move on with the with the closing agenda but no it's I hope you all enjoyed this conversation I certainly have and bringing all of the varied outlooks on this topic has really added to my understanding of what needs to be done as well as what we're doing already so thank you all very much and just hang in there while I go through the closing comments which is to remind everyone that the resources for this webinar are posted in the supporting resources tab which everyone's probably now familiar with and you will receive follow-up communication from MHPN with the recording of this activity and as I said to you earlier please please share this with your colleagues have a little loneliness party to talk about loneliness in aged care a lot of this is really just getting groups together what you were saying I think everyone said is let's meet up and talk about these things before it gets too late so we're not doing what what the governments that word that's in the press all the time scrambling how often does one get a call on a Friday evening or because something's happened and there's no one to look after them no one to have their back so let's all no one in this panel is young so we can all be good examples and make sure we've all got someone to help us and I suppose watching this webinar with friends is as good a way as any to start with a nice dinner so MHPN supports the engagement and ongoing maintenance of practitioner networks where clinicians from different disciplines meet regularly with other mental health practitioners and groups and resources and build local referral pathways and engage sometimes in CPD activities I personally have found the MHPN a wonderful resource not only in my work with older people but obviously when you go on their website if your interests are to the whole range of mental health issues that is a health professionals network it isn't restricted to older people alone and indeed next week on the 6th of July there is a webinar on Tourette's Syndrome so if you go back into the library you'll see resources on a whole range of topics for our local network in North Sydney they've been great in supporting our special interest network and we've shown films invited speakers on a wide range of people working with older people First Nation elders art and music therapists, psychiatrists and psychologists and social and mental health workers and it's been a little fallow during COVID but this is one of our meetings for this year and there'll be another one as well so if you're interested you should make contact with MHPN via the network section of their website there will be one more webinar in 2022 after this series the 6th one by way of partnership between the 31 PHNs and the mental health professional network so keep an eye out for future communications and as every time that something like this happens of course you have to or we would like you to fill out the exit survey so that's very helpful for us to improve continue to improve our service to you I hope that this evening's webinar may help you tomorrow and onwards in your commitment to your work as you care for and with older people so let's be strong and not focus too much on what's wrong but be able to identify it thank you all thank you for coming thank you for your questions look forward to seeing you at the next webinar which we will announce in good time thank you all