 Good evening. My name is Stephen Ginsberg and I'll be facilitating tonight's webinar. Non-medical supports and programs to improve older Australians mental health. Welcome everyone. We've got around 1500 people have registered to join us for tonight's webinar, as well as the viewers who are going to watch the recording. First, I'd like to acknowledge that we meet today on Aboriginal land, always was and always will be. And I pay my respect to elders past and present. First Nation cultures have flourished on this continent for over 80,000 years. And prior to 1788 people were in better health than by most of today's indicators of our health here in Australia. One of the ways that enabled families and communities to thrive were social structures based on mutual care and connection to country. Current social choices for addressing well-being have much to learn from First Nation cultures, including art, music and dance as some of these social choices. I also acknowledge the elders of other cultures who help create the lively communities that are Australia. This webinar is the result of a unique partnership between 31 Australian primary care networks and the mental health professionals network, MHPN. 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. And tonight's webinar is the sixth and final of the series. We're hoping to continue the series into 2023. I'd also like to say a special welcome to the members of the Sydney North Older Persons Mental Health Network, which I'm a co-coordinator and to the other networks around Australia who are meeting tonight to watch this broadcast. MHPN are looking to expand its older persons network program and are seeking expressions of interest from those who wish to join or lead an online or face-to-face network in 2023. We put up the QR codes if you'd like to scan those and in the resources we provided a flyer that you can download if you're interested. So we have given everyone the panellists bios, so I won't go over them again, but we've got a slide coming up with the tonight's panel. That's a Colleen Doyle, search psychologist, Dr. Zara Thompson, music therapist and Hilary O'Connell, occupational therapist. And there's a picture of me. And on the next slide, we have the webinar platform, which I'll let you just absorb for a moment. You'll see that those three dots allow you to ask a question and we will be monitoring those questions. We've had a lot of questions sent in beforehand, so we'll try and work through some of those. It goes over three pages, the number of questions and I've incorporated those into my questions that I'll be asking the panel. So hopefully you can go through all of those, ask a question, chat and of course help if everything goes wrong. And if you need any technical support, don't hesitate to go into that site. By registering, participants have automatically agreed to the ground rules, which can be found in the supporting resources tab. Also, by way of the registration process, participants will ask to submit a question and we're going to refer to those. So the aim is to discuss the evidence associated with using non-medical support programs to improve the mental health of older Australians living in residential aged care facilities and community settings. And appropriate to the festive season, we will be talking amongst other things about song and dance and art. So the learning outcomes are there, I won't go through them and you might like to look at them and then you can judge us severely when you fill in your assessment form at the end and say whether we met those learning outcomes. So I think we are ready to start the Q&A and I'll start by asking Zara's question. Hi Zara. Hi Stephen, how are you? Very well, thank you. So it's a broad question but I'll start with a broad question anyway and we can go down to some of the detail. What is music therapy? Great question. So music therapy is an allied health profession and practice in which music is used by registered music therapists as the method or the tool to enact therapeutic change. So like a speech pathologist might work with speech and communication goals and occupational therapist will use a range of tools as I'm sure Hilary will talk about. In music therapy we use music as the primary modality and I'm sure many people joining in tonight will have had experiences where they've felt that music has been therapeutic for themselves or for someone that they love. You know, going to the gym, listening to music to help pump us up or perhaps listening to a sad song when we're in emotional turmoil. And music therapists basically use those kind of properties for music and also the neurological aspects of how music works in our brain to help people seeking therapeutic change. Well that's a nice quick, and I think they call them an elevator pitch. You've got that in between the ground floor and the 15th floor. Can anything go wrong? Because a doctor will always say what are the contraindications? Of course, yeah, so I guess music is in a silver bullet and which is why we have music therapy and we believe that it's an important part of allied health. So music firstly is a really strong stimulus. It impacts a lot of our senses, not just auditory. If I play music with other people, we're using our tactile senses as well, our visual senses, and there's a lot of things that can be linked to music. So for example, emotions might be linked to music. It might trigger some positive or negative memories and emotions as well that can connect to that. So we know from a mental health perspective, sometimes people might get stuck ruminating due to listening to the same song over and over again. And that can help to exacerbate some negative emotions and things like that. We also know that in my area of work, which is working with people who are living with dementia, that sometimes things like headphones, which I'm sure many people might have seen examples of that if anyone has been the live inside documentary, which shows a really powerful depiction of a person who is wearing headphones and suddenly is able to recall things and engage when previously they've been sitting quite passively and not really engaging when people were talking to them. While these are really magical effects and it's really exciting to be able to bring those to people, what I see a lot in my work is people with headphones on who might not be able to physically remove them. Perhaps they might have limited mobility. They may not have verbal communication anymore, so they can't yell out or call someone to ask them to stop it. And so that could lead to a range of issues such as the volume being too loud, being really uncomfortable, causing headaches and things like that. It could, as I said before, trigger some really emotionally challenging memories or emotions that might leave them in a state of distress. So when we're using music, we're always thinking around the positive benefits, but also what potentially could go wrong and how we might mitigate that as well. Right. Well, we'll come back and have the conversation about where music therapy fits in and into the team that cares for people usually, hopefully, in the community. So introducing Hillary. Hi, Hillary. Hi, Stephen. How are you? Good. Thank you. Now, you're an occupational therapist and, you know, a birdie told me you're rather keen on re-ablement. I certainly am. I think it's not a term that many people have heard. Yeah, well, I'm certainly an area that I'm very interested in, Stephen. And I think to sort of, a tiny bit of background behind it, I don't think I've got the elevator speech quite there in a very short space of time. But what we do know from a lot of the evidence is that most people, as they age, want to stay in their own homes, in their own communities. And as we're living longer, people want to generally live those extra years in as good as physical and mental health and cognitive health as they possibly can. But to live at home independently, you have to be able to do a certain amount of everyday skills such as moving, transferring, getting up and down steps, cooking, cleaning various things like that to be independent and to sort of live well. And what we do know is loss of function in our later years is often down to fitness as much as anything as opposed to, you know, a specific disease process. So there's a lot so much we can do about it. So I've always been focused on what, when people are starting to receive community care, they're starting to want some low level CHSP services such as domestic assistance, gardening, meal prep, transport. What is it that we could be doing to enable them not to need those services? So particularly people at the beginning of their community care career, what we can, what can we do as a society and as a program to improve people's function, their strength, their balance, their endurance, their cognition as part of community care. And that's essentially what re-ablement is. I mean, it's been a, it's actually been in place for probably over 20 years in different countries in different contexts this. And in Australia since 1999, but it wanes due to the politics often of the country who's in charge, who fancies, you know, talking about in a different way. But essentially what it is is a short term targeted intensive service or an approach where you work with someone who's starting to struggle with their daily living activities and help them either regain that skill or learn another way of doing that skill or improve their fitness or their strength or help them with something like a piece of assisted technology or change the environment that they're actually living in to enable them to be able to do that activity themselves. So we've been retraining sort of community care organizations to try and think in this way. It's quite hard to change a culture in many ways, but more of a doing with approach rather than doing to someone or doing it for them. So we enable them to be able to do as much as possible for themselves. And if I've got a moment, if I give an example of some things that I've sort of certainly seen is people who perhaps needed some personal care assistance and support workers go in, start assisting someone to shower. But on the other days, the person showers themselves or they're able, you know, someone sort of turns up at the door to support someone and the personal care system grabs the arm and walks them down the corridor lifts the arm start sharing them. And yet the person's got out of bed, got dressed and made their own breakfast. So we have to sort of start thinking of changing that culture. And that's essentially what reablement is. It's outcome focused short term intensive getting the person to be the best they possibly can before any longer care decisions are made. So I mean, if the goal is autonomy, no matter what level of disablement the person may be living with, you're reabling. And is it mainly a program where you would train those who are working with the person rather than going in and doing something yourself like, you know, the OT goes in and stuff. So there's different there's been different sort of research reports done on this and certainly some of it's in some countries is multidisciplinary, but our argument has been that that's it's too expensive. It's not it's there aren't enough allied health to actually go around to be able to do that. So we've been very much training the support workers who are at the coal face to work in this way. They just think of it is over. I'm going to be doing with this person and I'm going to be slowly doing less and less for them over time. Then the approach works in that respect. So in some countries in some areas it's multidisciplinary, but from our perspective it's more around working with community care organizations and support workers. And there's quite a lot of evidence which Colleen might sort of talk about or re-opement within a residential care settings as well and the value of that and how it's actually improving people's mental, physical and cognitive outcomes. And it may be a theme that we'll come back to in the discussion because with the workforce shortage, obviously it's much more efficient to train people. That's right. That's right. And I know you're going to come back to it part of a site that we've set up, which I'll talk about afterwards. It's almost providing a virtual re-ablements platform for people certainly who have certain literacy levels to be able to sort of look at it and work through some of these things themselves. Yeah, we certainly come back to the joys of the digital. Yes. Thank you. So Colleen, welcome. Thank you Stephen and hello everybody out there. So you've heard Hillary and Zara discuss what they do. I suppose as everyone always wants to know what the evidence is and we've got that in one of our learning outcomes and as the professor on the panel, you're going to tell us hopefully what is the evidence for some of these non-medical supports. Well, how many months have we got to talk about this? It's such a huge topic that we can't possibly cover the depth and the breadth of this area of research, but in a nutshell, yes, absolutely. There is evidence that non-medical interventions can improve people's mental health and well-being, whether they have cognitively alert or they have some cognitive impairment or they're suffering from some degree of dementia. And so the latest evidence is really that for a whole range of interventions that we can talk about from music and art therapy to the sort of rehabilitation interventions that Hillary is talking about to physical activity, relaxation, sensory stimulation, environmental interventions, a whole range of evidence that all these things can help people to improve their quality of life and their mental health and well-being. The actually the strongest evidence that we've got so far is actually interestingly for music therapy. So, Sarah and her colleagues would know all about that research. But certainly we did an umbrella review published in the International Journal of Nursing Studies last year that looked at 26 systematic reviews and we screened thousands of reviews actually of non-pharmacological interventions for people with dementia, for example. And we found that interventions that were a combination of things really had the best evidence for making an impact on people with some cognitive impairment. But absolutely there's there's good evidence for all sorts of all sorts of interventions and probably the takeaway message would be that the best evidence is for those interventions that are tailored to the individual. And that's probably why some of the evidence is a little bit patchy. So for some things, for example, massage therapy, the evidence is not quite as good as for music therapy, but that may be because we're able to identify a music therapy more clearly than a massage therapy. So some of these some of these interventions that have been tested in the literature and in in clinical trials in community settings and in residential settings are not terribly well defined, which means that it's hard to demonstrate that they work very well. And so that might be contributing to the to the evidence not being quite as as strong in some in some areas. But the good news is that, you know, we're at the stage of research now in the aged care area that we've got a whole lot of tools in our toolkit, as far as how to to things to try to improve somebody's mental health and well being. And it's a matter of testing them out in the field, testing them with individuals and seeing what the impact is for that particular individual based on the evidence that has been brought from the literature. Yeah, this must be why the in in in the UK, the all party parliamentary group for arts, health and well being, can you imagine us getting one of those here, not in a hurry yet, but hopefully it's let's push forward. This is in 2017 key findings were the evidence that the arts can support longer lives, better lived, and can help to meet many of the challenges surrounding aging, including health, social care and loneliness and mental health. So I think in the UK, they had a Minister for Loneliness. They do. They still do. We don't have one of those yet. No, let's, you know, we're advocating right now. Yeah. And certainly for sure look beyond blue published summary of interventions to help older people's mental health and well being a few years ago and and music and the arts was one of the strongest areas for evidence that they have have a good impact. More so in residential settings than in community settings. But as we shift more and more towards providing support for people in community settings, I think that literature will start to build as well so that so that it's stronger. Well, the Royal Commission in their recommendation 38 certainly encouraged all of the modalities of non medical supports, and they included arts, art and music therapists in there as well as part of the suite of services. So, you know, things are looking up. Just going to ask you all now maybe to comment on in order to make these strategies sustainable. How we, we can involve community, the wider community, call them volunteers, call them peers, call them citizens, whatever, but how can we involve them in care of our older people. Can I answer that, Stephen? Yes, I'd want you all to answer it and discuss it. That's like an exam question. It doesn't. Look, we've been doing some research on befriending with volunteers for the last 10 years or so. And we've found very good evidence for an improvement in depression and anxiety among older people living in the community when they're provided with a new volunteer who makes regular contact with them on a weekly basis. And also in residential aged care, we have a, we have a current clinical trial that's not quite finished, but we are starting to recognize that we're getting good results in improving depression and anxiety among older people living in residential aged care by doing the same thing. And obviously this is not a substitute for a psychological intervention like cognitive behavior therapy or some sort of professional therapy provided by a health professional. But it may be a good, a good supplement to those sorts of professional interventions that are able to be put in place for people with depression or anxiety. And so I think, you know, we know that unfortunately during the pandemic, the rate of volunteering has gone down in the community as a whole. I know I saw an, I saw an article the other day about op shops really struggling to attract volunteers to come in to help with op shop sales. And certainly in the aged care area, the community visitor scheme has also, I know, struggled to attract volunteers, but it's not, it's not a pessimistic view. It's just that people are shifting the way that they're providing this sort of time. But certainly the, the evidence that we've been gathering has been really powerful that volunteering can be very good, a very good way to help older people. And in fact, it's good for the volunteers as well. We know that there are good mental health benefits for people who engage in volunteering themselves. So we need to get that message out there that it's good to make new friends. So places like organizations like Friends for Good, and there are all sorts of organizations like that in various states. I know in WA, Hillary, there's one called Be a Friend or Be Friend, something like that. Be Friend, yeah. Those sorts of organizations are starting to pop up in all the states. And it's a terrific way to help older people. I've got a few examples that I could talk about. Certainly this was quite a while ago now at a large organization I worked at over here. We researched and piloted something called social enablement, which sounds sort of a bit sort of medicalized, but it wasn't supposed to be, and that was engaging with people, older people who were already clients of the organization, asking them to volunteer to be part of a social enablement program to work with other older people who were lonely, not getting out, were becoming quite depressed and anxious. And we matched them all up. And it worked extremely well. That's a very good outcome. So I don't think it was ever written up, unfortunately. But what we found is that the people who were acting as volunteers, they actually came off home care after a while because they improved their well-being and both from a physical perspective and social and mental, they improved their own well-being so much that they actually said, I don't think I need to be supported by your organization anymore, which was a real win-win, which is something we hadn't thought of at that time. So I thought that was such a good way of going about it. That's great. You need us to help you evaluate that, Hilary. Exactly. It was a long time ago, and I'm not at that organization any minute, but that really worked. It was a surprising result. And the other thing I was thinking of, Stephen, was the Village Hubs. And I know everybody's got a different opinion about the Village Hubs that have been set up. But essentially, the Village Hubs are certainly the ones that have been set up recently. The 12 that have been set up across the country with government funding are essentially for people who volunteer to help actually set up the hubs themselves. So they're part of the driving committee behind it. So is there to attract people who have experienced an element of loneliness, who want to improve their well-being, and by them being engaged in the development of the hub? To me, that has multiple ripple effects from their own perspective, but also for the people that they're attracting to that hub. And again, that hasn't been evaluated yet, but it will be within the next six months. And that's working very well yet. So it's attracting people to it, who are volunteers, who are getting very positive outcomes from that. And can I say one more thing? Yeah, okay. I want to go on to a lot. Something on the site that I talked about that we were developing, we've been engaging older people to be part of the co-design process. So they've been helping us design the look and the feel and the content. And we've also taken that across now to First Nations people and people from multicultural backgrounds to ensure that the content works for them and is relevant to them. And that's sort of the people who are volunteering and they're finding that actual co-design process to be part of the design of something that's about them for them has been really important. Yeah, yeah, absolutely. I think the idea of a larger sense of kindness comes from the idea of kiss and kin. We are a community and we can all help support each other. Some would call that idealistic, but it's surprising how quickly change can occur. Yeah, I'm idealistic. I always think you should start with that. I think it's a good starting position. Thanks so much. Someone in the audience, Ohana, I hope I haven't mispronounced your name. Can you get aged care funding for music and art therapy? Yeah, you can. Sometimes it depends on what kind of package people have. So we know that the my age care packages can be used for music therapy and art therapy, but it really depends on the level of support package that someone has and I guess the access that they have to finding someone and to linking in with the right people. Sometimes it could be that the person helping them manage their package hasn't heard of music therapy or art therapy or other creative therapies or might see it as they might hear it, but assume that it's not an L. L. Health profession. So that can be a bit of a barrier sometimes. But and I can't speak for art therapy directly because I'm not an art therapist. But for music therapy, we have a directory of music therapists on our association website, which will be in the resources that I've provided. And I believe and so Carter, which is the Art Therapy Association for Australia and New Zealand also has a similar function on their website as well, which I can also share to MHPN team to share around as well. If that's something people would like. I'm sorry, Stephen. I was just going to ask Sarah whether attending a choir would be considered as music therapy because we were involved in an evaluation of a community choir for people with dementia a couple of years ago. And I know that the family carers who brought along the person with dementia that they were caring for were able to pay somehow through the community aged care funding that they were getting for attending the choir. It was a fantastic choir. I love that. It was a lovely project. Was that alchemy in Canada? No, it was anecto in Melbourne. Oh, right. Oh, that's it. Yeah, I'm not sure if there's still around. So it's funny that you mentioned that because that happens to be my PhD research topic. Oh, really? Yeah, so I currently facilitate the Rewire Musical Memories Choir, which started as a research project led by my PhD supervisors. And then when the research ended, I took over and then somehow got roped back into research and we did a PhD together with my choir, which was really beautiful. We'll hopefully have a publication from that coming soon. Probably not for a few months, but it's under review at the moment. But we have a few other publications that are in that resource thing that I did as well. But one of my big passions is community choir singing. To your question as to whether it can be considered music therapy from a funding perspective, we have had some success with people using their packages accessing community choirs. Again, it depends on the location and the amount of funding that they have and things like that. But it seems to be relatively accessible. I'm currently working with a few different choirs around Australia actually, some of whom are music therapy led like my own and some of whom are community led. So we don't like to gatekeep who can do music and who can have choirs and things like that. So we're starting a network called the Dementia Inclusive Choirs Australia Network. Again, website is coming soon. We've actually spent the afternoon working on it. It's quite hard to build a website apparently. But yeah, there's so many wonderful, wonderful choirs around the country that are inclusive for people living with dementia and family members too. What my research and other research has shown is that the choir singing, going back to that previous question around what communities can do to support people living with dementia, choir singing can create its own community within the choir itself. It's an accessible way for people who might have difficulty engaging in conversations or perhaps they've got a phasor due to their dementia or they might just have difficulty focusing for a conversation. It's a really beautiful space where they can be included and participate and work towards a goal together at the same time without needing to have that explicit conversation. And there's all the wonderful things like emotional expression, we're bonding, we're getting lots of endorphins and hormones released when we sing as well. So many wonderful things that can come through to that. But what my research also found was that stigma is a huge contributing factor to negative mental well-being or psychological well-being. The stigma of having dementia and even the stigma of being older has been a huge impact on the people that I work with in terms of their well-being and their quality of life and their mental and emotional states. People talk about once having received a diagnosis that people cross the road and don't come and talk to them from their local communities because they assume that they can't anymore. And one thing our choir in particular, and I know the other choirs around Australia like the Alchemy Chorus in Canberra and Good Life Chorus in Sydney have done a really amazing job at using the choirs as a means for engaging the wider community. So performing at local events, we were able to do pre-COVID lots of events where we would go and sing and invite other community groups to perform as well and really help to showcase the talents of our participants and show that even if you have a diagnosis of dementia, you're still able to do things and you're still able to be contributing to your community too. So I think that addressing that stigma, whether it is going to a concert or going to an art show produced by people living with dementia, I know there was a really great one, I figured what it was called, Hilary, you might know, in Western Australia, for younger dementia who are artists and they did a virtual exhibition, it was really incredible. But the arts are... I can't remember the name. I can't remember the name, but yeah, there's some really fantastic, accessible... Medium through art, I guess, so that would be my contribution to that. I saw a lovely programme in the UK, it was from Bingo to Bartok. There wasn't the one with Angela Rippon, was it? I think it was, could have been. Most people in Australia wouldn't know who Angela Rippon was. I just wanted to say something there, just out of interest, from just coming back to Zara, I have a friend who lost his wife probably four years ago now and he has dementia but he's been using his home care package and he had some sort of surplus funds or he wasn't using it for other things and he's using it to attend a choir and not only, say, has it improved his mood but also he's got this whole network of people now who pick him up and take him other places and they have coffee afterwards and things like that. But it's also improved his breathing tremendously, just so that from a respiratory perspective has been really, really good for him and he also, even though people in the audience may not want to know this, he also actually, he's going using it to go to the pool as well. So there are options of you, if you're, if you know sort of what to ask for in some respects on whether you actually have the funds available to use those packages and to use those funds for what you really find value in. Well, the evidence is that if you improve your connectedness and reduce your social isolation in the way that you're talking about Zara and I think we're all discussing this as groups. All of your chronic disease manifestations, cardiovascular, dementia, renal, they all improve as well. Of course, one's mental health sometimes by up to 30%. So if there was a medication on the market that improved things by 30%, everyone would be talking about it. That's right. There is a question from the audience which comes to the issue of groups. Can any other panel please talk about the role of therapeutically informed groups? Now, yep, I'm getting a nod from Zara. I can, but I'm aware I've spoken a lot lately. So would anyone else like to jump in? No, you go for it. Was there more to that or just in general? Can any other panel talk about the role of therapeutically informed groups? I like the idea of groups because they're more sustainable because less of you can be a group. Absolutely. And I think particularly for older people and one of the participants in my study did mention that their circle of community and their social groups are shrinking because people are getting old and they're dying or they're moving away into care and they're not able to connect anymore. So I think that any type of group is really beneficial. I think, and I know Stephen, we had a bit of a chat about this before we came on, but the idea of what is therapy and what is fun and how do we balance that and what are we policing or gatekeeping it, I guess. So this is something that I wrestle with a lot as a music therapist. And I think for me, I like to use the analogy of another allied health profession. So for example, if you're wanting to work on a physical goal, you might go to the gym and join a class there and you might experience some physical benefits and social benefits from being in the class. And that is no doubt literally therapeutic for you. However, if you need a little bit of extra help because you've got a specific goal that you want to work on or there's a problem or an issue that you want to resolve through therapy, then going to a physiotherapy group would be more appropriate. And I see it the same for music therapy. So even though I run my choir, I don't see it as a therapy group, although many of the members would argue that it is very therapeutic. But I also run targeted therapeutic groups, which is smaller. We work on more personalized outcomes and things like that. So I think that's the distinction. And I know a lot of people in the disability community also talk about their frustration that non-disabled people get to do music and gardening and art, whereas disabled people get put into horticulture therapy and music therapy and art therapy. So I think for me, seeing it as a continuum and doing all of those things as leisure without the therapeutic design is really helpful. And as we've talked about, we'll have incredible effects as well. And then for people who need that additional level of support, perhaps a more targeted therapeutic group could be more helpful. So I hope that helps. Yeah, that's great. Can I move the discussion to the topic of this more than decade, this century probably, which is the digital? What's the role of digital modalities in what the areas we're discussing tonight? Okay. I don't mind sort of talking from my perspective on this. I guess as a occupational therapist who I've been working over sort of 40 years now and recognizing more and more that the growing population, potentially reducing workforce too, not everybody's going to be able to get to see a occupational therapist, the physiotherapist, the music therapist, however much value we may be, even in groups, it's never going to happen. People aren't going to be able to access who they want to, when they want to. And so I think the digital world can really help for some people. It's not for everybody by any means. But I think if we can provide digital information in a format that, as I said before, is being co-designed, that is relevant to people, that is transparent and non-biased as well, and can help them through stages and help them with some of their decision making around what are they looking for? Are they looking for things that will help build their social connections? Are they looking for things that will help their mental wellbeing or their physical wellbeing? What exactly are they looking for? Then I think there's a place for a digital platform to be able to do that. But I think you've always got to be wary about what's out there and what the caveat behind it has it been written by health professionals? Is it anybody out there putting anything in there? Is there any risk attached to any of that? So there's an awful lot of information out there and a lot of information overload as well. But I think there's a real role for it, particularly even more so in rural and remote areas where people don't have access to other resources and services that might support them. Yeah, yeah. Certainly you can get funding through your package for devices. That's right. What we've found in our research during the pandemic is that we've had to offer digital alternatives to face-to-face interventions and certainly we've found that connecting people via Zoom like we're doing now or over the phone even or through a video screen is certainly better than nothing. It's a connection of some sort but it's not as good as person-to-person. It's not the older people that have been involved in our research. A lot of them have preferred a face-to-face contact for that social connection. But obviously during lockdowns and so on a digital connection is better than nothing. The other point I'd make is that from the point of view of learning about health literacy, learning about interventions, learning about dementia even, we've just recently completed a trial of training for aged care workforce in the community about dementia and we found that again the face-to-face training was much preferred by the workforce as well. They liked the online training because they could do it in their spare time or when they had a spare moment and they could do it on their phone if they wanted to rather than having to go to a special session. But in fact the results were better when it was face-to-face than when it was online. They learned more when they were face-to-face and they had that sort of extra social connection and it was more fun doing it in person. We found exactly the same with some training we've done previously around supporting people to be more independent and re-ablement and how it works. Say in the support worker role to have people face-to-face where you chat through scenarios and you can relate to someone and say, well in your circumstance this is how it might help you and then problem-solving together brought everybody together with some really good ideas and brainstorming and online it just wasn't the same. It felt more of a tick-off process if that sounds right. Maybe we haven't really learnt how to do the online thing as well yet. I mean things like the MOOCs, the massive online courses have really fantastic take-up and people do do them. I think we've got a way to go in learning how to have a good substitute for that good online face-to-face. I think, Zara, you would know this literature more than me but I think real-life music is better than digital music, isn't it? Yeah, well it's funny you say that because again that was part thanks to COVID of my PhD research as well and from our study with my choir. So we all went online and I guess one thing I want to say before I forget is not to underestimate the ability of older people to use technology. I think at the start of the lockdown none of my choir members or most of them had never done a video call. One didn't even have the internet or a smartphone and by the end they're all using iPads and laptops and even now because COVID is still a threat and because our participants are vulnerable we have a hybrid model. So people who are either not feeling safe or who maybe are having symptoms and can't attend in person can come online at the same time and the hybrid model has been really interesting. What our research kind of found was that there was the kind of magic of singing and that singing in unison we can't do on Zoom. We have to have one person singing and then everyone else on mute basically which is really tricky because that kind of social bonding that happens when we sing is missing and that kind of magic of all doing something at once which I think is really powerful and we know that when we sing together we get oxytocin released the hormone that helps promote social bonding so that wasn't happening. I don't know about the hormones I didn't measure that but that's what people were reporting is that they missed that kind of connectivity but they did find actually in some respects it wasn't really accessible for some people and in another study by my colleagues who were doing Parkinson's sorry, the Parkinson's Song Choirs online they found that actually sometimes for some people that could be quite helpful because they could see the mouth moving and they could see themselves up close and for working on speech and communication goals that was actually really beneficial rather than sitting in a big group in a room with everyone they could kind of see themselves and see the kind of mechanics of what was going on which was really helpful for them so I think there's a lot of pros and cons and as you said I don't think it quite replaces in person singing but definitely it's still something that people can enjoy and can get a lot out of. Yeah. No, that's a great summary of the benefits and some of the pitfalls of digital so as they say moving forward the Royal Commission showed up many of the difficulties of caring for people with distressed behaviors whether it be in community or in aged care facilities so I'm wondering what's the evidence for the use of non-medical supports for people with distressed behavior we doctors are very much discouraged to use medication anymore and that's as it should be but Colleen do you know the evidence for that more extreme behavior rather than day-to-day distress or difficulties? The clinical guidelines for people with dementia and how to handle the more extreme challenging behaviors still recommend trying psychosocial interventions first because of the difficulties with side effects and so on with pharmacological interventions and so even things like vocally disruptive behavior which is something that happens when people have moderate to severe dementia can be successfully improved by for example a music intervention I've done some research in the past showing that noise making for individuals can be improved and the person can be calmed down by a music intervention which is tailored specifically for that person and so the best evidence is really to if we look at clinical pathways for treatment of behavior on psychological symptoms of dementia the recommendations are always to try psychosocial interventions that are tailored to that individual based on a very careful assessment of their history and their environment the situation that they're living in the training of the individual people looking after the person and so on and the combination of all of those factors can actually have quite a big impact on the distress behaviors that are being exhibited by the person there's so much evidence around pet care to ask you a question I love animals and there's been a lot of dogs and other animals I think I saw a lamb not long ago and chickens going into residential care I love the idea of that personally there's been some studies of if you want to call it animal assisted therapy but sure, there's some good evidence in residential settings and community settings for an improvement in depression for example through providing visits by pets obviously not for everybody, some people hate pets but for sure I think for as I said before all of these interventions they need to be person centered and they need to be taking into account the likes and dislikes of the individual it's not something that you can it's not like panadol you can't just give the same thing to everybody so it does need some careful assessment before designing a social intervention knowing the life narrative is so important isn't it and speaking with family and involving family knowing what that particular individual found meaningful and what gave them the the reason to get up in the morning and reflecting on how that can be changed in some way to accommodate their reduced abilities but following along the same flavour of what made them a person in the past and trying to honour that history of the individual of course sometimes people who are making a noise or disruptive are taken away from the social situation and the connectedness and I'm wondering what the research is for doing quite the opposite to increase the social connection because the person may indeed be feeling very lonely which we know causes great distress it may well be there's some research about the built environment with cognitive impairment that perhaps a noisy environment might be distressing to somebody with dementia so putting them somewhere that's quieter might help them to relax more but as you say we really need to become citizen scientists don't we to try to work out a systematic way to approach these situations and to make a careful analysis of what the triggers were for the behaviour that has arisen and to reflect on how can we change those systematically and what are the outcomes that are the best ones that we need to measure and use those sort of scientific tools to have a systematic way to address these issues that's really the only way that we can improve the evidence base in general and also improve the care for individuals I think one of you mentioned tailoring what we do to support people must be very culturally aware and appropriate so I'm wondering if any of you can give your experiences of where that's either been a challenge or where we're for monocultural people here pretty much and how do we meet the needs of First Nations and other cultures at the National Aging Research Institute there's been some wonderful research programs being conducted with First Nations people in the Northern Territory if you look on their website there's some information about some pitch and jarra community work that's been done with art being produced by the elders in those communities and the impact of that on the elders well-being and so on it's a fantastic area to work in I'd love to go and see them and we've also been providing befriending in different languages for people from different cultural backgrounds and found that there are different attitudes in different cultural communities as far as bringing a visitor in whether it's a feeling of mistrust of a stranger coming into the community in some situations but in other situations a feeling of being able to connect with someone from the same culture and very quickly connecting because they felt as though they understood each other it's very important to respect those sorts of cultural differences we've certainly found from a community care, Reuben perspective different cultures have a different way of thinking about how someone should be supported as they get older and that not not supporting someone or not doing their shopping for them was actually very disrespectful we are sort of saying look we need to enable this person to be able to do as much as possible for themselves because they live well for longer but you've got the family saying no that's not how we work in our society if mum wants a cup of tea we're going to get up and make it for her we're not going to suggest she makes it for her so she should move a little bit more or if that's what mum and dad want that's what we're going to do for them because that's the culture in which we work I'm married to an Italian so I can say that myself within the Italian culture suddenly some older ladies of Italian ladies around 70-80 I'm sitting down now people are going to just do everything they possibly can for me because I've been working since I've been 12 or 15 sort of thing so very different culture in that respect to your other cultures that might say absolutely want to be independent we want to do what we want to do for ourselves we don't want any help from anybody it's quite different perhaps have a great place to play in this located in a culturally specific area yes yeah and there are the different hubs have been set up through different groups as well to support different groups of people whether they're sort of First Nations or LBGQQI they're sort of different groups different multicultural groups as well so it's going to be very interesting to see how they're set up the sorts of services and programs they're running and the evaluation from all of those and the hope that it'll be leadership by stepping back I hope so, that's certainly what the expectation is and over time for them to be self-sufficient that's it, that's it Sarah what have you had experienced in the multicultural? I guess there's a lot of angles we can look at this from a music perspective obviously coming back to tailoring things to meet people's personal preferences understanding their cultural background and what that relationship with music might be what's appropriate, what's not and things like that when it comes to running a community group and how we might balance people different people's cultural backgrounds and preferences within that group can be really challenging for a white Australian person I need to do all that over reflexivity and perhaps sometimes talking to people from other communities around how I might help support the people in my choir and knowing that I don't always have the answer if something occurs in that group session where I'm perhaps unsure of how to deal with it because it's like Hilary was saying it's something that's a very different cultural experience to have that cultural background to kind of discuss I think also as a clinician and as a researcher and part-time academic I think we have a responsibility as well to look up why aren't there more diverse clinicians and what can we do to support people from more diverse backgrounds to become clinicians and to work with diverse communities as well so not just thinking around what I can do personally but what can I do to support having more people from diverse backgrounds into the system as well and on that note I guess when we're talking about diversity in this field also recognising that a lot of people who work as support staff are from a range of diverse backgrounds and some people are on migrant visas as well and thinking about making sure we're taking that into account being respectful around that too Great So we're coming near the end and sort of time for summing up some thoughts we never have enough time to fully go into the depths of all of your areas of speciality but Colleen would you like to kick off and just sum up some of what you've heard tonight the take home messages as they call them Well I think the take home message from my point of view is really that there's good evidence for non-medical interventions to improve older people's mental health and wellbeing but we do need to consider it to be something that is tailored to the individual and it's not a one size fits all and also that because of that we all need to think about how best to improve the evidence when we're thinking about the individual and to have a systematic evaluation of the impact of the interventions that we're trying to do I think that's a good point Henry? Mine's probably similar but I'll phrase it a different way hopefully similar to the evidence is there to say that working with people in a reabling or restorative way works that it again improves people's physical, mental we know that people want to live well for longer and it's sort of that old age use it or lose it really does apply that I think within the community care sector we need to help people build reserves so that they are as resilient as they possibly can be as things come along and knock people about a little bit whether it's loss of a partner whether it's a disease process so that we need people to have some reserve in that and I think we know that age related decline is malleable and we can do quite a lot of it ourselves to enable us to live well for longer and I think it's the community care sector and the Royal Commission themselves have sort of said we need to be working with people in a way that's not task oriented that it's actually building people's capacity or at the very least not taking away from someone's capacity how we do this in the community care sector that's under stress currently you know workforce demands, the new reforms coming in and that side of things is a tough ask because we do need everything to be tailored personalised and individualistic for it to make a difference so I think from my perspective I've always tried to sort of see from an OT is is what I'm doing when I'm working with this person at any time taking away from something that they could do for themselves that would improve their wellbeing or am I helping build their capacity so my building the capacity from what I'm saying and what I'm doing or am I taking away and if we've got that in our head at every time we're working with someone and thinking about what we're saying and physically with them what are we doing and what's the impact of our own actions on them as well the same applies especially given the workforce issues, a reablement of community and the strengths that live in the community absolutely, absolutely the connections that are out there that reablement of bringing back community that supports community I think are really really important there's a place for compassionate communities there is, absolutely Sarah, sing us a song to round up I think the appropriate song would be I get by with a little help from my friends isn't it I echo what Colleen and Hillary have both said I think that community connection and making sure that things are tailored to what someone needs and likes and enjoys and is interested and motivated by is really essential and I think Hillary you mentioned quite a few times tonight the idea of co-design and involving people and even just within this panel as we're talking about the rather monoculturedness of this panel I know we talked a bit about age before we came on air but we also don't have panellists who are in their 70s and 80s and I think that when we're talking about what we can do to support the community and address stigma which is a big barrier to people accessing supports particularly when it comes to age-related illnesses and conditions I think also making sure that we're listening to people with lived experience listening to our elders and ensuring that we're having these conversations of people who are going through it and sharing their perspectives as well and as clinicians I think that's something we can all continue to do Thanks, well thank you to all three of you it's been very enjoyable speaking with you and perhaps see you again on a subsequent webinar that'll be great, thanks a lot Thank you Thanks Steven In conclusion mental health professional networks supports the engagement and ongoing maintenance of practitioner networks where clinicians from different disciplines meet regularly with other mental health practitioners, share tips and resources, build local referral pathways and engage in CPD activities so feel free to contact the MHPN we've got a slide up there of course it's not just older people who benefit from social connection we healthcare professionals also benefit from connection so that's one of the great strengths of local networking on a larger scale in 2023 the MHPN there's the slide we'll be having a conference an online conference called All Together Better and that's between the 28th and the 30th of March registrations are now open and the address is on the slide I like the subhead collaborative mental health care in a changing world and I look forward to that very much so it's time to encourage you to fill out the exit survey by scanning the QR code of your mouse at the top of the screen click the banner a statement of attendance will be sent to you in the next four weeks and you'll be sent a recording of the webinar when it becomes available so I always tend to end a little bit early so be it thank you people all for your participation travel safely over the Christmas period and I think the encouragement from tonight is sing dance decorate your Christmas presents and keep active so enjoy Christmas in the new year or whatever festival you may celebrate and hope to see you in the new year thank you for coming