Sue Gedeon (She/Her) - on Wurundjeri Country:
Hi Everyone, Welcome to this evening's abuse of older people, Webinar. My name is Sue Gedeon, and I’ll be your host for the evening. Before we get start, I would like to make an acknowledgment of country we recognize and acknowledge, the traditional custodians of the land and sea on which we live, and work and pay our respects to elders, past, present, and future.
Just a few housekeeping notes. This Webinar is being recorded and will be uploaded on the RACGP Website. We have put everyone on mute to ensure the learning will not be disrupted by any background noise. If you have questions during the Webinar, please add these, using the Q & A box at the bottom of the screen.
You can also interact with the panellists and other attendees using the chat function.
We will try and address questions at the end of the presentation. If we don't, get to your questions, we will review these and provide a response offline.
If you're not comfortable asking a question during this Webinar, please don't hesitate to email your question through, and we'll answer it offline. I'll put my email in the chat box.
I'd like to introduce Dr. Elizabeth Hindmarsh and Professor Dimity Pond.
Elizabeth, or Libby has been working in general practice for over thirty years she has worked as a GP principal int Glebe, and following that in Aboriginal health on Elko, Island, in the Northern Territory, and in an Aboriginal general practice on the outskirts of Sydney. She has been a GP Supervisor, and involved in many aspects of GP Education, and since 1992. She has worked on projects with the RACGP in the area of family and domestic Abuse and violence.
She was a co-editor with Professor Kelsey, Heggerty of the RACGP White book, Abuse and violence, working with our patients in general practice. She also teaches for Melbourne University, Safer families, and the RACGP and for a number of phones and GP synergies she is the chairperson for the RACGP Faculty of special interests, abuse and violence in Families Network and Dimity is a GP In clinical practice at Berrara, on the outskirts of Sydney she has recently retired from a role of for the last twenty years as Professor of general practice at the University of Newcastle.
Thanks, Libby and Timothy.
Dimity Pond:
Thanks, Sue.
Thank you very much, Sue. So Ah welcome everybody. It's really lovely to have you online. And I'm just going to share the screen now.
Libby Hindmarsh:
Thanks for joining. And we're going to talk about the abuse of older people.
Now, the reason we've chosen to describe it in this way is because we had some feedback from Aboriginal and Torres Strait Island of People, saying that they're not very comfortable with use of the word of elder abuse.
Of course it still occurs in the literature. But in this Webinar and in the White Book we've chosen to call it the abuse of older the people. And so that's and a little bit of an explanation for you about the name.
Dimity Pond:
So over to you, Dimity. Okay. So I might get you to put the next slide on. Is it not up. No, just the readiness program one is.
Libby Hindmarsh:
Oh, my goodness, okay, let's go back and start again.
Dimity Pond:
Then that come up. Now give it here. Well, I can see you know the slides down the side, but the one that's maybe showing is the readiness program.
Libby Hindmarsh:
He's her I’m still she with it.
Dimity Pond:
Who's just asking if maybe she should share it. We were discussing our like a facility. Well, I don't know why it's not coming up. It's not up.
You just need to move down to the next slide. That's the thing can you not click down? Maybe, Libby, if you want to press on, start slideshow that might be easier.
Libby Hindmarsh:
Yes, I've done that. I think we're seeing the other side of the screen.
So this this is I’m seeing it, and you're not. Is that right?
Sue Gedeon (She/Her) - on Wurundjeri Country:
So I think we're just seeing, like all the slides on the side it's not actually in slideshow.
Libby Hindmarsh:
If you've got me to share it. Yes, I think you can share it. Because, yeah, I've done all the things I did to do questions not for you.
Sorry, everybody.
Dimity Pond:
So Thank you.
Dimity Pond:
So I just mentioned about safer families. So that is a program that's being run with collaboration across the college., The University of Melbourne, Blueknot, Phoenix Australia, and the Safer Family Centre for research excellence, and uh, it does offer um training to general practices
about abuse and violence. So if anyone's interested, we'll have a bit more detail at the end about that and Libby and I both zoom into practices and do some very interactive sessions with the practices about that. So okay, So we might just look at the next one there.
So because we were also going to acknowledge the Aboriginal peoples on whose land we met, and I am on the land of the Geringi and Darak people. And so we want to acknowledge them. Their elders passed present and emerging, and we recognize that the land was never ceded.
Libby Hindmarsh:
We're just going to move on now to a poll. We would just like to have a bit of an idea who who's come in tonight?
And if you could, just tick the box that represents you and that will just give us all a bit of an idea who's online tonight.
Dimity Pond:
Will we be getting the PowerPoint Sue? It's being recorded isn't it so it'll be available.
Libby Hindmarsh:
Yes, if the whole session will be available later.
So how are we going with that Sue with the poll?
Sue Gedeon (She/Her) - on Wurundjeri Country:
Yeah. So we've got three GP’s, one GP register and three other.
Dimity Pond:
Not so I, by all that I can. All right.
So we'll just run through the learning outcomes.
So um!
The first outcome is to understand the prevalence of abuse of older people in our society, which is actually quite surprising.
Libby Hindmarsh:
Yes, and to discuss and become a bit more aware of how to ask and intervene with patients to help with safety.
Dimity Pond:
And we'll also talk about resources and options for referrals.
Libby Hindmarsh:
So the definition of older abuse from the World Health Organization is that it can.
So the abuse of older people can be defined as a single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.
So elder abuse takes various forms, financial, physical, psychological, and sexual, and it can be the result of an of an intentional act or unintentional neglect.
What we now have is the results of the national elder abuse, prevalence study, which came out in December 2021 and this is the first time we've had a national um prevalence study done, and this survey went out to seven thousand people, who was 65 and older, and who were living in the community.
It doesn't cover people in residential care or people with dementia. So, and the results show.
Dimity Pond:
So this is my slide. Is it so? One in six older Australians reported experiencing abuse, which is a lot isn't it in the previous twelve months prior to being surveyed. So that was between February and May 2020, I guess it might have been influenced a bit by the pandemic. But there's definitely a quite a high prevalence in Elder abuse, as Libby said earlier, can take the form of psychological. So that was twelve percent neglect, three percent financial, two percent and physical abuse, two percent and sexual abuse so one percent, so those are the figures from that.
So it actually adds up to more than fifteen percent when you add it up, because some people are were experiencing more than one form of abuse.
Perpetrators are off family members, mostly adult children, but they can also be friends or neighbours or acquaintances.
Dimity Pond:
So, unfortunately, when someone's vulnerable, I they certainly can be susceptible to abuse.
Libby Hindmarsh:
And so um other findings were the people with poor physical or psychological health and higher levels of social isolation were more likely to experiencing the abuse and the two-thirds of older people who are being abused, don't seek help so that's a very high proportion, two-thirds and so this elder abuse or this abuse of older people often remains hidden with the most frequent action taken to stop the abuse involving the victims speaking directly to the perpetrator, and then family and friends are the most common source of support for older people who experience abuse. And if you want to read the whole of those findings there, that's the link to it on the website. So, Libby, that would include that. They don't ask their GP, they didn't ask that question. I don't think I mean some people will be talking to their GP and some GP’s will be talking about it.
Um! But the most common people common thing they did was that they didn't speak to anybody, or they did try to speak to the perpetrator, or they talk to other family and friends that's the most common thing.
So this survey didn't cover people in aged care, and it didn't cover people with dementia, because, of course, they weren't able to answer the questions.
So in the community, people with dementia may or are also going to be abused, and the fact is that put them at increased risk ah inadequate support for their carers and the inadequate education of carer about the about how to manage, and then, and the natural progression of dementia.
It's very difficult, because it progresses at different rates for different people so, and carers get hugely stressed, really into people with dementia.
So what can the GP do. Well, I, when I've got a patient with dementia even, you know, cognitive impairment that hasn't quite hit diagnosis of dementia yet, but is causing problems with activities of daily living the I certainly regularly review them, so I will review them monthly or six weekly, sometimes the Carer says, Oh, she's okay, physically. And I say, Yeah, but I want to see her or him with you I just want to have a chat about how things are going.
What we need to do is provide that support for people as they as they are, find that they can do fewer and fewer things, and we need to be alert to when that supports needed, and get another reassessment through my age, care, and get extra support put in place otherwise, the wheels come off. The it's not going so regularly, reviewing, referring the family to Dementia Australia. So that's dementia. Australia's got some excellent help sheets which I often hand out actually There's a website. There are counselling services, and there are support groups that Dementia Australia runs so they're not available everywhere. And of course there's lots of people with dementia in turn for anyone who reach out to everyone or be suitable for everyone. But they're certainly there.
My aged care support so it's really important to get people registered with my aged care. I think they should get registered with my aged care before they get dementia.
I like people to be registered with my aged care, certainly from seventy onwards, sometimes earlier than that our practice nurse does it. Some of you may be familiar with that process. It's a bit of an art registering people with My Education and our Practice Nurse is just excellent at it, and she knows how to talk. Relate right language one people can do it themselves, but it can drive them crazy, really, it's very, very difficult.
So ah, yeah, and there are other forms of social support. I like dementia cafes, and so on, and what we call social prescribing needs to come in there, and it's good for someone in the practice to know what's around what's available locally and often, the primary health network might be able to help you.
Our primary health network has health navigators that that are sort of familiar with what's around, or sometimes the hospital um geriatrician might be able to help you, too, and actually our PHN has an outraged geriatrician. So It's really worth trying to find out what's available to help that carer, so that they don't end up getting frazzled and short with the person and becoming abusive because they can't. They're just not getting support that they need themselves.
They hand back to you, Libby, right So We've just had the Royal Commission into aged care, and the summary report stated that substandard care and abuse pervades the Australian aged care system, which is a terrible indictment of our country.
They felt at the heart of these problems lies the fundamental fact that our aged care system essentially be personizes older people, and this. Try to know your phone?
Um says that it's really important that we ensure that all older people live a dignified and autonomous life, free from pain and degradation of elder abuse, and this must be a priority.
Dimity Pond:
Yes, so Mavis is a bit of amalgam, some of my patients, and she's a case study from residential aged care, and later we'll be doing a community case study as wells so actually, I looked after Mavis for two or three years when they when she developed dementia. And then she moved into the facility.
Well, three months previously to the time I’m going to talk about, and I actually was able to be her GP. Because it was a local facility that doesn't always happen. I'm sure you're aware of that. But it was good in this case.
So she'd been diagnosed with dementia already for about five years. So her dementia was moderate to severe. So, I sort of average uh length of dementia is from uh around ten years from first symptoms although it's very, very variable.
So she was, you know she was halfway through, and I often like to divide it into a fairly long, early stage, where people still functional. And then she moved into the moderate stage where she really wasn't functioning at one stage er husband just stayed behind to chat to me after the consult, and she just left. She left the practice, and it took forty five minutes to find her, and we had to get the police to find her, and she was resting under a tree down the road a bit, so that that's a sort of level of her dementia, and she wasn't able to explain to anyone who she was, and so on.
But she wasn't at the severe stage, which is more bed bound, and so on so she moved into residential aged care. Partly it was that tendency to wander that decided us that it was safer there.
Her husband visits and takes her out twice a week, and the staff complained to me that she spends a lot of time crying, especially at night, and they'd email me ten, thirty at night, saying she's crying, I don't know what they expected me to do at that point.
We talked about them, reassuring her, and it was good and when they spoke to her she did settle down, but it was using up a lot of staff time.
Another problem was that she hates eating meals at a table where there are men sitting, and she sometimes, lashes out a under that ah condition also lashed out recently when someone took the remote control and changed the channel. That was another resident with dementia. So it's tricky, really.
So the staff complained that she was using up a lot of time, and the reassurance didn't last, and that the other residents were upset by her crying because she'd wander up and down the coral, crying at ten, thirty at night. Really, they thought that she was disruptive, and I felt that they were kind of depersonalizing her. But I have a lot of sympathy for this staff, because really most of these facilities are understaffed and really, many of the staff are not particularly familiar with you know the ways of managing dementia without using medication, and we do try not to use medication until we've tried everything else.
At least, so I tried managing it by talking to the family carer and the staff, avoiding contact with male residents, which is incredibly difficult when there's a lot of people wandering around with dementia, so that it was difficult providing support when she cries but if it that's at night, and there's only one registered nurse on it's can be difficult.
On one visit I found that she had, in fact, some bruising on her forearms, and that was from an incident where the male visitor came and set next to her the dining table so that was a challenge.
So I think Dimity this is related to previous experiences she's had in her life of being abused.
I think it must be, but that is not something that I’d be able to discuss with her at this stage. So yeah, so um, I think maybe you're doing the next slide, are you?
Libby Hindmarsh:
Yes, I’ll do the next one, so there's a lot of dementia amongst older people in residential care. It's been estimated that about seventy percent of people in residential care of some form of dementia, and we know that people living with the venture are more likely to be victims of abuse than those without dementia.
A number of facility factors have been identified as increasing the risk, particularly in residential aged care. And this is the this is the article.
Dimity Pond:
So you can see. Well, we've already mentioned poor staff training and here again It's that simple. It's a one of those wicked problems isn't it because staff come and go. A lot of staff are part time or casual. We've learned quite a lot about the staffing problems of residential age care during the pandemic, and they may be working across a number of facilities. They may not have had a lot of training at all, and that and you know they don't get paid very well.
So there's a lack of research into the how the facility should best be organized. We do know some individual things that work for behaviours, but organizing the facility under the circumstances of you know, being poorly resourced is tricky.
The working conditions in the facility contribute to the risk of abuse. So here again the uh, even things like the layout. I'll explain a bit later how the layouts are affecting our ability to manage. Mavis but I'll just have a little look at that question.
Yeah. So yeah. So why don't they separate it, if you can imagine. So this is really the working conditions.
There's a very large central room where there's one long dining table in this ward and then there's corridors off in a sort oven spoke fashion, where people have their rooms and this is a dementia ward, but not the highest level of security. It's locked, though people wonder everyone is wandering around all the time it's a mixed ward of male and female. And so the staff are working in this incredibly difficult scenario. Not enough of them hard to see down those corridors down the spokes. They can't see what's going on down the corridor, and only the one table for meals, and they can't manage, you know a quite a large number of people who are wandering around with dementia and don't understand when they're directed to do something. So it's challenging the policies and programs of that facility probably don't help either.
I'm not familiar exactly with what they do, but I’ll tell you what I was able to do, and screening and assessment can be a problem, too. There can be quite superficial given they their poor staffing ratios, and so on, and then they find themselves in difficulties later.
So, and staff characteristics. I think we've dealt with. So maybe you're doing the next one.
Libby Hindmarsh:
Yes, I was just replying to so. So what can be done about this?
Yes, we need to think about. So a review article that was cited above identified, factors that might protect against abuse in the case of dementia and GP’s can work with management around policies and programs. So Image is certainly been trying to work with this with this facility and dementia services.
Um have free education programs, facilities, and we know that the Government, but that the aged Care Commission said that we really need increased ours per resident staffing, and that's going to be mandated from next year, and as well as the increased our staffing will be required to include a registered nurse for twenty-four hours. That stopped a few years ago, and it's been very deleterious to the way things have been managed. Okay So I think we've covered a lot of that. The policies and programs we certainly have worked with the facility about that.
So what happened with Mavis's case? Well, uh the staff kindly kept a behaviour management chart, which was just a set of columns, saying what the behaviour was, what the staff did like, you know crying, and they say reassured. And then the third column is what the outcome was and settled, they are often said, settled
Sometimes the staff had witnessed what had caused me to be upset, so they didn't always know what the specific triggers were, but we talked about them, identifying specific triggers that they could then work on.
So I told you about the channel changing already. I'm sorry about that, but it was really good that Staff told me.
After we talked about triggers they told me what had made her upset. They told me it was the remote, and in fact, I said to them, Well, how are you going to deal with that? Because, you know, you got a lot of people with dementia. One of them is going to pick up the remote and change the channel, and someone else is going to be not happy with that.
So I think they've actually uh removed the remote from being able to be just handled by the residents. The residence in this place, which is Well, in quite a nice area, you know. A well-resourced area.
Ah, they all have TV’s in their own room, so they could go and watch Tv in their own room if they were able to figure out that that's what they could do which they can't always work that out.
So I then suggested that dementia services Australia be called to review the case.
So they have a couple of different programs for coming out to facilities. Um, and the dementia behaviour Management Advisory Service, Db. Mass. Is the first one that they will also give you the GP advice over the phone if you want to ring them, and sometimes that can be helpful as well. But they actually came out, and they came out within forty-eight hours, and they claim that they will do that I was highly sceptical, but they did. They came out in forty-one hours.
Thy suggested that Mavis be provided with a cuddly toy animal to calm her downs, because she's just anxious and stressed and crying.
They provided an iPad now, which I thought was a great idea at the time, and maybe Mrs. Family recorded messages on this and music that maybe it might like.
The idea was that Mavis would be prompted to look at me. I've had, or, in fact, someone would have to turn it on and make it go for her, because there's no way she could work the iPad she wasn't cognitively able to do that. But
so, um sadly when I um when I uh visited the next time after that the iPad was nowhere to be found, and it had been locked away, so that the practicalities of it are that in that place, with everyone wandering around all the time, residents will pick up things and move them, and his staff felt it was better to keep track of the iPad by locking it away.
But it meant that maybe this didn't. It really has access to it very much.
Of course her husband, when he visited her, would find it, but actually it wasn't needed when he was there, So that that's an issue. So, I so that these things have to be trialled, and there's trial and error to get things right. The cuddly toy is nice, and it's on her bed.
So there! There's also a question of reminding her that it's there if she's getting upset. Yeah, and thanks timidity.
Libby Hindmarsh:
So um, we there are now reporting requirements in aged care which have come about through the Royal Commission. And so it is essential that serious incidents, the guidelines indicate that all non-consensual sexual acts or physical violence needs to be reported.
From the beginning of April this year all the facilities are required to have an incident management scheme in place, and all reported instance must be reported to the aged care, quality, and Safety Commission, the portal, and there's the link to the Commission, and This is review of proportion. So between the first of July, the twentieth twenty, and the thirty first of March year, then the Safety Commission received four thousand four hundred and thirty, five, nine notifications, and so these are physical and sexual, or a combination of both. So we can see that a lot of abuse is going on within aged care. We've got a lot of work to do.
In response to the question about what settled mean. Yes, I wasn't there at the time the staff have stopped complaining. I presume that means She stopped crying. But I I can't be sure of that.
But when the pack, when the staff. Say settled, what do they mean? I think they meant She stopped crying.
Libby Hindmarsh:
Bye!
Dimity Pond:
Well, she's not a problem to them anymore.
Libby Hindmarsh:
Yes,
Dimity Pond:
whether that means she's gone into a room, and she's crying quietly in her room that could still be regarded as settled by the staff. I simply don't know if that's what's happening,
Libby Hindmarsh:
So we've talked a bit about what's going on in trying to manage some of the difficult issues in aged care. But we also need to think about what's happening in the community and addressing and addressing the abuse of all the people in the community.
So how can GP’s and practice nurses respond. So first of all, we need to recognize that this older patient that we're seeing could be involved in some form of abuse.
Also, it's good to ask the patient about these issues when they're alone.
Dimity Pond:
If they've got dementia, they still may not be able to tell you.
I mean ideally, you'd spend time there and note what's happening. But we haven't got time to do that. But to you so. But we're talking more now about people in in the community with Oh, yes, sorry. Yeah. With this.
Yeah. But well, there again you don't They've got dementia. You can't.
It's not necessarily all that helpful to ask them. But if they don't have to venture, or they're not very cognitively impaired It's certainly good to ask them when they're alone, so that that's a tricky thing getting them with their carer every time. But you might really want to know what's going on when they're not with their care.
Libby Hindmarsh:
So yes, are we thinking about their capacity?
Dimity Pond:
Yeah. So um. So that's really what I mean by saying I've got dementia. They might not be able to tell you.
Libby Hindmarsh:
And then knowing how to ask, So we're going to talk tonight. A little bit about the elder abuse, suspicion, index. Now the elder abuse, suspicion, index, was developed in Canada in general practice. So it was developed and trialled and shown to be a useful tool.
So there are, in fact, six questions, and it's about what's happened in the last twelve months.
So these are.
Please go back. Yeah, these are the questions: Um. Can be asked to people who've got capacity. So have you relied on people for any of for bathing, dressing, shopping, thinking, banking, or meals? That gives us a bit of an idea how dependent this person is. Um!
Has anyone prevented you from getting food, clothes, medication, glasses hearing? I don't medical at here from being with people you want to be with. Have you been upset because someone asked you in a way that made you feel ashamed or threatened? Has anyone tried to force you to sign papers or use your money against your will. Has any month made you afraid or touched you in ways that you did not want or hurt you physically.
So we're asking about how dependent the person is. Are they being prevented from doing things? Are they being spoken to in a way that's upsetting? Are they being?
Are their finances being used in a way that shouldn't be? And are they being sexually or physically abused?
So And then the sixth question is for the doctor. So elder abuse may be associated with fine findings. You know the poor eye, contact withdrawn nature, malnutrition, hygiene issues, cuts, bruises, lots of things. Did you notice any of these today, or in the last twelve months?
So that's what the elder abuse Sufficient suspicion, index is. And it so? It can be a tool that we can use to try and establish If the person we are seeing is, in fact, exposed to some sort of abuse and Libby artist. I'll just interrupt there and say that, and sometimes the family can help a little bit, particularly say with question one for instance, I had a daughter was looking after her elderly mother, and I asked the mother if she could bathe herself, and she said, yes, and the daughter said, yes, she can. She just needs a little bit of help, said the daughter, and just um, you know I just help her get undressed, and I turn on the shower. Make sure it's not too hot, and I just help it get into the shower with the sit in the chat chair, you know that.
And she said, and then I had the shower rose to her, and then she bears herself. It's really good. I put so forth, and then she bears herself.
It's really good she's still independent with that and then the mum say, Yes, that's right. It's really good. And then she said. The daughter said, Then I am. I turn the sheriff, and I hope we get out, and I just try and get into a call, and she's right, so she's, in fact, highly dependent. But if you asked her herself, she would say, Yes, I’m quite independent with baby. I can do that myself, so it sometimes it's worth just digging down a little bit further about some of these things, too.
It's a you know. These are really cute questions, and you can dig down a little bit further to find out what's going on. Obviously you can't ask question two or three, necessarily in front of the Kira, but some of those ones in question one.
Libby Hindmarsh:
So there's another question. Is there such a thing as an aged care, facility where no dementia patients are admitted? Um in my experience. The answer is, no. What's in your experience?
Dimity Pond: I The answer is, no they. I have had several patients complained to me that they're their relatives been fired from the facility that they're in.
It's often related to that they escape and walk, demonstrate on numerous occasions, because the facility really isn't set up for someone with that level of dementia.
Yeah, So And so another facility has to be found. So that’s very distressing for the family. That, and I feel a sorrow. Their relative is failed in some way.
So it certainly is worth talking to people about. If they've got someone with dementia. They are putting in a facility, talking to them about ensuring that it's sort of appropriate for that to that people of dementia. But it's also quite difficult for people who are very frail and need to go into aged care. You don't have dementia because they find they find themselves often surrounded by people who do have dementia. So it works. It works in both directions, and to Mentor is highly under.
I quite nice. Yeah. So ah, a facility might say. I think, on average, they say that they've got around fifty percent of people with dementia. But, as Libby said, it's more like seventy percent or more if they actually when people go in and do an actual assessment of each person.
So if if we've used the easy, and we might not use it all in one in one um appointment then, and somebody has said yes to that. Some of this is happening to them. Some sort of abuse or violence is happening Then who Ah, acronym of lives can be helpful, and life stands for that. We listen that we inquire about their needs and concerns.
We explore safety, and we support them. This has been developed for intimate partner abuse, but it is very applicable in this situation when we're dealing with um patience in our practice, and unfortunately ah! behaviours in residential aged care can result in the person being labelled as sort of bad or difficult.
My patient was getting that label. She's difficult, you know. She's crying a lot, you know.
And then there's pressure to use psychotropic drugs which we try to avoid because they're life shortening psychotropic drugs, even antidepressants, antidepressants. Don't work well in dementia, anyway, but they're quite they're not good for people. Ah, sorry But sometimes they're necessary, and I have now put my patient on at twelve-week course of a satellite a low d it's just ten milligrams, and the facility reckoned she's settled a bit.
I don't know if that's true, but they feel more comfortable about it so, but I've told them it's twelve weeks, and then we'll be looking at reducing it.
Libby Hindmarsh:
So we might go on and talk about the case a case from the community.
So Harry is eighty, two, and he's living in the community, and you've known him for a number of years.
His wife died two years ago, and he has two daughters and a son who live in the same city or town.
He has lost weight, and he's not involved in some of the activities he used to do like playing bowls.
So you decide to use easy to see what might happen and what he might tell you, and he answers, Yes, to question one and question one is, Have you relied on others for bathing, dressing, um, shopping, banking, or meals, and he has He didn't his wife did all the cooking, so he didn't cook, and so he has been more reliant on his children helping him with meals and shopping, and he answers, Yes, to Number three. Have you been upset because somebody talked to you in a way that made you feel ashamed or threatened, and he says that his children have been very angry and unhelpful lately. That's the way he put it. So, This gives you an idea that that you need to be concerned about this man at the moment. So, we've got a poll. And What would you plan to do now?
You can choose one of those things that we will start the ball rolling with Harry if you'd like to just choose one of those.
Dimity Pond:
There's no right Answer me. No, there's no right how we would manage this.
Libby Hindmarsh:
How are we going to?
Okay, So I think two people said they would see Harry again next week. Can you put that up? Oh, yeah, sorry.
Can you see that I’ll go it? Okay.
Um assess his cognitive state. And
Dimity Pond:
Yeah, I like that one. Yeah, that we could get the practice nurse to do it. Yeah, we good to do that. We think at the moment that his cognitive states Okay, but it's always a good thing to do, because um that might be happening and talk to the old abuse.
Yes, that's that. I found that to be very useful. And they're really nice. Something they are. They're wonderful.
So kind of clueless about what to do next. Okay, all right, so we'll Let's talk about what let's go on to the next slide. So
So you use lives. You listen to him. You think about what he needs. You So explain to him that this is not okay. You validate him, and that it's not his fault, and you talk to him about safety, and you arrange to see him again. So you're exploring what's happened.
You might start to explore this. Now you may need to make another time. And this is the validating
um, you understand he's never cooked. He's feeling lonely, and you talk to him about whether it feels safe and what supports his needs. And you're not sure how to deal with the family, and you might bring the abuse line to discuss the situation.
So this is going to be an ongoing process. Uh with Harry, and it may be possible Libby, too. I refer the family to a carer support group.
Libby Hindmarsh:
Yes,
Dimity Pond:
because the one in my local area which is actually run by the local council. Um, they have.
Ah, they have, you know. They have cup of tea and a bit of a chat.
Then they often have a speaker who speaks briefly about some topic.
Ah! And their person with dimension might come, but they're in a separate room, so that that works. That's really nice, And everyone's got similar problems, so they can really feel supported by that.
Libby Hindmarsh:
So after you've worked with Harry a bit. You may ask him if it would be
Dimity Pond:
um if he agreed to um some of the family coming in, and sort of having a discussion with them about how things are going and what to sort of help further with it. So is it possible to prevent the abuse
Libby Hindmarsh:
of older patients. So the Laura phone
says that we, as we said, I think before that, ensuring that all older people live dignified and autonomous lives ah, free from pain, and the degradation of Hilda. Abuse must be a priority for our society. So how might we go about that?
So there's quite a lot of discussion going on about healthy aging, how that can be helped by forward planning and encouraging our patients to consider writing. Advance, Care Directive, appointing an adjourning guardian.
It's so. That's somebody who's going to. If they lose capacity, help them, help to make decisions about their health care, and where they live, and appointing an enduring power of attorney, which is somebody who's going to look after their financial.
So these documents can be very helpful to family or friends, and GP’s and other health care is
Dimity Pond:
then know what that person wanted. When they lose capacity to make their own decisions, so it'll only be come into effect if they lose their capacity. And, Libya, I just might.
But in there that the enduring Guardian is actually a New South Wales term.
Yeah, I think in Victoria It's health power of attorney, maybe Queensland. So the silver book has a list of these terms.
So basically there are two different documents, one for health and one for finances. The whatever your State calls the financial one, which in New South Wales is called an enduring power of attorney that Doesn't actually give you the right to make any decisions about the person's health.
So you need a different document. Ah! For health, which may be called a healthcare of attorney, or in New South Wales, and enduring Guardian, and in other States other things. So the Advanced Care Directive, I think, is pretty commonly called that across all the States. I think so. Yeah. So But the enduring power of attorney.
Libby Hindmarsh:
these things need to be set up with a solicitor, and they, or at the court, and those very strict rules about what people can do with the money in in terms of being in the enduring power of it to me.
Dimity Pond:
Yeah. And ah! Dimity Pond: You know, if that those things aren't there, it may be that the States Guardianship people will then take control, Dimity Pond: and that it would be good. If the person, before they lose capacity to make decisions can indicate what they want themselves, then the guardian and power of attorney can follow what you know what is said in the advanced care plan, in a sense. Yeah.
Libby Hindmarsh:
So there's a number of other strategies that we're thinking about.
Dimity Pond:
So we've got the pressure on carers and working with them to increase support. So talk about that, and helping families to share the mode of care.
Libby Hindmarsh:
So you know, talking about who's going to do what and when, and share that load can be really helpful.
Dimity Pond
And um, in fact, there are networks of carers. There's usually not just a carer. But there are networks of family members that do to be up their load of care.
So, for example, a son may come and do garden stuff and heavy stuff, you know, whereas a daughter or a daughter-in-law might be involved in more personal care and shopping and so on,
Libby Hindmarsh:
and where family is not willing to be involved, which is the case Sometimes, then, we need to organize through my health care.
My aged care, I mean, was to get some of those jobs done, and that it provided.
Dimity Pond:
Then there's these supposed social services there uh levies put up there the day centres and respite, care and other support services, and that's where you could contact your phn and find out what's available in your area, or you could get your practice. Nurse could do that
it's wonderful if a practice nurse is interested because they I often live in the area, and they get to know the people, it's really good.
And Yeah, that issue about asking the patients when they're in line.
Libby Hindmarsh:
Then, using the elder abuse, self-line You can hear the both images. And I've done so and found them very helpful, and also know about whatever the tribunal is in your state, because you may need several occasions needed to go to the tribunal for them to make arrangements
about guardianship and finances, and care for patients, either because they didn't have anybody, or because the family were at odds about the whole situation, and we had to get that sort of out.
Dimity Pond:
So we've got some resources there. The white Book, which is freely available on the college website, and you don't even have to be a college member. Um! Students are, you know, nurses you any of you in the audience who aren't college members. You can still look up that white book, and there's a chapter on Abuse of Old people, and it does list all those confusing names for power of attorney and things.
There's that's the prevalence Study there, there's a help line, And once again that's listed in the White Book.
Yeah. And there's the local services, Our health pathways, of course. Um, if you're familiar with help from is in your area, they're often really helpful um with listing local services, and so on, so that if you don't know about health pathways, ask your primary health network, or someone else for the practice. It's still a bit underused, I think. But you can log in to health pathways and track through what to do, so that we talked a little bit earlier about the readiness program and the Safe Family Centre runs the readiness program, and they're running trade this training tonight, but other training in family violence where you do it as a whole of practice.
Libby Hindmarsh:
And there's more information on the views of older people. There's some e-learning modules um and at the reading this program, and there's the link for the one on older people, old people.
So the whole of practice training is some online workshops. There's a whole series of RACGP webinars and um a suite of e-learning modules. So if you go to Libby Hindmarsh family. So for families and the readiness program, you'll find those, and could I ask Sue
Dimity Pond:
About where the recordings will be Are they under safer families, or they're in another part of the world. So they'll be on the ah RACGP website under the On-demand Webinar Section Um. I'll email out a link to everyone, and I would like to thank you because I think this is good within us. I mean, as of course it's good. But there's other systems.
Okay. So self-care for health professionals. Am I doing this, Libby? Or are you okay? Oh, well, why are you going with you? I'll start. So, there is a chapter on self-care in a college white.
It is so amazing to neglect yourself when you are a health professional.
It's not good for you, and it's not actually good for your patients either.
So, it's really worth thinking about scheduling in some self-care each week, each day each week.
Then you know a bit of an extended period of a break every few months.
So, there's also support and counselling through the college there's the elder abuse helpline which we talked about, and that's his form of self-care because it's supportive and um one eight hundred respect and um Perhaps we should have mentioned up front that as some of you, you will have encountered some of these issues in your work or in your own family.
That may have triggered a bit of an emotional response in you. We recognize that that happened, and we do pay tribute to you for coming to this. If that's the case, the and one eight hundred respect is a great number to ring. If you've been triggered by any of the discussion that we've had to know, because you can just ring them and say little. I'm a health professional. I just went to this safely day thing one hundred and one.
And now I've just remembered how you know what happened in my family, and I just want to talk to someone about it, and they will understand.
So um! That's fair to say isn't it, Libby.
Libby Hindmarsh:
Yes, one eight hundred respect um will talk to women who've been in domestic violence or sexually abused. They'll talk to relatives and friends who are worried about them. They will talk to, and nurses who want some advice about how to manage things, and they will also provide counselling for the Kerry's trauma.
So, we've had a few questions. Let's look at what's going on.
Sue Gedeon (She/Her) - on Wurundjeri Country:
So, one question is, I work for elder abuse action, Australia, and was wondering if you ever use the resources on compass.
Dimity Pond:
I must say I don't know about that.
Libby Hindmarsh:
No,
Dimity Pond:
Okay. Thanks for that
Great resources. That's a great resource. We'll add that to the list of things that will go out to people is that a consumer organization you have to say in the chat, you and I. Yeah, could put in the website or something in there if people are interested to look.
Libby Hindmarsh:
So, I somebody saying that they found one eight hundred respect not particularly useful. Um. And yes, there are other numbers. So, the Blue Knot foundation is for adult survivors of child abuse beyond blue and suicide call back and lifeline. Yes, so that there are other numbers. Um, having talked to GP’s I know other GP’s have found one eight hundred respect to be very helpful.
Dimity Pond:
It's sometimes actually good to sit down with a person, if it's an older person with capacity, and they're telling you they're being abused, can actually ring one eight hundred respect right then and there with them in the practice, and have a little chat to them that that introduces the person to the sort of help that they might get from that, and they might decide. No, I don't want to talk to that sort of help. I'll try something else, but it's often really helpful to just do that in real time. Um, with someone who's with you, and of course it does blow out the time to the consult, it can be really effective.
Sue Gedeon (She/Her) - on Wurundjeri Country:
It's great,
Libby Hindmarsh:
It is. It is interesting trying to, and our patients find it the same trying to find service, or a person that's really going to, you know, on the right sort of level, and for them. So, it's good to know that there are other services around.
Dimity Pond:
Yeah. So, the older abuse Helpline is very good, too.
Yes, but as Libby says, it's horses for causes. So yeah, So to depend who you get on the night. Yes, it does a bit. Yes, yeah,
You can also ring dementia. Australia. The person's got dementia get some help with that.
Libby Hindmarsh:
This the Mentor Australia can be very, can be very, very helpful to us, to families, and also, you know, wanting to be helpful and supportive of aged care facilities.
So I know of a friend who's now in an age care of fertility, and has, you know, been quite distressed. And ah, dementia! Australia has come out, and he's working with them, and the facility and the family to try and sort that out.
Sometimes you know, these patients need to be seen by the nutrition or a psycho gym nutrition way to one help them.
Sue Gedeon (She/Her) - on Wurundjeri Country:
Someone's just said that it may depend on who you land with over the phone, so hang up and ring the same number again to get someone else.
Libby Hindmarsh:
Yes, that's a good suggestion.
Dimity Pond:
I think we've run out of questions.
Sue Gedeon (She/Her) - on Wurundjeri Country:
Yeah, there's no more questions. So I guess if anyone has any last-minute questions, they can just pop them in the Q. And a box now.
Libby Hindmarsh:
So, I would do. People sort of want to give us some feedback, too, about um What? What? That session's been like for them, because it's quite a It's quite difficult trying to deal with these things, and quite difficult trying to deal with things in the aged care system, too, It's a
Sue Gedeon (She/Her) - on Wurundjeri Country: the question.
Is there a link which lists the quality of each aged care? Facility in Melbourne in particular?
Dimity Pond:
Um, I don't think so. No, no
um.
The New South Wales Nurses and Midwives Association, which the college attends their aged care roundtable the they have a set of leaflets, ten questions to ask which is helpful for consumers, and it's there's a whole stack of different ones for nursing homes, but aged care facilities. So they've got a questions about how much it's going to cost, What questions you should ask doesn't give you answers, and it does break down the questions that you should ask quite helpfully, who's until recently been chairing New South Wales faculty, and I both on that committee.
And if you've got a cold background, there's a specific ones for various cold backgrounds which will ask, suggest You ask the facility about the availability of someone who speaks the language.
The food is like they will assist someone with clothing that's specific for their culture.
Plus one. So, there's quite a range of those pamphlets. It's worth going in and having a look, and I do regularly print them out and give them to people, so they can do their own assessment of how good the facility is using that sort of guideline. So that's helpful.
The New South Wales, nurses and midwives has been pushing very much for having a registered nurse on twenty-four hours a day. So, most of its pamphlets do include that. But that was also a recommendation of the Aged Key Royal Commission. So, I think it's reasonable. So yeah,
So, we could get that link and send it out with things we're going to do. All right. Yeah, we'll do that. Oh, you can find it. Yeah, yeah. And so, we'll send it to. We'll see, because there's a number of things, we're going to send out a copy of it. We're going to send you the link, the Webinar tonight.
Libby Hindmarsh:
You and you will get that to the link for that. For those questions. It's very difficult, I find for families, but I just suggest that they find out one who's got um better availability, because there's no point going and choosing some something. If the people are in hospital, often the social. If you talk to the social worker, they will be of some assistance telling you what's available in your area. It would be worth asking your PHN if they've got any information.
So, um Well, the questions somebody's asking about Melbourne that there is no list that we are aware of anywhere in Australia. That lists um the different facilities. We may not we? We may be incorrect about that. So, but the questions that Dimity is talking about would be a resource for anybody anywhere in Australia.
Dimity Pond:
Yeah, that's what I find. People. The relatives need to go and talk to various facilities and see what go and have a look at them and see what they think of them.
Libby Hindmarsh:
What the answers to those questions are for them
Dimity Pond:
Right. So, I've put the ten questions. Ah, link in the Q. And A and also in the chat.
But Ah, can you see it there soon? Yeah, I've just sent it to everyone. All right. Excellent. I couldn't work out how to do that. Yes, good.
Thank you.
Okay.
You're right.
Well, we might give people an early night they can guarantee if they haven't.
Sue Gedeon (She/Her) - on Wurundjeri Country:
Yeah, I think so. Um. So thank you. Everyone for coming this evening, and we hope you enjoyed the Webinar. Thank you so much to our presenters, Libby and Timothy for sharing your knowledge and time this evening. Please feel free to get in touch with us if you have any questions, any further questions.
Thank you.