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According to the Australian Institute of Health and
Welfare (AIHW) just over half of all permanent
aged care residents have significant symptoms of
depression. Of interest, about 45 per cent of people
entering residential aged care also had significant
symptoms of depression.
It has been known for some time that the incidence of
depression and anxiety among seniors (50 per cent) is much
higher than that in the non-aged care community (around 20
per cent). If this were the case for the general community, there
would be agitation for governments to do something about it.
Mental health policies for state and federal elections rarely
mention mental health and seniors in the same sentence.
What is even more worrying is that, apart from the awesome
silence about this issue in the general community, there is a lack
of best practice interventions for these mental health issues
both in the general community and in residential aged care
facilities. The most common response, particularly in residential
aged care, if the issue is treated at all, is to have a GP prescribe
some psychoactive medication. This is not best practice for two
reasons: firstly, introducing such medication to a person who is
already on a number of other medications commonly produces
poly-pharmacy problems. Side effects of the medications itself
are also common. Secondly, it has been well established that
non-pharmacological treatments, such as cognitive behavioural
interventions are as, if not more, effective than medications.
Given the problems that poly-pharmacy create, these should be
the first port of call.
An Australian research study that confirms the validity and
importance of these best practice principles was completed by a
clinical psychologist Michael Bird in aged care facilities in NSW.
Michael identified two groups of residents; the first group was
provided with a mix of psychosocial interventions tailored to
the individual needs of the case with only a minority receiving
psychoactive medication. The second group was treated mainly
with medication. Among the first group over the course of the
trial, only one patient was hospitalised (for a total of two days)
compared with more than 20 per cent (total hospital days 93) of
the second group. Drug side effects were reported in 12 cases
in the psychosocial group, and in 32 cases in the conventional
treatment group - a threefold reduction.
So what can we do to address this problem? We need
to provide staffing and resources to assist nursing staff to
identify and effectively support residents with depression
and/or anxiety; employ or fund expert psychologists to both
provide appropriate psychosocial interventions for residents
and provide some of the support noted above; and adopt and
endorse guidelines about best practice and provide these for
GPs to follow among the elderly both in residential facilities and
the community as a whole.
Australian seniors deserve better, if not the best, services.
David Stokes is a clinical neuropsychologist and principal advisor
with the Australian Psychological Society.
If the incidence of depression among seniors was seen
in the general community there would be agitation for
governments to do something, writes David Stokes.
Shattering the 'awesome silence'
staff regarding communication needs, and
providing specific information and strategies
for individuals with communication disorders
and their families.
In our submission to the Australian
Senate's Community Affairs Committee
inquiry into the prevalence of different types
of communication, we put forward several
propositions with regard to the care of older
Australians. In its final report (2 September
2014), the committee recommended an
investigation into "the current service
delivery model for speech pathology services
in aged care residential homes in Australia."
Following this investigation, "the findings
should be considered as part of the federal
government's ongoing aged care reforms".
We are vigorously pursuing
the implementation of all the
recommendations arising from the report
with government at all levels.
Notwithstanding the committee's
recommendations, there must also be a
change of mindset about the communication
needs of ageing Australians, and government
alone cannot bring this about. It is why, in
an endeavour to highlight the extremely
low profile of speech pathology and
communication services in aged care, we
have recently released a new video, titled
We are encouraging all providers to
show this video to their staff and engage in
a dialogue with speech pathologists about
how they can contribute to improving the
communication skills of their residents.
Go to speechpathologyaustralia.org.au
Gail Mulcair is chief executive officer of
Speech Pathology Australia.
www.australianageingagenda.com.au | 51
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