Home' Australian Ageing Agenda : AAA Nov-Dec 2014 Contents When clinical psychologist and neuropsychologist
Nancy Pachana is told an aged care resident with
dementia is unable to communicate, she starts
an exchange to show otherwise.
"People will say they can't talk. The best
thing to do is have a conversation with George and they say 'ooh,
George can talk,'" says Pachana, a professor in clinical psychology
at the University of Queensland.
How you approach the person is just as important as what you
say, she says, because even if the person doesn't understand all
the words, they take in the tone of voice.
"If you are angry or frustrated with them they pick that up 100
per cent. Staff will say they don't talk and they can't understand
but that is just not true."
Professor Pachana works with healthy community-dwelling
older adults and those who may have illnesses, dementia or live
in residential aged care. She also trains students to work with
older adults across a range of settings.
A native of the United States who has been in Australia for
14 years, Pachana is director of clinical training at UQ's school
of psychology, where she coordinates its professional doctorate
degree in clinical geropsychology. With UQ colleague and
psychiatrist Professor Gerard Byrne, she established the Ageing
Mind Initiative, a virtual space for people interested in older
adults for practice or research.
Her practice includes providing outreach to community carers
and residential aged care facilities through Alzheimer's Australia
Queensland's Dementia and Behavioural Management Advisory
Service in Brisbane. It involves going with a multi-disciplinary
team to a facility when called upon.
"We try and teach people a systematic way of looking at
behaviours and then teach ways of managing those behaviours in
ways that don't rely on medication; that rely on strengthening the
communication and the relationship with the person with dementia."
Pachana says she loves working in aged care facilities
because in addition to helping an individual they talk about basic
principles with staff.
"It is like throwing a stone into a pond. I can have this
spreading degree of activation in the nursing home and help
many more people."
One of the challenges is getting people to think beyond the
diagnosis, says Pachana, highlighting that a person with dementia
retains the essence of their personality so understanding
their background is critical to understanding the person.
All of Pachana's clinical practice and research is with older
adults. Much of that research involves residential care but also
extends to driving in older people and in people with dementia.
In addition to "liking older adults" she says seeing her
supervisor, who was a neuropsychologist, working with older
people during her training led her in this direction.
"What resonated with me was the fact that older people have
such a rich lifetime of experience that actually working with
them in therapy is easy because you are not teaching somebody
a new skill. Often times you are saying in the past you did cope
with this how can we help you get back to that level.
"For illnesses like Alzheimer's or other neurological or physical
illnesses, people often have complicated presentations and family
histories so you have to be a detective, a mediator and good at
communicating with other health professionals," she says.
Pachana says listening is the key to a lot of mental health
care in older adults, which she describes as a group open and
receptive to talking therapies. Myths and stereotypes that pitch
all older people as the same is the common issue for this most
heterogeneous group of all, she says.
"It is perpetuated in nursing homes where people's past
becomes almost invisible. One of the problems that is most
common in nursing homes is de-individualisation.
"All of the studies show that if you can introduce a more
person-centred approach and have as much personal meaning
brought back into that person's life than people do better."
While noting the best approach is multi-disciplinary, she says
she wishes there were more psychologists consulting to aged care
because mental health issues are prominent and under-addressed.
The Australian Psychological Society's national psychology
and ageing interest group, of which Pachana is the immediate
past convenor, is currently surveying psychology practitioners
nationally to understand barriers to accessing psychological
treatment for people in aged care. It is also trying to push
students to get aged care experience in their training, she says.
There needs to be more people on board because there are
not enough mental health nurses, psychologists and psychiatrists
who know about treating older people, Professor Pachana says.
"We need to increase the workforce there and we need to
reduce the stigma of treating older people. I do it all the time so
I don't understand why you wouldn't. Older people are incredibly
articulate in therapy and you see amazing benefits." n
Aged care from all angles
Mental health issues are under-
addressed in aged care and
there needs to be more mental
health professionals who know
about treating older people
psychologist Nancy Pachana
tells Natasha Egan.
52 | NOVEMBER -- DECEMBER 2014 | AAA
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