Panel on Ageing Parents and Relatives
At our last meeting about 50 people came to hear our panel of speakers on: Coping with Ageing Parents and Relatives. Who do I turn to? The panel was Shira Star, Social Worker; Associate Professor David Fonda, Geriatrician; and Dr. Harry Hechts, Psychogeriatrician. The panel was convened by Dr. Jack Felman who is our Vice President.
Shira Star spoke first. Shira has been working in the area of trauma for 20 years and for the last 6 years has been working for Jewish Community Services. She started the Holocaust Survivor Program which has been running for two years now. A major focus of her work with this program was to educate mainstream service providers who are working with survivors on a daily basis and to help them to become aware of their special needs. She has educated home carers, district nurses, hospital staff as well as setting up peer support groups for doctors and nurses working with survivors.
Shira is continuing her work with Holocaust survivors and their service providers in private practice. She is now working with the Montefiore Homes doing specialist training and debriefing for the 500 staff there. We must recognise that survivors are normal people who lived through abnormal circumstances and their caring needs move beyond the medical model of treatment. The issues of survivorship and ageing mesh and this recognition has only been recent. Issues such as lack of trust until the need was urgent must be understood by those caring for them. Shira emphasised that surviving means strength and clinicians should build on this strength. The emotions in ageing are the same whether or not they are Holocaust survivors: loneliness, depression, anger, guilt, isolation. The intensity of these emotions may be heightened by issues such as lack of trust or fear of doctors and hospitals.
If anyone would like further information on the Holocaust Survivors Program they can contact Jewish Community Services on 61 3 9525 4000. People wishing to contact Shira Star can reach her on 0416 225 214.
Dr. Harry Hecht spoke next. He is a Psychiatrist working with the elderly in private practice and at the Caulfield Hospital. Harry has worked with Shira in establishing the peer group for professionals dealing with ageing survivors. He said it is important to realise that therapists are feeling their way in this work as there are no role models. In many ways they are dealing with areas they haven't dealt with before. The peer group fulfils two needs: there is not a lot of information about the Holocaust, especially for the non-Jewish therapists; and it is a support group for therapists to share their experiences, to learn from each other and to share what they learn from their clients.
Melbourne has a high percentage of Holocaust survivors within its Jewish aged population. It is a cohort group going through a stage associated with ageing. The impact of ageing has to be seen in conjunction with the impact of their Holocaust experiences. Holocaust survivors share a lot of characteristics with other ageing people. The Holocaust impacts on this.
Harry continued by discussing about ageing with dementia, depression occurring in old age and how this impacts on the Holocaust experience. Dementia is not a diagnosis. It is a condition that starts with reduced memory function, reduction in activities of daily living such as of health services and the fact that many survivors did not seek these services cooking, showering, cleaning, the ability to solve problems and think problems through and the ability to think in an abstract way.
Early in the condition some people are aware of what is happening to them and this can cause a high level of anxiety. The person wonders if they are dementing and ones memory function declines with ageing anyway. It is hard to predict who is going to go further into dementia and who is just going to have forgetfulness.
There are a number of Memory Clinics in Melbourne, which can assess the impact of memory loss. Assessment is done by: social worker, occupational therapist, geriatrician, psychiatrist and neurologist. Feedback is given regarding the kind of care and treatment necessary. This is the best facility to look at what is happening.
When memory declines in Holocaust survivors, more and more of the recent past is forgotten and they are left with memories of a long time ago. This becomes their reality of today. They are living through those past experiences and emotions as if they are happening today. This is quite obviously very frightening for the person and disturbing for their carers.
Depression is a normal emotion; to feel sad, miserable and despondent sometimes is normal. As a feeling and an emotion, depression has to be distinguished from the illness of the same name. Depression as an illness is associated with the emotion of depression. Its hallmark is that nothing can lift the feeling and emotion of depression. If it is the illness there are other symptoms evident: agitation, restlessness, inability to stop ones mind going over things, slowing down, loss of interest, staying in bed, preoccupation with physical symptoms out of proportion to those symptoms, loss of appetite, sleep problems. As an illness depression is not just feeling depresses, it is a lot more complex than that.
If left untreated, depression can have a high level of morbidity and can increase in severity. It can result in neglect including poor eating and lack of exercise, very seriously damaging for an elderly person. If physical illness is added to this, there can be a lower rate of recovery.
Depression is a very serious illness. It is common in all elderly populations. Is it more common with Holocaust survivors? It is hard to say. Losses and deprivation early in life can be a precursor to depression. Poor health compounds the issues and can trigger depression. It needs medical intervention.
The family needs to be involved but they can't do it all. Other services need to be brought in and often it takes a lot of persuading for survivors to accept these services. There are a range of services e.g. at the Caulfield Hospital there is the Mobile Aged Psychiatry Team. Anyone can request an assessment from this team. To access the private psychiatric system one needs a referral from a GP.
The third speaker for the evening was Associate Professor Dr. David Fonda. He pointed out that we, as an audience, are interested in this topic because we haven't seen the ageing process. Predominantly second generationers didn't have grandparents, nor did we see our parents care for their ageing parents. There is an absence of this as a role model.
There is a general ignorance in our society about the processes of ageing. Ageism, a negative attitude to ageing, is prevalent in our society. In this year, the International Year of Older People, there are many attempts to promote positive attitudes towards ageing.
Ageing is a process of changes happening in our bodies, things slow down. This is different from disease. Ageing is a slowing down, the memory is not as sharp, movements are slower. Disease is a process that when superimposed on the ageing process has an unusual presentation. It is not so apparent what is going wrong. However, in the last 10 years doctors and scientists have been able to separate ageing and disease more successfully.
More and more drugs are causing side effects. It is a challenge to a doctor to seek the drugs with the least side effects. Problems that are presented are a combination of ageing, disease and side effects of drugs. It is a challenge to dissect these things out. What presents as a symptom may be illness or side effects of drugs. For example, drugs can cause instability and lack of posture which can lead to falls and fractures. It is important to encourage exercise and fitness programs; the recovery from a fall will be quicker if the person is fit.
David also followed on from Harrys discussion of dementia. 25% of people over 80 will suffer dementia of some form. We must be careful not to allow negative stereotypes to apply to all old people. We must not assume they all have these problems. Assessment can often reveal reversible causes, some conditions are treatable and new treatments are always becoming available.
The Labour Government established assessment centres and increased funding for community services to support ageing people to live in the community, rather than in nursing homes. This reflects the change in government policy and societys attitudes which is to keep people in their own homes as long as possible.
Questions from the audience promoted some lively discussion about the issues raised by the three speakers. The points raised included: