Dr Joanna Waloszek

Research Project Manager of the Elders AT Ease (ELATE) Program
Swinburne University of Technology

By 2060, 23% of Australians will be aged 65 or older. [1] We know that mental health problems, such as depression and anxiety disorders, are often observed in this age group. A recent report shows that almost 60% of those living in residential aged care have a mental health diagnosis. [2] With approximately 200,000 people living permanently in residential aged care facilities in Australia, we are not prepared for addressing this need for emotional support services.

Providing non-pharmacological mental health services in residential aged care settings comes with its own unique set of challenges which can be hard to overcome. Aged care staff often do not have the time and skills to identify mental health problems in residents. Even in situations where residents have been referred, they have numerous health problems making travel to outpatient services too difficult. There is also a shortage in mental health practitioners who have the skills to work in aged care settings. [3] So, what can be done to improve the situation in the immediate and long-term?

Led by Professor Sunil Bhar, director of the Swinburne Wellbeing Clinic of Older Adults, The Elders AT Ease (ELATE) Program team aims to address some of these concerns. [4] The ELATE program examines the effectiveness of an innovative outreach mental health program for reducing depression and anxiety, as well as improving the quality of life of residents in residential aged care settings. Funded by the National Health and Medical Research Council and Beyond Blue, this study has already enrolled over 150 residents in more than 50 Victorian residential aged care facilities.

We recognise that residential aged care facilities are not silos but rather a community of members including staff, residents, and their families. To have the greatest impact, the program involves a systemic treatment approach involving this whole community. Supervised postgraduate psychology students provide one-to-one emotional support sessions to residents weekly over 16 weeks using cognitive behavioural and reminiscence therapy. In addition, family members and facility staff are offered support and training workshops to better identify and manage depression and anxiety symptoms in residents through facilitated workshops.

The study provides an immediate, free, and accessible service to residents. It addresses the need to improve the training of the next generation of psychologists and aged care staff in recognising and responding to the mental health care needs of the resident. It also addresses the need to involve families in meaningful ways to assist their relatives living in residential care.

This study will help us understand the health, personal and economic outcomes of cognitive behavioural and reminiscence therapy for our elders living in residential aged care settings. It will also provide a blueprint for mental health service delivery in such settings.

The program will continue to enrol new participants until mid-2023. Results of the study will be analysed and made available once the trial has finished in 2024. Please contact elateprogram@swin.edu.au or jwaloszek@swin.edu.au for more information.
 

The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

Ms Elizabeth Robinson, Dr Marissa Dickins, Ms Lina Lad and Professor Judy Lowthian

Bolton Clarke Research Institute

The public health concern surrounding social isolation and loneliness has been heightened by the COVID-19 pandemic.

Prior to the pandemic one in four Australian adults experienced loneliness, [1] which is associated with negative health outcomes on par with smoking, affecting mental, cognitive and physical health. Infection prevention measures including stay-at-home orders have been effective but have led to increased feelings of loneliness and depression here in Australia [2] and worldwide. [3,4,5,6] HOW-R-U? is a volunteer-delivered social support telephone program that has been shown to effectively reduce feelings of isolation, loneliness, and depression in recently hospitalised older patients. [7]

The HOW-R-U? program was rapidly implemented early in the COVID-19 pandemic across Bolton Clarke, an Australian aged and community care service, and Northern Health, an acute health service. This involved ongoing co-design with both services to ensure the program was fit-for-purpose and met the demands of the ever-changing situation.

Evaluation of implementation involved analysis of (a) program data including referral, program uptake, and call log information; (b) pre- and post- symptoms of isolation, depression, and loneliness; and (c) semi-structured interviews and surveys with patients, volunteers, and front-line staff referrers.

Findings indicate the systems and processes developed effectively supported ongoing implementation and transition into business as usual. Over the 18-month implementation period, (23/6/20-31/12/21), 227 referrals were received. The 156 people enrolled in HOW-R-U? received 1,238 calls (median length 24 mins) from 83 volunteers. A subgroup consented to research participation (median age = 77.5 years (IQR = 11.7), 52.2% female). Reductions in loneliness and risk of social isolation, of 3.3% and 25.3% respectively, were recorded while depressive symptoms increased by 33.3%. These results are likely to have been influenced by various COVID-19 restrictions across the study period.

All referrers, volunteers and participants surveyed indicated they believed that HOW-R-U? should continue with benefits reported by all stakeholders. Participants felt supported, with one telling us ‘It is empowering to talk to someone when you’re down and know that you’re not alone.’ Some participants reported developing deep intergenerational relationships, with one participant saying her HOW-R-U? calls were like ‘talking to a daughter.’ Similarly, volunteers reported ‘There is something in it for the people we ring, but a lot more in it for the volunteers.’

More than 200 clients and residents have now been connected with around 90 volunteers with similar interests, drawn from across the organisation including senior executive management, for a weekly 20–30-minute support phone call. Clients say the weekly call is a highlight and the program continues to deliver strong results and improve wellbeing.

A range of enablers and barriers to implementation have informed successful implementation into business as usual at both services.

The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.