As a nurse with the Royal District Nursing Service for a decade and 12 years as a director of nursing in residential aged care, seeing the neglect, loneliness and isolation suffered by older people marked Dr Rosalie Hudson.
Two decades on, Rosalie remains passionate about improving the care of older people, particularly by educating nurses and carers about caring for people with dementia.
An elder herself, Rosalie received a Council of the Ageing Senior Achiever Award in 2018 for her community contributions, having chaired a support group for a person with an acquired brain injury for almost 25 years. She has also trekked Nepal’s Mt Annapurna in a group in which she was the oldest member by about 20 years, and the Inca Trail in Peru, raising money for dementia care.
‘I’m keen on exercise,’ she said, in something of an understatement.
Rosalie teaches several seminars related to the care of older people at our Education Centre, passing on the knowledge gleaned from her years of experience and education. These seminars concern managing pain in older people, elder abuse, advanced dementia care, meeting the needs of older people’s families, distinguishing between delirium, depression and dementia, and palliative care for older people.
The ‘Elder abuse’ seminar, launched in March 2019, looks at the issue through a wide lens.
‘I give a lot of emphasis to pain management,’ Rosalie said.
‘Neglect is a big form of elder abuse and it is a serious issue if people are not given proper pain management. It’s (also) abuse to leave somebody on a toilet for two hours or to physically restrain someone on a chair.’
In the ANMF (Vic Branch) ‘Management of chronic/persistent pain in older people’ seminar, Rosalie teaches nurses and personal care workers how to use tools to assess an older person’s pain level when their verbal communication is restricted.
What underpins mistreatment of older people, generally, is ageism, Rosalie believes.
Older people – even if they have the terminal illness of dementia – don’t command as much attention in the healthcare system as younger people, or people with cancer, she said.
A third to a quarter of older people in nursing homes do not receive any visitors, she added – another telling statistic of how older people are regarded within our culture.
It’s partly about the busy nature of working lives but it’s also the ‘dramatic escalation’ of dementia and relatives misunderstanding the nature of the disease, Rosalie offered. People believe that older people with dementia won’t notice if they are visited or not.
Even GPs are under-educated in dementia, she said, with many not understanding its various forms.
Ignorance of this progressive, incurable brain disease – the second leading cause of death in Australia – can lead to an ‘alarming’ over-prescription of anti-psychotic medication.
But use of chemical restraint to subdue aged care residents is also an understaffing issue, Rosalie added.
‘People with dementia often have behaviour that can’t necessarily be controlled…but busy nurses (and carers) don’t have time to sit and calm them down or give them a nice warm bath, or take them out in the sunshine; provide some alternative therapy.
‘So if the person is disturbing others, the quickest and easiest thing is to give them a pill.’
Rosalie is a firm supporter of ANMF’s national campaign for mandated staffing levels and promoting the availability of nurses 24/7 to provide care for a nursing home population that is increasingly frail and requiring management of multiple, often chronic, conditions.
‘A major concern of mine is a lack of attention to older people’s needs, as though they were less worthy, and we haven’t adjusted our attitudes to meet the advancing age – people are living longer,’ she said.
Rosalie believes there is a need to rethink residential aged care and to stop segregating and isolating older people. She cites the ABC program Old People’s Home for 4-Year-Olds as an inspirational example of how nursing homes can be transformed when generations are encouraged to intermingle.