The Future Of: Aged Care

Professor Victoria Traynor is a faculty member in the School of Nursing, as well as being affiliated with the Health Impacts Research Cluster and IHMRI. Professor Traynor earned her PhD in Gerontology from the University of Edinburgh and the focus of her research is policy and practice issues in aged and dementia care. This includes how developing competencies for health care practitioners working in aged and dementia care services to provide an organisational and professional development framework to delivering high quality healthcare services. Professor Traynor has also published extensive work on driving and dementia delirium care.

What are you researching or working on in 2018?

Like most researchers, my enthusiasm for discovering new knowledge combined with a passion to make a difference means I'm usually working on a few projects simultaneously. What motivates me most is working with clinical practitioners to develop work-based initiatives which will improve the quality of lives of older people and their family carers.

What has been keeping me busy this month is kick-starting a new phase of a driving research project I have been working on over many years. This driving research started as a Masters project asking older drivers about resources they would find useful for helping them consider driving retirement and has kept growing since then. With an increasing ageing population the issue of driving retirement among older drivers is a concern for individuals, families and policy makers.

After the Masters study, we recruited a PhD candidate and the research was used to develop what we call a ‘Dementia and Driving Decision Aid’ (DDDA). The purpose of the DDDA is to help individuals living with a dementia consider driving retirement. We want to promote the booklet widely so that individuals read it a few years before they might have to give up driving. What inspires me about this research is that the DDDA could never have been developed without input from a wide range of colleagues from different disciplines, including nurses and medical doctors, occupational therapists, public health practitioners, road safety officers, psychologists and lawyers. Most importantly, the consumer contribution was crucial to developing the DDDA. We tested the booklet and have shown there are positive benefits for individuals living with dementia who use the information we have provided. We did not ask whether individuals decide to give up driving; we asked if decisional conflict about driving retirement reduced after using the booklet; and it does. This is important research because it made a positive impact on the lives of a vulnerable population group.

The research has grown to researchers in the US adapting the booklet for consumers there and the same is happening in the UK and Taiwan. We also developed an educational module for GPs and Practice Nurses to help them learn how to use the resource and how to initiate the difficult conversation with individuals living with a dementia about driving retirement. The module was accredited by the Australian College of General Practitioners and was translated into Mandarin for use in Taiwan. It's satisfying to reflect on how this research is making such a wide impact on the lives of individuals living with a dementia.

What are some of the most innovative or exciting things expected to emerge from your field of expertise over the next few years?

For me, the most exciting aspects of ageing and dementia care are the use of assistive technologies. UOW is leading the way with its award winning SMART House Desert Rose - a dementia-friendly, solar-powered home.

As nurses and healthcare practitioners we are in for a huge shock when robots become part of everyday life. Our care will be transformed and we will be able to provide help to older people beyond our imagination. The benefits, as well as challenges, that this will bring is something we need to be prepared for; we will have a balancing act ahead of us. We know that assistive technology can support social engagement, decision-making and advance planning by people living with dementia, but understanding how these technologies have the potential to restrict freedom of movement and intrude into privacy also needs to be a priority. Professor Belinda Bennet from the Law School at Queensland University of Technology wrote a WHO Bulletin paper on human rights laws and assistive technology clearly articulates this complex area of life.

What are some of the things readers should be wary of over the next few years?

In the research field, I have a few words of caution about developing partnerships with aged care organisations. It is important to choose a research partner that truly has the best interests of their clients at the centre of their business. Do not embark on a research partnership without first visiting their services and spending time informally assessing the environment and notice how the clients use the facilities provided by the service. Aged care organisations also seem to be in an eternal phase of re-organisation, so before embarking on a partnership ask questions in order to assess the stability of the team you wish to work with. Changes in personnel cannot be completely mitigated against, but some organisations have a fast turnover of staff so investigating this before commencing the partnership could save some pain later in the process.

During the past two years, I have worked with the aged care sector collaboratively, including five aged care organisations simultaneously. Although the individual members stayed the same just about all of them had changed the organisation they work in and two of the organisations merged into one.

The launch of the new Aged Care Quality Standards will inevitably take organisations time to adjust to and so it will be sensible to wait until the new standards are embedded into organisational systems before starting new research initiatives. Health and aged care staff are continually adjusting to new systems and ways of working but the new standards are a major change which needs to be acknowledged.

Another other area of interest is ‘Grey Power' in politics and consumerism. It seems as if politicians and commercial companies have not caught up with ‘Grey Power’. In a recent book about the ‘The Grey Dollar’ it was found that older people account for 50 per cent of consumer spending, but only 10 per cent of marketing dollars are spent on older people. Are the advertisers complacent about the ‘grey dollar’ or missing out of generating ‘grey dollar’ revenue? In politics, the ageing population is often pathologised as a burden despite them being a large proportion of voters. And with rising life expectancy politicians do not seem to realise the potential power of the ‘grey vote’ for them or against them. Internationally, the ‘grey vote’ should be courted because in countries where voting is not compulsory older people are much more likely to vote than younger age groups. Last year, the Financial Times offered the UK parliamentarians some advice about their ‘grey voters’. Commercial companies and politicians need to wake up to their ageist attitudes and start realising who has the power.

Where do opportunities lie for people thinking about a career in this field?

In a society where youth unemployment is high, gaining volunteer experiences of working with older people is invaluable in increasing their chances of becoming ‘employable’ – better still, paid work as a care assistant will help the bank balance. The skills gained from working with older people provide experiences that can be used in any future job and personal life, and there is also the sense of fulfilment gained from helping an older person have a better day.

Working as part of a health care team also develops another set of skills which reporting back to senior staff about the health and well-being of the person in their care. Then there are the challenging experiences of working with older people which they can learn from, for example, older people reluctant to accept help being offered or ethically diverse situations when the older person wants something different from their family members and the family try to persuade or force the older person to their point of view. Learning to advocate for a frail older person is a rewarding experience and enables high level communication skills to be developed. An Open Colleges website summarises the benefits.

If someone is considering a long term career in aged care I see potential for fulfilling a diverse number of roles across a whole career, including clinical roles with daily contact with older people in nursing homes or the community, supervising care teams or managing a care service, clinical mentoring with students and new staff, teaching roles in aged care organisations or TAFE, or conducting research and becoming a lecturer in the university sector. In aged care, there are roles to suit every personality type at every level of career ambition. Aged care work is provided 24 hours a day seven days a week making it a very flexible career choice which can accommodate studying or family responsibilities. There are aged care needs and community service requirements in every town across the world, so the opportunities are limitless.

What’s the best piece of advice you can offer our readers based on your expertise?

My biggest learning from older people is that I need to slow down and go at their pace. Older people need more time to do just about everything and we need to respect that. Fitting in with older people can prevent us feeling frustrated and can prevent the older person feeling agitated by us rushing them.

This is exceptionally true when dealing with people with dementia. On a personal level I have witnessed firsthand how our own lack of compassion and understanding, labelled two feisty senior women, who overcame great adversities in their lives, as lazy and uncooperative. It showed me that despite the media attention and health campaigns there is still a long way to go in building community empathy and developing ways to adequately assist those living with dementia. So my final piece of advice, or even request would be: Please remember some people need more time and your patience. Don’t let frustration get the better of you, and remember in time, it could be you in the same position.

For more from Professor Victoria Traynor you can visit her UOW Scholars profile, which links to her papers and publications.

Professor Traynor is the founding director of Aged and Dementia Health Education and Research (ADHERe) where you can view the outputs from her research and education initiatives.