Breaking Barriers in Aging Care: Unveiling the Impact of Emotional Contagion and Redefining Mental Health in Older Adults

Breaking Barriers in Aging Care: Unveiling the Impact of Emotional Contagion and Redefining Mental Health in Older Adults – with Julie Bajic Smith

With our ageing population, it’s more important than ever before that the barriers to caring for our elders are addressed. In this wide-ranging conversation, Jo discusses how to break down these barriers using entrepreneurial thinking with Dr. Julie Bajic Smith.

Dr Smith is a registered psychologist who has over 15 years clinical experience in aged care. She is a board approved psychology supervisor and she regularly delivers clinical supervision to intern psychologists and other mental health.Julie is also an experienced researcher and writer who has developed several preventative psychological group programs for older adults entering residential care which won Positive Living in Aged Care Awards.

You can connect with Julie via her website at wisecare.com.au. You can find Julie’s podcast The Voice of Aged Care here.

Resources mentioned in this episode:

If you know you need more support, please visit my website at https://jomuirhead.com

Transcript

Jo:

So welcome back to yet another episode of the Entrepreneurial Clinician Podcast, where we are talking about future proofing health professionals, using entrepreneurial skills and knowledge so that we can become the significant difference that the world needs from us who today’s episode is. It’s gonna be another challenging but fun. And Julie, who is with me today, is going to be talking about her work and the way she has turned up in the world. That may have surprised her a little bit, but who is Julie? So Julie, tell us who you are and how you ended up here.

Julie:

Hi Jo. Thank you for having me on your podcast. My name is Julia Bajic Smith. I’m a registered psychologist and I’m an aged care psychology consultant. So I work with aged care providers to dispel the myth associated with ageing and the negative connotations about getting old and getting depressed and not doing much and overcoming those common and sadly untrue stories about ageing, particularly for elders in residential care or who are transitioning from independent living to supported accommodation.

Jo:

Wow, that’s

Julie:

Me <laugh>

Jo:

That is you.

And you’ve said it so succinctly because I started writing your intro and went, nah, it’s gonna take me too long. <Laugh> because we’ve known each other for a while. Like, we’ve watched each other do very different things in our careers, right? So can you talk about how we kind of crossed paths and what you were doing back in the day?

Julie:

Yeah, So I met Jo when I was getting interviewed for a job, And it was in a different area altogether. It was helping workers return to work after workplace injuries. And it was a big step at that stage for me. And I remember that interview so clearly, and you were asking me some really direct questions about whether I wanted it or not. And I was moving from living with my parents to living independently. I was in my early twenties and I was just like, wow, this woman, she’s amazing. And so that was the beginning and that’s how I met you. But since then, our journey has evolved and I think it’s taken me a while as well, both personally and professionally to see where I’ll find my niche and my calling, so to say.

And I feel that at that stage when I met you, that I didn’t really have much of my own input about what I really, truly wanted. Because what I wanted was to become a registered psychologist and to get my placement hours and to get everything underway. And so through accidents through chance encounters, I have been able to step into aged care work and through persistence and your coaching and determination, I have been able to sustain it. And even Jo, that journey itself, when I started working in aged care to where I am now, has involved lots of learning, lots of fallings, lots of opportunities, and it hasn’t just been like smooth sailing when you would think you found your calling. It still requires a lot of ongoing work.

Jo:

Yeah, it does. And I’m so grateful that you brought that up. So we got to know each other. I interviewed you for a job, <laugh>, and it was in a completely different field. And then you moved from that you had your own multi therapist practice for a while, didn’t you?

Julie:

I did. I did think at the time because aged care was in the psychology area at least, it was so underdeveloped. And so me stepping into aged care as a psychologist, it’s like, well, who are you? What are you going to do? And when I stepped into any retirement village or aged care facility, it was all about, oh, you are a psychologist, I need you to see Betty. But also I have my own problems and then I’ve got problems within the workplace and personally. So it became quite complicated in a way as to, ’cause I thought, well, I can do it all, but I can’t do it all at once. So I started with delivering treatment to older people and I did build a practice where I had a number of clinicians working for me. And after a few years I decided that I wanted to do further studying. I wanted to go back to uni. I wanted to do more research ’cause I felt there wasn’t enough research about the workforce and these people who are supporting the elderly what’s important to them, what’s motivating them, what’s their training. And so, then I was onto the next chapter as well.

Jo:

You actually made the choice to let go of your multi clinician practice? Yes. And just bring everything back to, because you actually went and decided to do a PhD. High five to you <laugh>. Because I’m not an academic. So you actually went, I don’t want to be managing people. I can make a different impact over here. Was that part of your thought process?

Julie:

I think it was part of my thought process. I wanted to make a lasting legacy. And I felt that focusing so much on just that support and intervention for elderly people at like stages of their life was not necessarily part of what I wanted to do, but I wanted to do something a little bit more different. And I feel that supporting the workforce has more of that lasting legacy ’cause they can support clients today, tomorrow, and into the future.

Jo:

Wow. Okay. <Laugh> here we are making a significant impact without having a multi therapy practice. That’s very cool. Julie, tell us about your PhD. What did you study?

Julie:

Okay, so my PhD was looking at that relationship between older people and their caregivers. And I focused, because I know quite a lot about residential aged care, I wanted to look what was it like in the community settings when people go visiting members in the public, to say, well, hang on, if I’m taking this client out for an outing or if I’m seeing them in their house, what does my workplace actually look like? Because I’m not going to an office, I’m not going to an age care facility. And how do I ensure that I have all the skills required with me in my car to go and support these clients out there? So I was looking at this concept joke called emotional contagion. And emotional contagion looks at the relationship that we have and how we catch emotions from one another.

Emotional contagion is an automatic process that happens. So it’s not something that you switch on, but obviously like if you see someone you know who’s sad, it can make you sad. And if you see someone happy, it can lift you up even if you’re not feeling so great. And so what my research found was that this bidirectional emotional contagion had a long impact on the elders as well as the workforce. So if you have someone who’s lonely and isolated and pretty low workers were less likely to want to engage with those people who are very low on an ongoing basis, they would say, oh, don’t send me there. That person is so low. But interestingly, the same was happening in reverse. Sometimes the clients would actually say, I don’t want to see that such and such person because they’re always negative. They’re so negative.

And I get this sense of negativity is an issue for our broader society. You know I just wrote down this quote, I was in a nursing home not long ago and I’ve kept one home just to have ongoing contact with the elders. And this man in his late nineties said to me, Julie, it’s really hard to find someone who’s not negative. And that really stuck with me. So my research looked at those long-term implications of those emotional sharing, because we know that the aged care sector has very, very high level of staff turnover in the community sector as well as in residential care. And I can go on about the impact of Covid and how the agency staff have not been able to work across different settings as well. So staffing has been a big issue for aged care. And that’s what my PhD was about.

Jo:

Wow. I love that phrase, emotional contagion. I think everybody who’s been listening to this podcast, their ears would’ve pricked up there ’cause I think you’ve given language to something we know goes on, but we don’t necessarily know how to explain it. So thank you for actually spending the time doing that research and creating a way for health professionals to be able to go, these are genuine needs in our community. And that you and I both know, I’ve got stats here. You and I both know that our population is ageing. Like in Australia, it’s ageing and we have residential care, but we have this huge push for people to be able to stay out their days in their homes. And one of the most significant things you said to me, and I still remember this was depression is not a normal part of ageing. And I still remember stopping in my tracks at that time going, oh heck no. It’s an illness.

Julie:

Yep. And it can be treated and it can be cured <laugh>.

Jo:

So how do you think that we’ve ended up thinking that things like depression in older people is normal?

Julie:

I think there’s so many elements that have resulted in that belief becoming so common. And I think, it has to do with the older population being the least likely age group to access mental health support. There’s a lot of stigma associated with ageism with, that, you just get on with it mindset. You don’t seek support. Soldiers coming back from World War II, not seeking help and support and coping in their own perhaps unhelpful ways with post-traumatic stress disorder with trauma, turning to alcohol, turning to other coping mechanisms. And I think that, we haven’t really built a society for that age group where accessing and help and support is actually okay. And so we’ve got a bit of that.

We also have a lack of understanding about ageing. And we know when people have chronic illnesses and not many people do. Like a lot of older people, they’re not automatically eligible to move into a nursing home, Jo. They have to be the criteria for their health. And we know that dementia is such a big part of you know chronic illnesses in older people. And so when we combine all that, I think sometimes, it’s just assumed that when people get older, they’ll have memory problems, they’ll have emotional changes, that all these factors will go on. And I’m not sure how much research you’ve done about ageing in Australia, but it’s important to note that only 5% of people actually end up in residential aged care. Most live independently, most remain living out in the community. So it is the 5% that are in residential aged care, where we think, wow, the prevalence of depression is one in two that is very, very high. Oh. When you compare it with the general population, which is only about 20%.

Jo:

Okay. <laugh>

Julie:

Oh, is that a bit of a surprise?

Jo:

Okay. That’s pushed some buttons. Oh, wow. Okay. I have got some stats here and I did do some research ’cause I know that you’ve done a PhD and this is me trying to impress you.

Julie:

Yeah, go ahead.

Jo:

So you and I are in Australia and we have a population of 26 million people. So I’m just trying to create some context because the USA has like 366 or some obscene number that I can’t even visualise. So what we know is that the rate of disability for people over the age of 65 is increasing. We also know that the number of people living longer than 65 is increasing. They’re being forced out of the workforce for whatever reason. They’re being asked to relinquish themselves from the workforce when they really do have quite a lot to contribute to. But we’ve got this bizarre imbalance happening here in Australia where we actually don’t have enough people in the workforce earning the money to pay the taxes to support the people who need long-term care, right? That’s a really big social problem for us. We’ve got women, I think the highest rates of homelessness are older women. Like those people at risk of homelessness in Australia are women. And the chronic condition piece. But when you say to me that only 5% of older Australians are living in residential care, I’m like, how are the people in the community actually getting the support that they need?

Julie:

They’re not, they’re not necessarily getting support. A lot of them are on wait lists. They might have a package available, but there’s no service provider based on where they’re located. And you have to remember that, Australia is a massive continent, and we have a lot of people living regionally. We have a lot of people who are not in inner cities. And people when they retire, they want to change their lifestyle. And COVID has also encouraged more people to leave big cities. So we have a lot of people who are very isolated. And I have received emails from some really isolated, lonely, older members of our community saying, I would love to have a support group in my local community. I would love to connect. I’m so lonely. And this is coming from people who are very educated, retired GPs, retired professionals who are just out there on their own not getting any help or support for their physical or emotional needs.

Jo:

Wow. So we automatically think telehealth is the answer. But this is a population where telehealth or video conferencing is not the answer. And you’re shaking your head no

Julie:

It’s one answer. And when you have sensory impairments, when you can’t hear properly, you can’t see properly and all that. So it makes it really hard to connect with a health professional. And then also, if they’re a little bit worried about where that information’s gonna go, who’s there on the other line, there’s a lot to consider there as well. So outreach work is the way, but then if you don’t have enough workers that becomes a problem. And sadly, some of them turn to Facebook and put ads there looking for a carer. And I just spoke with one lady in Queensland not long ago, and she just said, she’s got Parkinson’s disease. And she said, oh my goodness, Julie, I’m so scared when they put me in the shower because I don’t think that they know what they’re doing because they applied for a job because they want money, but they don’t have skills to do what I need.

And so with this lady, she really wanted to avoid going into residential aged care. She has a loving, supporting husband, but they’re both ageing, and it was becoming difficult for him as well to look after her. And so the workforce is a huge, huge issue and a huge barrier to a lot of people getting support that they need to remain living independent as long as possible. And just one little side note, and I know that this interview isn’t gonna go all day. We could chat all day, <laugh>, but I think it’s also important to note that as soon as we notice those little warning signs that someone is not doing okay, or that they need help and support, it’s better to support them sooner rather than put it off when they require high level of support needs.

Julie:

And over the years I’ve seen a lot of people in re residential aged care, and they get to this stage, and this is another very important term that I don’t know if you’ve heard from other health professionals, but with all the populations where they don’t have say about where they live, about the care that they receive, about the medication that they’re having, about will they be having pureed food or will they be having soft food or normal diet? What is one thing that they can still control is whether they eat, whether they get out of bed. And so when people actually engage in this stage, called intentional self neglect. We get to this stage where they’re not gonna get better. They’re not. And they will become harder and more difficult to support.

Jo:

That’s not necessarily a cause of ageing, right?

Julie:

No.

Jo:

Right. So we don’t just go, oh, she’s reached the stage of intentional self neglect. Okay, we know what to do here. It’s like, what we should be saying is, holy crap, how did we let that happen?

Julie:

That’s right. That’s right. And when someone engages in intentional self neglect, it’s really hard to support them. I’ve seen people in residential care who are bedbound not because of their physical disabilities, but more so about because of their mental state.

Jo:

Ooh, wow. Okay. So this might be a challenging question. Why do you think there is such a lack of health professionals particularly allied health professionals in private practice in Australia who aren’t doing this work?

Julie:

They don’t know where to start.

Jo:

Ah, so where do they start, Julie?

Julie:

<Laugh> They need to look within their profession, about interest groups, about ageing, they need to look at how they can connect with others. I’m happy for them to connect with me as well. But I think you need to start exploring if this is the work that you want to do and if this is the work that you want to do, what that might look like. And so we need to start exploring why aren’t we interested about ageing and how do we envisage this would fit into our private practice? And would it mean that I need to approach some retirement villages in my radius. We need to explore nursing homes and how to contact them, but just to actually look at our week, whatever days you might be working, see where you can actually fit it in and we need to think about all the factors associated then with your fees, with your location, with your service agreement. But you need to make a start somewhere. And I think that people sometimes just feel overwhelmed, Jo, not knowing how to do it. And the wrong thing to do is to just assume that older people are gonna come to your front door to your private practice.

Jo:

Yeah. Please don’t assume that <laugh>. Please don’t assume that. I remember doing a consult with a beautiful lady clinical psychologist here in Australia who really wanted to focus on working with older people with mental health. And her rooms were up two flights of stairs.

Julie:

Yeah.

Jo:

And I went, I’m sorry honey, this isn’t gonna work. <Laugh>. Yeah. And she just did not comprehend that that amount of stairs was gonna be inappropriate for this population. Like there was no lift.

Julie:

Absolutely. Yeah. That is a huge issue. And also for older people who might not be driving anymore, it’s about how will they get there? Will they use public transport? Will they drive, will they have a taxi? All these additional costs as well. And sometimes it just seems too hard and too difficult to actually access service. I know that some would think, oh yes, okay, I can do it. But it’s a very small percentage. And so we need to be a little bit more flexible and start thinking about home consults

Jo:

Oh, hallelujah. We got there <laugh>. ’cause When you think about the definition or the diagnostic criteria for depression, self-initiation is kind of difficult. So if you’re going to go, I am depressed, therefore I am going to go and find a psychologist who probably has a 12 month wait list and is going to make me climb two flights of stairs and I now need to book a taxi and use my taxi vouchers for that. Like, we’re not actually meeting these people where they’re at.

Julie:

Absolutely. And Jo, even in a nursing home, when I come to someone that might have depression, there’s so many barriers people might not recognize that symptoms they have are actually depression. Because a lot of older people report more physical symptoms associated with depression. So they might talk about their pain, their changes in their appetite, changes in their sleep patterns, rather than say, I feel sad, empty, lonely, that comes later. So if I go to someone and say, Hey, I have a referral to see you from your GP because you’re depressed. They said, I’m not depressed. And you can do a geriatric depression in inventory and they’ll score zero until they actually get to know you and trust you will they actually open up and give you any insight into what is going on for them. So there’s a huge barrier with who is detecting the symptoms? Does the person have depression? Is it dementia, depression, delirium? How long the symptoms have been there, is it maybe just their personality? Are they quiet or do they have depression in the first place? Then actually accessing the service. But it is so worth it because once you start delivering therapy to an older person, they respond to it as well as younger counterparts. Cognitive behavioural therapy for older people is the same as for younger people. And people do get better. And I have seen people in residential aged care who’ve been so isolated, withdrawn, improve their outcomes. They become more social, more engaged. They engage in activities, they engage in physical programs, they make friendships. And so the last years of their lives are fulfilled. And they have overall better engagement, which is great. They don’t just come to nursing homes to wait to die. They have this new stage in their life that they’re never envisaged before.

Jo:

That’s wonderful ’cause If we had a younger person, so somebody under the age of 65 who turned up, who was socially isolated, had significant changes in their appetite with some memory problems, self-initiation problems was constantly late or changing or cancelling appointments, that was a younger person, we’d be right in there. Absolutely.

Julie:

We would.

Jo:

But what I’m hearing from you is for a person who’s older, who is self-reporting physical symptoms, again, because we know this generation didn’t seek mental health support. And they still dunno how to ask for it. Okay. So I can imagine all these physiotherapists or occupational therapists or maybe even a speech pathologist being called in to assess these physical symptoms. So they’re probably getting, and then, so we need to be empowering those other disciplines to start going, it’s okay to talk about dementia. It’s okay to talk about feelings. It’s okay to talk about how feelings relate to body pain.

Julie:

And giving that psychoeducation and giving them that element. Because the bottom line is if your client feels well, it is easier to support them. And then the workers have a better day at their workplace and they’re more likely to go, yes, I’m gonna go back to work tomorrow. Because they can actually have fun. So what I’ve started doing is I run wellness adventure group programs in a number of nursing homes. I licence it out to age care providers and I train staff in how to run it with their residents. So they’re not delivering psychology or psychotherapy. It’s a training program. Residents come, it’s a setup room. They’ve got their name tag, they’ve got their pens, they’ve got their paper and they learn about strategies to help them connect with one another to reduce isolation. And workers report so much satisfaction out of running these programs. Cause they see the changes in their residents. And so residents say, wow, we feel like a part of the family. Thank you. I’ve grown my confidence, I’ve grown my skill set. And you know, you’re never told to learn a skill and set a new dream. And so I’ve seen this massive shift from, oh, you know, Betty’s isolated. We’ve gotta go and give her a meal in her room to actually get her out, mixing with others. And it’s not bingo, it’s not knitting. It is something educational and they thrive on it. We’ve got a waiting list across a number of homes now waiting. When is the next program going to start?

Jo:

Oh, Julie, I love it. Look at this for entrepreneurial thinking. It’s like, we don’t have enough people to do the work. So Julie’s gone in and she’s training residential care facility staff and those who go out into the community to say, these are the contributions you can make. So Julie, what I love about this is you’ve gone, I can’t see all the people who need help. I actually can’t. But it’s important to me to make sure that the people get the help.

Julie:

Yes.

Jo:

So your model is basically, I’m gonna go in and consult to these facilities or these programs or where this funding is so that the assistance in nursing or the recreational therapists or the OTs or whoever’s involved, even the family, can learn some of these skills so that we can reduce the amount of mental illness that’s happening.

Julie:

Yeah. Or the risk of developing it so we can support people as soon as they come in to do this preventative program that will help and set them up for a more successful placement in an aged care home. And I’ve been able to do it, Jo, by combining some of the lifestyle staff with allied health professionals with also some chaplaincy staff as well. So it provides this holistic approach to mental health. And I really like the fact that it is not just one person’s responsibility to improve mental health outcomes for all the people, but we’re doing it collaboratively. And so at the moment we’ve got the program running across a number of facilities and it’s going really well. And I’m visiting some of them to see how they’re going. And I’ve got a couple of meetings set up for next week. And it’s been a much better way of delivering services in terms of ensuring more coverage. So when I think about it, like I’ve got hundreds of residents in aged care homes now who are doing the program and staff who feel equipped to do it because before they started doing the groups they have been doing training with me how to recognize if someone’s depressed, how to recognize if someone has grief and loss how to recognize what might be going. It is not to get the staff to then treat the people, but then identify where they can go and get that help and support. So the number of people who come and do the groups, they might be seeing a psychologist as well. They might be seeing a mental health unit, they might be under supervision of their GP, but it’s just about, yes, antidepressants alone are not gonna make all the difference.

Jo:

<Laugh>. And for those of you listening to this podcast, if you have the opportunity, jump onto YouTube in time and, and see what’s going on with the, the social media posting ’cause The smile on Julie’s face, as she just talked about the impact she was making is huge. <Laugh>

Julie:

Thank you <laugh>. And I said to you, I don’t feel great, but yes, I love my work.

Jo:

I know, but I’m just watching you. Your smile. The love that you have for this work is palpable. And I’m just sitting here going, alright, that’s it. I need to build something in my private practice. I need to actually find a way that we can actually go and support people living in their homes. And I’ve got some ideas about that. Excellent. That’s me. <Laugh>. So you’ve written a book. Tell us about your book.

Julie:

Okay. So I’ve written a book about Beyond the Reluctant Move and about strategies to help older people once they move into residential aged care. So it’s about non-pharmacological ways to support that adjustment. I’m just finishing my second book.

Jo:

That was excited Jo <laugh>.

Julie:

So about Unwelcome Change in Late Life. So, as people are getting older, and if life is as it’s always been, it’s actually okay. They don’t need help. They don’t need tips on where to go in their caravan. It’s more so when something happens unexpectedly. So if they lose their spouse, if they get a diagnosis of some sort, if they need to relocate, that can set people off their track. And so the book is more about how to get back on the track after you’ve had some of those unwelcome changes in your late life. So I’m just working on finishing that whilst juggling other responsibilities and duties and kids and all that. So that’s right.

Jo:

You’re a mum of two little people. <Laugh>

Julie:

People who take a lot of time. Yes. So yeah, the first book is about residential aged care more specifically, but the second one is about people in the community and residential care as well.

Jo:

Wonderful. Oh, that’s exciting. I did not know that, that was why I gasped the way I did. ’cause I’ve actually sent Julie’s first book to a number of people who I know have appreciated it and, and felt like they were seen. These were people caring for older people in their home. Usually they’re parents. So I know how valuable that one’s been. And you also have a podcast? Tell us about your podcast.

Julie:

Oh, yes. I have a podcast called Voice of Aged Care. And in that podcast we talk about all non-pharmacological ways to boost wellbeing in late life. So I do have a lot of episodes where I record some of my experiences.. And often Jo, I get sent questions from people repeatedly, like, what if someone is unwell, what should I do? How would I go about getting support or how am I coping if my client dies? So I’ve shared some of my learnings and tips and strategies in the podcast. So the episodes are relatively short, about half an hour or so. So a lot of my aged care workers listen to them on the way to work. And I’ve had a few interviews in there, including one with you,

Jo:

<Laugh> Yes. Thank you for that. So Julie, you are going to be a part of the Future Proofing Health Professional Symposium, so thank you for saying yes.

Julie:

I am so excited about that. Yes. Thank you for the opportunity.

Jo:

Oh, my pleasure. You’re gonna be on a panel with Jill Johnson Young and Lisa George, and the magical other person that I have yet to find <laugh> because I so believe that working with older people is there’s a missing need, particularly in private practice. And we have the ability to actually go and do really great work as you have demonstrated today. So I think for anybody who are gonna buy your ticket and come along to the symposium, you really wanna be a part of the live conversation that Julie is having with the other panellists, because you’ll be able to get your questions answered, but you’ll see the energy. And if you think that working with older people is about depression and low mood and you’re gonna come home feeling flat and awful and horrible and the work’s too hard, when you meet these people and you see the joy that doing this work well brings them, you are gonna wanna be a part of that.

Julie:

Absolutely. I’m so excited. And Jill’s got her passion about grief, and I think that just highlights that we can all focus on different areas and I’m so excited that we all be able to contribute to something so important and needed for allied health professionals.

Jo:

Wonderful. Julie, thank you so much. If you would like to ask Julie questions, you can jump into the Future Proofing Health Professionals Facebook group. You can ask her a question, you can tag her in there. There’ll be snippets of this interview in there. We’ll put up the resources that Julia’s talked about, her book, her soon to be coming book, her podcast. And we are really looking forward to having more conversations with you, Julie, as the symposium gets closer. So thank you. Thank you to everybody who has listened today. If you’ve got any questions, please make sure that you reach out to Julie or you reach out to me or you pop it in the Facebook group. And until next episode, go be your awesome self.