Conference 2013

NZPOPs conference banner optimised

Day One

Keynote

Professor Janet Leathem, Massey University

Assessment issues

Service issues

The National Dementia Care Pathway Framework

Day Two

Keynote

Professor Kolbein Lyng, Victoria University

Psychosocial issues

Interventions

Day One

conf_title_card

Keynote

Professor Janet Leathem, Massey University

Professor Janet Leathem is the director of Clinical Psychology training at Massey University and teaches post-graduate classes in clinical neuropsychology.

Her current research programme focuses on issues in neuropsychological assessment and intervention, particularly concerning children and adults with acquired impairment, such as traumatic brain injury, neurotoxicity and aging.

She is supervising doctoral students currently conducting research in the areas of aging, posttraumatic stress, brain injury/concussion, ECT and various aspects of attention and memory.

Various Matters concerning Ducks in the Neuropsychology of Aging

The prospect of older adults becoming an increasingly larger proportion of the general population has seen a corresponding increase in the amount of research devoted to assessment and treatment of problems associated with aging. That research has been at times compelling, often sobering and usually ends up being quite controversial.

This presentation will focus on the assessment and intervention of cognition associated with normal aging and through the use of case material and review of recent research will identify various lame/dead ducks in the research area and suggest ways of getting ducks lined up in the future.

Assessment issues

Prospective memory – An overview and a proposal

Prospective memory has become a topic of considerable interest to researchers as demonstrated by the approximately 135 experimental research papers published on prospective memory between 1996 and 2000. In the subsequent five years further studies on prospective memory resulted in another 150 papers being published. Prospective memory continues to be an area of interest to researchers. Not surprisingly there have been changes in the way prospective memory is conceptualised with McDaniel & Einstein’s (2000) multi-process model of prospective memory receiving strong support while Craik’s (1986) theory that timebased prospective memory places greater demands on self-initiation than event-based prospective memory has been disputed.

Prospective memory and ageing has attracted considerable interest in the literature with debate as to the susceptibility of prospective memory to age-related decline. Prospective memory tasks have been found to make a useful contribution to the assessment of the elderly; impairment in prospective memory has been identified in the preclinical phase of dementia. Questions have been raised about the likelihood that prospective memory tasks could be a useful diagnostic tool for detecting early dementia of the Alzheimer’s type.

This presentation will discuss the main conceptualisations about Prospective memory, its measurement and some of the relevant research that has derived in relation to the aging brain.

Michelle Woodfield, Master of Psychology student
Massey University

Horses for Courses: Which Cognitive Screen to Choose?

Until the 21st century, clinicians wanting to test cognition were likely to reach for the Mini Mental State Examination (MMSE), and it is still the most widely recognised screening tool.

In the past decade a number of new screening tools have been developed and published in the literature, no doubt due in part to our increasing knowledge and understanding of the range of differing presentations of cognitive decline / dementia. These newer screens are still in the relatively early stages of their development, and like the MMSE have their own strengths and weaknesses. This presents the clinician with a dilemma as to which to choose, and also challenges us to move away from reliance on any single screening tool.

This presentation discusses the MMSE and 3 of the newer and arguably more promising cognitive screening tools: the Addenbrooke’s Cognitive Examination – Revised (ACE-R) and its successor the ACE-III; the Montreal Cognitive Assessment (MoCA); and the Rowland Universal Dementia Scale (RUDAS). The strengths and weaknesses of these tools will be compared and contrasted, and available validity and reliability data will presented.

Dionne Taylor, Clinical Psychologist
Mental Health Services for Older People, Counties Manukau DHB

Normative data for older New Zealanders using the Addenbrooke’s Cognitive Examination-Revised assessment

Using psychometric tests for screening purposes in community settings is dependent on the availability of appropriate norms for interpreting a person’s performance. Most psychometric measures have been developed and standardised on North American or British populations and may not be applicable to people from other cultural backgrounds. There has been a large increase in the development of overseas norms for older people, and New Zealand (NZ) is following the trend with more research being undertaken in this area. Normative data for the ‘Kiwi’ Addenbrooke’s Cognitive Examination-Revised is presented using a sub-sample, (N= 1005) of participants from the New Zealand Longitudinal Study of Ageing (NZLSA). Results suggest that the Kiwi ACE-R is a feasible and valid tool for assessing cognition in older adults.

Lauren Callow, DClinPsych Candidate, Massey University
Clinical Psychology Intern at Wairarapa DHB

A case study of Parkinson’s Disease: When basic cognitive screening is not enough

A case study of an 65 year old client with Parkinson’s Disease will be presented. The client shows no evidence of Parkinson’s related dementia, yet is showing specific functional difficulties in day to day to life. This case study will discuss the complex interplay between the disciplines of Neurology, Neuropsychiatry and Neuropsychology in understanding the client’s presentation. The role that cognitive screening measures versus full neuropsychological assessments will also be discussed.

Dr. Sharon Green, Consultant Clinical Psychologist / Neuropsychologist
Neurology Department, Capital & Coast District Health Board

Service issues

Icebergs & Tsunamis: assumptions & limitations of NZ dementia demographic data

Government and DHB strategies for diagnosis & management of dementia assume some 40,000 New Zealanders living with dementia and a further 12,000 new cases every year. Further, that the majority of dementia cases go undiagnosed and that the shifting demographics of New Zealand will result in a “tidal wave” of dementia in the coming decades.

There is a dearth of real prevalence, incidence, diagnostic & prognostic data for dementia in New Zealand. All of the commonly quoted figures are estimates derived from other estimates. In the absence of hard data, these estimates are informing strategy, which dictates service development, which in turn shapes clinical practice.

This is an overview of the key prevalence, incidence, diagnostic & prognostic research, highlighting the assumptions & limitations of these studies. How likely is it that we are working from under or over-estimates of the real problems?

Dryden Badenoch, Consultant Clinical Psychologist
Relaxed Therapy

An audit of the service access by people with younger onset dementia in a rural health board

Dementia is estimated to effect approximately 67 people in 100 thousand aged between 30 and 64. The diagnosis of dementia in younger people can be difficult and take a considerable time. Younger people are more likely to have financial and family commitments that could be significantly affected by dementia resulting in a distinct set of support needs following diagnosis. When services are required, a focus on older service users may result in younger people feeling isolated.

The Royal College of Psychiatrists guidelines recommend the development of specialised services for people with young onset dementia in association with older person mental health teams, with dedicated staff (where the population base allows) and strong links with neurology and mental health services. In a sparsely populated rural health board area with an ageing population there are practical and financial challenges to developing a co-ordinated and responsive service for this group of service users.

An audit of service access by people under the age of 65 accessing a rural DHB Older Persons Mental Health service is being carried out. The aim of the audit is to identify the level of need of this population; current care pathways and current offered interventions and supports. Results are pending. Recommendations will focus on creating a streamlined and responsive care pathway to ensure that the needs of this population are identified and met.

Dr. Frances Oliver, Clinical Psychologist
Older Persons Mental Health Service, Hawkes Bay District Health Board

Memory Clinics in East London

East London is home to around 800,000 people, with older adults (over 65s) accounting for approximately 53,000 (6.6%). Much like New Zealand, this population is ethnically and culturally diverse, with close to 50% of the population of non-white origin. This is a population that is repeatedly listed as the most deprived in London, and is reported to have higher than average rates of mental illness, disability, and premature death.

All of these factors provide challenges when providing services that meet the needs of older adults. For those with suspected cognitive impairment or dementia, there are currently three borough based memory clinics, each of which is run in conjunction with a local acute hospital. The three services receive a total of around 1,400 referrals per year, and where necessary refer on to other services for ongoing support. This presentation will discuss how these services are run, and consider what lessons may be learnt for working with a New Zealand population.

Dr. Susan Yates, Clinical Psychologist
formerly of the Diagnostic Memory Clinic in City & Hackney, East London Foundation Trust

The National Dementia Framework

The Ministry of Health and the health and social sector recognises the need for improvement in dementia care throughout the country. The Ministry of Health has worked in support of this by developing a national framework for dementia care pathways which will be adopted locally, regionally and nationally to improve the acceptance, support and care of people with dementia.

The aim of this framework is to encourage district health boards in the development of clear, consistent and resourced dementia care pathways in collaboration with primary, community and secondary care services that work towards New Zealand becoming a “Dementia Friendly” country where integration occurs across the health, support and community sectors including housing, emergency services, education and leisure.

The framework has been developed to provide a guideline to develop national consistency with local delivery and it identifies what is important when developing a dementia care pathway. It is recognised that models and pathways are already being developed within district health boards and that the framework will be used in different ways to achieve the same ends. The national framework is purposefully not prescriptive so that regional and local innovation in the development of pathways can occur. At the same time the national framework points towards best practice and aspirational goals which may take some years to achieve. We hope that steady progress can be made towards these goals and that Dementia Care services will be significantly improved within five years.

Trina Tautau, Policy Analyst, Populations Policy
Policy Business Unit, Ministry of Health

Day Two

conf_keynote

Keynote

Professor Kolbein Lyng, Victoria University

Professor Kolbein Lyng is trained as a clinical and research psychologist. He received his Magister Artium Degree (PhD) at University of Oslo in 1979 and started his career as a research fellow at the Work Research Institute (WRI) in Oslo where he worked on how security issues on merchant ships were related to social and psychological factors. He later (1985) returned to WRI to work on issues on safety and the introduction of new navigation technology.

Professor Lyng has a long career within gerontological research and teaching in Norway, first at the Norwegian Institute of Gerontology (1985–1996) and later (1996–2007) in the Aging Research Group at Norwegian Social Research (NOVA) where he was associated with the Norwegian Study of the Life Course, Ageing, and generations (NorLAG). Organized under the auspices of the Norwegian Ministry of Education and Research, NOVA is the major center for social gerontological research in Norway, including networking in the field. From 2007–2012 he worked as a professor of Health Sciences at Molde University College in Molde.

Professor Lyng’s main research work and teaching is in development and ageing with a particular focus on aging as a developmental phenomenon, dual sensory losses in old age and the meditational character of cognitive processes in old age. He headed a project on autism and ageing (2003–2006) at the Autism Unit at the Department of Special Needs Education at the University of Oslo.

As a clinical psychologist professor Lyng has also been member of the specialist board for Geropsychology of the Norwegian Association of Psychologists (2004–2012) where he designed the course work program for the Specialist program in clinical gero-psychology, that he also taught and coordinated.

Kolbein Lyng is now retired and is Adjunct Professor at the Faculty of Education at Victoria University in Wellington.

Psychology and Ageing: Between Culture, History and Biology – Theoretical and Practical Issues

Statements about age related changes imply a position about how mind and developmental change are conceived. Changes in core cognitive functions are usually held up as indexing an aging process without making these positions explicit. In developmental psychology change processes are usually conceived as complex and multi factorial.

I will argue that some of the difficulties in defining ageing phenomena for cognitive functions, in addition to relying on a simplified model of development, also fails to recognize the many factors influencing the meditational processes involved in cognitive functioning.

From this discussion I will also try to point out some basic knowledge psychologists working with older adults should hold to grasp the conditions of life of older people and their variation.

Psychosocial issues

The New Zealand Longitudinal Study of Ageing:

Loneliness, Depression and Social Support Impacts on the Wellbeing of Older People

Aim: Results are provided from the New Zealand Longitudinal Study of Ageing (NZLSA). The aim of this paper is to explore the relationships between loneliness, depression and social support respectively, with quality of life and health measures. Amartya Sen’s capabilities approach formed the conceptual basis of the theoretical framework of this research programme (Sen, 1999).

Methods: An extensive survey of a national random sample of 3,317 older New Zealand citizens aged between 50 to 84 years was carried out in the second half of 2010. The survey questionnaire included scales on Loneliness, Depression and Social Support. These variables were tested for statistical associations with Wellbeing (Quality of Life) and Health measures.

Findings: The results demonstrated highly significant relationships between each domain scale and wellbeing. Higher loneliness and depression scores were strongly associated with lower wellbeing and health scores, whereas higher social support scores were strongly associated with higher levels of wellbeing and health.

Relevance: The results are relevant because they demonstrate the important associations these domains have with wellbeing and health. They point to the need for practical planning, policy and service responses to be designed to overcome the problems of social exclusion and the social causes of depression.

Sexuality and Discrimination Impacts on Health and Wellbeing of Older People

Aim: This presentation will provide results from the New Zealand Longitudinal Study of Ageing (NZLSA). The aim is to explore the relationships of sexuality and discrimination respectively with health and wellbeing.

Methods: Amartya Sen’s capabilities approach has formed the conceptual basis of the theoretical framework of this research programme (Sen, 1999). An extensive survey of a national random sample of 3,317 older New Zealand citizens aged between 50 to 84 years was carried out in the latter half of 2010. The survey questionnaire included questions on sexuality and discrimination which were tested for statistical associations with health and wellbeing measures.

Findings: The results demonstrated higher incidence of sexual contact and lower levels of discrimination than predicted. They also revealed significant associations, indicating that older people who engage in sexual activity show higher levels of wellbeing and those who are discriminated against show lower levels of health.

Relevance: The results demonstrate the important associations sexuality and discrimination have with wellbeing and health. Furthermore they address sexual stereotypes of older people, the types of discrimination older people experience and the dangers of double discrimination like age and gender or age and race.

Charles Waldegrave, Cultural Co-ordinator, Family Centre
and Research Leader, Social Policy Research Unit

Interventions

Cognitive Stimulation Therapy: A vehicle for change

Since 2009 Hawkes Bay DHB has been offering Cognitive Stimulation Therapy (CST) to individuals with mild to moderate dementia. CST is the only non pharmacological treatment modality recommended for the preservation and maintenance of cognitive abilities in people with dementia. CST is a group based treatment programme, which initially involves 14 themed sessions twice weekly followed by weekly maintenance sessions for six months.

Not only has CST been a beneficial treatment tool for people with dementia it has been integral in helping to alter perception and attitude towards early diagnosis. This presentation will discuss how the CST programme has been delivered within a NZ context and how it has been a useful tool to open dialogue and elicit change within primary and secondary care.

Maree McLean, Occupational Therapist
Older Persons Mental Health, Hawkes Bay District Health Board

A review of the existence and usefulness of assistive technologies in the management of cognitive impairment of older adults

Cognitive rehabilitation is increasingly embracing the new technologies being offered in general society. With ‘Baby Boomers’ moving into the age bracket in which progressive cognitive disorders (such as dementia) are most likely to emerge, their familiarity with technology increases the potential for them to using strategies delivered via electronic devices. Such media are likely to already have acceptability and many of the foundational skills having been put in place prior to individuals developing cognitive impairment.

This presentation seeks to explore the various devices, programmes and apps that offer compensative and restorative ways of managing problems, such as dementia. Both clientand carer-specific platforms will be described. It is hoped that further discussion will be generated at the end of the presentation about what this can add to the practice of therapists doing cognitive rehabilitation. Conference attendees will be welcome to bring along and add their favourite resources and ideas to an idea pool to share amongst the NZPOPs group.

Helen Paton, Clinical Psychologist
Older People’s Health, Dunedin Hospital

Making the Most of the Family: widening the focus of memory management interventions

Memory impairment is a common clinical presentation, whether progressive (dementia), static (stroke & head injury) or transient (pain, fatigue & stress).

Strategies to alleviate clinical memory problems can also be used by the general population to optimise their own memory function. Memory interventions tend to target the person coping with stroke or living with dementia. Spouses and relatives are enlisted to assist, encourage and police the implementation.

Takeup & maintenance of memory strategies can be facilitated by demonstrating their benefits for all. Explicitly encouraging their adoption by the whole family can reduce stigma for the index person and facilitate empathy & trouble-shooting.

Making the Most of your Memory is a four-part family-focussed cognitive remediation course, delivered either as group presentations or a DVD package (to optimise use of clinician’s time).

Dryden Badenoch, Consultant Clinical Psychologist
Relaxed Therapy

The diagnosis of dementia and suicidal ideation: What do we need to consider?

Some authors have suggested that suicidal behaviour is not necessarily regarded as a likely outcome following the diagnosis of dementia and that the role of dementia as a risk factor for suicide is controversial. However, there is increasing evidence that depression and anxiety are more likely to occur early in the course of dementia, therefore increasing the risk for suicide.

This presentation aims to increase the awareness of this issue for clinicians and will examine the factors which have the potential to either increase or mitigate the risk. Possible interventions, including ways to manage and monitor suicide risk, quality of life aspects and the concept of prediagnostic counselling, will be discussed.

Dr Helen Foster, Clinical Psychologist
ElderHealth, MidCentral DHB

ACT for Oldies: Applying Acceptance & Commitment Therapy with Older Adults

As the numbers of people over the age of 65 years old continues to increase, so too does the need for empirically supported approaches for the psychological issues that present in this population. Distinctive difficulties of this age group include issues of chronic poor health, pain, immobility, loss of loved ones, cognitive impairment, and higher comorbidity rates of depression and anxiety. Acceptance and Commitment Therapy (ACT) is an emerging approach for the treatment of psychological distress that emphasises increasing psychological flexibility and modifying behaviour based on reallife experiences and long-term values. A substantial amount of literature has now been published supporting the use of ACT with a wide variety of physical and psychological ailments. Nevertheless research examining the effectiveness of ACT with older adults is extremely limited. This presentation will provide a brief rationale for using ACT with older adults. A short case example of applying ACT with an older woman experiencing depression, anxiety, and multiple health problems will then be discussed.

Dr. Nick Mooney, Clinical Psychologist
Older Persons Mental Health Service, Capital and Coast DHB