Transitions: A Conversation on Ageing

Disclaimer: The following transcript has been autogenerated and may contain occasional errors or inaccuracies resulting from the automated transcription process.

Host (00:01):

Hi there. Welcome to Mental Health Professionals Network podcast series. MHPNs aim is to promote and celebrate interdisciplinary collaborative mental health care.

Ms Julianne Whyte   (00:17):

Welcome to this podcast. This is a series of podcasts around ageing well, and these two episodes, my beautiful colleague and friend, Dr. Monica Moore and myself are focusing on older people today.

Dr Monica Moore    (00:31):

Yeah. Hi, I’m Monica Moore. I’m a GP working in Sutherland, and I’ve got experience both in general practise and doing counselling. Really looking forward to having a chat with Julianne because we’ve collaborated before and we so enjoy our conversations. And so we’re very excited to be invited by MHPN to present on this series of podcasts.

Ms Julianne Whyte   (00:51):

Absolutely. And my role too as our mental health social worker in private practice in the Riverina region, which is a large rural community. So I’ve been working in that space for about 10 years with a big focus on palliative care and grief and loss. So Monica and I have got a lot in common around our clinical practice, and we are going to bring that to you today as we look at transitions adjustments for people in that older age group. We’re both part of this new group, the young old, and we both acknowledge that older people are not just a homogenous group of people, that ageing is individual and affects us all individually. And that’s some of what we are going to talk about today. So Monica, over to you. You’ve got some wonderful stuff to bring to the table today.

Dr Monica Moore    (01:39):

Well Julianne, when I was thinking I was coming on the train today and about the whole topic of ageing well and how we are not just talking about being old and elderly and frail, which is what comes to mind, but over this series of podcasts, we’re actually going to be talking about how we evolve and change over the life cycle because the minute we are born, we are ageing. The minute we are born, we’re actually taking on new things and letting go of things. And that’s exactly what’s happening now. It’s the taking on of things and letting go of things as things evolve. And so I’m really excited to be working on this series of podcasts with you,

Ms Julianne Whyte   (02:17):

But also what I love about this, Monica, with the mental health practitioner network, letting us talk about how we collaborate as healthcare providers in me and my role as a mental health social worker and you as a gp. I think it’s really important to look at what we do and how we work closely together and what skills we bring to compliment the work in that multidisciplinary space with people.

Dr Monica Moore    (02:42):

And when we were sort of putting our ideas together and we were talking about what it means to age well and you were thinking about all the people that you work with and even the people in your community, there’s a whole lot of people who are actually really, really happy, who feel positive about the future, who have really well supported relationships and who actually have really good skills to deal with things. And if they don’t, they come and see us. And remember when we were talking about the statistics that over the age of 65, 15% of people are still working, which means only 85% are retired. And the big boogeyman or bogeyman, the dementia bogeyman that only 9% of people 65 and under have dementia, which means 91% don’t. And even when you get to 85, like my dad, he’s turning 87 in a week. He is still working full time, and so he’s clearly one of the 67% who don’t have dementia. And I think it’s something that we, as we think of ourselves going through these transitions that we can look forward to our future, that we are actually going to feel happier in our lives than perhaps we did between 20 and 30.

Ms Julianne Whyte   (04:04):

I’m struggling sometimes with my adjustment to I’m 62, all my children have now left home and I’ve got a tribe of kids. So we’ve had kids at home for 40 years and I’ve now got to learn how to be this wise, mature person who can listen to my adult children, do their thing, trust them to make their own mistakes and know when to offer advice and when not. And oh, I sit with my colleagues and sometimes come to work and go, oh, the pain I feel sometimes is I watch my adult children do things that I did or things that I would’ve loved to have done and then my grandchildren coming along and then feeling a little bit helpless and one step removed, loving the opportunity. Actually they’re the blessings. Sometimes they’re my beautiful grand babies. But knowing that they’ve all got to go through those difficult years, the transition years and like you coming on the train today when I was driving up to Wagga, just thinking if we are in the demographic, what people are feeling that come to us for help is often we have that too. We are people with them. We are on this journey together. And I think we have people like you and I, and I’m not saying other people can’t, but when you’re actually blessed to be in the demographic, we’ve actually got some sense of mentalizing thinking of having that empathy for where their journey is or the transitions they’re facing. Do you sometimes do that? Do you know when you think professionally we talk about transference, countertransference, do you get that sense sometimes of this is a common journey?

Dr Monica Moore    (05:42):

Oh, absolutely. Absolutely. Before we started the podcast, we were talking about the fact that I had my chair on the veranda a little bit close to the edge, and I went overboard and got a bruise on my face. And so I’m walking around with a black eye at the moment and people look at you and I didn’t just have an accident, I had a fall because that’s what older people have. So you were saying I should have an ACAT assessment and God, and it’s one of the losses as we look at ourselves and perhaps we’re not as nimble, and I mean I’m sure I could have done this putting my chair too close to the edge at any age really, but it’s one of those things that you start to get more aware of your losses and more aware of your risks. And as Philip Roth said, old age isn’t a battle, it’s a massacre.

(06:34):

But I don’t think it’s like that for everyone, but it is for some people and we can sort of put ourselves in that space. We gained so much. You talk about grandchildren, but they’re also the losses like the embarrassments, the fact that now I need glasses at all the times and my hearing isn’t so good, which makes it some very humorous conversations with people and there are changes. I mean as a GP, when people say to me, oh, and there’s that thing, you’re putting your key in the lock in the door and you’ve just got to go, you’ve just got to go. And I go, yeah, that urgent incontinence get as you get older, it’s just the pits, isn’t it? So all of those sorts of things that we have to compensate, we’re continually sort of having to compensate for things. And I think because you were talking about the transition of your kids moving out and then sort of going into that next phase, and so a lot of that transition that the people that you work with as well, that you can really relate.

Ms Julianne Whyte   (07:34):

Most definitely. And I feel sometimes that the value of that therapeutic relationship when people have a sense that you have a knowing, I mean, it’s not saying that just because we are both a little bit, we’re no longer 20 or 30, that because we are older, we can’t work with younger folk that you can only work with your cohort. I think it’s important though to know that when people come to us with concerns about memory loss and they have concerns around some of the health things that come up, the number of times I get asked by people, look, I think I’m losing my mind. Have I got Alzheimer’s? I’m not sleeping well, I’m getting hot flushes. I’m really feeling like my relationship’s not as good as it used to be. We’re going through transition and when you can say to people, that sounds really, really hard, and you can say it with meaning, and I know that you’re probably experiencing all of the above.

(08:24):

I think sometimes there’s a connection that’s really nice with people and you can have the laugh and say, well, yes, I really do know that continence. I know that one really well, and they’re not sleeping very well. I know that one really well. And not knowing faces, I reckon I’ve lost, I dunno. You can tell me, Monica. Is there a part of the brain that’s geographically located for recognising faces? Like who I can see people, they’ll be introduced to me and I’m like, oh my God, what was their name again? It’s just that, sure. That’s the early sign of something.

Dr Monica Moore    (08:56):

I’ll have to send it to the ACAT team. I know we’re making light of all these embarrassments, but I think even as a younger GP that even though I didn’t have that lived experience, that part of our training and so much of our training is focused on the degenerative processes that happens within bodies and things that happen above the older we get, the more things go wrong theoretically. I mean, you can be young and have all sorts of things that are wrong as well. Of course termed illnesses don’t just affect the older generations. But it’s one of those things that recognising helping people to recognise is this a nuisance and how do you adjust to it and how do you cope? Or is this something that is really life-threatening and you’ve got to do something about it and it’s an emergency? And that sort of letting go of expectations I think is something that is a lifelong process.

(09:56):

Even my husband, like we were bush walking the other day, and I’m sure he’s got mountain goat jeans in him because we go up a hill and he just takes off. He just floats over the rocks. It’s amazing. But he got a little twinge on the back of one knee and boy or boy it was oh, the twinge. Oh, and supporting our patients to sort of go through those phases and to be patient and recognise, yeah, that’s what happens. But we’re going to be talking in a second session about what strategies we use. I mean, everybody will use different things, but what strategies we use to help people to sort of cope with all of that. And even the sort of losses, I think you were talking about someone who couldn’t come to your practice anymore because they’d lost their license. Like that kind of loss.

Ms Julianne Whyte   (10:50):

That’s a really significant loss. And then the huge adjustments that have to be made about all of those accessing the supports you have and how do you do it from home and what does that mean and how do people think about them and adjusting to asking for help every time you want to do something. And I think what this particular lady was experiencing too was that loss of spontaneity in her life. She couldn’t just go, oh, I’ll just go and post a letter. I’ll just go and visit person. She had to go, oh, I’ve got to arrange this. I’ve got to either order a taxi, get a friend, and then it becomes sometimes overwhelming. It’s just too much. I can’t do it. The twinge becomes more than a twinge, it becomes a pain. And I think sometimes as you were talking, I was, in my mind was coming up an image of the, I dunno, the Medibank private ads of these beautiful gracefully ageing people’s tripping along the beach with beautiful grey hair, nicely dressed, looking absolutely gorgeous.

(11:45):

I think if I skipped along the beach, I’d trip and fall knowing me. I would. And my husband can’t skip like that, and he doesn’t look that sexy as these guys do. And I think that’s sometimes an image that we might have of we are all off there having holidays and we’ve all got access to everything and we’ve got great superannuation and we’ve got great relationships and it all looks good. The images of graceful ageing are out there in the media and I think they’re all very clean and sanitised. We don’t often see healthy ageing that’s got a few little flaws and warts and bumps and twinges and the loss of license or the transitions and the sadness and early deaths, the unexpected deaths to just take you by surprise and change the future of your ageing. Actually, I had a gentleman just yesterday came in and he’s 82 and God, he looked 60, he just looked fabulous, but his wife just dropped dead, literally dropped dead.

(12:44):

And he was like, he just said it’s not the future I’d planned. He said, our future was we were going to be 105. And everyone said, oh, she had a good life. And he said, life’s not a cricket match, a good innings. And he was really, really sad. And he said, I just need to talk about my disappointment and about my future. My ageing now is I feel old all of a sudden. I’m like, yeah, that’s really, really hard. So the image of what those cultural expectations that are out there for us too as we enter this ageing place, I think you and I as clinicians have been really mindful of the, a person’s perception, what’s their story of their old age, the people that come in that get cancer, but they’ve had a great fit life, they’ve been the healthy eating person and exercised, and then they get cancer and it’s like, well, wow, why did this happen?

(13:38):

I never smoked or drank or did all those bad things and now I’ve got this thing. And that can change those older years, and that’s really significant. That’s what I’m finding a lot of, and I think about that myself as I’m thinking ahead. I’m 62, I’d love to be 105 if I’m still able to have the blessings to live that long and see some great grandchildren and keep writing and reading and doing things and podcasts with Monica in the next 30 years. As you said, we don’t want to make light of it, but I think while there are blessings that there are also some great challenges for people within that that perhaps trip them up a bit.

Dr Monica Moore    (14:17):

Yeah, as you were saying about the challenges, and I was thinking when we were putting these ideas together, when you mentioned society’s expectations where it becomes no, no, no, no, you are too tired to do any exercise. You can’t walk to the shops. Let me take you. And so there is this almost taking away of, it’s almost infantilizing an older person who might still be able to do a lot of stuff and might still be able to keep active. And so the less exercise they do, the less fitter they are, they’re more prone they are to falls. And even that sort of, I’m sure I’m not the only one who’s sort of stood at a counter and being female and grey not being served because somehow I’ve become invisible. And even when it’s well meant, that thing about getting on a crowded train, pre covid of course, and a young person standing up because they see your grey hair and how old you are and they go, here you are madam. You can sit down or lady or whatever, and I go, no, I’m fine. I’m fine. I’m not that old. I’m not that old. I’m very fit. So it’s just one of those,

Ms Julianne Whyte   (15:28):

Oh, I take those seats gratefully.

Dr Monica Moore    (15:30):

Do you? Yes, maybe I should too, but I really should go to someone who’s recently pregnant or someone who’s just tired. I’m not tired. That’s why I talked about those statistics at the start because just because you have grey hair and maybe your voice is a bit wobbly and you might think speak a little bit more slowly doesn’t mean that you’re not on the ball. My in-laws, they are just wonderful, even though they’re elderly. As I said, my dad’s still working as a psychoanalyst. So really it is important for us to maintain that sort of perspective of find the individual in front of you and really study them. And don’t just go by physical appearances and your expectations of what someone who looks like this should be like. I think it’s a really important thing whenever we are working and have the expectation that when there is a lot of tragedy, there might also be because of a lifelong lived a lot of good as well, and how can we help people to connect to their resources when we’re working together with them? We’ll be talking a bit more in detail how we do that.

Host (16:35):

We’d appreciate it if you would take a few moments to tell us what you think about this episode. Simply follow the link in the show notes.

Ms Julianne Whyte   (16:43):

And actually another little story came to mind as you were talking, and I’m working with our local primary health network on a wonderful project in an aged care facility. A couple of them actually, and because of Covid, we have to zoom. So I’m thinking, oh, how are these poor people going to go? So they had a nursing assistant or an employee of the age care facility had iPads, and so we had six older folk, I think all of them were in the eighties or nineties, but I couldn’t get over the fact that these people, we had good vision, we had good audio, so it made it easier. The webcams were excellent. And so these people with help, so the assistant was holding the iPad in front of them. Every single one of the older people I was talking to, or I should say these residents in the nursing homes, not older people, residents, they all embraced it just beautifully.

(17:30):

They spoke to the screen, they engaged really beautifully. They were able to still have their cup of tea and do things and they would talk to the screen and chat about serious stuff quickly. They got to the point actually, they were easier to engage with because they knew they had me for 20 minutes. What was interesting, Monica, was that two of these people, a gentleman and a lady both said, when I said, look, would you like to do this again next week? They both said, out of the six that I spoke to, we haven’t spoken like this for years. I haven’t had a conversation about this stuff for years. And they were telling you about some family abuse, some skeletons in the cupboard, some traumas that they had as kids bullying that happened at school. And then they just said, please, yes, yes, we want to do it again. So we’ve got six sessions booked in with these beautiful residents who just really want to and are asking for these sessions. And like you said, just because we’re people are a bit grey or a bit older, a bit slower, it doesn’t mean their brain reflects that’s what’s happening. Or even if it is a bit, the recency of memory might not be there. But the beautiful stories, if people have got that cognitive skills still in place and they can extract these stories and talk about them and be listened to.

Dr Monica Moore    (18:47):

And that’s one of the things that’s one beautiful things from the pandemic from Covid 19 that’s come out. And that is the boon of telehealth because you’re not the only one. I have a colleague who is also a psychologist who goes into residential aged care facilities. And in the past, these home visits that she’s done have always been very rewarding and satisfying. But of course at the age of Covid 19, she thought, how am I going to do this? She was reluctant to embrace telehealth thinking that perhaps this would be too difficult or too confronting or not. And she was bowled over by the easy acceptance. It’s almost like when you get to the end of your life, you just go, yeah, sure. I’ve had so much change in my life. These are people who are born way before television existed and mobile phones and computers, and clearly they can cope with change if they’re still cognitively on the ball.

(19:44):

And this is one of the burns. I mean, this is one of the reasons why I think even people can now access their specialists through the telehealth portals and they can have scripts sort of faxed over. It is just so much easier. I really hope this is one of those opportunities that would be great. And it is one of those things where you kind of think, we expect people in the community, for example, to be able to access technology like my age care portal and those government organisation, Joe Centrelink and all that. And that can be really challenging if they don’t have support. But now you can have someone through telehealth guiding them through how to do it. It just makes it so much easier.

Ms Julianne Whyte   (20:27):

It has been a real, you know, how we’ve been trying to move our professions to this to be more accepting of technology. I think Covid has made us, it’s just brought it on at an accelerated pace. And I think anyone listening to this podcast out there, if you’ve got an opportunity and you can’t get in face-to-face delay, ask your clinician, ask that person, will they do Zoom? Will they do a phone call? And we are all finding it’s really rewarding. And I think if the people at either end embrace it and say, look, this will work, that positive approach, that’s the point. You can’t not talk about too, Monica, the positivity bias. But I think that’s part of this as well, having that, you talked about it, didn’t you? More of an acceptance and a positive. They have dealt with so much change in transition that perhaps this is a beautiful stage that allows us to go, okay, what next?

(21:21):

But when I wanted to just bring in here, we were reading a paper, everyone that’s listening, Monica, and I shared one with her the other day, that research is showing that happiness is, or contentedness in life is not just a steady decline towards ageing. And when you get old, you’re depressed and sad and it’s the end, the valley of death. I’ve got here in one of my quotes, one of the article I read was, it’s U-Bend with Positivisms and Measures of Happiness Increasing with Age, which as you said, Monica, about the clients that we see and the people that we talk to so often, that’s the surprising factor. There’s so much going on in the lives of people. And when we see such resilience and stoicism and they talk so interestingly about the things that have happened in their life, one of the stories that we talked about the other day was this older lady in the nursing home who her husband had parkinsons, and he was very frail and she was so, so sad, really sad.

(22:25):

And when I sat down with her and said, so what’s troubling you the most? And she recalled a time when the young son died, her husband was looking after him, and then she was told by very caring family around, oh, you’ll be right. She can have another one. And she’d lived with that all her life that this little boy had died and she’d never told anyone about it. And here she’s living with her older stage of her life with this deep grief and just thinking about she was getting closer to perhaps the end of her life and would she see this little boy again? And she actually said to me, she was quite scared because she didn’t know whether if she met him what it would be like. And I just sat with her for a bit and thought, wow, such incredible story to hold. And I said, is this grief for you? And she said, it’s just really sad, isn’t it? Isn’t it sad? And I said, yeah, so how does the sadness affect you? And she said, oh look, it’s okay. It’s just sad. And she had a bit of trouble forgiving her husband, and we talked a lot then about what does forgiveness look like and how can she feel okay in this older stage of her life? And I think those stories just touch you so much.

Dr Monica Moore    (23:42):

We do hear these stories about griefs from the past coming up, and even my family is Jewish and stories of people who survived the Holocaust and put it behind them. And then as they get older, it sort of starts to sort of bubble up again. But that article that you mentioned about the U-Bend, it’s that it’s even this ability to recognise and make space for all of their emotions that comes up, which I think that a life well lived where they’ve had connected relationships and or still have and they’ve lived their lives and had joy and fun and continue to sort of do so. And they can actually make space to explore those things that they couldn’t do at the time that they happened. And I think that that is something people fear, the connection to grief. And yet it is such, when you have deep sadness, when you allow yourself to feel, it creates a space for great gentleness afterwards and a sense of deep calmness, which I think in your work with grief that you often talk about and acknowledge.

Ms Julianne Whyte   (24:46):

I totally agree. Yes.

Dr Monica Moore    (24:48):

Yeah. Yeah. And I think that thing, I was part of a DBT group supervision session last night, and we were discussing the concept of radical acceptance, which is the ability to accept reality exactly as it is, not as you wished for, not as you expected it to be, not as you were told it to be. But that is just that concept of radical embodied acceptance. And I think that that is one of the reasons why statistics show that people who, as you say, it’s U curve of happiness, that as we get older, we in fact get happier.

Ms Julianne Whyte   (25:24):

Look, you gave, you shared a beautiful quote, which is, I’m going to read it. I just think it’s excellent and I’ve actually printed it off and put it on my wall at work. When you get older, if you have two of anything, chances are one of them is going to hurt. And when you get up in the morning, but you have to get up and move beyond the pain. And when your mind is busy, you won’t hurt so much. And I just thought, I really like that. If you’ve got two of things, only one will hurt. So enjoy the one that doesn’t. So I like that one. The other thing that I really wanted to put out there is that for all people listening, regardless of whether you are a professional or a lay person or wherever you are, to know that old age is not homogenous.

(26:04):

We don’t enter this sixties and then all of a sudden we are like whatever the image, whatever the cultural view is, we are unique and individual. We have to be respected as friends. We’ve got to be mindful of each person’s story As clinicians, we’ve got to be mindful of those systems around people, the big picture around people and the impact that has on them, society’s expectations and that you talked about around letting people do things. And that’s called that dignity of risk, allowing people to take some risk, finding out what are they prepared to. You should be allowed to sit on the edge of your veranda on a rocky chair, not have to be put on a nice special, what do they call ’em? Kingston chair neatly placed six feet away from the edge of the veranda. Maybe you like it a little bit on the edge. You don’t have to wear hip protectors. But understanding that people need to have risk. We can’t wrap up people just because you’re now in the sixties, 65 and then onto the seventies and just say, well, you can’t do this now. I think we must be very mindful of asking, what type of life have you had? What risk are you prepared to have? What does life mean for you? Does your future look like they’re really important stories, I think.

Dr Monica Moore    (27:23):

And so as we wrap up next session, Julianne you and I are going to be talking about a great working relationship. What does it look like? What does it look for a GP? What are the sorts of things that I do as a GP that you need to know about or that you can help me with or that I can help you with? And again, as a mental health social worker, what are the sorts of things that you specialise in? How can you help me? How can we work together in the interests of this one person that we are working with together? And how can we work effectively and efficiently? And I think for those of you who are listening who are not clinical, knowing that these are the sorts of things that are available that might actually help you to ask your clinician, say, look, could you just contact this other clinician? And these are the sorts of things that I think would be available and would be really helpful for me. So these are the sorts of things we’re going to be talking about. And hopefully we’re also at a few tips of the sorts of things that you and I use with our own, the people that we see and how things that we use for ourselves. I mean, I’m going to put a few of my tips about how I’m not going to end up a really angry old woman. That’s my aim.

Ms Julianne Whyte   (28:38):

That’s a good goal. I’ve got that one too. I want be, that’s a very good goal, a really lovely, polite, engaging, a bit crazy actually. I’ve just allowed my hair to go curly, which I think is a bit exciting. 62, and let it go curly, not straight it. So is that about radical acceptance of my reality?

Dr Monica Moore    (28:57):

It’s about radical acceptance. So we’ll be talking about all these things in the next podcast, so I look forward to it.

Ms Julianne Whyte   (29:04):

My name is Julianne White and my role as a mental health social worker in private practise in the Riverina region.

Dr Monica Moore    (29:11):

I’m Monica Moore. I’m a GP working in Sutherland, in specialising in counselling. Okay, bye over and out.

Host (29:20):

Visit mhpn.org au to find out more about our online professional program, including podcasts, webinars, as well as our face-to-face interdisciplinary mental health networks across Australia.