S7 EP 7: Professor Kate Laver, Summer Series

Kate discusses her role as a researcher and Occupational Therapist to help improve expertise in rehabilitation of older people including people with dementia as well as neurological conditions such as stroke.

If you'd like to learn more about the AHDC, please connect with us on our website www.aushdc.org.au or on LinkedIn at linkedin.com/company/aushdc.

Transcript

[00:00:00] David Cummins: G'day and welcome to the AHDC podcast series, Health Design on the Go. I'm your host, David Cummins, and today we are speaking to Professor Kate Laver, who is a professor of Allied Health and Active Aging. 

[00:00:29] With a background as an occupational therapist, Kate has a solid clinical background, which has elevated her research into persisting older people with neurological disorders. We look forward to discussing Kate's research into older generations and how we can better design and build for an increasing aging population.

[00:00:45] Welcome, professor Kate. Thank you for your time to be here. 

[00:00:48] Kate Laver: Thanks for having me on your podcast. 

[00:00:50] David Cummins: It's a really interesting topic for a younger generation to be deciding to study older generations because traditionally the older generation study their own persona. What got you more interested into working with and assisting the older generation of Australia?

[00:01:07] Kate Laver: It's funny because I went into my university degree, my degree as an occupational therapist, thinking that I really wanted to work with children. I had some placements working with children, I had a great time, I thought it was great. 

[00:01:19] But my first job following university was in a big public hospital working with older people, pretty much only older people, and I actually just found it a lot more rewarding. So older people were so grateful for my input, they really appreciated having professional support, they were collaborative. You can really make a lot of difference for older people just by doing relatively simple things.

[00:01:47] Since graduating, I actually haven't worked with children at all, and I've worked with older adults for my whole career. 

[00:01:54] David Cummins: Yeah, it's interesting. 

[00:01:54] I was very similar, as a physiotherapist I worked with a lot of footy clubs and I just found they expected a lot versus the older generations, and I did Age Care for 10 years, they were so grateful for the ability to sit, to stand or to walk or to be that little bit more independent and absolutely enjoyed, and did everything you wanted them to do, and they were basically the perfect patient or perfect resident. 

[00:02:17] And I found I got a lot more outta that as well, so I totally understand what you're talking about.

[00:02:21] Kate Laver: Yeah, absolutely. 

[00:02:21] And I think they're very clear on what they want and what will make a difference to them. That's different for younger people, they can't really see the big picture. Older people have that wisdom and really can be very specific in what will make a difference for them and very focused.

[00:02:34] So I think that really helps a lot. 

[00:02:35] David Cummins: Yeah, and it's very interesting in your research, and I'm sure 20 years ago you probably didn't consider it, but the aging population is going to be over double in the next 10 years. So we are all looking for ways to soften that blow to make sure that the healthcare system survives and to make sure that older generations are getting the care that they deserve with increasing complexity and comorbidities as they get older.

[00:02:59] What has your research shown in reference to older generations, how to get older with less complications and with more help with a limited framework? 

[00:03:08] Kate Laver: Well, it's interesting because we are really just seeing the start of the baby boomer population aging now. So our baby boomers, most of them are relatively young-old, I would say, rather than old-old. 

[00:03:19] And most of the people that I would see tend to be old-old because they have higher levels of disability. So we are really just at the start of needing more health and aged care services for older people and there really is quite a shift in the older population.

[00:03:34] So we are seeing, as baby boomers come through, they use Google a lot to search for information, they're more technologically savvy, they're looking up their own health conditions, they're often clearer about their expectations and also they're very diverse. 

[00:03:48] They come from different cultural backgrounds, they have different needs and family situations. So our older population is definitely changing and our health and aged care system needs to be able to give them what they want and they want choice, they want information, they want to be empowered, they want to be really the leader in their own healthcare, but have those choices and the information available to them to make the right decisions.

[00:04:14] Those are things that are really important. The other things that traditionally we would've thought about, the very basic aspects of access like making sure that someone can get in and out of the house or on and off of the toilet but older people now are saying, "well, actually we need a house, which has really good wifi and can be adaptable to my leisure interests and is in a really nice neighbourhood". So, things that really support them to have a very high quality of life and wellbeing. 

[00:04:43] David Cummins: Yeah, that's really interesting about the wifi and technology and innovation, especially in healthcare is becoming more and more prevalent, especially with the work works of AI and things like that.

[00:04:52] So what is your research showing that older people can do to help plan that little bit earlier for aging, and even further, that what we as an industry can do to help that?

[00:05:04] Kate Laver: Yeah, so it's really interesting. 

[00:05:05] Just recently in my research we interviewed 16 people who lived in Adelaide aged between 52 and 75.

[00:05:12] And some people are like, "well, why are you interviewing people who are so young, surely people in their fifties aren't thinking about aging?", but partly they are caring for older parents so they're thinking about their parents aging, but also, I recently had some bathroom renovations done at my house, I'm thinking that I'm going to be living in my house for probably at least another 20 years. 

[00:05:33] I'll be in my sixties, and I'm already thinking about picking tiles in the bathroom that are non-slip and making sure that the shower alcove is flat to walk in and making sure that in 20 years, not just for myself, but if my parents come over, they're able to get on and off the toilet so it's not too low. 

[00:05:51] From between 40 and 70, you might be doing renovations, you might be changing your backyard. So we are suggesting that people start to think about long-term housing plans early rather than what we've, what I've seen in the past is, typically an older person, they to want to stay at home.

[00:06:08] They'll stay at home for as long as possible. Then they'll have a health crisis. They might fall over, break their hip, they might fracture their pelvis and be non-weightbearing. And then I take them to their house for a home visit to look at access and there's no way they can access it.

[00:06:23] So they've really left, and they've known for their last 10, 20 years of their adulthood that the steps at the front are really steep and the back garden is really gravelly and hard to access. So we are encouraging people to think about some of those decisions earlier, rather than wait till a health crisis, because the longer people put off these decisions, the harder they are to make and have changes and also you'll get less choice.

[00:06:47] I've had people that I've taken them home for a home visit. They've got a shower over the bath, so they have to climb into the bath to have a shower, which is an absolute nightmare. And then we have to find someone who would do a very rapid bathroom renovation and they may not get, the quality or the price or the fittings that they would've wanted if they'd had more time to make those decisions.

[00:07:10] David Cummins: Yeah. It's so funny you say that, I think it's our background, but mum and dad a few years ago were designing a new apartment and I made sure that we got the extra high toilet seats and the non-slip tiles.

[00:07:21] I think we're in a unique position, but it's a really good point that people do want to stay in their home for longer, what can we do now to maintain that? So what would be some of the common issues that older generations have in their homes? 

[00:07:35] What's something we can look for or design better and, even further to that, when should we be designing that? Should we be designing that now knowing that they want to stay there for longer?

[00:07:44] Kate Laver: Yeah. Well, so we should be.

[00:07:45] When I talk about design, which is suitable for older people, I'm not just talking about ramps or rails or the assistive devices that we'd typically think would be put in for older people but a couple of areas that we find are difficult are the bathroom.

[00:07:59] As I said, when you're in your forties or fifties, just for all of us, make choices with your flooring that aren't going to be too slippery. Making sure again, that the toilet's a good height, that getting in and out of the shower is flat. The bathroom is a big area of focus I suppose, other areas that come up are entrances. 

[00:08:19] Typically we would recommend that at least one entrance to the house doesn't have steps, so that if you are ever in the situation that you are getting about on crutches or a wheelchair or a walking frame, having a flat entry, whether you go around the side of the house or the back of the house, whatever, as long as you've got one entry, which is flat, makes it a lot easier.

[00:08:38] And the other thing is just getting that balance right in the garden. Not everyone, but a lot of older people, they love gardening, they love spending time in their garden. That's great, and we always think that there's a lot of benefits to gardening, both for mental and physical health.

[00:08:52] But just having options as you get old, starting to think about having an irrigation system in place, starting to think about trees that may not be deciduous, so you don't need to rake up leaves all the time, having surfaces that are flat. So the garden, the entrances, and the bathroom would be probably the three areas of focus.

[00:09:14] The other things that people find can be tricky are things up high. So keeping appliances in high cupboards or having to climb under a desk to plug in cords. Just making sure that things can be more easily accessed without having to climb under things or climb up on top of ladders or step ladders or chairs to try and access things. 

[00:09:35] David Cummins: In public hospitals, obviously they're built for multipurpose and for an array of patients, I've been pushing pretty hard for most of my products to have high raise toilets to alleviate the need to have an over toilet chair, which obviously has got infection control, point of view, and anesthetic's point of view. 

[00:09:54] Do you think that all hospitals or certainly in certain departments should have higher toilets or are you comfortable as an OT and have researcher for an over toilet chair just to be a temporary solution? 

[00:10:06] Kate Laver: Over toilet chairs can be very helpful, but they're not ideal, are they? They can slip around a bit, they need maintenance, people don't like the aesthetics of it, so I would say generally to have higher toilets would be better, but we also do need to bear in mind that some of our patients can be shorter and so to have an option for them available. 

[00:10:27] But on average, they are too low and it is better to have something which is a bit higher rather than have the over toilet frames or the rails next to them.

[00:10:35] David Cummins: Yeah. Cool.

[00:10:35] I'll quote you next time I'm in a value management meeting to make sure that we have them.

[00:10:41] Knowing that the aging population is doubling in the next few years, the health system won't survive in its current form. So what techniques or strategies have you been looking into for models of care or for an aging population to make sure the older generations can stay in the home longer, more than just design because the current trajectory is that we're all going to be in a bit of trouble in a few years time?

[00:11:03] Kate Laver: Absolutely,

[00:11:04] I'll move from design in a minute, but part of it is around preventing trips and falls. We see people who have a crisis and then have difficulty accessing their house. But we also see a lot of people who come in because they've tripped over a rug or they've slipped in the shower. 

[00:11:18] So, having homes that are saveable and more accessible should lead to prevention of a lot of these issues and a huge amount of our hospital ED presentations are older people who've fallen over. 

[00:11:28] Once you end up in ed, then you can get admitted to hospital and then you're at risk of further falls, delirium, medication errors, functional decline. So if we can prevent those issues in the first place, that's really important. So other things that we think about are, there's a lot of evidence that staying very physically active is important.

[00:11:48] And interestingly, the research is supporting being active across the day. Exercise is really important and that we have physical activity guidelines around doing a mix of balance and strengthening and cardiovascular exercise, but also just number of steps across the day.

[00:12:05] So there's research that shows that if you are more active across the day, through total number of steps, you are less likely to have cognitive decline and you're less likely to be frail. 

[00:12:15] As an occupational therapist, one thing I see is families. As people age, they want to help so they think, well, let's get a cleaner in and let's get a gardner in.

[00:12:23] But it does mean that the person then gets into this cycle where they're doing less. So they become more frail and the family think they're doing the right thing and of course they're trying to help. 

[00:12:33] But actually what we should be supporting older people to do is stay as active as possible through continuing to clean, continuing to garden, continuing to do the shopping, or have those community outings rather than have people come in and do for them. 

[00:12:48] Even if the person needs a bit of help, we should be doing with rather than doing for. So, exercise is really important. Staying physically active across the day and that community engagement is really important.

[00:12:59] And there's also really good evidence around maintaining social connections and how important that is for brain health. 

[00:13:05] Loneliness, depression, social isolation can be really bad for cognition and brain health as well as our mood. So trying to keep people socially connected for as long as possible and part of that is around making the community accessible. 

[00:13:19] Because if people know that they can access transport and then when they get to whoever it is's house or the shops or the library or community centre, if they know that there'll be suitable bathrooms there, they can get in and out of them, they're more likely to do that trip rather than being worried about the broader community environment and design.

[00:13:40] David Cummins: So what can we do as a health industry to try and encourage these type of behaviours, obviously they've got a limit as well, people are going to get more frail and immobility is going to decline. What strategies can we put in now that we've got about five, 10 years of planning, what can we do now into our design, into our models of care to try and make sure that we get better clinical outcomes for our patients and residents?

[00:14:03] Kate Laver: Healthy homes and healthy communities. 

[00:14:05] Older people do need more options, so at the moment there's the option of staying in the family home or moving to a retirement village. A lot of older people are moving to an apartment so looking at making sure that new apartments and new developments are friendly and then any new buildings, communities... and just thinking about green spaces and public transport. 

[00:14:25] So any of those built design or community design features that enable older people to get out and about for as long as possible, safely is really important. 

[00:14:34] In the health industry as well, thinking about how we can keep people in their own home. So there's a lot of models and some of the work we are involved in is around telehealth. The hospital can be a dangerous place for people in terms of falling over or becoming confused or medication errors, functional decline. 

[00:14:53] So, when people do have illness or accidents, trying to support them to stay in their own home and then support them in their own home using telehealth or hospital in the home type models is really good.

[00:15:05] David Cummins: It's really interesting because there's a lot of older generations who rely heavily on having animals and their dogs but I still don't know too many aged care facilities that allow dogs to come into their practices.

[00:15:16] It's a catch 22 where sometimes they need that extra care, but they actually also need to be in their home. So I truly believe that, by allowing them to stay in their home a little bit more and having the extra fur support and their family support, but obviously that comes at a cost as well, unfortunately.

[00:15:30] Kate Laver: Yeah, absolutely. 

[00:15:31] And I think we are seeing a move where people are less likely to go residential care. So residential care is typically now only for the very old and very frail who need a lot of support and we are going to see models where we are having a lot more support in the home through carers, through technology, through monitoring devices as well so that really you can be in your home unless absolute worst-case scenario and you need a lot of help. 

[00:15:57] David Cummins: Yeah, that's very different from even when I was at uni 20 years ago, it was very much, at a certain age, you go to aged care and you stay there for x amount of years but I think you're right, that delay has certainly got a lot of benefits and that ability for people to have more empowerment with their activities of everyday living certainly has a lot of benefit as well. 

[00:16:16] So just before we go, is there anything that you would like to see as a major change or something we can rely on ourselves, especially to try and protect our older generation? 

[00:16:25] Obviously it's about staying home, staying there as long as possible, but just any little tips and tricks that we can just try and make in the home ourselves to try and make sure our older generations are protected a bit more?

[00:16:36] Kate Laver: I think really it's around having those conversations.

[00:16:38] So for example, you might have a parent or an aunt or a neighbour and you can see some issues.. So just have a discussion with them about it because as I said, a lot of this stuff isn't expensive and it's not complicated. 

[00:16:52] It's about making sure that there's enough space for the person to walk around that there's not too much clutter, that the surfaces are flat and not uneven, that everything's within easy reach.

[00:17:03] Just having conversations with people and offering to help them as well, maybe making some suggestions. They're not always complicated changes that we suggest. 

[00:17:12] David Cummins: Yeah, that's a really good tip. 

[00:17:14] Thank you so much, Kate, for your time. I think your research is phenomenal. I think the fact that you are a professor in this space is just an absolute whirlwind. 

[00:17:23] No doubt you're a world leader in this space. Purely for the fact that I find it very interesting to know that the timing of your research and where we're about to go as a healthcare industry is phenomenal.

[00:17:34] So I have no doubt we'll be hearing more about you and your research in the near future. So thank you so much. 

[00:17:38] Kate Laver: Thank you, David. 

[00:17:39] David Cummins: You have been listening to the Australian Health Design Council podcast series Health Design on the Go. To learn more about the AHDC, please connect with us on our LinkedIn or website.

[00:17:48] Thank you for listening.