Exploring excellence in gerontology Liao named gerontology nurse of the year.

If nurses really believed in holistic care, they would not regard the brain as more important than any other organ. They would respect a patient's humanity, even if that patient had advanced dementia.

This was the message--a plea for nurses "to distinguish the person from the disease"--given by keynote speaker Rosalie Hudson in her first address to the 5th national gerontology conference in Wellington last month. The conference explored the theme Excellence in Gerontology. Hudson is an Australian nurse and theologian who has most recently served as the Victoria project officer for the Australian Palliative Aged Care Project. She is an author, teacher and associate professor with the University of Melbourne. Her two presentations--one on contemporary issues in dementia care and the other on ethics at the end of life--were regarded as conference highlights by the around 350 attendees. Hudson described dementia as a "malady with a mystery", with the most common form being Alzheimer's disease. "There are now around 20 million people with dementia worldwide. This figure is predicted to increase to 80 million by 2040. Each year there is more to learn about the disease, but the most important thing nurses must do is confront the language of prejudice and abandonment that so many people with dementia are subjected to. The media is particularly prone to transmitting stereotypes, using language like 'the never-ending funeral' and the 'battle against Alzheimer's. Even nurses resort to negative language when they say things like 'Shoot me if I ever get like that'. How can nurses respond to these stereotypes and the fatalism of families? We can counter this ignorance by modelling a new language of dementia."

Hudson said people often dismissed people with advanced dementia by questioning the usefulness of theft lives and seeing them as "already in the house of the dead". "But does a person cease to exist when the brain is diseased?" she asked. "Why do we put so much emphasis on cognition? People with Alzheimer's still experience loneliness, boredom and pain, and we need to assess their pain within the field of cognitive impairment. This requires real skill."

Hudson described the guidelines A polliative approach to aged care, recently published in Australia, as a world first and as being particularly useful when treating people with dementia. "People dying from dementia have symptoms and health care needs comparable to those dying from cancer. They are on a slow journey to death, but we can generate hope and manage their symptoms. Why should people with dementia suffer from unrelieved pain? In other areas of nursing, pain management is paramount. Pain is associated with challenging behaviour and needs to be managed skilfully."

Hudson urged nurses to replace the three dreaded "Ds" of old age and aged-care--death, dying and dementia--with the three hopeful "Ds" of dancing, dignity and dialogue. "If we believe a person is no longer there, they will be treated accordingly, but we can still see a person with dementia as a whole person. It all depends on our attitudes. If we relate to people with dementia, even through dialogue without words, we give them dignity and show them they matter. We need to know someone for what they are, what they have been and may yet become."

Sponsored largely by Pfizer New Zealand and Guardian Healthcare Group, the conference had no concurrent sessions and was ably and amusingly compared by comedian Jim Hopkins. Minister of Health Pete Hodgson addressed the conference on the first day, conceding there was still some way to go to bridge the pay gap between nurses and other staff working in aged care and those working in district health boards. Although rest-homes had received a nine percent increase in funding over the last two years and hospital and dementia units 12 percent, that was not sufficient. He predicted further increases in the May 2007 budget. "I have a cycle to break. I have to ensure that the funding flows adequately, to reduce the turnover so that investments in training that we are also making, separately and additionally, are not lost by that turnover of staff."

Ending his address on a positive note, Hodgson said "nearly all residential care facilities in this country are run to a good or very good standard by a workforce that has a strong dedication, a strong ethos of care and which can and does bond with those they care for, such that friendship and love are common, normal and rewarding experiences for residents".

In his address, Ministry of Health chief nursing adviser Mark Jones outlined the increasing demands on health services as the older population continued to grow. These statistics also affected the nursing workforce. "In 15 years, 30 percent of the nursing workforce will retire. We will soon have elderly nurses looking after elderly patients. We need a young workforce coming up behind."

However, he warned against junior nurses working in aged care too early in their careers. "Too often junior nurses end up in positions of responsibility in elderly care. They jeopardise their careers and the quality of care given to the elderly. Looking after older people is a specialist skill. We need a specialist nurse resource in aged care, including nurse practitioners. Caregivers also need a career pathway. Older people must not be given a second-rate service."

Other speakers included nurse practitioner, aged primary health care, Michal Boyd, who spoke about the conundrums of implementing care coordination for older adults; director of MidCentral District Health Board's primary health care nursing development team, Chiquita Hansen, on gerontology in primary health care nursing; nursing lecturer Anne Schumacher and nurse Judy Dickie who spoke about the future of gerontology nursing, and nursing lecturer Vivien Rodgers who spoke on autonomy for older adults in residential care.

Consent and privacy issues, including a response to the photographic essay on caregivers, published in the May issue of Kai Tiaki Nursing New Zealand, were given a satirical twist by entertainer Ginette McDonald, with Boyd presenting a more serious response to the issues. This was followed by a debate on the topic Age should influence the health treatment you are given, chaired by Hopkins.

The award for Gerontology Nurse of the Year went to Louisa Tsai-Fen Liao, who has recently resigned from Princess Margaret Hospital in Christchurch, where she specialised in gerontological rehabilitation nursing, and acute stroke care and rehabilitation. She helped set up pathways for stroke patients in the first stroke rehabilitation unit in New Zealand. In 2000, she received the Canterbury Volunteer Recognition Award for her service to people with intellectual disabilities and elderly people living in the community. Liao has registrations and nursing experience in three countries, including the United Kingdom and Taiwan. She returned to the United Kingdom earlier this month to work in neurology rehabilitation nursing for a year. Reflecting on the conference, section chair Beth Kelly said she was delighted "everything had gone like clockwork". Feedback from attendees had been very positive, with people commenting on the relevance of the presentations to their practice.

At the national gerontology section AGM, a new committee was elected. Retiring members were Beth Kelly, Christine Davies, Lyneta Russell, Dorothy Moore and Juliet Kenworthy; staying on are Lois Waugh, Gillian Meek, Annette Senton and Sally Fleming; with new members Carole Fisher from Northland, Margaret Stevenson from Dunedin, and Jan Featherston and Sarah Walters-Puttick from Auckland. Featherston was presented with her NZNO award for services to nursing at the conference.

Report by co-editor Anne Manchester