Presentation by Alice Rota-Bartelink, Reserach Manager, Wintringham, 5 September 2011

1. Long-term Problematic Alcohol Use and the Older Person WINTRINGHAM Alice Rota-Bartelink

4. Alcohol Related Brain Injury NEUROANATOMY Alzheimer’s Australia (2008)

7. Enlargement of the Ventricles Reduction in Volume of Frontal Lobes and Cerebellum Normal Brain Alcohol Related Brain Injury Ref: www.niaaa.nih.gov

19. Uncoordinated Service Systems

27. Behaviour Monitoring TIME/DATE SITUATION/ TRIGGER (what triggered the behaviour or what occurred just before the incident) A WHAT HAPPENED? (describe the incident/behaviour) B WHAT DID YOU DO? (What was done) C WHAT WAS THEIR RESPONSE? C 17.00 22/1/10 Mary demanded a cigarette from another client but when this was refused she persisted and was eventually told to “Piss Off”. Physical aggression: Mary pushed the client against the wall swearing repeatedly and waving her fist in the threatening manner. The client yelled at Mary to “stop” and reception staff informed Mary that they had called the police. Mary quickly released the client and ran out of the building

30. The Downward Spiral 1. The PERSON with ARBI is “difficult,” “hard to manage,” or even “aggressive” 2. Caregivers attempt to change the PERSON’s behaviour 3. If they aren't successful, the PERSON may be labeled: “Problem person” -“Impossible” - “Mean” -“Unappreciative” - “Manipulative” - “a Pain” 4. No new interventions are tried because THE PERSON IS the "PROBLEM" 5. Caregivers “cope” by ignoring or avoiding the PERSON 6. The PERSON is NOT comforted or assisted and behaviours become more intense 7. Caregivers feel even more distressed and frustrated by the behaviours 8. Caregivers avoid, ignore, or even "fight back" 9.The PERSON’s behaviour continues, and often becomes even more intense

35. WINTRINGHAM Dignified services to elderly homeless men and women

38. Wintringham is driven by a simple and overwhelming conviction: we believe in social justice

39. The Wicking Project In October 2006 Wintringham was awarded a $900,000 J.O and J.R Wicking Trust Research grant administered by ANZ Trustees to develop and trial a specialised model of care to support older people living with an acquired brain injury (ABI), in particular older homeless people with challenging behaviour as a result of an alcohol related brain injury (ARBI). This grant was the largest ever awarded by The Wicking Trust and regarded as a flagship project. Older People with Acquired Brain Injury and Associated Complex Behaviours: A Psychosocial Model of Care

41. Wicking Participant Demographics

44. Wicking Project Overall Outcome Scores (Non- standardised scales)

45. Frequency of Incidents of Challenging Behaviours Overall among Wicking Participants Over Time (F= 4.820, p=0.008)

47. Where to next?

48. Policy Recognition, Support & Funding Education & Training Research Prevention Service Improvement Cultural Establish Specialised Care Services Coordinated Service Delivery Prevention New Vs Long -Term Homeless Older Person Living with an ARBI