Queensland Floods Crisis

A note of support and concern for all our friends living in the flood affected areas of Queensland. We know many of you will be struggling with your own homes and families affected and also trying to be there for the elders you are caring for who may also be located on flooded areas.

We are thinking of you all and ready to support in any way we can.

Know your distressing situation touches us all.

We wish you speedy recovery to normal life but know it will take months and years for many.

The trauma of this will, like the bushfires of 2009 in Victoria, take tens of years to recover from. Many will be changed by it for the rest of their lives.

You can find out more about how to deal with natural disaster trauma at www.psychology.org.au, the website of the Australian Psychological Society. There is information on how to recognise that you are having a “more than usual reaction” to what is happening, how to communicate well with children about such traumatic events as well as good information for you both for coping now and in the future.

If you are able tell us of your situation.

with best wishes


Changi Prison

I have just visited Changi Prison Museum and Chapel in Singapore. I am here for four days to conduct a Dementia Care Mapping course with Virginia Moore in the Lions Home for Elders.

The museum is a very moving chronicle of the tragedy of 1942-1945 in Singapore under the Japanese. I am reminded of the several POWs I have had the privilege to talk to in my time as a psychologist working with people living in nursing homes and hostels in Victoria, Australia., many of whom had dementia and were reliving the horrors of those 3 1/2 years in prison.

Changi was not the only POW camp. 16,000 died on the Thai-Burma railway. Many civilians died in the villages of Singapore and beyond. Stories of heroism and immense suffering in the face of unthinkable cruelty made me numb with the barbarity of some of the things that were done to people. But it still happens if you look at the newspapers and TV. People can be both cruel and wonderful to each other. I was viewing it for a moment in my life but the soldiers and civilians who lived through it endured it for 3 1/2 years not knowing if it would end.

Not all Japanese were cruel. There is the story of the Japanese man who was in Changi prison for spying before the war and  was released when the Japanese overtook Singapore, to take up a position with the military government in charge of welfare. He ensured many survived with permits and passes that he did not have to give. Thirty years after the war he was welcomed back by the people who remembered his goodness. There are photographs of two unnamed young Japanese soldiers who gave Vitamin B tablets to soldiers.

Weary Dunlop has demonstrated the way to build bonds of relationship that can overcome fearful anger and resentment. We had the pleasure of hosting a Japanese student a couple of years ago and it was a happy sharing of stories and perspectives that I am sure will build interest and positivity into the future.

I wonder from the safety of my room how I would cope. What would I do? Would I be able to withstand the daily punishments and deprivation. I guess those men and women must have asked themselves similar questions. They were ordinary people much like you and me, asked to do extraordinary things under extraordinary circumstances.

I can only say thanks for the example and the memory of their endurance.

I think of them today and remember the men and women I have come across who have suffered not just physically but now in the course of the progress of dementia find themselves mixing up present and past. Unfortunately their past contains unpleasant memories that confuse and hurt them, causing them to be fearful or angry or afraid. It calls on all my empathy and compassion to try to understand what it must be like to live in that reality again. For many their bodies now look and feel like they did but now due to ageing and the wasting of inactivity rather than starvation and malnutrition. The very weight loss is enough to convince their brains that now is then.

Tell me about your experiences caring for people who have endured the punishments of being a POW.

PTSD and service dogs

Yesterday I took a kayaking/hiking tour with a small group on the island of Kaua’i, Hawaii. As I stepped into the bus to join my eight companions for the short trip to the mouth of the Wailau River I noticed a quiet Golden Retriever lying on the seat alongside her owner. I asked a few questions by way of making conversation but the dog’s owner was as quiet as the dog. She seemed reluctant to make small talk.

At the river we milled about preparing the kayaks. We each paired up and that left the owner of the dog by herself. I wondered how this was going to work. The guide called her over. “Carly *, you and Goldie* can take this single.” (*not their real names)

I looked at the saddle cloth he was wearing. It read, “Service dog, PTSD, Some wounds are not visible”. I looked at my fellow traveler with new respect as I realized she was a currently serving service woman who had Post Traumatic Stress Disorder and that this was a way for her to live a normal life with the support of her companion Goldie. She remained self-contained throughout the day but engaged in everything we did with equal enjoyment.

Veterans of the Iraq and Afganistan wars are being offered therapy dogs to assist them to recover from Post Traumatic Stress Disorder. These dogs are specially trained by prisoners in programs in the US for the therapy dogs program. The dogs, usually golden Retrievers, are chosen for their placid nature. They are expected to keep close to their owner at all times, to sleep in their room, to walk with them wherever they go, to stand behind them to prevent someone approaching from behind or stand in front to prevent someone moving into their space. They are trained to protect their owners, to remain calm when the owners become hyperaroused with anxiety from time to time. Waking in a nightmare can be frightening but can be made less so if you wake and see that your dog is calmly asleep or unperturbed.

Post Traumatic Stress Disorder (PTSD) is known for the hyperarousal (overstimulation of the normal stress reaction we have to frightening events) that causes heart palpitations, rapid breathing, shortness of breath, shakes, cold sweats; Re-exeriencing in which a person believes they are back in the traumatic situation; and avoidance of the distressing situation or anything that has or might cause them to experience distress again. This disorder has gained recognition in the medical community in recent decades through the work of researchers studying veterans of wars over the past century. It is now widely accepted as a common response for up to 30% of veterans, 15% of people living in the community and up to 70% of ex-POWs.

Therapy has consisted largely of cognitive-behavioural therapy (CBT) which attempts to change the way survivors interpret and experience their symptoms. Drug therapy for PTSD has also shown good effect. A combination of psychotherapy and drug therapy has proven the most effective. However, for some, the only therapy that has made a difference is the companionship of an animal that is unfailingly faithful, vigilant and protective.

The programs that supply these dogs have been overwhelmed by requests for dogs to support civilians as well as the many veterans who have struggled to endure the distressing symptoms of PTSD. For some veterans theis service ha come after suffering untreated for decades since the Vietnam war.

Companion animals may also prove to been valuable for the many civilians in the community who have PTSD due to assault, robbery, car accidents, public safety roles, or torture in other countries.

Yesterday Carly had a good day. She kayaked and hiked, calmly and with enjoyment, a long way from the war that left scars we couldn’t see. So did Goldie.

Your lifestyle and dementia

The International Conference on Alzheimer’s Disease in Hawaii opened this morning with a re-affirmation that in addition to the well known genetic risk factors for dementia, lifestyle factors can have a significant effect in contributing to or decreasing your risk of Alzheimer’s Disease (AD).

I will begin by briefly summarising the genetic knowledge in one paragraph (presumptuous I know).

Dr Jonathan Haines of Vanderbilt University Medical Centre gave a comprehensive review of the genetic literature that emphasised just how much has been achieved in the past ten years. APOE is still the most consistent gene that turns up in all the studies that search for markers for AD. A long list of other genes are turning up in studies of particular populations. The message here is that some genetic changes are particular to families or groups of families and may have to be studied in detail to find the small indications of the genetic changes that are missed in larger studies. The genetic risks are only about 50% known so far but the next ten years should show remarkable progress.

Lifestyle factors include diet, exercise, cognitive stimulation and sleep. It has been common knowledge for the past decade or so that most of these are contributors to many disease conditions including cardiovascular disease, high cholesterol and diabetes and obesity. All of these conditions are in turn factors that can make your risk of Alzheimer’s disease worse.

Dr Kristine Yaffe, of University of California at San Francisco spoke of the importance of mid-life high blood pressure in increasing your risk. She also mentioned diabetes in mid to late life as a risk of dementia due to unstable insulin levels affecting the levels of beta amyloid which has been implicated in the onset of Alzheimer’s Disease. Obesity is increasingly common but she also included in her remarks “overwieght“. This condition can be as harmful as obesity even though the Body Mass Index may not be as high. Fat is not an inert substance but can have toxic effects in the body by causing inflammation. Inflammation is harmful to neurological function. Numerous studies have shown that reducing inflammation by improving immune function can stimulate cognitive function and everyday living. Dr Yaffe remarked that combinations of these factors can increase your risk of AD markedly.

Other factors that can be important in the risk profile for AD include depression. This has been around for a while as a risk for dementia but she clarified that mid-life depression untreated may in fact be a prodrome or early phase of AD. This is a startling way to understand mid-life depression. This is of concern because many people do not seek treatment for their low mood which can then build into depression. This is particularly true of males.

Post-traumatic Stress Disorder (PTSD) is a disruptive condition that is now associated with a raised risk of dementia in veterans up to 2.5 times. The common element in this relationship is that the hippocampus (the brain area mostly responsible for memory decreases in size in PTSD. This also happens in AD but it seems that the shrinkage that occurs in PTSD may increase the risk of it developing into AD.

Sleep is the final are covered by Dr Yaffe. Sleep helps to decrease the levels of beta amyloid , the protein that is associated with AD. Sleep is often disturbed in people with AD. The common disturbance of sleep, sleep apnoea may be associated with hypoxia (deprivation of oxygen) that can contribute to brain injury.

So the message is take care of your brain and your body and you will be more likely to live a healthy old age.

How you live makes a difference. The science is pretty strong now. The areas of your life that influence the presence of high blood pressure, diabetes, obesity/overweight, depression and poor sleep are:



Cognitive stimulation

Social engagement

The evidence of other speakers this morning have reinforced the importance of diet. Dr Martha Clare Morris of Rush University Medical Centre, Chicago, reviewed the literature around nutritional factors. These included antioxidants, omega 3 and fish, fats, and Vitamin B12/Folate. You will know from media coverage that when a new discovery is made supporting the use of a particular food to prevent AD, an equally strong study can be quoted to show that this is not so. Dr Morris explained that some of the studies were with subjects who already had adequate dietary levels of these nutritional supplements. Giving them even more showed no effect. The greatest effects have been shown in studies where the subjects have been shown to have inadequate levels of the dietary factor in the first place. Only then does cognitive performance improve or risks decrease. It reaffirmed the importance of the advice that the food supplements we take in such great quantities are really only beneficial when our diets are inadequate in the first place. Eat a healthy balanced diet that is high in antioxidants such as Vitamin E and C, beta carotenes and flavonoidesDHA from fish and other sources and you will maximise your cognitive function and protect your brain into the future.

Exercise, even  every second day is effective in reducing your risk of dementia. The size of the hippocampus (remember this is the brain area for memory!) increases with exercise even after 3 months. Exercise also reduces other dementia risk factors such as high blood pressure, obesity, poor sleep and depression. So get out there and buy a pair of trainers and  shorts and go for it every second day for at least 45 minutes.

Cognitive skills training is the latest thing to become a popular way of fending off the effects of ageing. What is the evidence? Does it stand up? Yes it does. Dr Sherry Willis, of University of Washington, Seattle, looked at Reasoning, Memory and Speed and asked if cognitive skills training made a difference to actual daily living task such as dressing, eating and toileting.

She found that there was a good effect on reasoning ability, speed of performance and for memory function.  For speed she found 86% of people who participated in the cognitive skills training had in improvement in the speed that they could do their tasks while in the control group who had no training only 31% improved. However this improvement does not generalise to other abilities or tasks.

Her study also looked at the effect of a booster session at 1 and 3 years. They found that the booster did  improve the effect of the Cognitive Skills Training for both reasoning and speed but not for memory. Lower functioning subjects improved more than higher functioning people.

Of particular interest was her finding that driving skills improved for the group who had Cognitive Skills Training. This may be an important finding for the safety of elderly road users in helping to maintain their driving skills and so their social independence for longer than is currently the case.

Brain plasticity has been in the news  a lot in recent years as discoveries of just how much brain change we can expect from aging brains changes by the minute. It is extremely heartening to see such evidence for the usefulness of cognitive skills training in fending off the effects of such conditions as dementia and improving functional abilities for longer so that people who have such a condition are enabled to continue to function with success and confidence long into their futures.