Learning Link-Up: Strengths and Frailty in older Aboriginal and Torres Strait Islander Peoples

Estimated read time: 1:20

Learn to use AI like a Pro

Get the latest AI workflows to boost your productivity and business performance, delivered weekly by expert consultants. Enjoy step-by-step guides, weekly Q&A sessions, and full access to our AI workflow archive.

Summary

The 'Learning Link-Up' event hosted by Frailty Nexus delves into the impacts of frailty and strength-based approaches among older Aboriginal and Torres Strait Islander peoples. This online forum highlights the importance of culturally appropriate healthcare for Indigenous communities, discussing research and methodologies to address high frailty rates among these populations. Presentations by Ebony and Dr. Jesse Zanker focused on existing studies, the need for community-engaged research, and the implementation of strength-based strategies over deficit approaches. The session concluded with discussions on culturally sensitive terminology and the importance of listening and engaging with Indigenous communities to foster trust and effective care.

Highlights

Frailty affects older Indigenous populations more severely compared to non-Indigenous groups 🌿
Strength-based approaches focus on capabilities rather than deficits ✨
Cultural sensitivity in healthcare leads to better outcomes for Indigenous populations 🌱
Studies reveal high levels of frailty in younger age groups among Aboriginal peoples 🧓
Engaging communities in research ensures culturally appropriate health strategies 👥
Integration of traditional knowledge enriches current health models 📚

Key Takeaways

Culturally sensitive healthcare is crucial for Aboriginal and Torres Strait Islander communities 🏥
Frailty occurs earlier in Indigenous populations compared to non-Indigenous groups ⌛
Strength-based approaches are essential to combat negative impacts of frailty 🤝
Community engagement is key in developing effective health interventions 🌏
Deficit discourse often overshadows the capabilities and strengths of Indigenous peoples 🚫
Importance of integrating Indigenous perspectives into healthcare 💬

Overview

Ebony and Dr. Jesse Zanker delivered an insightful presentation on frailty in older Aboriginal and Torres Strait Islander peoples. They highlighted the increased prevalence of frailty in these populations and the importance of strength-based, culturally sensitive healthcare approaches. The speakers emphasized the need for community engagement and integration of Indigenous perspectives in health research and practices.

Focusing on existing studies, they revealed higher levels of frailty in Indigenous populations occurring at younger ages compared to non-Indigenous counterparts. Emphasis was placed on the need for culturally specific tools and interventions to adequately measure and manage frailty within these communities, uncovering gaps in current methodologies.

The session stressed replacing deficit discourses with strength-based approaches, which prioritize individuals' capabilities over limitations. Engaging in dialogue with communities and respecting their perspectives were identified as essential for designing effective health interventions. The event wrapped up with a call to embrace holistic definitions of health, recognizing the interconnectedness of physical, emotional, and cultural well-being.

Chapters

00:00 - 00:30: Acknowledgement of Traditional Owners and Introduction The chapter begins with an acknowledgment of the traditional owners and custodians of the land where the meeting is held, specifically mentioning the Turrbal and Yagera people in Brisbane. There is a respectful recognition of the Elders past, present, and emerging, as well as indigenous attendees participating in the discussion. The chapter also mentions Jesse's willingness to present, highlighting a sense of excitement and learning about the subject matter.
00:30 - 01:30: Introduction of Presenters The chapter introduces the presenters, with a specific focus on a presenter named Ebony. It shares the exciting news of Ebony completing her PhD and becoming a postdoctoral fellow at the University of New South Wales School of Population Health. Her research has concentrated on areas such as frailty, healthy aging, and enhancing end-of-life care.
01:30 - 08:00: Ebony's Research on Frailty in Indigenous Populations The chapter provides an overview of Ebony's research program focused on frailty among older adults, particularly within Indigenous populations. It highlights the importance of culturally appropriate methods for screening and managing frailty. Additionally, it introduces Dr. Jesse Zanker, who contributes to the field as a geriatrician working with Aboriginal communities and as the director of ARA Health.
08:00 - 18:00: Frailty in Aboriginal Population in Australia The chapter introduces a post-doctoral research fellow who completed his PhD and is part of the on track dementia program at the University of Melbourne. This program focuses on teaching, research, and community knowledge about dementia. The fellow's work specifically involves improving dementia and frailty management among Aboriginal and Torres Strait Islander peoples.
18:00 - 26:00: Strength-Based Approach to Health The chapter titled 'Strength-Based Approach to Health' features a presentation by Ebony, a graduate woman and postdoctoral fellow at the University of New South Wales. She collaborates with Jesse to discuss their work on vitality and strength-based health approaches, focusing on both indigenous populations internationally and in Australia. Ebony leads the first half of the presentation, highlighting projects she completed during her PhD studies.
26:00 - 35:00: Exploration of Strength-Based Approaches in Research The chapter discusses the exploration of strength-based approaches in research, particularly in the context of working with Aboriginal communities in New South Wales. The speaker acknowledges and pays respects to the Aboriginal and Torres Strait Islander Elders, both past and present, and extends this respect to any Indigenous individuals in the audience. The conversation highlights the significance of understanding and incorporating Indigenous perspectives and knowledge systems in research methodologies.
35:00 - 43:00: Discussion and Audience Questions The chapter titled 'Discussion and Audience Questions' begins with the presentation of a map displaying different Aboriginal Nations in Australia. It emphasizes the diversity among these nations, highlighting that each has its own distinct culture, customs, and languages. This serves as a reminder that when discussing the indigenous population in Australia, specifically the Aboriginal and Torres Strait Islander peoples, we are actually referring to hundreds of diverse groups. A foundational understanding of this diversity sets the stage for further discussions.
43:00 - 47:54: Conclusion and Acknowledgements The Aboriginal population in Australia, despite being younger on average, is aging more rapidly than the non-indigenous population. This demographic experiences disproportionately high levels of chronic disease, often occurring at younger ages. For instance, they face dementia rates three to five times higher than the non-indigenous population.

Learning Link-Up: Strengths and Frailty in older Aboriginal and Torres Strait Islander Peoples Transcription

00:00 - 00:30 perfect so to begin with um I'd like to do an acknowledgement to the traditional owners and custodians of the land on which we meet today and there's um many of us joining from different parts of the country today um for us here in Brisbane it's the table and yagura people um and we pay our respects to um Elders past present and those emerging and those indigenous people who are joining us today and we're really excited to be learning about this topic and um Jesse was very kind enough to agree to present to this um when I spoke
00:30 - 01:00 to him last year and we're very excited as well to have ebony who's um come on board as well to present to us so um ebony has exciting new she's just um finished her PhD which is such a massive Milestone so um yeah Round of Applause for Ebony finishing she's now a postdoctoral fellow um at the unw school of population of Health population Health rather um and her research has largely focused on Frailty healthy aging and improving the end of life care
01:00 - 01:30 experience for frail older adults their caregivers and clinicians uh she currently leads a program of research around Frailty and aging in the Indigenous landscape with a strong focus on culturally appropriate screening and management of Frailty so very important and interesting work and we're also joined by Dr Jesse Zanker um who is a geriatrician at the Royal Melbourne hospital and also works at Aboriginal Community Elders services and is also the director of ARA Health um he's also
01:30 - 02:00 completed his PhD um and he's a post-doctoral research um fellow with the on track uh dementia program which is teaching research and Community knowledges dementa um program at the University of Melbourne um doing work there with Aboriginal and T straight Islander peoples to improve dementia and Fry management so without further Ado um please welcome our fabulous guest speakers this afternoon thanks again for coming on guys many thanks Mingus and look thank
02:00 - 02:30 you everyone for joining Jesse and I today to share some of the work we've been doing around fality and strength-based approaches um both in indigenous populations internationally and here in Australia uh so I'm ebony I'm a grad woman and as Mingus mentioned I'm a postto fellow at the University of New South Wales so I'm going to start presenting for the first half of this presentation and I'll be going through some of the projects I did um for my PhD
02:30 - 03:00 where I had the privilege of working with um Aboriginal communities in New South Wales here where I'm based so I'm coming to you today from bigal country here in Sydney and I'd also like to pay my respects to all Elders past and present and extend that respect to any Aboriginal and tourist straight Islander people online with us today so many of you may recognize this map of the Aboriginal and tourist straight Islander
03:00 - 03:30 homelands and if you're not familiar with this map all these different colors represent the different Aboriginal Nations each with their own cultures Customs languages so it's just a reminder when we refer to the indigenous population in Australia so the Aboriginal and T straight island of peoples we're referring to hundreds of diverse groups so just to sense the scene and
03:30 - 04:00 provide a bit of background um so despite having a relatively younger age structure the Aboriginal trr population here in Australia is aging um and at a faster rate than our non-indigenous population so Aboriginal people do experience disproportionately high levels of chronic disease um and often earlier or younger age onset so for example they experien dementia 3 to five times High higher than that of our
04:00 - 04:30 non-indigenous population and there is a well-known life expectancy Gap so about 8 to n years lower for our Aboriginal population and these poorer Health outcomes can be attributed to these longterm effects of colonization uh past policies including past government policies and marginalization and these disparities in those social determinants of Health that we hear of so those are those sort of
04:30 - 05:00 non-medical factors that can influence Health whether it's um education income employment and so on um but importantly um and it's consistently recommended that Health Care is tailored to meet the needs of our Aboriginal and tourist rade Islander population now I just wanted to briefly touch on perspectives of health and well-being because for many Aboriginal and T straight L of people um health is
05:00 - 05:30 defined differently to I guess more the western or biomedical constructs in which we tend to work or operate within so this definition on your screen is from the national Aboriginal Community controlled Health Organization um and it's a commonly accepted and and very widely cited definition of Aboriginal health and just to have a look at this we can see that good health it's more than just that absence of disease is an illness and
05:30 - 06:00 it's this holistic concept so it has physical social emotional and cultural well-being of both the individual and the whole community so it's it's very different to um even more IND individualized um Health definitions that we're probably more used to seeing and this figure on the left here is the um Aboriginal health and well-being model and again this is also widely cited and what this model's recognizing
06:00 - 06:30 is that connections to um country land um ancestors family kin um Community they're just as important to well-being um as physical health is and I like this model because it also um I guess recognizes those wider determinants of health so the historical the political and of course our social determinants of Health um which definitely play have an influence
06:30 - 07:00 um either good or bad and so it's just good to keep this in mind that if we're ever working in this space of indigenous Health um we should have a good understanding of these differences um in perspectives and anything we do going forward should be integrating these perspectives and of course this has implications for how we currently approach um fry so our team began looking at fry in indigenous populations a few years back
07:00 - 07:30 and this was one of my first projects um where I wanted to find out what the literature reported around fraly within indigenous populations um and this was published in 2021 and um there could be some familiar names um on that author list so Kenneth Rockwood of course um and I was very lucky Ken was actually my supervisor um throughout my PhD and had a big interest in fry in the Indigenous landscape so it was great to learn a lot from Ken um and
07:30 - 08:00 of course many of the other people um who have been involved but specifically so this was a scoping review and specifically we wanted to map the characteristics of Bry um we wanted to look at the tools used to measure it um and any strategies or interventions which had been developed um to combat proudy in indigenous populations so we searched several databases um relevant institutional websites up till October 20 and in total we had nine articles
08:00 - 08:30 that met our inclusion criteria and they were in Australia New Zealand Canada and the US so this is just a snapshot of some of the findings of the review so as mentioned we had nine articles and seven of them pictured here had used a formal fality measure and we can see that several fry definitions and scoring criteria were used so for the Australian and the Canadian studies they used the
08:30 - 09:00 fry index um or the FI a couple used the freed and another New Zealand study had used the Edmonton frail scale now in all the nine articles that were included fry was used as a descriptive measure so for example reporting on the prevalence uh three of the Articles assess fraly as an assessment of risk so that was where Fry could predict poor outcomes and two of them had used fry had included fry I
09:00 - 09:30 should say as an outcome measure okay so more of the findings and some of the gaps of this review so we did find that indigenous populations had a higher prevalence of fry and Fry was occurring at younger ages when compared to their non-indigenous counterparts in the Articles now a handful of studies um as mentioned before looked at fry import outcomes um we can see an article um
09:30 - 10:00 found Ry was a significant predictor of mortality positive correlations between po glucose control and higher levels of fraly um as well as dementia and fraly but no articles included in our review um had any sort of culturally specific fry tool so they were all based off those I guess largely Western tools that we are all familiar with in research and clinical practice but there were some fra indices
10:00 - 10:30 that it did include culturally appropriate measures uh so what I mean so I'll give you an example there was an Australian study um uh in wa which used they used a fry index and they used the Kea which is a culturally appropriate measure for cognition in Aboriginal people and we couldn't find any articles that looked at interventions or strategies for management of fry and Indigenous views of Fry were missing uh we only found nine articles we
10:30 - 11:00 definitely need a lot more research um in this area especially given those high levels of pry we found in this review okay so for the remaining few slides I just want to now focus on Fry in Australia so fry in Aboriginal people I should say in Australia now this article's from Zoe Hy and colleagues and this was included in our review and this is probably one of the first froud um Aboriginal fry
11:00 - 11:30 studies I'm aware of in Australia um so hiy and college hi and colleagues were looking at the prevalence incidents and associations of prity with um uh mortality and disability now this was a longitudinal study um and it was conducted in the kimbery um which is in Western Australia from what we can see on that map of Australia so what did they do so they applied a fry index to over 360
11:30 - 12:00 Aboriginal people aged 45 years at the start of the study and then around 6 years later follow up they had 182 surviving participants that they measured FY on again now they defined fail in this study as having an fi score of2 or more and just a couple of their way to or their follow-up outcomes I've just put down here for you they found Baseline fry was associated with all
12:00 - 12:30 cause mortality at followup um but it wasn't associated with disability now the prevalence of fry um in this remote population was very very high so estimated about 20% of um Australians over 65 are living with fry here we can see that prevalence is much higher in this Aboriginal population um in wa so I've just marked that that box in
12:30 - 13:00 red there because we don't usually see those younger age groups in other faly studies but this is the 45 to 49 year age group um reporting over 50% um classified as F at the start of the study and this increased to over 83% in that oldest age groups so very high levels um and they also looked at change or transition in Fry status and so what
13:00 - 13:30 we can see here is at the start of the study at Wave 1 um those who were classified as not frail they had about an equal chance of either staying in that not frail State at six-year followup or transitioning to that worst state of frail or having died um at followup but for those who were classified as frail at the star the study they were less likely to transition to a Nona State and again they probably is equally they were they
13:30 - 14:00 had equal chance of either remaining in a frail state or having died that study was done in remote in a remote region um of course if we think back to that original homelands Map There's great diversity in our population and of course Geographic diversity um so we undertook a study and it was published a few months ago which is here on your screen um to describe the fality profile of Aboriginal people
14:00 - 14:30 living outside of the remote setting so we use data from the career Growing Old World study which is a longitudinal study which is includes Aboriginal and T straight Islander people 60 years and over from Urban and Regional um areas in New South Wales and we actually had similar numbers to the uh remote study in wa so we applied a prity index just um to over 300 Aboriginal people um and 153 were followed up um 6 years
14:30 - 15:00 later as well we use the same um fry def fry cuto scores for comparison purposes so anyone who had a score of 02 or more was defined as frail for this study um and we also looked at Frailty severity within that so mild moderate and severe now we did have um a survival status as well and we found uh severe fality at Baseline was
15:00 - 15:30 associated with all cause mortality uh but this was not significant for those who were classified as either being mild or moderately frail okay and again very similar to that remote study we found um very very high levels of prevalence in our study this is just from the paper here 75% were classified as were defined as frail classified as frail either mild moderate
15:30 - 16:00 or severe severity did increase with age um females tended to have higher levels of fality and that's pretty consistent with um fality research studies in other populations and this sski chart here so this is looking at the transitions in fraly status between Baseline and followup um I guess a couple of points um that I really wanted to make here um those who were moderate or severely fra
16:00 - 16:30 at Baseline mostly stayed in that same state or transition to a worse State at followup um and very few transition to a better State and actually no one um who was classified as moderate or severe frail at Baseline actually transition to a robust state or not frail state so just really quickly to recap just on um those few studies look there is very little research on Fry and
16:30 - 17:00 Aboriginal people here in Australia but the info the studies that we do have report some of the highest levels of fry worldwide we need to know what are driving these high levels um so yes we've got um a high prevalence of chronic disease early age onset but there's likely going to be other determinants which are unique to indigenous populations and they need to be explored um and of course we need strategies to be able to combat fry um
17:00 - 17:30 in our first peoples um but to do anything any development of intervention strategies whatever we're doing just want to emphasize that this should be co-designed with the community and we need Aboriginal perspectives in this research so the final um study I guess I want to share with you today is that um is a qualitative study where we actually did um explore the views that Aboriginal
17:30 - 18:00 people and it was done here in Sydney hold around Frailty um so we used yarning circles and oneon-one yars with uh 22 Aboriginal people who are 45 years and up um now this uh data collection had to go online we originally planned to have it face to face but we ended up in a second lockdown here in New South Wales um so what we did afterwards is one of the Aboriginal Community controlled organizations we partnered with once everyone was vaccinated it was
18:00 - 18:30 safer to go out after we had the preliminary results we went and disseminated them to the community and the participants and we had a big lunch um it was a really fun day and this is just one of the photos from that day of a few of us now I just wanted to spend a few minutes on this slide and I've got some notes down here um because this slide is showing the seven themes we identified from these
18:30 - 19:00 Ys and I don't want to miss anything so our participants R participants Ry was understood as being a multi multi-dimensional experience and it encompassed not just those physical aspects but social cultural spiritual and psychological aspects too now it was largely discussed in the context of advanced age but there was acknowledgement um from participants that fry could occur at any stage of the
19:00 - 19:30 life force and in younger ages and this was largely in the context of participants who had perceived themselves as frail at one point in time either mentally or physically frail um and then who had since recovered now having a strong connection um to both Aboriginal culture and the community was felt to be an essential element to alleviate or prevent proudy um and this also facilitated you
19:30 - 20:00 know more positive Perceptions in health and well-being there was interesting the concept of fry um by our participants but the way in which this information was conveyed by health of by health professionals was Paramount so there was a strong preference um for strength-based approaches to proudy assessment um and management and this had to also consider the wider family Network so not just the individual it
20:00 - 20:30 had to take in account the family and it also had to acknowledge a person's strengths and capabilities so I guess really in other words it's not solely focusing on what the person cannot do so their losses their limitations but there has to be a balance where um health professionals clinicians researchers whoever it is recognize those strengths and assets of the of the both the individual and the
20:30 - 21:00 community now participants perceive the term frail to have negative connotations uh for older Aboriginal people and when we showed the participants these fry uh tools that I have here on the screen they highlighted um that these tools uh in their current form did not reflect Aboriginal cultural norms although they did preference visuals um over the other two tools because because this was said to overcome complex medical jargon um
21:00 - 21:30 and help if people had poor health literacy just keeping in mind though that we're showing these tools to the community I mean these these you know so these findings of the tools may only be relevant to Aboriginal health workers um because these tools aren't intended to be self-administered um and I just wanted to present some of the selected quotes here um so we can see here one
21:30 - 22:00 participant talking about a physical and a mental reaction um lots of participants wanted Healthcare to be delivered by Aboriginal Medical Services they found this to be more culturally appropriate and they wanted to know things such as what rate their fry was um going to progress what they could do to slow it down and really important if they could still live at home um here's a quote about um continuing connection with the community um and here's another quote here's one
22:00 - 22:30 participant saying that they'd prefer another a more positive word um instead of fry to describe their aging and I don't like the word frail um and this was felt to diminish you as a person and the last two quotes are from participants around those proudy tools um so quite a strong language here I don't think they're culturally appropriate for the community um but another participant has said you know I can look at the pictures and think um
22:30 - 23:00 not that the pictures are everything um but it tells a story okay so I just wanted to finish up my section on just with I guess maybe the take-home messages um from our qualitative study um and really it's just as clinicians and and researchers we do need to acknowledge um and be acting on the factors that are known to promote good health and well-being um from what aigal older people people themselves tell us so from our from our
23:00 - 23:30 work that is having a holistic um and multi-dimensional approach to fraly related care um that supports strong cultural identity um and Community connections and we need approaches that recognize Aboriginal people um in their community's strengths and assets so on that I'm going to hand over to Jesse now who's going to talk to us a bit more about strengths thanks J thanks thanks that overview um
23:30 - 24:00 and Brilliant work and congratulations again on the PHD it's fantastic effort and um great work you've done I'd like to begin by acknowledging the traditional Hors from the lands from which I'm zooming which is warer country in N Melbourne and pay my respects to Elder's past and present uh and a shout out to any Aboriginal and torist trade Islander people with us today I can see a few familiar names which is nice to see and also those who will view it later on YouTube thanks to the faly
24:00 - 24:30 network for inviting us to talk so Ebony's given a brilliant overview and led really nicely by painting the picture of fry uh and then what culturally safe preferences older Aboriginal people have for the description of fry and the preference for a strength based process strength based approach so as ebony said I'll be focusing on that and I took um Liberties in drawing some more quotes from eon's uh unpublished paper um which is Rich
24:30 - 25:00 with um wisdom from the participants and I think uh this these two quotes one of the bottom one of which ebony has already described but really I think uh highlight the importance of framing of challenges and problems and being able to apply uh management approaches in a person centered way that is culturally safe so in the words of the the participant uh you might not feel great in yourself and you know things are changing when someone labels you frail
25:00 - 25:30 it's almost like it changes your own mindset to go okay I might as well give up and the second important quote uh as as e described highlights the the Gap that we've currently got in trying to find a way to better frame Aging in a positive in a positive way Ebony's driving for me so next slide please ebony so when we're framing things in a negative way constantly this is known as a deficit Discord so deficit discourse is something that
25:30 - 26:00 focuses on deficiency it can be the absence of something lacking something or a failure to do something I've got the icon there of uh glasses because it really frames the the the lens through which we view the world the thing about deficits is they tend to be individualized so they're very much focused on the individual and places responsibility on the individual and it really doesn't pay any attention to the systemic uh structural disadv vage and circumstances in which people live it
26:00 - 26:30 it's a wholly individualized way of viewing things we know that deficit discourses negatively impact Health outcomes and as in the next slide I I'll show how this might be so because this constant reporting of negative stereotypes that we see in in Media or more broadly can reinforce undesired behavior um and this is a slide that um that ebony shared with me it's from 2014 uh but it reports on uh the the
26:30 - 27:00 topics that are reported on with reference to Aboriginal and T State Island to health and looks at whether these reports and clickbait were negative were they positive or were they neutral and you can see that almost 75% of articles are negative looking at uh things like alcohol U misuse and domestic violence and only 15% uh positive looking at education um advocacy sport successes and culture
27:00 - 27:30 and that's very much in disproportion to the reality so it's sort of like a um a false presentation of the the the state of reality and that can really negatively skew um people's own aspiration and self-belief and feed and feed that aspiration next slide please Evony so in contrast to a deficit uh discourse is a strength based concept this has been around for decades and has been
27:30 - 28:00 advocated for by Aboriginal and torist right down Scholars both in Australia and then First Nations and um indigenous peoples around the world strength based concepts are embedded in a holistic definition of Health they just don't consider the person as an island but consider them in their context uh as a gerrian this is something that we try to do with all of our patients but the strength-based approach really consider the importance of the environment and
28:00 - 28:30 the person's connection to community and Country uh if you're familiar with Western philosophy Rene day cart uh he's famous for the quote I think therefore I am and that has informed a lot of Western philosophical progress when you break that statement down it's it's it's it really is focusing on the individual and that individual's thought processes not necessarily paying attention to what's around them uh over the years this quote has come up in a variety of sources uh in
28:30 - 29:00 Sovereign statements in qualitative studies so it can't really be attributed to anyone but it's an important take on that original Western conception of I think therefore I am and is I belong therefore I am uh T Island uh nephologist associate professor Jackie Hughes when uh who's working in Darwin when I presented uh the the study that I'll present later the proposed study she describe this statement as a very important Sovereign statement because it
29:00 - 29:30 identifies uh people's connection to to those around them to their country and to their community and this in in a way informs a strength-based approaches too so strength based approaches provide a framework uh in order to Aid growth and thriving and this is the from William foggy and his team seminal work published in the Le Witcher papers um in 2018 it's really worth a read it's a very powerful um body of
29:30 - 30:00 work uh foggy and his team described that strength based approaches are needed to achieve Equity it's not being achieved with the current business's usual model particularly highlighting that Health Care in our present system focuses purely on deficits uh so how does how does this work in practice and how can we think about this reframing well to give you a couple of examples we we'll often in the medical history history when we're taking medical history from people just think about
30:00 - 30:30 someone being a smoker but often neglect the health um engagement or positive um attempts someone has made at trying to address that so instead of thinking just about someone being a smoker think about attempted or successfully ceased instead of just focusing on diabetes and its complications focusing uh on what what is being done or can be done to um minimize the impact of that disease on the person's life Life Next
30:30 - 31:00 slide thanks so I I want to just highlight that there are a number of different definitions um that are somewhat related and I haven't done a ven diagram because I don't think it can conceptually um capture the differences well but here are some quotes so you may have heard of uh the who's approach to this kind of strength-based approach um focus which is on intrinsic capacity but the intrinsic capacity is an
31:00 - 31:30 individual's physical and mental capabilities so it sits within that individual and then the wh see intrinsic capacity as a subset of functional capacity which relates to that person's intrinsic capacity and their relationship to the environment uh and the interactions between those so you can see that it does consider the person the individual characteristics in their environment how it contrasts a strength spased it doesn't necessarily provide a
31:30 - 32:00 framework for how to address um the issues or enhance or optimize the strength that already exists a lot of the work in in the UK um has produced this concept of Health assets which is described as any factor or resource which enhances the ability of individuals groups communities populations social systems and or institutions to maintain health and well-being and to help reduce Health inequalities so it's it's also quite broad um but it looks at individual
32:00 - 32:30 factors and not that person as a whole within their context and Community when discussing this with other clinicians this concept of strength-based approaches and having presented before in in Clos groups um I was asked questions by particularly basic scientists uh well aren't you just ignoring problems how can you um only focus on strengths you you dis Advantage people more by not actually exploring
32:30 - 33:00 the problems and strength based approaches aren't an antidote to deficit discourse they're not intended to be but they're intended to be a counterbalance to problems and to to offer solutions to um two challenges uh I've listed quotes here because I think they're very powerful and to try to paraphrase them would have been an injustice to William foggy and co-authors um but I think I'd like to just read one which I think is quite um powerful so when discussions
33:00 - 33:30 and policy aimed at alleviating disadvantage become so m in narratives of failure those ex those experiencing the disadvantage are seen as the problem and a redu reductionist vision of what is possible becomes pervasive so when we're only focusing on deficits we're becoming narrow in our vision we're not thinking about that person's capacity and potential and not really understanding um how we can best uh support them to live their best life a depic of discourse as this quote says
33:30 - 34:00 only provides one side to a multifaceted story next slide thanks so measuring um quality of life is a really important metric a lot of uh research in decades past focused on hard Health outcomes and metrics and in sort of the in the recent more recent decades quality of life has se to be important but how do you measure quality of life in a culturally safe way uh one of our
34:00 - 34:30 colleagues from uh wa Kate Smith and her team um in 2021 and 2022 developed um with an nhmrc Grant the good spirit good life tool now this is seen as a culturally safe uh tool to measure quality of life in Aboriginal torist St Islander peoples over the age of 45 um you now know about yarning cir ebony taught you about that um and in with yarning circles in wa and
34:30 - 35:00 Vic um 12 factors were identified as contributing to good quality of life and a good spirit and good life in in aberer on T State and people in those groups these factors are interconnected they're all related uh and I suppose when you think about uh strength based approaches these this sort of quality of life measures do feed into strength-based approaches um in November last year the good spirit good life tool was endorsed
35:00 - 35:30 by the age care quality and safety commission uh to be used in aged care assessments of older Aboriginal on tarate Islander people uh so you may begin seeing this tool pop up and I suggest you have a read of it it's an excellent excellent tool thank you an example of some of the recommendations so while there are 12 interconnected factors each uh each factor has recommendations that can be applied in practice uh as an example so
35:30 - 36:00 I've picked out the the factor of community and does does the person feel connected to their Community um if not or if that can be improved uh there are recommendations specifically that that were developed through the yarning circles and validated subsequently uh including things like intergenerational exchange uh sharing knowledge uh through or history between between generations and promoting community events such as naok week reconciliation week and sorry day um and
36:00 - 36:30 and and visiting just being more social with people and Connecting People which can often uh be overlooked by service providers the link at the bottom right is the direct link to the tool so I suppose the challenge so we've got the concept of strength based approaches we know that fry exists and it has been under underrecognized and undermanaged but how can we convert strength-based approaches to into practice that's
36:30 - 37:00 culturally safe and has been um prioritized as as an approach um by many Aboriginal and trr Islander Scholars so this is uh not diminishing the role of identification of faly it's incredibly important and it's led to um important targeting of resources and understanding the extent and scale of the health challenges that we face um but we've got a persisting health Gap and uh Aboriginal and Scholars have been
37:00 - 37:30 calling for strength based approaches for decades uh we know that as ebony described that deficits are accumulated earlier and um relate to structural and social inequality and it's not just individual factors in people it relates to systemic factors so how can we measure strengths how can we operationalize strength based approaches and then how can we optimize them and this is to consider uh strength based approach is not just
37:30 - 38:00 in responding to a situation or a Health Challenge or a new illness it's thinking about strength based across the life course so thinking about instituting strength-based approaches uh at a younger age uh which will result in better prevention and and and maintenance of good health so I'll present now a study concept and I'd like to give um a shout out and acknowledgement to um the mentors and um Aboriginal Scholars and
38:00 - 38:30 friends who have uh provided um invaluable insights into developing these research Concepts so Dr tro Walker um Dr Julie McDonna Dr Evony Lewis uh Dr Shantel Gibson and Prof Sean Taylor have all been instrumental in um helping conceptualize this concept um so we're we're hoping to look at Australian Bureau of Statistics um uh data which has captured uh nationally representative data and develop uh a
38:30 - 39:00 fraly index uh for Aboriginal and tarist Road Islanders over the age of 45 but also develop a strength based index uh for the same population which is something that hasn't been done before because the data is cross-sectional unfortunately we can't do something as robust as eony and uh Zoe and dena's study which looks at longitudinal outcomes of mortality and disability we have to look at something cross-sectionally measured and an important metric in this population is self assessed health so how does someone see their own health and then we can
39:00 - 39:30 examine the interactions between fality and strength-based indices so the data is the national Aboriginal and T Islander Health survey and Social Survey which was taken in 2018 and 2019 um onethird of the Aboriginal toist State Islander population at the time was included in the survey and it's nationally representative uh which means that Metropolitan Regional remote and discreet communities are presented in the studies um and it was uh designed uh
39:30 - 40:00 and led in consultation with iig um and Community I've just given a snapshot of um this uh metric of self assessed Health between the 20202 and 2018 surveys in people 15 years and over obviously we'll be looking at a smaller uh proportion of people 45 years and over so Ebony's already given you a an overview of the fraly index and a reminder of a of how a fraly index is
40:00 - 40:30 calculated and um this paper that ebony pointed me to of how to construct a faly index is a very important one um When developing a faly index um by Theo and colleagues including Ken Rockwood so uh a faly index is a cumula accumulation of deficits so each uh deficit or problem um is given a score of one unless of course there are grades of uh of or degree deficit I've given you an example
40:30 - 41:00 of one in disability um which you can see uh zero is um no specific disability or limitation and one has profound um activity limitation and there's a range uh between those so add up all the um deficits and add up the score the score in this case would then be divided by 22 and someone gets a a decimal point or a whole number um but would be a score from 0 to one ebony identified in her
41:00 - 41:30 study that a score of greater than 02 was considered frail so that's 20% of the deficits are present um would would contribute to a score of 02 and next slide so then thinking about how we can invert that narrative not just focusing on deficits but think about health engagement access individual factors but also Community environment factors how can we measure the strengths that uh that uh people in community have uh and
41:30 - 42:00 then use that to to determine whether there's an association with self assessed Health uh here are some domains that and these domains have been um co- prioritized with colleagues um and uh Dr Joe Luke has been gratefully assisting with that as well um so uh the things we're looking at here are Health engagement Health Access there's also important um parts of this survey that look at unfair treatment so systemic factors including racism or how health
42:00 - 42:30 care workers uh treat uh people and you can see here how often GP show respect for what was said um and you can see that that uh if the GP shows respect for for what the the person or patient says then that would be considered a one um that would be a strength all right next one thanks s so what comes next so you develop an index uh that's all well and
42:30 - 43:00 good that is ABS data is it appliable to the real world how can you sort of validate that and and make uh work together to to create manful change um so it needs to be validated and tested and so similar to um Ebony's uh study once you've got an index you you've got to explore what it actually means to people is it culturally safe can it be used in in culturally meaningful ways to to create positive change is it
43:00 - 43:30 appropriate in different um Nations and language groups um and so to do that you need to really explore qualitatively through yarning circles the gold standard in qualitative studies with Aboriginal until straight Islander peoples um and then establish consensus approach and then once you've you've got a consensus approach think about doing a pilot RCT to see how you can uh optimize strengths in the real world setting uh and if if that's appropriate then um then potentially scaling the
43:30 - 44:00 approach so that's the end of my talk but I'd like to give a shout out and um thanks to my team so I'm under the supervision of Professor Dana L at Uni Melbourne through the um Center of research Excellence on track team which is an mrf funded um uh thing uh thing Grant research program I'd also like to um uh thank the community reference group this is a a group of wise Elders
44:00 - 44:30 who provide oversight and support uh and all research projects through on track um run by the community reference group um which is chaired by Auntie Ros Malay and uh Uncle Harry Douglas um the logo down the bottom is the on track logo and that's produced by Sher joh Sher Johnston who's a git Mara woman so uh thank you to my team over to you eony
44:30 - 45:00 Jesse um and yes and and again simil Jesse um I just want to thank um our collaborators um co- researchers and of course our community partner organizations and Elders um who have been involved with the New South Wales study which are all mentioned here and of course actually very importantly actually the most important thinking all our Aboriginal participants who've been in all these studies that um Jesse and I have been involved
45:00 - 45:30 in and we've come to the end now so we're very happy to take questions thank you so much um so benus unfortunately had to step away so he's asked me to um do some closing um so if anybody has any questions we do have 10 minutes um so if you could pop them in the chat or even raise your hand um because there's so many of us I'll have to flick through screen so maybe chat might be best um I just wanted to thank
45:30 - 46:00 you both so much um ebony I had read your um systematic review but it was really good to see some of your other papers and I was actually texting my ra throughout it going oh we need to read that one oh we need to include that and um uh Jesse it was great to hear obviously we met recently Jesse so it was great to hear more about what you do and I really like the idea of that strength based approach but actually providing examples for us um so so I think that really helped me conceptualize how we could do that in
46:00 - 46:30 practice um people are just saying thank you um no questions so far so I might start uh oh we do have a question so um you talked about negative connotations associated with the term frail do you have some suggestions for more appropriate wording um and that was going to be my question as well actually because I think it's something we all struggle with uh and while I think when you're working with uh you know individual groups I think you can talk to them um what terms do
46:30 - 47:00 you like and what terms should we use and things like that but if we're looking at trying to I guess convey research or research findings or whatever it is to large groups of people do you have any thoughts on what language we could we actually asked we actually asked the participants that in our yars we said you know be we said um you know is there any other word um that we should be using besides fail um and it was actually really really difficult
47:00 - 47:30 for for people to sort of think on the spot and it would be for most of us so um interesting well probably not that surprising but a lot of people gave us back words um in their Aboriginal language um sort of meaning poor fellow and and things like that but they just thought that sounded better um so I'm just thinking I can't what was it not so strong was another one so we were after words um but of course if we were going to look um at renaming something we'd
47:30 - 48:00 have to work with whatever Community there was going to be um and see what they said um so that was but it was just really good to um get some insight on that um as a starting point but I think it was really more around I mean if you I I know when I do my own um older Aboriginal people Health assessment I used to work so much in that deficit you know space I as soon as a patient came in the dark you know what's wrong with you and it really just changed that
48:00 - 48:30 whole sort of mindset and after I've been sort of working in this space and in Academia now learning a lot from Elders myself over the last 10 years I've started to just be able to reward things so instead of someone sort of coming into me and and me just automatically saying what are all your problems list them to me I've now tried to change that a little bit by saying to let's say an older patient who might be struggling what keeps you strong um and it's just
48:30 - 49:00 fascinating how that just changes um just the whole conversation straight away so I don't have any magical um word or term we can use but uh being able to reframe those conversations um as best as we can um in practice and I didn't expect you I was I would love if you had a magical termal solution I think we're all trying to solve it um but no I think that was uh yeah really kind of helpful advice um
49:00 - 49:30 and I think it also helps maybe to think about some of those things for example in research when we're doing participant information consent forms or whatever it is going to going out to communities and and trying to um promote research or involve people uh it's just made me think about how okay we might use the term Frailty potentially you know because that's what the study is about but giving more explanations um and probably having uh what is frailty and and looking at the strengths and
49:30 - 50:00 problems as you called them um looking at both ends of the spectrum thank you uh Megan says or Megan I'm so sorry if I pronounce it wrong I missed the start apologies is there a published article we can access on this topic as yet um so I know that uh ebony as you were going through um uh we saw some of your Publications at the start and so what I might do oh thank you Jesse I was going to ask Jesse so there we go um yes and
50:00 - 50:30 and the recordings are available on teams for the Frailty Nexus you can always go back um and have a look at them and I'm not sure if we've got a library on teams yet but that's something I know I wanted to start so we might um find some of your articles and pop them in there as well thank you uh says fantastic presentation so uh we do have six more minutes if there was any other questions I might ask one more um library is a great idea thank you um benignas and I were as we were doing
50:30 - 51:00 the little Handover we did have a chat um and we were wondering uh if you have any advice again another broad question for both of you but if you have any advice particularly uh not just for ecrs but clinicians as well who are kind of starting out in this area um and don't know I guess um how to connect to these communities or what kind of what are the most appropriate tools you know brand new kind of approach where's the best place to start um and that's a very big question but
51:00 - 51:30 yeah where you know where can people reach out to or where should they be researching themselves um to uh yeah connect with with people in the communities did you want to go great um I suppose in answering that question I'll reflect on um my experience um thank you working in Aboriginal community services so I I think as a as a starting point um you
51:30 - 52:00 you have to be very prepared to close your mouth and listen and look and and take advice and learn um I think it's really important to start off with cultural safety training as well uh that's something that all of us clinicians should be doing particularly if we're working with Aboriginal t St Islander people um and uh you know not just once off either because things evolve and knowledge changes too and so thinking about doing that periodically
52:00 - 52:30 you're always going to learn something more I think over the six years I've been at Aces my Approach has evolved to one of strength bace so starting out with my deficit discourse biased lens on I too was probably focused on trying to uh patch things I suppose and respond to problems rather than really listening and understanding and um and learning and developing trust particularly as a
52:30 - 53:00 clinician in this space uh we often represent things that have been an institution that have done a lot of great harm to ainal tourist St is of people um and so bearing that in mind many people won't necessarily trust us many of our patients more broadly don't necessarily trust us because great harms have been done in the past so you start with I'm starting to starting to get
53:00 - 53:30 feedback is that is that doubling up on your end no it sounds fine to me okay all right we'll see how we go um uh and so starting off with that knowledge that it's important to go with an open mind um and to learn is really really important and to develop that trust sitting down and having having a Yan listening and learning um and and really becoming part of um that person's care through run understanding the community in their context and not just individualizing
53:30 - 54:00 it thank you so much Davis just said it's my feedback so I'm I apologize if I'm now echoing um but yeah I think that was an incredible answer thank you so much um and we do have two more minutes and I don't want to go over time ebony did you have anything to add just to close off today no I completely agree with um what Jesse said and it's great to hear his um his experience as well well um but but if you uh if you needed um to find out
54:00 - 54:30 about cultural safety training or just say you weren't part of a hospital or a health network if you have a local AMS local Aboriginal um Community controlled Health Organization they should be able to probably steer you in the right direction as well um and health infonet um is quite a good resource um as well um for clinicians so that will go through different sort of tools and measures um and all the different yeah it's a good one to have a look
54:30 - 55:00 through amazing thank you so much um well thank you both again I can see wonderful comments coming through um in the chat just saying how um yeah interesting and fantastic and helpful this was today uh so with that I'll draw the meeting to a close um and say goodbye and enjoy the rest of your afternoons everyone thank you thanks for having us have a great holiday thanks for having us thanks Jesse yeah thank you bye bye
55:00 - 55:30 by
55:30 - 56:00 e
56:00 - 56:30 e
56:30 - 57:00 e
57:00 - 57:30 e
57:30 - 58:00 e
58:00 - 58:30 e
58:30 - 59:00 e
59:00 - 59:30 e
59:30 - 60:00 e
60:00 - 60:30 e
60:30 - 61:00 e
61:00 - 61:30 e
61:30 - 62:00 e
62:00 - 62:30 e
62:30 - 63:00 e
63:00 - 63:30 e
63:30 - 64:00 e
64:00 - 64:30 e
64:30 - 65:00 e
65:00 - 65:30 e
65:30 - 66:00 e
66:00 - 66:30 e
66:30 - 67:00 e
67:00 - 67:30 e
67:30 - 68:00 e
68:00 - 68:30 e
68:30 - 69:00 e
69:00 - 69:30 e
69:30 - 70:00 e
70:00 - 70:30 e
70:30 - 71:00 e
71:00 - 71:30 e
71:30 - 72:00 e
72:00 - 72:30 e
72:30 - 73:00 e
73:00 - 73:30 e
73:30 - 74:00 e
74:00 - 74:30 e
74:30 - 75:00 e
75:00 - 75:30 e
75:30 - 76:00 e
76:00 - 76:30 e
76:30 - 77:00 e
77:00 - 77:30 e
77:30 - 78:00 e
78:00 - 78:30 e
78:30 - 79:00 e
79:00 - 79:30 e
79:30 - 80:00 e
80:00 - 80:30 e
80:30 - 81:00 e
81:00 - 81:30 e
81:30 - 82:00 e
82:00 - 82:30 e
82:30 - 83:00 e
83:00 - 83:30 e
83:30 - 84:00 e
84:00 - 84:30 e
84:30 - 85:00 e
85:00 - 85:30 e
85:30 - 86:00 e
86:00 - 86:30 e
86:30 - 87:00 e
87:00 - 87:30 e
87:30 - 88:00 e
88:00 - 88:30 e
88:30 - 89:00 e
89:00 - 89:30 e
89:30 - 90:00 e
90:00 - 90:30 e
90:30 - 91:00 e
91:00 - 91:30 e
91:30 - 92:00 e
92:00 - 92:30 e
92:30 - 93:00 e
93:00 - 93:30 e
93:30 - 94:00 e
94:00 - 94:30 e
94:30 - 95:00 e
95:00 - 95:30 e
95:30 - 96:00 e
96:00 - 96:30 e
96:30 - 97:00 e
97:00 - 97:30 e
97:30 - 98:00 e
98:00 - 98:30 e
98:30 - 99:00 e
99:00 - 99:30 e
99:30 - 100:00 e
100:00 - 100:30 e
100:30 - 101:00 e
101:00 - 101:30 e
101:30 - 102:00 e
102:00 - 102:30 e
102:30 - 103:00 e
103:00 - 103:30 e
103:30 - 104:00 e
104:00 - 104:30 e
104:30 - 105:00 e
105:00 - 105:30 e
105:30 - 106:00 e
106:00 - 106:30 e
106:30 - 107:00 e
107:00 - 107:30 e
107:30 - 108:00 e
108:00 - 108:30 e
108:30 - 109:00 e
109:00 - 109:30 e
109:30 - 110:00 e
110:00 - 110:30 e
110:30 - 111:00 e
111:00 - 111:30 e
111:30 - 112:00 e
112:00 - 112:30 e
112:30 - 113:00 e
113:00 - 113:30 e
113:30 - 114:00 e
114:00 - 114:30 e
114:30 - 115:00 e
115:00 - 115:30 e
115:30 - 116:00 e
116:00 - 116:30 e
116:30 - 117:00 e
117:00 - 117:30 e
117:30 - 118:00 e
118:00 - 118:30 e
118:30 - 119:00 e
119:00 - 119:30 e
119:30 - 120:00 e
120:00 - 120:30 e
120:30 - 121:00 e
121:00 - 121:30 e
121:30 - 122:00 e
122:00 - 122:30 e
122:30 - 123:00 e
123:00 - 123:30 e
123:30 - 124:00 e
124:00 - 124:30 e
124:30 - 125:00 e
125:00 - 125:30 e
125:30 - 126:00 e e