Working alongside tāngata whai ora

Aotearoa context

Engagement

Creates a comfortable environment where older people feel at ease to share information and experiences. 

Demonstrates respect for older people by fostering honesty and hope. 

Takes additional time with older people to understand and validate their strengths, needs, experiences, and history. 

Explores concerns that may affect older people’s engagement. For example, self-stigma, ageism, loss of independence, connection with dependant whānau, connection to their home, or access to services. 

Recognises older people’s worldviews are shaped by their diverse life experiences over time, which can influence their engagement. 

Discusses topics sensitively, free from judgment, and recognises some topics may be considered intrusive or disrespectful in some cultural contexts. For example, substance use, sex, and sexuality. 

Clearly communicates challenging or difficult information while conveying realistic hope for the person.

Accessibility

Recognises possible physical barriers to accessing support for older people. For example, transport, disability, and limited mobility. 

Acknowledges potential communication barriers to accessing support and provides appropriate resources. For example, access to interpreters, augmentative and alternative communication (AAC) tools, easy read and visual aids for older people with language differences, cognitive challenges, hearing impairments or other disabilities. 

Supports the creation and maintenance of safe, accessible, and age-appropriate environments in older people’s mental health and addiction services. For example, ensures spaces are designed to reduce stress and confusion, and accommodate mobility and sensory needs. 

Where appropriate, collaborates with specialist, community, or social services to assist older people to overcome barriers to accessing support.

Stages of aging

Recognises the significant impact transitions and losses can have on an older person’s wellbeing. For example, changes in social or whānau roles, place of residence, loss of independence or social connections. 

Discovers what wellbeing means to older people as they transition through different stages of aging. 

Recognises the level of support needed by older people can differ over time and for each person. 

Recognises that supporting older people includes whānau (when appropriate) as they adapt to significant life transitions.

Spirituality, wairuatanga, and religion

Acknowledges the significance of spirituality, wairuatanga, and religion for some older people, and attentively listens to their beliefs and needs.

Engages sensitively when discussing spirituality, wairuatanga, and religion with older people, and recognises some older people may have had negative or traumatic experiences when engaging with religious organisations. 

Involves appropriate support as needed for spirituality, wairuatanga, and religion. For example, cultural support and services, kaumātua, or religious and spiritual leaders.

Sex and sexuality

Recognises the significance and changing nature of intimacy, sex, and sexuality for many older people. 

Recognises barriers to intimacy that older people may experience. For example, in settings where they are separated from their partners or due to impairments. 

Adopts a respectful, sensitive, and trauma-informed approach when discussing older people’s sexual health or sexuality. 

Understands sexuality can be fluid and older people may choose to express this in diverse ways, including those identifying in rainbow communities.

End of life

Understands end-of-life processes and acknowledges the varying needs of older people and whānau during this time. 

Discusses end-of-life with the upmost respect, sensitivity and compassion, and engages with appropriate cultural, religious, and community support if needed. 

Explores specific end-of-life concerns for older people. For example, whether their wishes for a preferred burial place will be respected by whānau and others, and the rights of partners from people in rainbow communities.

Technology

Recognises the value technology can have in enhancing older people’s wellbeing. For example, enabling connection with whānau, support networks, or tools such as smart watches to support independence. 

Supports development of older people’s data literacy and recognises potential risks, such as digital harm and scams. 

Uses or recommends technologies that support older people’s wellbeing. For example, telehealth services, apps, and medication reminders. 

Recognises barriers for some older people in using technologies and applies alternative strategies to mitigate impacts on access to health services.

Diversity

Works effectively with older people from diverse cultural, social and community backgrounds. 

Asks respectful questions rather than making assumptions. For example, based on gender identity, culture, age, disability, sexual orientation, and spirituality. 

Responds to older people with respect, validation, and recognises previous experiences of ageism, racism, homophobia, biphobia, transphobia etc. 

Understands barriers diverse groups might experience in accessing or engaging with support. Such as concerns about continued access to gender-affirming care or historical distrust of addiction and mental health services. 

Recognises the impact of generational social norms on older people, including social and legal changes they have experienced through their lives. 

Recognises older people may have a diverse range of emotions and worldviews about becoming older and some may not identify as an older person.

Kotahitanga including supported decision-making

Recognises and respects older people as experts in their own life and includes them in all decisions, whether they are present or not.

Supports older people to be active participants in decision making. For example, adapting information and processes to their current cognitive capacity. 

Recognises decision-making norms vary across cultures and is guided by older people and whānau (where appropriate) in determining decision-making approaches, roles and responsibilities, and engaging cultural support as needed. 

Involves identified whānau, Enduring Power of Attorney, or other trusted people where appropriate to support decision making. 

Ensures information is available in appropriate formats to make informed choices. For example, facilitating access to relevant communication aids and devices to support decision making. 

Ensures older people and whānau understand the purpose and process of informed consent, including rights, options, and potential risks or benefits. 

Balances maintaining a person’s safety, with positive risk taking, autonomy, and independence, and recognises some systems or whānau, may prioritise risk elimination over the person’s autonomy.

Assessment, planning, support

Assessment 

When applicable to the role, implements evidence-based screening and holistic assessment, using age and culturally appropriate tools, and involving whānau as required. 

Acknowledges assessments can be challenging for older people and whānau, and ensures assessment processes are clear, understood and respectful. 

Takes time to conduct assessments with older people. For example, allowing time for revisits or gathering additional information later when the older person feels more settled. 

Ensures older people are routinely screened for changes in physical health. For example, cognitive health, substance use, sexual health, pain and sensory impairments like hearing loss.

Considers all forms of abuse towards older people (elder abuse) in screening and assessment. This includes physical, emotional, sexual, financial, neglect, and psychological abuse. 

Ensures assessment outcomes are delivered in a timely, sensitive, and culturally appropriate manner. 

Understands suicide risks may present differently for older people, particularly in the context of declining health and wellbeing challenges. 

Responds in a culturally aware way in supporting tāngata whai ora who are feeling unsafe or at risk of suicide at different age stages. 

Complexity and overshadowing 

Recognises that a complex range of challenges can impact on older people’s wellbeing. For example, grief, loneliness, physical health and discrimination. 

Recognises that physical health factors can mimic or worsen mental health concerns and cognitive functioning for older people. For example, urinary tract infections, nutrition, sleep issues, dehydration, chronic pain, and medications. 

Recognises some mental health challenges can manifest as physical symptoms, such as anxiety or depression. 

Recognises cognitive impairments and intellectual disability, can mask, mimic or overshadow mental health concerns and substance use in older people. For example, dementia can mimic mental health challenges with symptoms such as anxiety and depression. 

Understands the concept of social frailty and its impact on mental and physical health. 

Cognitive capacity 

Understands the range and impact of cognitive impairments, which can change or reverse over time.

Understands the concept of mental capacity and implications for older people’s autonomy and decision making. 

Understands that psychological factors can worsen or mimic cognitive impairment. For example, loneliness, and post-traumatic stress disorder (PTSD) can look like dementia. 

Recognises problematic substance use can cause cognitive impairments. 

When applicable to role and indicated, uses appropriate tools to carry out basic screening for cognitive impairment, and seeks support to interpret results, and refers for comprehensive assessment when needed. 

Integrated support 

Works in an integrated way within multidisciplinary teams to support older people with multiple or complex needs. 

Demonstrates an in-depth understanding of the wider health, disability, social, and community sectors, and how older people's mental health and addiction services fit within these. 

Collaborates across health, disability, social, and community sectors to ensure continuity of care and holistic support for older people. 

Supports older people and whānau to understand and navigate the wider health, disability, and community sectors and systems where appropriate. 

As appropriate to role, provides consultancy to aged care facilities about the treatment and wellbeing of older people. 

Recognises when to refer older people for specialist assessment, specialist services, or specialist environments. 

Facilitates smooth transitions to different settings and minimises distress and trauma. For example, from losing one's home or independence.

Operates effectively in various environments, including care facilities and hospital environments, and recognises the unique challenges settings pose for both older people and the workforce.

Formulation and planning 

Recognises older people have developed many useful coping strategies over their lives and incorporates these into wellbeing plans, treatment, and support. 

Recognises the experiences and needs of older people who have faced mental health challenges and addiction earlier in life may differ from those who encounter these for the first time in older age. 

Recognises older people who develop a disability later in life may adapt differently to people with lifelong disabilities. 

Recognises when extra support may be needed to cope with natural life events and facilitates access to appropriate support. For example, from grief or loss. 

Uses holistic models of wellbeing (like Te Whare Tapa Whā) and understands how factors, such as social and community connectedness and physical activity, help prevent conditions like dementia and improve wellbeing. 

Works collaboratively with older people and whānau to identify and access meaningful activities that support their wellbeing. 

Understands factors influencing brain health, such as untreated hearing loss and substance use. 

When applicable to role, adapts and applies a range of best practice therapeutic approaches to support older people. For example, Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT). 

Understands age should not be the sole determinant of access to older person’s mental health services, as other factors impact the appropriateness of these services. For example, young onset conditions, cognitive function, and personal preferences.

Recognises many older people may choose to be supported by adult, rather than older adult services, and advocates for access to services people are most comfortable in. 

Medication and physical health 

Understands the importance of screening and monitoring physical health in older people, referring to specialist support when needed. 

Understands the purpose and risks of medications commonly prescribed to older people. For example, their typical side effects, potential for addiction, interactions with other medications or substances, and potential impacts on physical and cognitive functioning. 

If role appropriate, ensures older people and whānau understand all relevant information related to prescribed medication to help make informed choices. For example, risks, cost, right to decline medication. 

Understands older people may use a range of alternative, traditional, or non-pharmaceutical approaches to manage pain or overall health. 

Ensures older people have access to regular medication reviews. 

If within role scope, effectively measures and assesses physical pain in older people, referring for further specialist assessment as needed. 

Substance use 

Understands risks for older people in relation to substance use and the effects of aging on substance metabolism. For example, falls, self-neglect, elder abuse, lower mental and cognitive wellbeing, and impaired driving. 

Understands alcohol-related dementia can present in younger people. 

Understands the range of best practices to address addiction among older people, including gambling and behavioural addictions.

When indicated and applicable to role, screens for addiction using appropriate tools, seeking cultural or other support as required. 

Responds effectively and sensitively to addiction in older people and provides relevant information. For example, interactions between alcohol use and medications. 

Works in partnership with older people and whānau (when appropriate), to create harm reduction plans and facilitate access to appropriate support. 

Safety considerations 

Understands specific safety considerations for older people. For example, cognitive decline, prescribed substance misuse, poor medication management and review, social isolation, elder abuse, and the impact of falls. 

Collaborates with older people and whānau (where appropriate) to recognise, assess, and mitigate safety concerns. If role appropriate, uses relevant tools to support their safety.

Trauma-informed approach

Recognises older people may have additional needs and challenges when addiction and/or mental health challenges have significantly affected their lives. Such as experiencing homelessness or institutional care. 

Understands the cumulative effects of experiences and incorporates this understanding into health planning and support. For example, experiences of institutionalisation, abuse in care, strained whānau relationships, and trauma over time. 

Grief 

Understands the diverse types of grief and trauma older people may experience, including historical or intergenerational trauma.

Understands grief can stem from multiple cumulative losses and may have compounding effects. For example, from loss of loved ones, independence, jobs, mobility, housing, lifestyle, hobbies, or pets. 

Works sensitively with older people and whānau (where appropriate) to explore their experiences of grief and trauma, avoiding re-traumatisation, and acknowledging the impact on wellbeing. 

Understands specific bereavement and trauma support options and integrates this understanding into wellbeing planning. 

Elder abuse 

Understands abuse of older people can take various forms, including intimidation, neglect, and abuse. For example, institutional, emotional or psychological, financial, physical, and sexual abuse. 

Recognises older people may find it difficult to disclose abuse when perpetrated by someone in a close relationship with them and/or they rely on for support. For example, whānau or people providing services. 

Recognises signs of abuse, such as unexplained injuries, behaviour changes, withdrawal, or poor hygiene. 

Understands service processes for reporting abuse. 

Sensitively supports older people and whānau to seek appropriate professional support when needed. 

Least restrictive practices

Avoids labelling older people or their behaviour as difficult, instead seeking to understand what needs are being expressed. 

Uses best practice de-escalation techniques and least restrictive practices to safely support older people, seeking support where needed.