Kotahitanga

Introduction

The second principle is Kotahitanga | Holistic Development

Looking at the holistic development of older people is a way to recognise the importance of supporting the many dimensions of their lives. This perspective emphasises that these needs are interconnected and supporting them can enhance overall quality of life.

Approaches to meeting holistic needs

The Eden Alternative

This approach seeks to improve the quality of life for older adults and those living with disabilities.

It emphasises creating a more person-centred and empowering environment by promoting companionship, meaningful engagement, and the opportunity for individuals to make choices and have a sense of purpose. The Eden Alternative focuses on combatting feelings of
loneliness, helplessness, and boredom by fostering close relationships, nurturing a home-like environment, and encouraging the participation of residents in decision making and everyday activities.

This framework for inclusive care was initially developed by doctors in the US in the 1990s and is now used all over the world, including in 20 not-for-profit or independent aged care homes in New Zealand. Although originally designed for aged care facilities, the Eden Alternative can also be adopted by people caring for family members at home.

Models for caring for those with Dementia Mate Wareware

There are a number of approaches (e.g. Spark of Life, Montessori for Dementia, Butterfly model of Care) used in Aotearoa by those caring for people living with dementia mate wareware, which focus on enhancing holistic wellbeing.

These prioritise a sense of connection between the resident and their carers (including their loved ones), creating opportunities for kindness, compassion, respect and joy, usually in group settings with trained facilitators. Outcomes seen by settings using this approach include positive changes in language and movement, reduction in distressed behaviour and falls, and an increase in resident, family and staff satisfaction.

Kaumātua Units

Kaumātua housing being available on marae is not a new thing but is becoming increasingly supported.

Funding is increasing to ensure a high standard of housing is available in a culturally supported context for kaumātua and kuia, although more will be needed in the coming years. Iwi building these units report there are benefits to the older people as well as to the community. It ensures that older people are supported within the context of te ao Māori and can also be a key part of their marae by being on-site to perform karakia, karanga and share their wisdom to tangata whenua and manuhiri.

A similar approach is being taken by a small number of care homes around the country too, working with local marae to provide supportive living with a kaupapa Māori approach, such as Whare Tiaki in Ōtautahi Christchurch – eight independent suites for people, supported by a kaiāwhina to provide meals and other assistance, as well as supporting each other.

At home activities

Project Village focuses on supporting Pacific aiga caring for their elders at home by providing activity bags and activity ideas which support holistic wellbeing by providing mental stimulation, movement, joy and connection through family time. Their ideas could be used by any family and are wide-ranging, budget-friendly, accessible and adaptable.

Therapies and Practices

There are many ways of engaging with older people, and ensuring their holistic needs are met. Below is a sample of some well-known approaches. Most of these do not receive funding to allow them to be accessed by everyone.

Diversional and Recreational Therapy

For older people living with poor physical, emotional, or mental health, therapy in the form of play and recreation can be powerful. Recreational therapy can help rebuild skills, improve mood, boost quality of life, and strengthen social connections. Recreational therapy uses leisure activities to help people with specific health conditions improve their skills, abilities, overall health, and emotional wellbeing.

Intergenerational Connections

There are numerous benefits of intergenerational connections for everyone involved and these connections are an integral part of many cultures around the world, including Māori, Pacific and Asian cultures.

Intergenerational living is not as common in Pākeha families so these connections can be more
difficult to sustain.

Two programmes which brought together older and younger people in New Zealand are Intergenerational Playgroups and Grandfriends.

• There appear to have been a few intergenerational playgroups around New Zealand during the late 2010s. These were when a group of babies and children, with their caregiver, would regularly visit care homes for their play times. It broadened social circles for all involved, providing joyful connections and bringing people out of their shells. Sadly, since the Covid pandemic it seems that many of these programmes no longer run.
• Grandfriends is a small charity which exists to link young families up with older people in their community, especially when they may not live close to their own family. These relationships are mutually beneficial and about creating genuine friendships to combat social isolation and loneliness.

Music Therapy

Music therapy and group singing has been found in some studies to be beneficial for older people, including those who have experienced a stroke or are living with dementia mate wareware.

Music can impact our emotions, cognition, and physical responses so music therapy works by engaging people in various musical activities, which can contribute to positive changes in their mental, emotional, and physical states. It can also provide an outlet for self-expression, reduce anxiety, improve mood, enhance communication and social interaction, and support cognitive function as well as motor skills development. Around 90 music therapists work in various settings around Aotearoa, and it’s estimated that we need over 250 to be able to meet demand.

Sporting Memories

This organisation is relatively small and quite new to Aotearoa but has been established in the UK for a number of years.

It runs facilitated group sessions, split into two halves of 40 minutes each, bringing together sports fans aged 50+ to reminisce about significant sporting moments in their lives as well as do some light physical movement. This provides a holistic approach to wellbeing through connection, belonging, fun and activity.

Robot animal companionship

A small robot in the form of a baby Canadian harp seal has been found to enhance quality of life for older people in aged care settings, including daytime dementia clinics. The PARO therapeutic robot can respond to touch and other stimuli (e.g. being held, patted, spoken to) by moving its head and tail, making soft noises and opening its eyes.

Studies by the University of Auckland in conjunction with the Selwyn Foundation showed that time with the seal robots resulted in older people feeling less lonely, depressed and agitated as well as being more communicative with their caregivers. Those attending dementia day programmes which included the robots had improved facial expressions and communication.
It’s important to note these results were in people that were not significantly cognitively impaired. These seal robots use advanced robotics, so therefore are very expensive and do not appear to be available to purchase privately in New Zealand. However, there are Joy For All Cats which are more basic robots and are available to provide companionship to people around
Aotearoa.

Companion Dolls

With many of the same benefits as robotic companion animals, the use of both static and interactive dolls has shown an increase in the wellbeing of older people. The dolls themselves can range from simple baby doll toys, to dolls with soft weighted bodies, through to dolls with simulated breathing and facial expressions.

In addition, specialist dolls such as the HUG provide research-backed wellbeing support through weight and sound. Like companion animals, cost varies greatly with the quality of the product.

Other Uses of Technology

In addition to robotic companions, technology is being used in a variety of ways to create devices and experiences for older people which enhance their wellbeing. These include an interactive screen wall called Multi-Ball which can be used to play different games and sport; a musical sensory cushion called inMU which is easy to hold and responds to touch and movement; and virtual reality experiences such as SilVR Adventures which foster connection, reminiscence and joy.

The high costs of these products mean they are most likely to be found within care facilities to be used with many residents

Clown Doctors

Although clown doctors are primarily known for their work with children, they also have success working with older people. Different from clowns you’d find in the circus, these clowns undergo specific medical clown training, which includes gerontology and health science, alongside performing arts. They use humour, playfulness, and therapeutic techniques to create emotional
connections, reduce stress, stimulate cognitive abilities, enhance communication, and promote a sense of joy.

This approach contributes to holistic, person-centred care for older people. Clown Doctors NZ are based in Christchurch and have worked with several aged care providers around the country, including previous work with the Selwyn Foundation.

Virtual Village

This initiative supports the idea of Ageing in Place (see page 27) as a way to connect older people to each other and also to services within their communities. It is about creating a village-like network of neighbours who support each other and have fun together. Members can enjoy a range of activities, services and events designed with older people in mind, which provide opportunities to enhance holistic wellbeing through physical activity, companionship, and trying new things. In New Zealand, Virtual Eastern Bay Villages – Te Kokoru Manaakitanga supports the community in Bay of Plenty, and Virtual Village East offers regular activities for older people in East Auckland to attend.

Virtual Village East is administrated by a local aged care facility but is open to all local residents. Unfortunately, these appear to be the only Virtual Villages currently operating in New Zealand.

Research

There is plenty of excellent New Zealand based research which helps us to understand the health, wellbeing, and social experiences of older people in New Zealand. These studies highlight the importance of addressing the diverse needs of this population, and developing policies and services that promote healthy ageing and social connectedness. They can also help people to understand their own needs to plan for personal healthy ageing.

Below is a summary of the research that we think is crucial to the sector, key to understanding the cohort, or simply too good not to share!

Longitudinal Studies

What is a longitudinal study?

These are projects in which researchers regularly and repeatedly observe participants to discover any changes which might occur over time.

LIFE AND LIVING IN ADVANCED AGE (LILACS NZ)

Conducted at: University of Auckland
Led by: Professor Ngaire Kerse

This longitudinal study follows a cohort of New Zealanders (both Māori and tauiwi) living in advanced age (80+) from 2010. Also known as Te Puāwaitanga O Ngā Tapuwae Kia Ora Tonu, this was the first study in the world to look at an indigenous population aged over 80 years old. This study has produced many reports and publications which delve further into the research.

Their findings were a key foundation of the Healthy Ageing Strategy (see page 24).

NZ HEALTH, WORK AND RETIREMENT STUDY

Conducted at: Massey University (Health & Ageing Research Team)
Led by: Professor Christine Stephens and Professor Fiona Alpass

This longitudinal study focuses on New Zealanders who are over 55 years of age and looks to understand which factors impact healthy ageing, including social (community), wellbeing (health) and economic (work / wealth). This work was previously known as the NZ Longitudinal Study of Ageing (NZLSA) which had limited funding from 2010 to 2015. This data is used to further explore many aspects of the health and wellbeing of older people in Aotearoa New Zealand. This is our key local study into the experiences of older people in the workforce.

Collections of Research

AGEING WELL SCIENCE CHALLENGE

Hosted by: University of Ōtago

This is one of 11 science challenges funded by the government to look into the big issues around
New Zealand over a decade to 2025. The Ageing Well Challenge explores ways to harness science to sustain health and wellbeing into later years in life across a broad spectrum of medicine, housing and social connectedness, including looking at these through a non-Western lens.

Specific Topics

NEVER2OLD EXERCISE PROGRAMME

This individualised exercise programme for people over 60 was originally created following a 69-yearold student’s project in the early 2000s at Auckland University of Technology. Initially focussing only on weight-training and improving balance and flexibility, over time it brought in other learnings around holistic wellbeing, including social connection. It was designed to be flexible, for those who had always been gymgoers as well as those who had never visited a gym
before.

This programme appears to only be offered in limited places now, but will likely have contributed
to other programmes on offer today such as GoldFit, through the YMCA.

SPINPOI

The benefits of poi for older people were researched in 2018 by Dr Kate Riegle van West at the University of Auckland. The study found that the group who had followed the poi exercises had improved balance, upper limb strength and range of motion, memory and blood pressure. Dr van West now runs SpinPoi as a social enterprise which aims to improve the health and wellbeing of older people throughout the world.

SpinPoi classes are offered throughout New Zealand.

COGNITIVE STIMULATION THERAPY – CST

CST is a treatment for those with mild to moderate dementia mate wareware which involves group-based activities and discussion. It does not involve any medicines. This therapy was developed in the UK and is backed by extensive evidence showing how it can improve memory as well as quality of life, and is used in 23 countries around the world, including New Zealand.

HAUMANU WHAKAOHOOHO WHAKĀRO – MĀORI

This is an adaptation of CST specifically for Māori, developed by Dr Makarena Dudley from the University of Auckland and launched in March 2023. It ensures that CST programmes within Aotearoa are part of te ao Māori and follow tikanga Māori in order to be able to support as many people living with dementia mate wareware as possible.

THE RONNIE GARDINER METHOD (RGM)

This practice, created by jazz musician Ronnie Gardiner, is a multi-sensory exercise method for the brain combining rhythm, music, verbalisation and movement in order support both the brain and the body. It has had a variety of successes worldwide with older people, particularly for those living with neurological conditions such as stroke or Parkinson’s Disease. It is still a relatively new offering in New Zealand – there are approximately 30 RGM practitioners working in Aotearoa, mostly in aged care settings, although public classes are also available in a few areas around the country.

LONG-TERM INSIGHT BRIEFING (LTIB) FROM THE
MINISTRY OF HOUSING AND URBAN DEVELOPMENT

These documents are designed to help people understand what trends are being seen in a particular area, what risks and opportunities these trends bring, and how the government might respond. This particular Briefing was released in 2022 and focusses on how Aotearoa’s ageing population will impact the future of housing and communities.

It found that what was needed was more affordable housing, different choices other than renting or owning a home (such as co-housing, shared equity co-ownership and papakāinga), more accessible houses, and age friendly design of communities.

One of the main contributors to this is that as the proportion of older people in society increases over the next few decades, so too will the proportion of people who do not own their home, placing many older people risk of becoming homeless (due to housing insecurity, unsuitability or affordability) or having to leave their community in order to have a roof over their head. This
is happening to some people now but will happen to far more people in the coming years if the changes suggested by HUD as part of this document do not happen.

HOUSING

One of the research areas of the Ageing Well Science Challenge looks at housing for older people. One of their recommended approaches to transforming the housing market is to look into options such as co-housing and urban papakāinga (an ownership model where whānau own their house which is on iwi-owned land).

Office for Seniors

The primary advisor to the Government on issues affecting older people, Office for Seniors (see page 21) is able to facilitate research, support pilot schemes and create strategies, all with the aim of improving the lives of older people in New Zealand.

This includes:

• core government strategies in this area including the Better Later Life Strategy and Age-Friendly Communities Aotearoa
• key reviews of social impacts for Older People including the Attitudes on Ageing report, and Older People Experiencing Vulnerability and Multiple Disadvantage in New Zealand report
• the Homeshare Pilot which sees older homeowners be matched with another adult who lives with them in exchange for helping out around the house
• Research about and support for older people continuing to work such as The Business of Ageing report, Senior Enterprise pilots which support older people to create their own businesses
• the Older Worker Employment Toolkit to support workplaces to employ older people
• Digital Inclusion training around the motu.

Weaving in the strands

Mana Whenua | Belonging

A sense of connection to where you are

Looking at older people’s needs in a holistic way helps to maintain a sense of belonging and connection to those around you. By focussing on what is important to older people beyond their physical health, they are more supported to remain part of their communities, continue to be a part of their workplace, and connect with others with similar interests (for example people who like to sing in a group, or spin poi, or fix things).

Mana Atua | Wellbeing

Spiritual, physical and mental wellbeing

Holistic development research continues to show how important it is to nurture the whole person in order to enhance quality of life.

Mana Tangata | Contribution

Feeling a sense of purpose and being of value to your community

Schemes such as intergenerational playgroups and kaumātua units as well as support to ensure older people can continue to work and volunteer in ways which suit them foster a sense of purpose and giving back to your community.

Mana Reo | Communication

Understanding others and being understood

Adopting a person-centred, whole-self approaches means that those working with older people will be looking at different ways to listen to them and understand their needs. The recent longitudinal studies in NZ have provided data on older Māori people’s ageing experiences for the
first time which has led to culturally inclusive ways of communicating being explored as well.

Mana Aotūroa | Exploration

Continuously learning to discover new possibilities

Providing opportunities for older people to continue to learn and grow is vital for the overall wellbeing. This may be through work training, classes, hobbies or intergenerational schemes and relationships. This strand also refers to the importance of continued funding for more research in this area.