Reading minds and emotions
Understanding how social cues help us navigate society and our relationships is what drives Dr Michelle Kelly’s research into dementia and older people.
Neuropsychology explores how changes to the brain can influence our behaviours, which is where Michelle’s research is focussed. Michelle is currently researching how the brain changes that occur with dementia or traumatic brain injury (TBI) impact on a person’s behaviour. “After a change to the brain, basic tasks can become difficult – for example, some people can no longer draw simple items such as a clock. They’ll put the hands in the wrong places, or the numbers on the outside of the face,” Michelle explains.
However, there are also a number of personality changes that can occur with any kind of brain change, and this makes it very difficult not only for the person themselves, but for their families to manage. “Suddenly people are caring for someone who is not the person that they once knew,” Michelle says.
Quick switch to a life-long fascination
An interest in a career as an organisational psychologist rapidly morphed as Michelle realised that this field was more focussed on the success of the business, rather than the people. After studying her undergraduate degree Michelle then training as a Clinical Psychologist while undertaking a PhD in neuropsychology . Michelle had an interest in both the research and the clinical side: “I wanted to do both, which is not an easy thing. The degree is doable, but once you try to find a job that will allow you to do both, that’s quite hard.”
However, she persisted. After attaining her PhD Michelle worked closely with carers of people with dementia and continues to collaborate with researchers from the National Ageing Research Institute in Melbourne, UNSW and University College of London. Michelle also works closely with clinicians in public health settings, aged care service providers and not for profit organisations. This practical work inspires her research, and, vice-versa.
With researchers, there’s usually one pivotal event that sets off a career in research. Michelle’s interest in ageing and brain health was piqued while she was studying her Master of Clinical Psychology at UNSW. A guest lecturer (Deborah Koder) came to give a talk about the challenges of working with older people, declines in mental health and additional medical needs – and Michelle’s attention was immediately captured. And this fascination has continued to grow.
It was Michelle’s PhD supervisor, Professor Skye McDonald from UNSW, who inspired Michelle into exploring social skills after brain injury. “Skye is a neuropsychologist by training, but she’s a guru in looking at social skill changes in people who’ve acquired a traumatic brain injury, such as the inability to be able to recognise a facial expression or the inability to pick up on someone’s tone of voice when they’re being sarcastic or are angry.”
Michelle is now researching whether social skills can be relearned and is co-supervising a PhD student with Professor McDonald, and that student is looking at an intervention in social skills in traumatic brain injury. “We’re looking to address the fact that until now, we’re not actually doing anything in this area, aside from trying to encourage people who don’t have the social skills anymore back into social situations. As you can imagine, that’s quite anxiety-provoking and not very rewarding or successful.”
With continued mentoring from Professor McDonald, Dr Kelly is also now exploring these changes in social skills in people with dementia and impact this has on family members: “With dementia, people can lose the ability to be empathic, so you can imagine the impact on a friendship or a relationship. It can seem that they no longer care about how the other person is feeling. It’s a big, sudden change and it can be devastating for the person and the family and social relationships can fall away leaving the person at risk of social isolation.”
The loss of these social skills in people with dementia is an underexplored area. “There is increasing evidence about TBI and social skills, and also in schizophrenia and autism spectrum disorder, but with dementia, there’s very little research, and thus, very little evidence for how we should assess and treat these problems.”
Michelle and her team are working on developing an assessment tool using pictures of faces displaying a wide array of emotions to assess how well people with a diagnosis of dementia can read social cues on faces. “We rely on cues such as if someone smiles at us, it makes us feel good, and we know that they’re happy.”
Hopefully it’s tests such as these that will help clinicians determine a person’s level of social skills and this can then be relayed to the carer so they can maintain the relationship for longer. “If we can give the carer information about what’s going on with the person living with dementia, the carer can understand that it’s not a change in personality or that they’ve suddenly become an awful person, it’s merely a symptom of the illness. This could then hopefully help carers cope with the many and varied pressures of looking after someone living with dementia,” Michelle explains.
Caring for the carers
There are a lot of expectations on people caring for someone, it’s very physically and emotionally demanding. Michelle and her team are looking to provide a program to help carers deal with the emotional challenges of caring, which are on top of all the physical challenges. “There are many behaviours associated with dementia such as aggression or socially inappropriate remarks and behaviours that have an emotional toll on carers,” Michelle explains.
With an ageing population in Australia, the challenge will be to ensure that people living with dementia can have their needs met. It’s being increasingly recognised that if people are allowed to ‘age-in-place’, in their own homes, in a familiar environment, they have better quality of life. This is the next challenge we face: how do we best care for people with the nuanced changes that occur with dementia? Michelle’s research aims to provide one piece to help solve the puzzle.
Michelle is also collaborating with Dr Stefania Paolini on stereotyping and prejudice around older people. “Once upon a time the older person was the holder of all the knowledge and revered for this. However, now, with all that the internet can offer, young people are less likely to go to older people for their wisdom. As a result, we’re now seeing an undervaluing of older people as a group.”
Stefania and Michelle are exploring the way that we view older people, and how we can change that. Often the vision of an older person is someone who’s weak, frail and infirm – however, most people are actually quite healthy and are still very physically active.
One of the areas they’re exploring is to look at descriptive labels and how stigma can become attached to these labels. “This is something that’s happened right throughout the history of psychology, words really do hold a great deal of weight,” Michelle says.
“This is a new area of research that we’re exploring, to see how we can do little things to change the way that younger people view older people and to see if that will change the way that we value or devalue them currently,” Michelle says.