Lifting the barriers to mental healthcare for older people
New resources are tackling the stigma and social issues that restrict access to care
New resources are tackling the stigma and social issues that restrict access to care
Mental ill health is not an inevitable part of ageing, but for many older people it may feel that way.
Growing older can make people more predisposed to conditions such as dementia and delirium, while higher rates of social isolation and bereavement among this group leave individuals vulnerable to depression.
Access to care
Difficulty in accessing mental health support is a long-standing issue affecting older people. While Age UK found that nearly half of over-55s have experienced depression, the Royal College of Psychiatrists believes 85% of older people with the condition receive no help from the NHS.
To meet this need, NHS England has launched the website MindED for Older People, which provides accessible and reliable information about mental health for individuals and their carers.
NHS England national clinical director for dementia and older people's mental health Alistair Burns says the website produced in partnership with Health Education England is a ‘game changer’.
older people in the UK are chronically lonely
Source: Campaign to End Loneliness
‘It plays a crucial role in raising the profile of mental health issues in older people and providing information about their significance, and assessment and treatment options,’ he says.
Triggered by grief and debt
The website covers memory loss, depression, delirium, dementia, lack of sleep and loneliness among other issues and sets out how and where to seek advice and support, as many older people with mental ill health do not ask for help.
Age UK says that while numbers affected by mental health problems are not higher than for other age groups, older people receive much less support.
'Older people say healthcare professionals sometimes think a low mood or grumpy attitude is a natural part of ageing'
Tom Gentry, Age UK
The most common triggers for mental health problems are bereavement (36%), ill health (24%) and financial worries (27%) according to a survey of more than 1,600 people over 55 conducted by the charity last year. One in five of those who reported experiencing anxiety or depression said symptoms worsened as they got older.
Higher rates of medication use
Age UK senior health influencing manager Tom Gentry says older people are six times more likely to be prescribed tranquillisers or similar medication, but much less likely to access talking therapies or counselling. A 2016 report from the charity found only 6% of people using the Improving Access to Psychological Therapies programme were 65 and over, trailing well behind the 12% target set by the Department of Health.
Age UK was part of the consortium that developed the MindED for Older People site, which Mr Gentry says 'demystifies' some of the issues around mental ill health. He urges nurses and other healthcare staff to tackle stereotypes and stigma that may be barriers to people seeking help.
'Social isolation and loneliness affect quality of life'
Claire Nelson, consultant nurse for older people, Frimley Health NHS Foundation Trust
‘Older people say healthcare professionals sometimes think a low mood or grumpy attitude is a natural part of ageing,' he says. 'We want nurses to acknowledge when someone might have signs of depression.
'If they are planning care and don’t seem particularly engaged in decisions or the process, they may need additional support. Giving older people space to acknowledge they may have a problem, and there are things that can help, is important,’ adds Mr Gentry.
of older people with depression receive no care for the condition
Source: Royal College of Psychiatrists
Frimley Health NHS Foundation Trust consultant nurse for older people Claire Nelson says mental and physical health problems in older people are often bound together in a complex cycle.
‘When people think about mental health conditions, they mean depression and dementia, whereas the effect of social isolation on mental and physical health and quality of life is huge,' she says.
Other issues to be aware of include delirium, anxiety, alcohol abuse and psychosis.’
Frailty can be a significant factor in increasing social isolation, while social isolation and loneliness can contribute to frailty and increase its effect, Ms Nelson says. One in ten over-65s is living with frailty, rising to 25%-50% of those over 85.
'Don't go straight for anti-agitation or sedative drugs’
Wendy Mashlan, advanced nurse practitioner, Abertawe Bro Morgannwg University Health Board
To improve the mental health and well-being of older adults living with frailty, nurses can request or carry out a comprehensive geriatric assessment. This holistic approach assesses cognitive function, mood, anxieties and fears, and this can lead to an individualised care and support plan, says Ms Nelson.
Recognise the signs
In June, NHS England announced that people aged over 40 in England will be given advice on avoiding dementia as part of their free NHS health check. This followed its advice for primary care staff in Mental Health in Older People: A Practice Primer.
people have dementia in the UK, and that figure is set to rise to more than one million by 2025
Source: Alzheimer’s Society
Published last year, this covered taking a medical history and responding to depression, anxiety, bipolar affective disorder, psychotic disorders, delirium, personality disorders and alcohol problems. The guidance points out that older people are much less likely to volunteer information about mental health problems, partly because these issues become normalised in old age.
Lead advanced nurse practitioner for care of elderly medicine at Abertawe Bro Morgannwg University Health Board in Wales, Wendy Mashlan, urges nurses to recognise that issues related to ageing and mental health are different, and to be alert to those with delirium and dementia.
Delirium is a state of heightened mental confusion that comes on suddenly, particularly in older people, and requires a swift response. The RCN is running a campaign to train nurses and other staff to be delirium champions in recognition of the seriousness of the condition.
In tune with patients
‘Take a conservative management point of view rather than going straight for anti-agitation or sedative drugs,’ says Ms Mashlan. ‘It is about knowing your patient and taking a good history as soon as someone comes into hospital so that people can recognise if things are different from the norm.’
The older people’s ward where she works takes an innovative approach by offering beds specifically for patients with mental and physical problems, understanding how the two are intertwined.
These are for patients with problems such as dementia, delirium, challenging behaviour, severe depression and bipolar disorder. Only those with acute psychiatric conditions, who need acute mental healthcare, are excluded.
‘Where patients have not been managed in other parts of the hospital, they can come to our ward and within 24 hours things settle down,' says Ms Mashlan. 'We work very differently and are much more in tune with agitated patients.'
Loneliness is as damaging as smoking
There are nine million lonely people in the UK and 1.2 million chronically older lonely people, according to data from the Campaign to End Loneliness.
Loneliness has a major impact on mental and physical health and research shows a lack of social connections is as damaging to health as smoking 15 cigarettes a day.
Loneliness puts individuals at greater risk of cognitive decline, makes them more prone to depression and increases the risk of suicide in older age. A study in the Journal of Neurology, Neurosurgery and Psychiatry suggested lonely people have a 64% increased chance of developing dementia.
Being part of a community is key to keeping well. The NHS, charities and third sector organisations run events including exercise classes, lunch clubs and support groups.
One charity working to tackle the loneliness epidemic among older people is Contact the Elderly, which puts on free monthly tea parties across the UK.
The social events, which are offered to 6,000 isolated older people, are usually hosted on a Sunday by a volunteer in their home. Each guest is picked up by a volunteer driver, who accompanies them to the tea party and drives them home afterwards.
The charity's chief executive Meryl Davies says: ‘Breaking the cycle of loneliness can have a profound impact on health and well-being.
'We know how powerful our service is, as 95% of the older people we work with tell us our events give them something to look forward to, and 90% told us they’ve made new friends through our service.’
Erin Dean is a freelance health journalist