Assessing the mental health needs of older people

Mental health and emotional well-being are as important in older age as at any other time of life. Many people fear growing older and assume that growing old is depressing and distressing, characterised by loss and disability, offering little to look forward to. But the reality is that older people are as capable as younger people of enjoying life, taking on challenges, coping with difficulties, engaging in satisfying activities, supporting each other with warmth and good humour, and making a real contribution to their families and communities.

For health and social care professionals, who often meet an older person for the first time during a crisis, it can be hard to keep in mind the positive picture. Low expectations about life quality for older people are widespread among service providers, assessors and older people themselves. However, this is age discrimination, which leads to poor service responses and the social exclusion of older people. Assessment should focus on a person’s strength as well as their difficulties.

Assessing the mental health needs of older people requires the same skills as any other assessment, and is based on the same principles of a person-centred approach and the individual’s right to high standards of assessment and services. People with mental health needs may be more vulnerable, more anxious, more confused, and perhaps have a history of being dismissed as mentally ill. You can help by adopting the same approach as you would to anyone else, by being open, honest, respectful and empathetic.

Evidence

The Department of Health estimates that perhaps 40% of older people seeing their GP, 50% of older people in general hospitals, and 60% of care home residents have a mental health problem. Depression is the most common and most reversible mental health problem in later life, followed by dementia. It is estimated that there are 700,000 people with dementia in the UK, supported by about one million carers.

There is a tendency for older people’s needs to be defined by professionals rather than by the older people themselves. Older people don’t necessarily value the same aspects of an assessment as professionals.

Although there is a substantial literature on mental health in later life, much of it has been driven by researchers and comparatively little has been based on the views of older people themselves. Nevertheless, there is consistent evidence that having a role, good social networks, an adequate income, and living in a supportive neighbourhood are important factors contributing to sound mental health in later life.

Older people are an increasingly diverse group and current research now emphasises the need to look at how mental health is influenced by the interaction of factors such as gender, socio-economic status, and ethnicity. However, despite advances in our ideas about the process of ageing, older people themselves still experience discrimination and older people with mental health problems remain a stigmatised group.

Further information

● SCIE’s Practice guide 2: Assessing the mental health needs of older people
● Dementia – Supporting people with dementia and their carers in health and social care, a joint publication from the National Institute for Health and Clinical Excellence and the Social Care Institute for Excellence
● The Alzheimer’s Society
● Help the Aged
● Age Concern
● Carers UK
● The Princess Royal Trust for Carers