Assessing the mental health needs of older people
Treatment and recovery
Accurate diagnosis and early intervention is important for all forms of mental ill health in older people. There may be underlying physical conditions such as viral conditions or poor nutrition, and treating these can result in improved energy and mental state. Many symptoms of physical illness can be mistaken for mental illness, and physical conditions should always be considered first. For instance, conditions such as kidney infection, thyroid deficiency or a stroke can sometimes lead to 'dementia-like' symptoms; loss of appetite and disturbed sleep may be caused by heart disease or arthritis rather than depression. Extreme worry and agitation can make some older people appear quite confused, as can urinary tract infection.
- Early recognition of physical and psychiatric conditions can benefit the individual and avoid the use of inappropriate and disproportionate services.
- Early and accurate diagnosis of mental health problems enables older people and those caring for them to understand what is happening to them and to access appropriate treatment and help.
- Early and appropriate recognition and information lets individuals and their carers understand the present and prepare for the future.
There are treatment options for all forms of mental health problems in older people, and there is no reason for older people to be denied access to medication, or services such as counselling, which would be considered for a younger person. Even for conditions where there is as yet no cure, as with dementia, improvements in care and treatment are achievable and can make a significant difference to older people's quality of life.
'Recovery' and well-being approaches to mental health issues developed by younger adult service users and working-age mental health services are equally applicable to older people. 'Recovery' does not imply 'cure', but builds on the personal strengths and resilience of an individual 'to recover optimum quality of life and have satisfaction with life in disconnected circumstances'. (19) Recovery is about the development of coping skills, and about social inclusion, making it possible for people to have quality of life and a degree of independence and choice, even those with the most enduring and disabling conditions. See also Mental health and well-being - What you can do.
In the National Service Framework for Older People, Standard 7, the Department of Health makes it clear that an integrated mental health service for older people should encompass:
- promoting good mental health
- the early recognition and management of mental health problems
- access to advice and treatment from specialist mental health services when needed.
Standard 7 also says that while in-patient admission may be indicated for severe mental illness, 'the emphasis should be on promoting the independence of older people with mental health problems and supporting them, and their carers, in the community wherever possible and practical.'
For more on the National Service Framework, Standard 7, see Section 8.
As part of the implementation of Standard 7, to increase awareness and the appropriate diagnosis of dementia and depression, Primary Care Trusts are expected to produce guidance for GPs on local care pathways for the treatment of older people with depression or dementia. These should include guidance on symptoms, risk factors, treatment options, and when to refer to specialist services.(20)
The National Institute for Clinical Excellence and the Social Care Institute for Excellence have produced joint guidelines for health and social care professionals on the identification, treatment and care of dementia.
Next: The assessment process