Assessing the mental health needs of older people
The importance of involving the older person fully in their assessment remains true for older people with mental health needs, but there may be particular difficulties which the assessor will need to take into account. Getting an accurate picture of the person, how they are coping and the needs they have may be particularly difficult because:
The experience of being assessed is likely to cause older people anxiety, and this is especially so when it appears that the assessor is looking for signs of cognitive impairment (see Research Summary 1 ).
- The stigma attached to mental illness may make it difficult for older people to acknowledge that they are having emotional difficulties or are worried about memory problems, for fear of being labelled 'senile'.
- Many older people fear that if they admit to finding it difficult to cope they will be 'put in a home'. Fiercely guarding their independence, they may insist they are all right and refuse all services.
- If depression has caused them to neglect themselves or their home, they may be reluctant for others to know this.
- Memory loss may mean they give a genuinely misleading account of what they can do, for instance assuring the assessor they shop and cook for themselves, forgetting that they have not performed these tasks for some while.
All this means that it is essential, in order to gain a fuller picture of the older person and any difficulties they may be experiencing, to get as much information as possible from others, including family and any other professionals involved. This information should complement and expand, not replace, what the older person has told you. It is important to explain to the older person that it will be helpful for you to get a fuller picture of their circumstances by talking to others who know them and have some involvement in their situation. Remember to get their permission to do this, and take seriously any concerns they may have.
Older people's lives and experiences do not fit into neat compartments any more than anyone else's do, and their needs frequently cross organisational and professional boundaries. The Single Assessment Process is intended to ensure that the older person experiences a co-ordinated approach. Practitioners working with older people are likely to be used to working alongside a range of colleagues from different health and social care disciplines and organisations, and will value the contribution of other professionals. Your local arrangements for the Single Assessment Process should include a procedure for obtaining the older person's consent to share information with other professionals. (For an example, see the Information Sharing Protocol produced by Solihull Metropolitan Borough Council, which has been adopted as a template by other West Midland authorities.)
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