Assessing the mental health needs of older people
Assessment tools are standardised systems that help to identify and gauge the extent of specific conditions and provide a fair approach in response. They can be the means whereby individual and particular assessments contribute to the overall picture. They can provide systematic information on the needs across client populations and target resources. Tools include scales, checklists and interview schedules. They must be culturally sensitive, reliable and valid if they are to inform professional judgement. The use of standardised measures in current assessment practice is rare, but is increasing with the introduction of the Single Assessment Process.
Research into the use of standardised measures (28) suggests that when assessments do not include measures to screen for cognitive impairment and depression, their existence may be missed. This reduces older people's chances of being treated appropriately, and may also reduce their quality of life. High levels of cognitive impairment and untreated depression have been found among people in residential and nursing homes, among users of community care services and among home care clients. It should also be remembered that, just because a person has had a particular diagnosis, this does not rule out the existence of other, additional, problems. National guidelines suggest that people with dementia should also be assessed and monitored for depression and anxiety.
Two of the most common screening tools used for identifying dementia and depression in older people are the Mini Mental State Examination, which tests memory and cognitive skills, and the four item Geriatric Depression Scale. Some health and social care organisations have included these, or adaptations of them, in their Single Assessment Process documentation.
'But it is important to recognise that these measures are only one element of good assessment practice, and that they do not diagnose dementia or depression, but merely indicate their possible presence.
For more information on communicating with people with dementia, see SCIE Research Briefing 'Aiding Communication with People with Dementia'
The key point here is that these scales add to, rather than replace, other salient pieces of information upon which decisions about access to treatment or care are based. Alone, they are not sufficient to establish the content of need.'
(Cordingley et al. 2001)
For more information about using assessment scales, see the Department of Health guidance and Standardised assessment scales for elderly people (29), a joint report by the Royal College of Physicians and the British Geriatric Society, based on their members' experience.
For a summary of the Social Care Workforce Research Unit review of the use of standardised measures, see Assessing the mental health needs of older people .
The Alzheimer's Society produces a useful information sheet on the Mini Mental State Examination for people with dementia and their carers.
Jo Moriarty (2002) Assessing the mental health needs of older people: Systematic review on the use of standardised measures to improve assessment practice, London: Social Care Workforce Research Unit.
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