Assessing the mental health needs of older people

Assessing the needs of carers


Many older people with mental health needs receive help from a family member or friend. It is estimated that three quarters of older people with moderate to severe dementia living in the community have a family carer. Looking after another person affects people's lives in many and various ways. Support to carers needs to reflect individual differences.

Key research findings

For a more detailed account, see Research summary 5 (443kb PDF).

Issues to consider

Carers are often in an invidious position: families are assumed to be the people in the best position to protect an older person's interests, but they do not often have a clear legal mandate to act on behalf of the older person. At present, Enduring Power of Attorney only covers financial and property matters, not decisions about health, care and well-being, although this will change with the implementation of the Mental Capacity Act. Some carers are powerful advocates for their relative's right to live independently in their own homes; others do not want to see their relative exposed to risk and feel they should persuade the older person to accept the 'safe' option of residential care. Relationships between older people and their carers are not always positive, and occasionally there are conflicts of interest between the carer's wishes and the older person's best interests. Some older people are abused by their carers.

Relationships between carers and professionals are not always straightforward, either. Sometimes professionals take a negative view of carers, seeing them as putting their own interests before that of their relatives. At other times professionals may get drawn into acting on behalf of the carers rather than the older person, ignoring the older person and communicating directly with carers. This is more likely to happen where there are communication difficulties with the older person.

Practitioners' responsibilities will be primarily to the older person with mental health needs, but it is in the interests of the older person that the enormous contribution made by carers, often at considerable cost to themselves, should be acknowledged and supported.

There may be particular stresses associated with caring for someone with mental health needs, for example:

Case example An older man with dementia being cared for at home by his wife would regularly climb out of the windows or call out to passers by that his wife was keeping him prisoner in the house. This caused his wife extreme distress. Not only did she have to deal with the impact of her husband's lack of trust and the practicalities of making sure he came to no harm; she was also afraid that her neighbours might think she was mistreating him.

What you can do as a practitioner

Further information for practioners and carers

For more information on policy and legislation relating to carers, see Section 8.

Further information

The following organisations provide information on caring and services available:

Fordementia www. fordementia .org. uk offers advice to family carers through a helpline: Admiral Nursing Direct, freephone 0845 257 9406: an Admiral Nurse is available to give advice on services available, and Uniting Carers for Dementia is a national network of family carers, who are prepared to speak about their experiences and make a difference to the lives of other carers and the people they care for.

Leeds City Council Social Services Department have produced a video portraying the types of community-based and statutory services that can be accessed by carers and service users from black and minority ethnic communities.