Assessing the mental health needs of older people
Information, advice and planning
Early and accurate diagnosis enables older people with mental health problems to benefit from improved medical treatment and support (see The main problems). It also provides older people and their families with the opportunity to understand the present and plan for the future. This may be particularly important for people with dementia. In the past, received opinion often saw little value in early diagnosis because it was thought nothing could be done, and because breaking news about a deteriorating condition for which there is no cure can seem cruel. Attitudes are changing, however, partly because of advances in drugs treatment, but also because individuals, and their families and friends, can benefit greatly from knowing what is happening to them. Research undertaken with people with dementia found that in general they wanted to know their diagnosis and were able to find positive ways of coping with it. (32)
Giving people accurate and timely information, and helping them to understand their diagnosis and make plans with their families, is a crucially important role for social workers and other professionals involved in Assessing the mental health needs of older people and is likely to be the first task in meeting needs.
I was diagnosed as having the early stages of Alzheimer's disease. While this was a terrible blow to both myself and my wife, we were glad to have been told so that we could discuss the possible effects on our lives and plan how we could adjust to the situation. I have made an Enduring Power of Attorney and a will. I think it is important for the partner of the person with dementia to be fully informed of the diagnosis and possible effects since the partner's life is affected quite dramatically also. Fortunately for me, my wife is an intelligent and caring person with a strong personality. We have had 54 very happy years together and she is most supportive.World Alzheimer's Day Bulletin, 21 September 2001 © Alzheimer's Society
It is important for assessors and care managers to aim to be well informed themselves about the sorts of conditions older people might experience and what might help, and to have access to clear information which they can share with older people and their families. The sorts of information that older people and their families are likely to require include:
- up to date information about symptoms, diagnosis, prognosis and treatment options
- services available locally and how to access them
- the availability of local support groups and sources of information and advice.
Increasingly, access to information is available from the websites of voluntary organisations and central government. Knowing where you can find information is useful for assessors. A number of sources are highlighted under 'Further information' in each page in Section 2.
Assessors and their agencies may also need to create sources of information for themselves, or for older people and their carers. An example is Cardiff 's Signpost magazine for professionals and care staff working with older people using mental health services.
Traditional social work skills such as counselling and helping people to face and cope with significant life changes also have critical importance. Many older people are reluctant to accept the need for intervention in their lives, and this can be particularly difficult for older people with mental health needs. Older people with depression may find it impossible to imagine that anything can be done to help their situation, while older people with dementia may not understand why help is being suggested. Many older people are faced with difficult decisions about whether they can continue to live independently. Some will be faced with the need to accept residential or nursing care, or a move to more suitable housing, while others will have the unwelcome prospect of accepting help from strangers coming into their home.
Older people with mental health needs may be particularly vulnerable and anxious in these situations, and may find it difficult to have their views and wishes properly taken in to account. Persuading older people to accept the help they need while maintaining their sense of autonomy and self-respect requires skill and empathy.
Mrs W had been persuaded to accept a regular home care visit as it was clear she was neglecting herself, but she found the visits irksome and could not see why she needed help. On a number of occasions she wrote to the Director of Social Services politely asking for the care to be withdrawn. On each occasion the social worker from the Community Mental Health Team for Older People came to see her and persuaded her to continue. He understood and sympathised with her irritation, but he also knew from previous discussions with her that it was important to her not to feel a burden on her family. He was able to convince her that the home care visits stopped her family worrying about her, and she was prepared to accept them on this basis. Gradually the home carers became trusted by Mrs W, and as her needs increased the social worker was able to increase the visits.
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