Assessing the mental health needs of older people
Depression is a state of low mood which in some individuals can be moderate and in others severe and prolonged. There appears to be a complex interaction between external events, inner stresses, genetic predisposition and biochemical changes in the brain, which is not fully understood. People of all ages can experience depression. Risk factors include:
- social isolation
- pain and physical illness
- multiple adverse events or change in circumstances
- family history or past episodes of depression
- alcohol abuse.
Depression is the most common mental health problem of later life, affecting 10-20 per cent of older people (National Institute for Mental Health in England 2005) (12) and up to 40 per cent of care home residents, yet in older people depression is often under-diagnosed and under-treated. Older people in residential and nursing homes are two to three times more likely to experience depression than older people in the community. (13)
Older people tend not to complain of being depressed, they are more likely to refer to physical symptoms, and some symptoms of physical illness are similar to those of depression. Physical illness is also a common trigger for depression in older people.
The most common symptoms of depression are:
- a pervading feeling of sadness
- a loss of interest in life and inability to take pleasure in things
- tiredness and sleep problems
- loss of appetite
- poor concentration and memory
- anxiety and agitation
- feelings of guilt and worthlessness
- thoughts of suicide.
Depression causes great mental distress and affects a person's ability to function day to day. When untreated, depression shortens life, exacerbates disability from medical illnesses, increases health care costs and is the leading cause of suicide among older people. When treated, quality of life improves (National Institute for Mental Health in England 2005) (14).
Suicide is a significant risk for older people who are depressed. Older people are less likely than younger people to talk about suicide, but more likely to carry it out (Help the Aged 2004) (15). Older men aged 75 and over have the highest incidence of suicide - 11 per cent higher than the rates for all males aged 15 and over (Samaritans 1998).
Make sure that you always consider the risk of suicide in an older depressed person.
For more information, see:
- Depression is the most common and most reversible mental health problem in old age.
- Older people and professionals tend to underestimate the significance of late life depression.
- Risk factors for depression in later life
- other life events such as the onset of illness or disability
- financial crisis
- being a victim of crime
- moving accommodation
- illness of or separation from a loved one
- poor social support and loneliness
- lower socio-economic status.
- Older people, and older men in particular, comprise a higher percentage of 'completed' suicides.
For more information on depression, see:
Reducing social isolation and tackling depression
RISE An initiative of REGENERATE.com is based on a large housing estate in a Neighbourhood Renewal area in SW London. The project aims to improve the mental and emotional well-being of isolated older people through a programme of health promotion. Clients enjoy regular visiting, outings, transport to the Lunch Club, care, support and social interaction. Referrals are from a network of health and social care providers. RISE began as a response to the awareness of isolated older people in the community and the project was identified as an example of positive practice in the King's Fund's paper Promoting Health, Preventing Illness (2002).
The benefits of RISE are summed up by the words of a service user: I no longer feel like I have to look at the same four walls, I am enjoying travelling, making friends and enjoying living again. Initial evaluation results show a positive impact on mental health and well being, reducing social isolation, increasing social contact and support and sense of self and worth. For further information contact Jon Wilson at Rise - 020 8878 8648 - e-mail email@example.com.
Deal for Communities The West Ham and Plaistow New Deal for Communities programme aims to reduce the social isolation experienced by older people and to encourage active participation in the local community. The programme runs a variety of activities and services for people over 50 years. These include lunch clubs, Tai Chi, silk scarf painting, model making and flower arranging. The programme also provides practical help and support through the Safe and Secure Project, the Handy Man Services Scheme, the home visitation service and even the distribution of free fresh fruit and vegetables. Older people are also encouraged to share their skills and capabilities for the broader benefit of the community. The programme has been running since June 2003 and will be formally evaluated. Initial results however look promising in relation to increased participation and supporting individuals. For further information contact Edlynn Zakers, the Older People's Programme Co-ordinator at NDC Offices - 020-8586-9493 - email - firstname.lastname@example.org
Mood Project The Mood Project has been running for five years in West Lothian. It aims to identify older people (60+ years) at risk of depression and devise a range of resources to help and support them and to prevent institutional care. The project provides weekly groups to approx 60 people, each of whom has been interviewed personally before joining. The groups aim to raise self esteem and confidence and to support the development of friendships further. The groups include self help, specific interest groups, carpet bowling, music, photography, local history and carer support. The sample evaluation scores to date have been encouraging (using the Beck Depression Scale). The project is aiming to increase intergenerational work, such as working with schools.For further information contact: Robert Cook at the Mood Project - 01501-749974 - email - email@example.com