Assessing the mental health needs of older people
Other mental health problems
A small number of older people enter old age with enduring or relapsing mental illness, for example, schizophrenia or bipolar disorder. An even smaller number develop these disorders in later life.
Schizophrenia is a serious psychiatric condition, characterised by disordered thinking, hallucinations and delusions, apathy and social withdrawal. Paraphrenia is the name given to a form of schizophrenia with its onset in later life. Older people with schizophrenia often have often had the condition throughout their adult lives.
Bipolar disorder (manic-depressive illness) leads to severe mood swings, from severe depression to extreme elation. Some of the symptoms include:
- excessively 'high' mood
- decreased need for sleep
- increased energy
- increased talking and activity
- racing thoughts
- being easily distracted
- having grandiose notions
- an impaired ability to make decisions.
It is unusual for this illness to start for the first time in later life, but it requires medical treatment at whatever age symptoms occur.
The Royal College of Psychiatrists has highlighted the lack of attention given to older people who enter old age with enduring or relapsing mental illness. Such people are 'graduating' from services for people of working age to services for older people, and are often neglected by both (18). The Royal College states that many 'graduates' will continue to exhibit symptoms, and some may be suffering from the effects of long-term medication. People suffering from major psychiatric illnesses are also likely to have poor physical health and to have an increased risk of early death. Some will develop additional psychiatric problems in later life, such as dementia.
Whereas once these patients would most probably have been inpatients in long-stay psychiatric hospitals, most now live in the community in a variety of settings. Many are socially isolated and have lost contact with their families through years of illness.
The Royal College recommends that the point of transition from working age to older people's services should provide the opportunity for a review of the treatment and care needs of the individual, to include an assessment of their physical health, accommodation, need of support for activities of daily living and carers' needs.
The number of older people with long-term mental health problems or intellectual disabilities is set to increase.
For more information on other functional mental illness and older people, see the following websites: