Assessing the mental health needs of older people

Getting the basics right


Don't make assumptions, do address the basics.

It is important to keep an open mind when assessing someone with mental health needs, and not make assumptions based on what others may have told you, or on your experience of other older people. Don't assume the person is confused because they have dementia - be open to other possibilities. Don't assume the older person knows who you are or what you are talking about; think about how you might appear to them, explain everything carefully, and be prepared to do so again the next time you meet them.

Very often people with mental health needs, and their carers, have very low expectations. Don't assume that they don't want or need help just because they don't ask for help or they have difficulty articulating their wishes. They may assume that the sort of help they really want is not available, or would not be offered to them.

As in any assessment it is important to address the basics. For instance: how is their physical health? Are they physically ill? Can they see, hear, and understand you? Do they normally wear glasses, and if they have a hearing aid is it working properly? Are they fluent in English, or is an interpreter needed?

Case example

Mrs D was lethargic, not sleeping, not eating, feeling low and tearful, and not really connecting. The practice nurse thought she was depressed and was about to ask the GP for a prescription for anti-depressants when Mrs D happened to mention feeling a burning sensation when she passed urine. She was found to have a severe urinary tract infection.

It is important to know as much as possible about a person's physical state and any medication they are taking in order to properly assess their needs. Some illnesses result in confusion or low mood, which can lead to an inaccurate picture of how the person copes when well. Chronic pain, insomnia or anxiety may make it hard for the older person to concentrate. Medication may dull the senses. Some medication for long-term mental health conditions has severe consequences - for example some medication suppresses psychosis but may make men impotent and emotionally 'flat'. All these factors can make it more difficult to get an accurate picture of the older person and their needs.

Think about the effect of the environment they are in. Does the person feel safe? What about noise levels, lack of privacy, and possible distractions? If someone is in an unfamiliar environment such as a hospital, they may be confused and disoriented, and their confidence may be affected. This is especially likely to be the case if the admission to hospital was the result of trauma such as a fall or stroke, or if the person is still feeling ill.

Next: Communication skills