Assessing the mental health needs of older people
Good communication is at the heart of assessment: listening carefully and understanding what is said, what is felt and what is helpful are essential skills for an assessor, as is the ability to explain clearly what you are doing and why. At assessment the individual and their carers are likely to be dealing with a completely unknown professional, who may not expect to have long or regular contact with them. Good communication skills are particularly important in these situations, and when the older person may be anxious, inhibited, depressed or confused, or have impaired memory or speech.
Dementia, depression or any other form of mental illness may affect an individual's capacity to communicate, but the older person will still have opinions, preferences, and the capacity for feelings and emotions.
Sometimes you find carers surprised that you want to talk to their elderly relative with dementia - showing that you expect some communication - and how you go about it can model something for those carers.(Social worker)
You may be anxious about how to assess someone who appears confused, or has been diagnosed with dementia. The mental health problems of older age, including dementia, mean we have to use imagination and skill to communicate effectively with older people if their needs are to be understood.
Slow down, explain carefully, find out about the person's life, let them take the lead, listen carefully.
Good practice in communication with older people emphasises the need to work at a pace that suits the older person:
- Assessors should be mindful of the physical frailty of some older people, who tire easily. This may mean 'little and often' contact is the best means of ensuring the assessor understands the older person and makes himself or herself understood in turn.
- Take time to build up trust. Develop a rapport over several visits.
- At each visit, remind the person who you are and what you talked about last time. Take time to talk around the situation don't hurry.
- Do not try to move the person on faster than they can cope with.
It is important to ensure that working practices in your team or unit allow for this slower pace when required. For many practitioners, the volume of work dictates rapid assessments through one-off visits, with little opportunity for follow-up or continued involvement. Services resulting from the assessment are likely to be provided by another organisation or section, with responsibility for monitoring and review passed to someone else again. Working with older people with mental health needs may require you and your colleagues to think through how your working practices can be adapted to enable you to conduct assessments appropriately and effectively.
In many localities, the introduction of new assessment forms to support the Single Assessment Process and the introduction of electronic care and health records has involved major changes for staff. In some places the work involved in implementing standard assessment documentation across organisations has deflected attention from the core purpose of the Single Assessment Process, which is not about more or different paperwork or computer systems but about changes in practice and organisational culture which put the older person at the heart of decision making.
An assessment form is the record of a complex activity, not a substitute for it. So aim to have a conversation with the person you are assessing in order to find out how to help, and use your organisation's agreed assessment format to record the essence of that conversation.
Below is an experienced practitioner's advice on how to have a conversation on a 'cold call', when first visiting a confused older person who lives alone:
- You need to invest time in the beginning: it's all about building up a relationship. You may get a lot of suspicion, and some people are very vulnerable - they open the door and think you're a relative.
- Always stress who you are and what your job is.
- Keep the contact short and gauge the response you get.
- Cars passing, clocks chiming, can all completely distract the person. Physical and eye contact can help, especially when something is distracting.
- You have to get inside the attention bubble - whatever gets you on the same wavelength. You may only get information from spontaneous comment.
- Singing a song together can be a great way of getting on.
- If they start talking to you, let them carry on.
- Don't finish sentences; don't provide words; don't rephrase your question when they're struggling to answer.
- However bizarre the message may seem, it's a communication. You'll get the meaning from tone, expression, and mood as well as from words.
- Make short daily contacts: often on the third or so visit you'll be familiar and accepted.
- Get an idea what makes them tick - what point in their lives are they talking to you from?
Next: Understanding dementia