"The thing that is needed is an understanding of older people without ageism. It's probably the most important thing to make recovery real." Dr Rod McKay, psychiatrist Recovery into Practice forum, Sydney 2013
Read about HammondCare's Linden unit - a facility that runs on a person-centred philosophy that interferes as little as possible with residents' preferences.
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Getting older, wiser, freer and more able to cope with life’s ups and downs should be something we can look forward to. But it’s true that lots of changes occur as we age and some of those, such as retirement from work, changes in family life, social isolation and bereavement can have significant impacts on our physical and mental health.
We are in the midst of an unprecedented increase in the population aged 65 years and older. The fastest rate of growth is in people over 80. The steepest period of growth in the number and proportion of people aged over 65 will take place during the next 10 years.
And people’s needs at 65 will be different at 75 and beyond. From a positive perspective this offers the prospect of many more Australians living long and fruitful lives, a collective source of strength and capability.
Yet so far there hasn’t really been a focus on the mental health needs of older people. Everyone in the community, whatever their age, benefits when we have the right kinds of supports in place to let people age well. We need to rethink how mental health contributes to people living full and successful lives for as long as possible.
Who are we talking about?
More people are joining this journey as the average age of our population increases.
The experience of mental illness changes as people get older and can be very damaging, especially if someone also has physical illnesses or dementia.
People with a mental illness are more likely than the general population to have another significant illness, such as cardiovascular disease. The onset and severity of mental health problems, especially if drug and alcohol issues are also present, are likely to be compounded for people with underlying conditions such as a physical disability, brain injury, degenerative neurological illness or age-related cognitive impairment.
Though the prevalence of mental illness is markedly higher for people with a disability or impairment, they often have reduced access to support for mental health, and drug and alcohol issues.
People with pre-existing mental health problems who develop a terminal illness and need end-of-life care are possibly among the most under-represented and deprived populations in our society.
What is important for older people?
- A full life
- Care planning
- Early intervention
- Recovery focus
Why has it been so tough?
With resources stretched to breaking point we can’t seem to meet the needs of older people, focusing only on those with the most severe problems and often only once they are extremely unwell.
Our public hospital system often struggles to provide multidisciplinary care, comprehensive assessment, proper care planning, and follow-up monitoring and care. And people with mental health problems or illness may also have unmet social, housing, income and support needs.
Services often fail to engage with family and carers, so people’s needs go unrecognised and unaddressed, particularly in rural and regional areas. A heavy and sometimes intolerable burden falls on carers, affecting their own health.
People whose care and support have come through public mental health services may feel abandoned if responsibility for their care is handed over to residential aged care or other age-related services once they turn 65, or sometimes earlier. Therapeutic relationships established over many years can be forced to cease.
Our systems and services for people with disabilities tend to operate outside mainstream primary, community or hospital-based mental health support.
Having a disability or impairment often means reduced access to mental health or drug and alcohol misuse support. Availability and easy access to services for older people with mental illness are often lacking, and their complex needs are not being met by the mental health, general health, disability or aged-care sectors. For those over 85, who are at the highest risk of suicide, use of supports is even lower.
There is a paradoxical divide between mental health care and aged care which makes each the other’s lowest priority. Services that should be seamless across settings are commonly perceived to be someone else’s problem. Priorities don’t align, opportunities for co-ordination are lost and bad care often follows.
There are also questions over the use of antipsychotic medications in residential care. While people with dementia can exhibit aggressive, violent or socially inappropriate behaviour, there is growing concern that antipsychotics are being overused or used inappropriately for behaviour control.
Many palliative care units don’t have the facilities to ensure the safety of distressed patients or to manage difficult and challenging behaviours.
The research tells us
- Just over half, 52%, of all permanent aged-care residents had symptoms of depression about 87,000 people out of a population of 166,000
- 45% of people admitted for the first time to residential aged care from 2008 to 2012 also indicated symptoms of depression - about 160,000 out of a population of 235,000
- In that period, the proportion of newly admitted residents with symptoms increased by 21%
We need to help people manage the impact of disability, including long-term disabilities, or the cumulative effects of ageing on cognitive or physical health.
A key element in improving services for older people with mental illness is keeping the social bonds of family, friends – and more formal supports – intact.
This is because the continuing nature of most disability and cognitive impairment, combined with relatively unsupported mental health issues, can lead to a loss of hope, a loss of capacity to participate in the community, and reduced physical health. .By addressing mental health issues – particularly the impact of depression – and integrating mental health support with physical health care, we can help people to be more resilient, live longer and feel better in themselves even if their health is declining.
Partnerships among mental health, palliative care and wider social services can make things better for people who experience mental distress or illness at the end of their lives.
We especially need appropriate mental health care for older Aboriginal people, who tell us they require services that build relationships with their communities, respond flexibly to them, and are culturally competent.
"If we can ensure older people live healthier as well as longer lives ... these extra years can be as productive as any others. The societies that adapt to this changing demographic can reap a sizeable 'longevity dividend' and will have a competitive advantage over those that don't."
World Economic Forum 2012
- My carer is my mainstay so needs and deserves to be supported too: Those who care for people like me need mental and physical health support, not only because they’re vital to helping us age well but because they need to remain vital in their own lives. Early intervention will make sure there are regular and close connections between our families and carers and the services we use, including GPs, to monitor mental health and wellbeing and respond when necessary.
- I'll get better care and support if services find new ways to partner up: People like me need innovative partnerships that focus on the community while bringing together organisations responsible for mental health, physical health and social services.
- The ageism and eligibility barriers built into the system mean I can't get the care I need: Concern for administrative efficiency rather than quality of care means my needs can’t be met. Aged care needs support from mental health so that the right skills are available and I can get the right care.
- I want to live well at home for as long as I can: Mental health services need to provide integrated support for people like me to be independent at home but they also need to provide a seamless transition of that support into aged-care facilities when needed, and to be alert to any physical illnesses or impact of chronic illness or disability.
- My mental health must be a core concern when treating my physical problems: Mental health treatment, care and support for people like me who also have chronic illness must be integrated, must actually work and must become the norm. The services must recognise and respond to depression, thoughts of suicide, and drug and alcohol misuse that can sit alongside the onset of dementia.
- I'll do better with a prompt response to my issues: It’s no good assuming only certain age groups have certain problems and that nothing can be done because I’m elderly. People like me can stay resilient and capable if our problems are recognised early and the response is effective.
- I want to complete my life's journey with dignity: As I come to the end of my life, I deserve quality, holistic care and support for my mental and physical, including palliative, health needs. I am still a person. I have value.
Source material for content on this page is from the Living Well Report