By Valerie Freestone, Senior Lecturer in Mental Health Nursing, at the University of Bedfordshire (www.beds.ac.uk)
According to the World Health Organisation (WHO), the world’s population over 60 will double globally from 12% to 22% between 2015 and 20501. About 6% of this group will face mental health illness and neurological conditions. Older people have extra stressors and are more prone to mental illnesses due to factors including reduced mobility, chronic pain, long term conditions and increased frailty. However, as mental health problems are not part of normal ageing, it is important to ensure that older adults are diagnosed and treated so that they can enjoy and engage in all activities of daily life2. This is further reaffirmed by research that suggests that older people have lower mental health literacy and are unlikely to seek help themselves3. As a result, there are ways to recognise the two most common mental health problems affecting older people, anxiety and depression, and how to address this.
Firstly, Generalised Anxiety Disorder (GAD) is characterised as excessive worrying and anxiety where worrying is difficult to control4. About 1 in 5 older adults may have an anxiety disorder often triggered by life events such as falls, bereavement, sudden loss and admission to hospital. If an older person finds communication difficult, the outward signs of these symptoms may include restlessness, fidgeting and irritability particularly when this marks an acute change in behaviour. It is therefore crucial that social care staff observe service users for any symptoms of anxiety after they have experienced any of these life events. Staff are also equipped with various tools that can help resolve patients’ queries relating to anxiety, including the GAD75 scale or the GAD assessment tool. As a result, they should be on the outlook for these signs and continue to check up on patients’ symptoms. Family and friends can also play a role in identifying these sudden changes in behaviour and staff should first rule out any physical health cause before reorganising this as anxiety related.
Depression, on the other hand, affects 10-20% of older people6 and up to 40% of those living in care homes are affected by this. Depression in older age is associated with increased cognitive and functional disabilities leading to higher care needs and increased costs for areas such as adult social care. However, as depression can be difficult to spot in older adults, it means that many do not get the help or support they require. For example, some signs of depression may be confused with other mental health problems common in older adults such as difficulty concentrating, memory problems, loss of appetite, irritability and restlessness or symptoms associated with dementia or anxiety. It is therefore important that adult social care staff recognise the early signs and symptoms of depression so that treatment can be introduced. Outward signs of depression can include withdrawal from day-to-day activities, forgetting appointments and lack of enjoyment of hobbies. The most commonly used tool in identifying depression is the geriatric depression scale. Hence, if treated it can lead to an improvement in quality of life, wellbeing and reduce the need for further intervention from adult social care staff.
In conclusion, while legislation including The Care Act (2014)7 and National Institute of Health and Care Excellence (NICE) Guidelines8 mandates that local authorities and adult social care staff must recognise and promote the mental and emotional wellbeing of individuals, staff, family and friends all play a role in identifying mental illnesses within older adults. It is important that they recognise these signs and intervene early so these people can get the right treatment.
1 World Health Organisation, Aging and health (2023)
2 National Institute for Health and Care Excellence (NICE), mental wellbeing of older people in care homes (2013)
3 How well do older adults recognise mental illness? A literature review (2019)
4 National Institute of Health and Care Excellence (NICE), Generalised anxiety disorder and panic disorder in adults: management (2011)
5 Generalised Anxiety Disorder Assessment (GAD-7)
6 Social care institute for excellence, Assessing the mental health needs of older people (2006)
7 Care Act 2014
8 NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE (NICE) Guideline, Older people with social care needs and multiple long term conditions (2015)