Ageing and mental health

Question 1

The biopsychosocial model

Answer 1

First conceptualised by George Engel in 1977, suggesting that to understand a person’s medical condition it is not simply the biological factors to consider, but also the psychological and social factors

Question 2

According to the World Health Organisation, 2002, when does old age begin

Answer 2

65

Question 3

What do some people argue about old age

Answer 3

Some argue that chronological age is an arbitrary construct.

It is subjective - you are as old as you feel. You can be a very healthy 100 year old and unhealthy 50 year old

Question 4

Milne (2020)

Answer 4

‘Mental health in later life is complex, multi-factorial and an issue that cuts across time, place, cohort, social categories and individual experiences’

Question 5

Two media steretypical views of older people

Answer 5

2 extremes - The active golf club member, allotment-keeper or busy grandparent vs The lone pensioner, huddled in a chair by the fire trying to keep warm while using as little heating as possible who doesn’t see anyone for days on end.

There is no nuance in our discussion. its important as psychologists to be critical about this because it doesn’t represent the truth

Question 6

Impact of the ageing population on the health and social care system

Answer 6

The problem with living longer is our health system is not set up to deal with all of these older people

People are also living longer with disease and we are dealing with frailty in a way we have never had to deal with it before.

Social care system not set uo fr the challenges old age brings – no funding even tho demeand is there

Question 7

Why are people living longer

Answer 7

Advances in medicines

Question 8

What is happening to the age in our population

Answer 8

Increasing rapidly

Question 9

Department of Health, 2005

UK health district

Answer 9

In one typical UK health district, out of 250,000 people diagnosed with mental stress, 45,000 are elderly

However, this is 20 years old

Question 10

Kessler et al., 2005

prevalence of DSM-IV disorders

Answer 10

Lifetime prevalence of DSM-IV disorders in the National Comorbidity survey

Prevalence of anxiety, depression, alcohol abuse and dependence is lower in 60+ group, but it is still present

Question 11

Reynolds et al., 2015

Prevelance of psychiatric disorders

Answer 11

Prevalence of psychiatric disorders in 4 cohorts of community-dwelling US older adults

Broken the 60+ group down into 65-74, 75-84, 85+

Less variation in people’s psychiatric conditions as we get older

Question 12

Goldberg et al., 2012

older adults admitted as an emergency to a UK general hospital

Answer 12

Prevalence of mental health problems among older adults admitted as an emergency to a UK general hospital

Rather than thinking about a diagnostic label, we are thinking about individual symptoms e.g. irritability, sleep problems, poor appetite, apathy

It is the people with cognitive impairment that are more likely to experience delirium, dementia, aggression

The older we get, the more likely we are to experience cognitive impairment. So this shows that cognitive impairment exacerbates psychiatric symptoms

Question 13

What do healthcare professionals need to be aware of working with older people in a hospital setting due to Goldberg et al’s findings

Answer 13

That if someone is presenting with cognitive impairment, it is going to predispose them to conditions such as apathy etc and make them worse

Question 14

How should we approach old age

Answer 14

By taking a multidisciplinary, biopsychosocial approach.

Mental health in later life sits on the intersection of a range of interrelated concepts (psychology, public health, gerontology, sociology, health studies)

This warrants a multidisciplinary approach to research.

Should also take a person-centred approach that reflect the lives, experiences and perspectives of older people themselves.

Question 15

Cohort effect

Answer 15

Pensioners are more likely to hide any mental health condition due to old school British ‘still upper lip’

Born in post-WW2 era - tend to share values of stoicism and a ‘just get on with it’ attitude toward adversity

Historical influences

Question 16

What did data from the NHS show about recovery rates in older people

Answer 16

Over 65s actually have the best recovery rates

if you can get older people into psychiatric services they have really good outcomes but they are not being referred in due to perception amongst practitioners that it is not for them or not efficacious

Question 17

Local NHS data from the Liverpool ECHO

Answer 17

Three older adults a week were newly diagnosed with a mental disorder.

More than half were older men
About a third were aged over 75

Likely to be many more who have yet to seek help

Question 18

A multidimensional lifespan approach to mental distress in older adults

Answer 18

Older people face unique mental health challenges.
Changes in the following ‘forces’ can influence mental health and distress:

Biological forces

Psychological forces

Sociocultural forces

Life-cycle factors

Question 19

Biological forces

Answer 19

Health problems can provide clues about underlying mental distress

Question 20

Psychological forces

Answer 20

The psychological changes that people experience as they gelt older

Question 21

Sociocultural forces

Answer 21

Social norms and cultural factors influence behaviours and affect our interpretation of them

Question 22

Life-cycle factors

Answer 22

Transitional life events we all go through and contextual factors in our lives that shape our behaviour e.g. becoming a carer

Question 23

Biological risk factors of mental distress in older adults

Answer 23

Dementia
Heart disease
Cancer
Stroke - impact mobility
Thyroid problems
Vitamin deficiencies
UTI

Question 24

Psychological risk factors of mental distress in older adults

Answer 24

Memory
Intelligence
Personality
Motivation - to seek support
Resilience - your ability to adapt to, manage and negotiate significant sources of stress
Loneliness
Self-efficacy - confidence in your competence to overcome challenges

Question 25

Difference between loneliness and social isolation

Answer 25

Social isolation is the physical absence of people Loneliness is the subjective appraisal of our state of isolation

Question 26

Sociocultural risk factors of mental distress in older adults

Answer 26

Ageing population Social support Education Place of residence Social isolation Religion Ethnicity

Question 27

Life-cycle risk factors of mental distress in older adults

Answer 27

Marital status Bereavement Retirement Household income Elder abuse Substance abuse Caregiving

Question 28

Intersectionality

Answer 28

Different social identities like race, gender, class, and sexual orientation interact to create unique experiences of privilege and oppression Being older, male, black, low SES - subpopulation that is at risk

Question 29

Individualistic culture impact on ageing

Answer 29

Social and geographical mobility increasing - less support from family as further away - as opposed to collectivist cultures where its multigenerational households

Question 30

Biopsychosocial model in relation to old age

Answer 30

All these factors shape and in some cases make worse and exacerbate mental distress in older people

Question 31

Age concern and Mental health foundation (2006)

Answer 31

According to these two charities there are 5 most important factors that affect mental health and wellbeing: Relationships Participation in meaningful activities Discrimination Physical health Poverty

Question 32

Loneliness and health in older people study findings

Answer 32

The Guardian (2014) - lonelinesses twice as unhealthy as obesity for older people Holt-Lunstad et al (2010) - Lonely people are 50% more likely to die prematurely than those with healthy social connections

Question 33

What % of older people report having less than monthly contact with family and friends

Answer 33

11%

Question 34

What % of older people report that TV is their main form of company

Answer 34

50%

Question 35

What % of older people report being 'often' or 'always' lonely

Answer 35

6-13%

Question 36

What two things increase the risk of physical and mental health problems in older people, including cognitive function and dementia

Answer 36

Loneliness and isolation

Question 37

Livingston et al (2020) | Review

Answer 37

Conducted a review where they identified a range of modifiable risk factors for dementia in early life, midlife and later life.

Question 38

What % of risk factors for dementia could be modified

Answer 38

40%

Question 39

Early life and modifiable risk factors (Linvingston et al)

Answer 39

If you are highly educated in early life, you are 7% less likely to get dementia when you get older.

Question 40

Midlife and modifiable risk factors (Linvingston et al)

Answer 40

If you don’t have hearing loss you are 8% less likely to get dementia

Question 41

Later life and modifiable risk factors (Livingston et al)

Answer 41

If you don't have depression you are 4% less likely to get dementia Interesting to consider the overlap between mental health and dementia risk factors

Question 42

What does Livingston et al's findings suggest about risk factors for dementia

Answer 42

Overall, 40% of risk factors of dementia are modifiable. This means that there are factors that are not genetically fixed - social environmental and behavioural factors that we can do something about So if we try to reduce these things, we could reduce up to 40% of the dementia risk.

Question 43

What is Assessment?

Answer 43

A formal process of measuring, understanding and predicting behaviour. Gathering medical, psychological and sociocultural information Clinical interviews, observation, tests and examinations.

Question 44

Difference between the DSM-IV and DSM-V for Major Depressive Disorder

Answer 44

No bereavement exclusion criterion in the DSM-V In the DSM-IV, recently bereaved, can't be diagnosed with MDD

Question 45

Kendler et al (2006)

Answer 45

Bereavement related depression is indistinguishable clinically from depression related to other stressful life events. If you look at those criteria there isn't really any meaningful difference between what it looks like in the context of bereavement or caregiving or divorce etc Questions the validity of the bereavement exclusion criterion - influenced the DSM V

Question 46

What kind of assessment and treatment do we need for older people

Answer 46

We need age-sensitive assessment measures of mental health and distress and a multidimensional assessment approach may be the answer. Multidimensional assessment is often done by a team of professionals There are more complex factors such as bereavement and health problems etc - can't apply the same criteria to older people

Question 47

Barriers to assessment and treatment - Age UK report (2016)

Answer 47

Lack of ‘joined up’ health care - 37% of Mental Health Trusts in England have no policies for providing integrated (mental and physical) care to older people. Fewer over 65s are being referred to IAPT services compared to the general population, despite: - Higher treatment completion and recovery among older people relative to the general population. - Older adults respond better to psychological therapy than working age adults (Saunders et al., 2021).

Question 48

Barriers to older people accessing IAPT services - older people

Answer 48

Perception - don't recogniser their symptoms as an issue - 'stiff upper lip' Practical barriers - may not be able to get out to attend an appointment, lack of internet

Question 49

Barriers to older people accessing IAPT services - clinicians

Answer 49

Lack confidence - in providing age sensitive support because they don't know how to tailor and personalise services to this particular group Exclusions - they don't know who is eligible and what things are relevant due to muddiness

Question 50

Independent Age (2018)

Answer 50

24% of older people felt uncomfortable with people being aware they were depressed

Question 51

Why do older people feel uncomfortable with people knowing they are depressed

Answer 51

A study foud that public and self-stigma both identified in older people living with mental illness, manifested through fear, reluctance for social interaction, shame, secrecy and withdrawal.

Question 52

Key conclusions from the lecture

Answer 52

Older people are a complex group and face unique mental health challenges. Multidimensional life-span approach is key to understanding risk factors and assessment. Numerous personal, societal and institutional barriers to successful assessment and treatment Older adults need specialist, integrated mental health services delivered by multidisciplinary teams to overcome these barriers.

Question 53

Normalisation of potentially problematic symptoms

Answer 53

People are not seeking treatment because they just think it's a normal part of getting older

Question 54

Why are assessments and treatments difficult for older people

Answer 54

Ageing is complex Transitions older people go through, physical and cognitive health deterioration muddies the waters, making assessments and treatments very difficult

Question 55

What would a good older people’s mental health service look like?

Answer 55

Psychoeducation - not normalising things that are potentially problematic symptoms and understanding what mental health symptoms look like and the treatment options are Co-production in planning of local services - important for professionals to collaborate to design services that are in line with people's needs Specialist, age-appropriate services Integration with social care Seamless care across services