Mental health in later life

Older people may experience mental health issues. These could be long-standing mental health conditions or more recent diagnoses. 

Nurses working across a range of areas should be able to identify and support people with their mental health and wellbeing. They should also signpost or support people to access the help they need. 

Mental health is as important as physical health. Nurses are in a key position to engage with multi-disciplinary teams to maximise collaborative work to improve and support older people’s mental health and wellbeing.

Nurses should be able to recognise when a person is experiencing mental ill health or wellbeing and signpost them to access appropriate health and social care services. 

In addition to reducing the impact of mental health problems on daily activities, it is important that we also support people in preventative strategies. 

Depression and anxiety

One in four older people have symptoms of depression that need treatment, but fewer than one in six older people with depression seek help from their GP. Care home residents are also at an increased risk of depression. 

Depression in later life can be a major cause of ill health and can have a severe effect on physical and mental well-being. Older people are particularly vulnerable to factors that lead to depression, such as bereavement, physical disability, illness and loneliness. 

Depression in older people can be treated through antidepressants and talking therapies. Effective interventions to prevent depression in older people include reducing loneliness and isolation through encouraging learning, physical activity, social interaction and volunteering.

Most people experience short-term anxiety at times during their lives. However, if it affects a person for a long period of time or affects a person’s activities or behaviour, they may have an anxiety disorder. Older people with chronic health conditions are more likely to experience anxiety. Anxiety is often present with symptoms of depression. 

• You can find further information on the Anxiety UK website. 
• Read the NICE guidelines on Generalised anxiety disorder and panic disorder in adults: management.

Delirium

Delirium is defined as an ‘acute confusional state’, which is characterised by fluctuating and disturbed concentration, attention, consciousness and perception. Delirium usually has a fast onset and can have single or multiple causes, including infection, polypharmacy and constipation. It is often confused with depression or dementia, so it is important for nurses to have a good working knowledge of delirium and how it can present in older people.

Delirium is more common in older people, especially those who have a diagnosis of dementia. 

• Visit The Alzheimer’s Society website to read more about delirium symptoms, diagnosis and management.
• Visit the NICE website to read the guidance ‘Delirium: prevention, diagnosis and management in hospital and long-term care’.

Dementia

Dementia is an umbrella term for a number of conditions. All of these are characterised by progressive, irreversible cognitive and behavioural issues. 

Loneliness

The health consequences of loneliness can result in both psychological and physiological issues. People of all ages can experience loneliness. However, older people are particularly vulnerable to loneliness and social isolation. These issues also affect their health. The effects of long-term conditions can amplify loneliness. 

According to Age UK, more than 2 million people in England over the age of 75 live alone, and more than a million older people say they go for over a month without speaking to a friend, neighbour or family member. Bereavement, disability and retirement can all lead to older people experiencing loneliness.

Nurses can help older people overcome loneliness with several interventions. These include encouraging them to engage in lifelong learning and involve themselves in activities in their local communities. Engaging in group activities can help reduce loneliness in older people and has benefits in preventing depression. It is also important to help people build, develop and maintain meaningful relationships. 

Other mental illnesses

Bipolar disorder and schizophrenia usually start in the late teens and early twenties, but can affect older people for the first time. Antipsychotic medication and talking therapies can be used to treat mental illnesses in older adults. Older people with mental illnesses may live in care homes or live independently with the support of community mental health teams. 

NICE recommends anyone providing treatment and care for people with schizophrenia should:

• work in partnership with people with schizophrenia and their carers
• offer help, treatment and care in an atmosphere of hope and optimism
• take time to build supportive and empathic relationships as an essential part of care.