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Transforming mental health care for older veterans in the Veterans Health Administration
- Authors:
- KARLIN Bradley E., ZEISS Antonette M.
- Journal article citation:
- Generations, 34(2), Summer 2010, pp.74-83. Published online.
- Publisher:
- American Society on Aging
Older adults often lack familiarity with mental health symptoms and services and may hold negative beliefs about mental health care that can prevent them from seeking treatment. The Veterans Health Administration (VHA) operates the largest and one of the most elaborate mental health care systems in the nation and perhaps the world. The recent history of the system is described. One successful new model for providing mental health care to older veterans that has been nationally implemented in the VHA is the integration of a full-time mental health provider on each of the more than 130 VA home-based primary care (HBPC) teams. Another major psychogeriatrics initiative involves the integration of a full-time mental health provider in VA community living centers (CLC), formerly designated as nursing home care units. It is critical that increasing national attention be devoted to the mental health needs of older Americans and that policies and processes be developed to extend the reach and potential impact of mental health care for older adults.
Formal support, mental disorders and personal characteristics: a 25-year follow-up study of a total cohort of older people
- Authors:
- SAMUELSSON G., et al
- Journal article citation:
- Health and Social Care in the Community, 11(2), March 2003, pp.95-102.
- Publisher:
- Wiley
This study was designed to describe the pattern of long-term formal support received by people with mental disorders and to investigate the relationship between the medical, psychological and social characteristics of the participants and types of formal support, based on a cohort of 192 people born in 1902 and 1903 in a community in Southern Sweden. They were assessed using interviews, psychological tests and medical examinations. Information was collected about the use of primary healthcare and social services. The first assessment took place when the cohort was aged 67 and on 8 further occasions until they were 92. Participation ranged from 72% to 100%. During the observation period of 25 years, 53% of people with dementia eventually received both home help and institutional care compared to 34% with other psychiatric diagnoses and 12% with good mental health. The last group all had physical health problems and/or problems with activities of daily living. However, 35% of the dementia group, 46% with other psychiatric diagnoses and 52% with good mental health received no formal support. Males and self-employed people were significantly less likely to use formal support. The institutionalised group reported loneliness significantly more often than the other 2. In a logistic regression analysis, loneliness, low social class, high blood pressure and low problem-solving ability were predictors of formal support use. People with mental disorder, including dementia, were significantly more likely to use formal support compared with people with good mental health. Social factors were the main factors predicting formal support.
Educator’s guide to 'an introduction to the mental health of older people' e-learning resources
- Author:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2007
- Pagination:
- 32p.
- Place of publication:
- London
In these learning objects students will have the chance to explore the nature and characteristics of the ageing population in the UK, what being 'old' means, and some of the complexity surrounding the concept of 'mental health'. As this learning object presents basic facts and concepts surrounding mental health and older people, it is recommended that students use this object as an introduction to the area.
Does the length of institutionalization matter? Longitudinal follow-up of persons with severe mental illness 65 years and older: shorter-stay versus longer-stay
- Authors:
- FINKEL Deborah, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 36(8), 2021, pp.1223-1230.
- Publisher:
- Wiley
Objectives: As part of the process of de-institutionalization in the Swedish mental healthcare system, a reform was implemented in 1995, moving the responsibility for services and social support for people with severe mental illness (SMI) from the regional level to the municipalities. In many ways, older people with SMI were neglected in this changing landscape of psychiatric care. The aim of this study is to investigate functional levels, living conditions, need of support in daily life, and how these aspects changed over time for older people with SMI. Methods: In this study we used data from surveys collected in 1996, 2001, 2006, and 2011 and data from national registers. A group of older adults with severe persistent mental illness (SMI-O:P) was identified and divided into those who experienced shorter stays (less than 3 years) in a mental hospital (N = 118) and longer stays (N = 117). Results: After correcting for longitudinal changes with age, the longer-stay group was more likely than the shorter-stay group to experience functional difficulties and as a result, were more likely to have experienced ‘re-institutionalization’ to another care setting, as opposed to living independently. Conclusions: The length of mental illness hospitalization has significant effects on the living conditions of older people with SMI and their ability to participate in social life. (Edited publisher abstract)
Are older adults also at higher psychological risk from COVID-19?
- Authors:
- GARCIA-PORTILLA Paz, et al
- Journal article citation:
- Aging and Mental Health, 25(7), 2021, pp.1297-1304.
- Publisher:
- Taylor and Francis
Objective: Given the lack of information on the psychological impact of COVID-19 on people aged ≥60, we aimed to describe their psychological responses to this pandemic and lockdown situation and compare them with those under 60 years of age. Methods: Secondary analysis of a larger online cross-sectional study designed to determine the psychological impact of the COVID-19 pandemic and lockdown across Spain. We analyzed a total of 1690 respondents aged ≥60 years and compared them with 13,363 respondents under 60 years of age. We employed the Depression, Anxiety, and Stress Scale and the Impact of Event Scale to evaluate psychological responses. Results: In all, 52.6% of women and 34.3% of men were found to be probable cases of any emotional distress (p < 0.001). In both sexes, the most common psychological response was avoidance behavior (34.7% and 23.8%, respectively), followed by depression (28.5 and 14.2%). Older women and men were considered probable cases of any emotional distress less often than younger ones (women: 52.6% vs. 72.3%, p < 0.001; men: 34.3% vs. 50.6%, p < 0.001). Finally, the results of the binary logistic regression showed that only depressive and stress responses are psychological factors associated with age group [age ≥ 60 years, O.R. = 0.617 (95% CI = 0.501 − 0.759) and 0.437 (95% CI = 0.334 − 0.573), respectively]. Conclusion: Contrary to our hypothesis and despite the high percentage of emotional distress we found in older adults, especially women, they are actually at lower risk of developing depressive and stress consequences from COVID-19 and lockdown than those under 60 years of age. That said, we believe our results highlight the need for expert guidance in this age group, especially older women living alone. (Edited publisher abstract)
Follow-up services for delirium after COVID-19 - where now?
- Authors:
- RAHMAN Shibley, BYATT Kit
- Journal article citation:
- Age and Ageing, 50(3), 2021, pp.601-604.
- Publisher:
- Oxford University Press
Delirium is a common presentation in older inpatients with coronavirus disease 2019 (COVID-19), and a risk factor for cognitive decline at discharge. The glaring gaps in the service provision in delirium care, regardless of aetiology, after a hospital admission pre-existed the pandemic, but the pandemic arguably offers an opportunity now to address them. Whilst a delirium episode in itself is not a long-term condition, the context of it may well be, and therefore patients might benefit from personalised care and support planning. There is no reason to believe that the delirium following COVID-19 is fundamentally different from any other delirium. We propose that the needs of older patients who have experienced delirium including from COVID-19 could be addressed through a new model of post-acute delirium care that combines early supported discharge, including discharge-to-assess, with community-based follow-up to assess for persistent delirium and early new long-term cognitive impairment. Such a drive could be structurally integrated with existing memory clinic services. To succeed, such an ambition has to be flexible, adaptable and person-centred. To understand the impact on resource and service utilisation, techniques of quality improvement should be implemented, and appropriate metrics reflecting both process and outcome will be essential to underpin robust and sustainable business cases to support implementation of delirium care as a long-term solution. (Edited publisher abstract)
Supporting frail older people with depression and anxiety: a qualitative study
- Authors:
- FROST Rachael, et al
- Journal article citation:
- Aging and Mental Health, 24(12), 2020, pp.1977-1984.
- Publisher:
- Taylor and Francis
Objectives: Depression and anxiety are common in later life, particularly when people are frail. This leads to reduced quality of life, faster decline in physical health and increased health/social care use. Available treatments are commonly not tailored to people with frailty. We explored frail older peoples’ experiences of depression and/or anxiety and how services could be adapted to their needs. Methods: Semi-structured interviews with 28 older people in the UK purposively sampled for practice location and severity of frailty and anxiety/depression. We asked about symptoms, interactions with physical health, help-seeking, treatments and what might help in future. We audio-recorded and transcribed interviews, using thematic analysis to inductively derive themes. Results: Frail older people had low expectations of their wellbeing at this point in life due to multiple physical health issues and so anxiety and mild depressive symptoms were normalised. There was a particular reluctance and uncertainty regarding help-seeking for anxiety. Treatments were considered appropriate where they aligned with coping skills developed over their lifetime, and facilitated independence and problem-solving skills. Most older people felt their knowledge of mental health was limited and relied upon information about and endorsement of therapies from an expert. This was usually their GP, but access was often problematic. Online methods of accessing information and therapies were not popular. (Edited publisher abstract)
Peer support and peer support workers in older people’s mental health
- Authors:
- WILLIAMSON Toby, DURCAN Graham
- Publisher:
- Centre for Mental Health
- Publication year:
- 2020
- Pagination:
- 12
- Place of publication:
- London
This briefing explores the evidence, opportunities and issues relating to peer support models for older people with mental health problems There is very limited evidence on what works and the best models for older people’s mental health peer support. While narrowly defined examples of peer support within mental health services are thin on the ground among people in later life, there is some evidence that peer support benefits people with dementia and poor mental health. Combatting social isolation, and cognitive engagement in particular, seem to be features of ‘positive’ peer support that can prevent or slow down either depression or dementia. Using a looser definition of peer support that involves befriending, volunteering, social groups and activities (often for older people with multiple morbidities) may make it harder to ‘manualise’ peer support, but it has a number of benefits. These include the existence of some well-developed and evaluated models, being accessible to a wide group of older people, and being effective both in preventing poor mental health and improving the wellbeing of older people with mental health problems. (Edited publisher abstract)
Physical and mental health correlates of perceived financial exploitation in older adults: preliminary findings from the Finance, Cognition, and Health in Elders Study (FINCHES)
- Authors:
- WEISSBERGER Gali H., et al
- Journal article citation:
- Aging and Mental Health, 24(5), 2020, pp.740-746.
- Publisher:
- Taylor and Francis
Objectives: Financial exploitation (FE) in old age is poorly understood, particularly among those without significant cognitive impairment. The Finance, Cognition, and Health in Elders Study (FINCHES) aims to identify factors associated with FE among cognitively-healthy older adults. Preliminary findings regarding physical and mental health correlates in the pilot phase of FINCHES are reported. Method: Sixteen older adults who self-reported FE were demographically-matched on age, education, sex, and race/ethnicity to eighteen older adults who did not report past FE. Results: Those who believed they were exploited endorsed significantly greater symptoms of depression (p = 0.014) and marginally greater symptoms of anxiety (p = 0.062). Participants trended towards lower perceived successful aging (p = 0.094). Perceived FE participants also endorsed greater medical conditions (p = 0.047), but follow-up individual item analyses suggest that this was driven by problems with sleep (p = 0.030). Conclusions: These preliminary findings from the pilot phase of FINCHES highlight negative mental health factors associated with perceived FE among cognitively-intact older adults. (Publisher abstract)
Inclusion/exclusion criteria in late life depression antidepressant efficacy trials
- Authors:
- ZIMMERMAN Mark, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(9), 2017, pp.1009-1016.
- Publisher:
- Wiley
Objective: The generalisability of antidepressant efficacy trials (AETs) has been questioned. No studies have examined the inclusion/exclusion criteria used in placebo-controlled studies of late life depression and compared them to the criteria used in non-late life AETs. Method: The authors conducted a comprehensive literature review of placebo-controlled AETs published from January, 1995 through December, 2014. They compared the inclusion/exclusion criteria used in the 18 studies of late life depression to those used in non-late life depression. Results: There were nine inclusion/exclusion criteria that were used in more than half of the late life depression AETs: minimum severity on a symptom severity scale (100.0%), significant suicidal ideation (77.8%), psychotic features during the current episode of depression or history of a psychotic disorder (94.4%), history of bipolar disorder (77.8%), diagnosis of alcohol or drug abuse or dependence (83.3%), presence of a comorbid nondepressive, nonsubstance use Axis I disorder (55.6%), episode duration too short (66.7%), and an insufficient score on a cognitive screen (88.3%) or the presence of a cognitive disorder (55.6%). There were some differences between the late life and non-late life depression studies—use of a screening measure of cognitive functioning, presence of a cognitive disorder such as dementia, and the minimum depression severity cutoff score required at baseline. Conclusions: The inclusion/exclusion criteria in AETs of late life depression were generally similar to the criteria used in non-late life depression (Edited publisher abstract)