Mental health in later life

Older people, like the wider population, may well experience mental health issues, these may be long standing acknowledged mental health conditions such as bi polar disorder or schizophrenia or more recent development such as depression related to chronic conditions or bereavement. Annually one in four people will experience mental health needs and depression or apathy are not a normal part of the ageing process. Older people can find access to services difficult and nurses, in any area, are well placed to identify the impact of mental health difficulties and sign post or support people to access the help they need. Increasingly the divisions between mental and physical health services are being bridged and the multi-professional nature of care for older people means we all need to be well versed in working in a collaborative way to act to improve mental wellbeing.

Nurses should be skilled in recognising the effects of mental health issues on the lives of individuals and help them to gain the most benefit from health and social care services. These pages provide access to key documents that help us work together to identify and support people who need assistance with mental health difficulties. 

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

Depression

One in four older people have symptoms of depression that require treatment, but fewer than one in six older people with depression seek help from their GP. Care home residents are 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 wellbeing. Older people are particularly vulnerable to factors that lead to depression such as bereavement, physical disability and illness and loneliness. 

Depression in older people can be treated effectively 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.

Loneliness

Older people are particularly vulnerable to loneliness and social isolation and the effects on health that accompany them. 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 a number of interventions including encouraging older people to engage in lifelong learning and involve themselves in activities in their local communities. Engaging in group exercise can help reduce loneliness in older people as well as having benefits in preventing depression. 

Serious 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 serious mental illnesses in older adults as they are in younger people diagnosed with the conditions. Older people with serious mental illnesses may live in care homes or may 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

Read the NICE guidance on schizophrenia.