As a consultant psychiatrist working solely with older people, too often I see older people who have been struggling with their mental health for a long time as they were unaware of how to access appropriate support. I therefore heartily welcome Centre for Mental Health’s report on mental health in later life, commissioned by Age UK. The report highlights how we as a society are failing to provide the best mental health services to older people. This is partly owing to ageism (unintentional or otherwise), and partly through a failure to recognise the interconnection between the mental and physical health needs of many older people.
Our failure to provide the best care for older people is one of the most important issues in health and social care. People are living longer, and our population is ageing. According to projections by the Office of National Statistics, the population aged 65+ will grow by around 50% (in both urban and rural areas) between 2016 and 2039, whilst the population aged under 65 is projected to grow only by 8% in urban areas – and by almost nothing in rural areas. With these types of figures, equality of access and outcomes for older people is not just a matter of fairness: if our health care and social care systems do not work for older people, they will not work for any of us.
We need to counter ageist attitudes while also focusing on the real needs of older people so that we can make appropriate adjustments where necessary.
How can we improve mental health support for older people?
Fair provision of services: There is still work to do to ensure that older people are being offered the same opportunities to treatment as younger adults. For example, older people are still less likely to be offered NHS talking therapies – despite evidence showing that overall they respond better to this than younger adults. This may be that staff who might refer them to the services are unaware of what services are available or the extent to which an older person might benefit from the. More training is needed.
Appropriate access to services: Too often services are provided in a way that are not easily accessible to older people. Sometimes services can be accessed only via a computer or a smartphone and require internet access, which older people are less likely to have. Venues may be difficult to access by public transport, restricting access for older people who have stopped driving. And older people may also struggle with practical elements of health and social care settings, for instance if the chairs are too low for them to get out of easily, or the lighting level makes it hard for them to see clearly.
Combatting ageism: Too often, staff may not understand the needs of older adults and may hold ageist attitudes that prevent them doing the best for them, assuming that nothing can be done. Contrary to myth, older people can have the same range of mental health issues as younger adults, and neither dementia nor depression are inevitable consequences of being old. As the Chief Medical Officer’s Report 2023 stated, “mental health improvement interventions for older adults are key to improving overall quality of life in people’s later years”.
To be able to make improvements, we need everybody in contact with older adults to have the knowledge and skills to recognise when an older person has a mental health need, and an understanding about what can be done to address these needs. Older adults with mental health needs can present in a different way to working age adults. For example, an older person with depression may present with persistent and distressing physical health symptoms for which no underlying physical cause can be found. A newly developed e-learning resource on depression in older adults (which requires no previous knowledge) may help with this – watch it or listen to the podcast.
As our population gets older and people live longer with multiple physical health problems, it becomes increasingly important for the whole system to pay attention to the mental health of older adults. Everyone’s needs are different, so there is no one solution to meet these needs. But by working together and refusing to overlook older people’s needs, we can ensure that everyone has better mental health in later life.
