Barriers and facilitators to accessing psychological therapies for severe mental health difficulties in later life

2019 ◽  
Vol 48 (2) ◽  
pp. 216-228
Author(s):  
Katherine Berry ◽  
Jennifer Sheardown ◽  
Uma Pabbineedi ◽  
Gillian Haddock ◽  
Catherine Cross ◽  
...  
Keyword(s):  
Mental Health ◽  
Older People ◽  
Health Care Professionals ◽  
Later Life ◽  
Past Research ◽  
Ageing Population ◽  
Attitudinal Barriers ◽  
Psychological Therapies ◽  
Age Related ◽  
Mental Health Difficulties

AbstractBackground:The number of people growing older with severe mental illness (SMI) is rising, reflecting societal trends towards an ageing population. Evidence suggests that older people are less likely to seek help, be referred for and receive psychological therapy compared with younger people, but past research has focused on those with mild to moderate mental health needs.Aims:This research aims to identify the specific barriers faced by older people with SMI.Method:We interviewed 53 participants (22 service users with SMI aged over 50 years, 11 carers of people with SMI, and 20 health care professionals) about their views and experiences of accessing therapy for SMI in later life.Results:Thematic analysis revealed five themes: organizational and resource issues; myths about therapy and attitudinal barriers; stigma; encouraging access to therapy; and meeting age-specific needs.Conclusions:Barriers faced by older people with SMI are not only age-related, but also reflect specific issues associated with having a SMI over many years. Improving awareness of the benefits of psychological therapies is important not only for older people with SMI themselves, but also for their carers and staff who work with them.

Mental Health in Later Life

2020 ◽  
Author(s):  
Alisoun Milne
Keyword(s):  
Mental Health ◽  
Older People ◽  
Life Course ◽  
Mental Health Problems ◽  
Later Life ◽  
Health Issues ◽  
Mental Health Issues ◽  
Age Related ◽  
Health And Social Care ◽  
Life Course Studies

Focusing on mental health rather than mental illness, this book adopts a life course approach to understanding mental health and wellbeing in later life. Drawing together material from the fields of sociology, psychology, critical social gerontology, the mental health field, and life course studies, it analyses the meaning and determinants of mental health amongst older populations and offers a critical review of existing discourse. The book explores the intersecting influences of lifecourse experiences, social and structural inequalities, socio-political context, history, gender and age-related factors and demands an approach to prevention and resolution that appreciates the embedded, complex and multi-faceted nature of threats to mental health and ways to protect it. It foregrounds engagement with the perspectives and lived experiences of older people, including people living with dementia, and makes the case for a paradigmatic shift in conceptualising, exploring and researching mental health issues and supporting older people with mental health problems. The book is essential reading for policy makers, health and social care professionals and students, third sector agencies, researchers and all of those concerned to more effectively and collaboratively address mental health issues in later life.

The impact of age-related risks and inequalities on mental health in later life

2020 ◽  
pp. 81-104
Author(s):  
Alisoun Milne
Keyword(s):  
Mental Health ◽  
Older People ◽  
Later Life ◽  
Age Discrimination ◽  
Psychological Wellbeing ◽  
Physical And Mental Health ◽  
Care Services ◽  
Age Related ◽  
Indirect Discrimination ◽  
The Impact

In broad terms there are two sets of age-related risks to mental health. The first set are those arising directly from experiences and losses common to later life, including physical ill health and/or disability, being a carer, retirement, and bereavement. These are associated with impaired psychological wellbeing and heightened risk of depression, particularly amongst older people with few economic or social resources. The second set of risks arise from ageism and age discrimination, and their intersection with other types of discrimination such as sexism for older women. Direct and indirect discrimination is widespread; it is located in all areas of society including health and social care services. It is profoundly damaging to older peoples’ psychological wellbeing and is associated with fear, helplessness, low self-esteem, anxiety and depression. It is also linked to exclusion, marginalisation and abuse. In recent years there have been efforts to ensure that older people are overtly included in policies intended to improve the population’s physical and mental health; this includes access to treatments e.g. for depression. There has also been a focus on addressing age discrimination in specific arenas e.g. in employment and mental health services. These initiatives have had mixed success.

Demography, topography and mental health problems in later life

2020 ◽  
pp. 7-32
Author(s):  
Alisoun Milne
Keyword(s):  
Mental Health ◽  
Older People ◽  
Mental Health Problems ◽  
Later Life ◽  
Health Problems ◽  
Ageing Population ◽  
Adult Lifespan ◽  
The One ◽  
The Uk

Chapter 1 offers an overview of the UK’s socio-demographic and policy context. The UK has an ageing population that is increasingly diverse and heterogenous. Whilst for many older people health outcomes have vastly improved since the introduction of the welfare state, prevalence of ill health does increase with advancing age. The number of older people living with dementia is 850,000, a figure expected to rise to over 2 million by 2051. Disability, pain, chronic physical illness and dementia are risk factors for both depression and suicide. It is estimated that 30 per cent of older people have ‘depressive symptoms’ and that 1 in 8 of all suicides relate to older people. 4 per cent of older people suffer from ‘anxiety disorder’. Although not mental health problems as such, a growth of the number of older people experiencing isolation and loneliness, problem alcohol issues and social exclusion are contributors. In terms of policy, all four UK nations, have specific policies relating to dementia, on the one hand, and policies relating to preventing and treating functional mental health problems on the other. The former tends to be older age focused whilst the latter extends across the whole adult lifespan.

scholarly journals Sexuality in Later Life and Mental Health Among Older Black Gay Men

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 313-314
Author(s):  
Darlingtina Esiaka ◽  
Alice Cheng ◽  
Candidus Nwakasi
Keyword(s):  
Mental Health ◽  
Gay Men ◽  
Later Life ◽  
The United States ◽  
Mental Wellbeing ◽  
Self Identity ◽  
Sexual Identities ◽  
Age Related ◽  
Wide Range ◽  
Black Gay Men

Abstract Self-acknowledgement and integration of racial and sexual identities are significant to one’s overall sense of identity because of their implications for mental health and wellbeing. These issues are important as one ages because older people experience a wide range of factors that add layers to their ability to (re)integrate subsets of their identity into their overall self-identity such as age and age-related disabilities. This study examined the intersection of race and sexual identities on overall health status in older Black gay men, a demographic group that has historically received less attention. Data from the Social Justice Sexuality (SJS) survey of LGBTQ+ people of color which occurred over a 12-month period in the United States were analyzed. Participants (N=160), 50 years and over, responded to questions about their sexuality, social identity, family dynamics, community connection and engagement, and mental and physical health. Results show an association of mental wellbeing with racial and sexual identities. Further, results show that a strong sense of connection to other sexual minorities is positively associated with mental health in older Black gay men. We discuss the implication of findings for mental health interventions targeting this gendered population.

scholarly journals Developing a recovery-focused therapy for older people with bipolar disorder: a qualitative focus group study

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e049829
Author(s):  
Elizabeth Tyler ◽  
Fiona Lobban ◽  
Rita Long ◽  
Steven H Jones
Keyword(s):  
Older Adults ◽  
Bipolar Disorder ◽  
Focus Group ◽  
Older People ◽  
Focus Groups ◽  
Later Life ◽  
Focus Group Study ◽  
Age Related ◽  
Health Related ◽  
Age Related Changes

ObjectivesAs awareness of bipolar disorder (BD) increases and the world experiences a rapid ageing of the population, the number of people living with BD in later life is expected to rise substantially. There is no current evidence base for the effectiveness of psychological interventions for older adults with BD. This focus group study explored a number of topics to inform the development and delivery of a recovery-focused therapy (RfT) for older adults with BD.DesignA qualitative focus group study.SettingThree focus groups were conducted at a university in the North West of England.ParticipantsEight people took part in the focus groups; six older adults with BD, one carer and one friend.ResultsParticipant’s responses clustered into six themes: (1) health-related and age-related changes in later life, (2) the experience of BD in later life, (3) managing and coping with BD in later life, (4) recovery in later life, (5) seeking helping in the future and (6) adapting RfT for older people.ConclusionsParticipants reported a range of health-related and age-related changes and strategies to manage their BD. Participants held mixed views about using the term ‘recovery’ in later life. Participants were in agreement that certain adaptations were needed for delivering RfT for older adults, based on their experience of living with BD in later life. The data collected as part of the focus groups have led to a number of recommendations for delivering RfT for older adults with BD in a randomised controlled trial (Clinical Trial Registration: ISRCTN13875321).

scholarly journals Establishment of variation source and age-related reference interval models for 22 common biochemical analytes in older people using real-world big data mining

2020 ◽  
Vol 49 (6) ◽  
pp. 1062-1070
Author(s):  
Chaochao Ma ◽  
Liangyu Xia ◽  
Xinqi Chen ◽  
Jie Wu ◽  
Yicong Yin ◽  
...  
Keyword(s):  
Big Data ◽  
Older People ◽  
Real World ◽  
Reference Interval ◽  
Reference Intervals ◽  
Ageing Population ◽  
Factors Affecting ◽  
Age Related ◽  
The Status ◽  
Source Models

Abstract Background the ageing population has increased in many countries, including China. However, reference intervals (RIs) for older people are rarely established because of difficulties in selecting reference individuals. Here, we aimed to analyse the factors affecting biochemical analytes and establish RI and age-related RI models for biochemical analytes through mining real-world big data. Methods data for 97,220 individuals downloaded from electronic health records were included. Three derived databases were established. The first database included 97,220 individuals and was used to build age-related RI models after identifying outliers by the Tukey method. The second database consisted of older people and was used to establish variation source models and RIs for biochemical analytes. Differences between older and younger people were compared using the third database. Results sex was the main source of variation of biochemical analytes for older people in the variation source models. The distributions of creatinine and uric acid were significantly different in the RIs of biochemical analytes for older people established according to sex. Age-related RI models for biochemical analytes that were most affected by age were built and visualized, revealing various patterns of changes from the younger to older people. Conclusion the study analysed the factors affecting biochemical analytes in older people. Moreover, RI and age-related RI models of biochemical analytes for older people were established to provide important insight into biological processes and to assist clinical use of various biochemical analytes to monitor the status of various diseases for older people.

Socio-economic disadvantage and poverty

2020 ◽  
pp. 105-114
Author(s):  
Alisoun Milne
Keyword(s):  
Older People ◽  
Later Life ◽  
Poverty Line ◽  
Developed Countries ◽  
Economic Disadvantage ◽  
Fundamental Building Block ◽  
Age Related ◽  
The Uk ◽  
State Pension ◽  
The Impact

Chapter 5 is the first of three chapters exploring the impact of age related risks affecting particular sub populations of older people. Socioeconomic disadvantage in later life tends to reflect a lifecourse status. It amplifies what is already present. In 2016/17 one million older people were living in poverty; an additional 1.2 million were living just above the poverty line. These numbers are rising. Those aged 85 years or over, frail older people, older women and single older people are particularly at risk. Poor older people are also more likely to live in poor housing and be exposed to fuel poverty. Being poor - and its concomitants - compromises mental health in a number of profound ways. It undermines an older person’s capacity to make choices, retain independence, save for a crisis, maintain social contacts and be digitally included. It is linked with worry, loss of control over life and shame. Poor older people are at heightened risk of isolation and loneliness, stress, anxiety and depression. The UK has a weak policy record, compared with other developed countries, of sustainably and coherently addressing poverty in later life. One of the cornerstones of doing so is a continued commitment to the basic state pension as a fundamental building block of a secure old age. Addressing poor housing is also pivotal.

Introduction

2020 ◽  
pp. 1-6
Author(s):  
Alisoun Milne
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Health Outcomes ◽  
Later Life ◽  
Social Categories ◽  
Age Related ◽  
Wide Range ◽  
Life Itself ◽  
Life Course Analysis

Despite much emphasis on mental illness in later life, limited work has focused on mental health. This book aims to address this deficit by exploring, and explaining, mental health outcomes in later life through the lens of critical social gerontology and via the conduit of life course analysis. It adopts an approach underpinned by a commitment to understanding, and making visible, the role of lifecourse, and age related inequalities in creating or amplifying risks to mental health, as well as exploring those issues that afford protection. It aims to offer a critical review of existing discourse and disrupt the ‘taken for granted’ paradigm, including in the dementia arena. This approach not only recognises that mental health in later life is a complex multi-dimensional issue that cuts across time, cohort, social categories and individual experiences but that it is affected by a wide range of lifecourse and age related issues. It also encourages the development of understanding that adopts a wide lens of analysis and of policy and service related responses that reduce risks to mental health during the lifecourse and in later life itself. Further, it engages with the potential to learn from older people’s perspectives and lives.

scholarly journals Factors affecting primary care practitioners’ alcohol-related discussions with older adults: Qualitative study

2021 ◽  
pp. BJGP.2020.1118
Author(s):  
Bethany Kate Bareham ◽  
Jemma Stewart ◽  
Eileen Kaner ◽  
Barbara Hanratty
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Older People ◽  
Focus Groups ◽  
Old Age ◽  
Later Life ◽  
Long Term Conditions ◽  
Age Related ◽  
Comparison Results ◽  
Primary Care Practitioners

Background: Risk of harm from drinking is heightened in later life, due to age-related sensitivities to alcohol. Primary care services have a key role in supporting older people to make healthier decisions about alcohol. Aim: To examine primary care practitioners’ perceptions of factors that promote and challenge their work to support older people in alcohol risk-reduction. Design and Setting: Qualitative study consisting of semi-structured interviews and focus groups with primary care practitioners in Northern England. Method: Thirty-five practitioners (general practitioners, practice/district nurses, pharmacists, dentists, social care practitioners, domiciliary carers) participated in eight interviews and five focus groups. Data were analysed thematically, applying principles of constant comparison. Results: Practitioners highlighted particular sensitivities amongst older people to discussing alcohol, and reservations about older people’s resistance to making changes in old age; given drinking practices could be established, and promote socialisation and emotional wellbeing in later life. Age-related health issues increased older people’s contact with practitioners; but management of older people’s long-term conditions was prioritised over discussion of alcohol. Dedicated time to address alcohol in routine consultations with older people, and training in alcohol intervention facilitated practitioners; particularly pharmacists and practice nurses. Conclusion: There are clear opportunities to support older people in primary care to make healthier decisions about alcohol. Dedicated time to address alcohol, training in identification of alcohol-related risks, particularly those associated with old age; and tailored interventions for older people, feasible to implement in practice settings, would support primary care practitioners to address older people’s alcohol use.

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