Mentally health later life

  • Desired outcomes
  • Current evidence and recommendations
  • Equality and diversity
  • Scotland's population over the age of 50 years currently represents 35 percent of the Scottish population – and this number is on the increase. To meet our goal of a mentally flourishing Scotland, mental wellbeing in later life is vital.

    As with other age groups, people in later life in Scotland should enjoy mental wellbeing (feel confident, experience life satisfaction, have a sense of belonging, feel empowered and in control of their lives) and the absence of mental health problems.

    When mental health problems do arise, people in later life should have access to appropriate services to help reduce problems, address disadvantages, and enhance physical health, social networks and meaningful activity.

    The Scottish Government's vision for people over the age of 50 years in Scotland is that all years of life should be fulfilling. Also, that the contribution of people – irrespective of age, ethnicity, disability, gender, sexual orientation or religious belief – is valued, appreciated and, where necessary, supported.

    back to top

    Desired outcomes

    The desired outcomes are:

    • Improved mental wellbeing in later life.
    • Reduced prevalence of mental health problems in later life.
    • Increased quality of life for people in later life experiencing mental health problems.
    • Increased participation in a wide range of meaningful and health-improving activities.
    • Reduced discrimination.

     

    back to top

    Current evidence and recommendations

    Informed by reviews of effectiveness evidence, NICE have produced public health guidance on mental wellbeing and older people. NICE public health guidance 16: Occupational therapy interventions and physical activity interventions to promote mental wellbeing of older adults in primary care and residential care [external website] made four action recommendations each with a number of action points.

    • Occupational therapists (or other relevant professionals) should offer interventions to encourage older people to identify, construct, rehearse and carry out daily routines and activities
    • Older adults should be offered a range of appropriate exercise programmes (mixed exercise programmes of moderate intensity, strength and resistance training, and stretching and toning)
    • A range of organisations should provide a range of walking schemes.
    • Organisations working with older people should ensure occupational therapists are involved on the development of locally relevant training schemes for those working with older people.

    Involving older people in the development of programmes underpins these recommendations. The NHS Health Scotland Scottish Perspective on this guidance [external site] supported the action points subject, where appropriate, to adaptation to fit Scottish organisational arrangement.

    The original NICE recommendations, and the evidence statements that informed them, can be found on the NICE website [external site].

    Also informed by reviews of effectiveness evidence, the Foresight project called Mental Capital and Wellbeing suggests actions aimed at optimising the mental wellbeing of older adults, and unlocking their potential.

    Interventions identified as being important ways to support the mental wellbeing and mental capital of older adults include:

    • Maintain mental capital and promote mental wellbeing: promote social networking; protect against age-related mental decline starting earlier in life through physical fitness, tackle risk factors for white matter lesions, and manage stress; improve learning opportunities for older adults; and promote valued and valuable engagement.
    • Promote environments for mental wellbeing: improve physical environments; improve work environments; improve access to information and communication technology; improve the social environment regarding stigma and negative attitudes towards older people.
    • Address dementias: identify people at risk early and monitor; provide prompt treatment; review basis of treatment options.
    • Improve treatments for mental health problems: tackle depression using pharmacological and psychological therapies; provide better social care through improved training and organisation; leverage new technologies for managing memory loss.

    Promoting mental health and well-being in later life [PDF: 303kb], published by Age Scotland and the Mental Health Foundation in 1996 draws on a comprehensive literature and policy review, and the views of nearly 900 older people and carers, together with the views of nearly 150 organisations and professionals. The report identified five key areas for action to promote mental wellbeing in later life:

    • Tackling discrimination.
    • Supporting participation in meaningful activity.
    • Supporting the development and maintenance of positive relationships.
    • Improving physical health.
    • Tackling poverty.

    Tackling discrimination

    Age discrimination is the most frequently experienced form of prejudice for people in later life and has a negative effect on mental health. Challenging ageist public attitudes and related discrimination needs to be at the heart of mental health improvement in this area. In addition to work with the public, action to tackle ageist attitudes and discrimination among decision-makers and planners is required. The public sector has a major role, nationally and locally, as provider or commissioner of services and programmes to improve health and wellbeing.

    Supporting meaningful activity

    Staying active and involved in society helps maintain a sense of wellbeing, yet older people face many barriers to participation in areas including transport, learning, employment, hobbies, and everyday activities. Removing barriers so older people can participate in meaningful activity is an important component of mental health improvement in later life.

    Supporting positive relationships

    Good relationships are vital for mental wellbeing, while the absence of social contacts can lead to loneliness, isolation, mental health problems and suicide.

    Promoting physical health

    Poor physical health has a negative impact on mental wellbeing and is a risk factor for mental health problems. Action to improve physical health in later life supports mental wellbeing and reduces the risk of mental health problems. Physical health is also important for those experiencing mental health problems and can be addressed by individuals changing their behaviour, community action and structural change.

    Tackling poverty

    Poverty is a clear risk factor for mental health problems in later life. Not being able to afford decent housing, heating, travel and social activities undermines mental wellbeing. Assistance to improve financial security in later life will help address mental health improvement.

    Promoting mental health and well-being in later life [PDF: 303kb] draws on a comprehensive literature and policy review, and the views of nearly 900 older people and carers, together with the views of nearly 150 organisations and professionals.

    In addition, local actions are needed to address issues of equality and diversity, vulnerable groups, carers, early intervention, dementia, abuse (including neglect and domestic abuse), suicide, recovery and inclusion, and positive steps in later life.

    Mentally Healthy Later Life Reference Group - Recommendations to inform Scottish Government's action plan to promote mentally healthy later life in Scotland. Following consultation with older people, NHS Health Scotland, in 2010, produced recommendations to inform the Scottish Government's action plan to promote mentally healthy later life in Scotland.

     

    back to top

    Equality and diversity

    A report by the European Healthy Ageing Project identifies a number of cross-cutting areas for action to address equality and diversity in later life.

    It is vital that mental health improvement in later life takes equality and diversity of ageing into account and considers gender, sexuality, race, disability and spirituality. Such actions must be fully inclusive of the particular needs of older people from different groups.

    Although many older people in Scotland are healthy, a significant number are at risk of inequalities with regards to mental wellbeing and mental health problems.

    People at most risk are those in their 80s and 90s-plus from ethnic minority communities, with poor physical health, who are on a low income, and with limited social and community contact.

    Vulnerable groups

    Vulnerable groups include older people in prisons [external site] or older people in residential and care homes [external site] or who have home care.

    Carers

    Under the Community Care and Health (Scotland) Act 2002, NHS Boards are required to develop and implement Carer Information Strategies, including improved information and training to help carers in their roles. The Scottish Government's Better Health, Better Care: Action Plan [PDF: 2.83mb] includes a commitment to support carers to look after their own health.

    Suicide

    In 2006, an average of five people aged over 50 completed suicide each week. Although, for men, suicide rates generally decline with age, for women, the highest rate is observed in the 45–64 year old age group [PDF: 1.22mb].

    Breathing Space [external site] was set up as part of the Scottish Government's National Programme for Improving Mental Health and Wellbeing. It provides emotional support for all ages.

    Abuse

    Research suggests one in four vulnerable older people are at risk of abuse, including domestic abuse, and that levels of detection are low.

    A study by the Centre for Research on Families and Relationships called Older women and domestic violence in Scotland [PDF: 316kb] found that older women are more likely than younger women to stay within an abusive relationship, and have a higher incidence of being exposed to long-term trauma.'

     

    back to top