The assumption that mental health problems are a 'normal' aspect of ageing is not true. Most older people do not develop mental health problems, and they can be helped if they do.
However a significant number of people do develop dementia or depression in old age. Between 10-16% of people over 65 have depression. An estimated 2-4% have severe depression. Older people living alone or in residential/nursing care and those with physical illnesses and/or disabilities are more at risk, with some 40% affected by depression.
An estimated 4-23% of older adults seen by medical staff have an alcohol problem.
Fewer than 1.6% of men and 0.5% of women aged 60-65 have dementia, but this increases with age to over 32% of men and women aged 90+.
Many older people experience psychological or emotional distress associated with factors linked to old age, including isolation, loss of independence, loneliness and losses of many kinds, including bereavements.
Depression affects more older people than any other age group.
Some 10-16% of older people in the community have depression, rising to some 40% of older people in residential and nursing care homes. This is because older people are much more vulnerable to factors that lead to depression.
However, although it can be prevented, they are not always offered the treatments that working age adults are offered. Up until recently many health professionals failed to identify depression, seeing it as an inevitable feature of aging and so have not offered the treatments and support available to other age groups.
It is can be difficult to diagnose depression in older people because it often occurs alongside other mental and physical illnesses, such as dementia and chronic illnesses such as stroke, diabetes and cancer. In addition many older people do not seek help from their GP.
Age discrimination in mental health services needs further attention.
Services developed for working adults need to be available to older adults on the basis of need, not age. Mainstream primary care, intermediate care, hospital care, residential and other long-term care services all need to be able to not just accommodate the care, but facilitate the treatment of older people with mental health problems as these often co-exist with other problems.
There are however some improvements in recent years and more ideas are in play for how to recognise and help mental illness in older people. It is however still behind in the implementation of these ideas as it will take a lot to break the barrier in society that has been there for a long time.
Occupational therapy interventions
The expert group considered this recommendation to be still relevant and useful. New evidence was identified that might add detail to the recommendations, for example occupational therapy interventions improving the mental wellbeing of older people diagnosed with dementia.
The expert group considered this recommendation still to be relevant and useful. New evidence, for example on the role of physical activity in preventing or delaying dementia might add detail to the recommendation but would be unlikely to change it. It was suggested the guidance could be amended to include a link to the Chief Medical Officer's physical activity guidelines for older adults (2011) http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-olderadults. aspx
There is new evidence of the cost effectiveness of walking for health schemes.
The expert group considered this recommendation still to be relevant and useful. They noted that occupational therapists are asked to help adapt physical activity for people with cognitive impairment and to provide training for care home staff. The group also noted new schemes for accredited training and skills development for those who work with people with cognitive impairment and/or dementia.
However these are not readily offered as mental health problems are still 'accepted' in older people and not seen as so much of a problem. Further investment in specialist old age mental health services is required if we are to provide care for those with greatest needs as well as providing advice and support to mainstream services