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Older people’s mental health

There exists a broad assumption that older people’s mental health is all about dementia. This is untrue. According to Age Concern and the Mental Health Foundation, depression is the most common mental health condition in later life, and there are currently 2.4 million older people in the UK with depression severe enough to impair their quality of life. Aside from depression, older people are also prone to other mental health conditions: 5% of the population aged over 65 have dementia; 20% of older adults in an acute hospital environment will develop delirium, and 1% of the older population within the UK have schizophrenia.

While wishing to avoid ‘labelling’ or to focus merely on diagnosis, it is important to recognise that older people experience a broad range of mental health issues, and these may also include: dementia of varying types; schizophrenia and paranoid states; bipolar disorders;  anxiety states; stress-related disorders, post-traumatic stress;  the e ects of alcohol or drug misuse. Apart from dementia, many areas of older people’s mental health have been particularly neglected, and this may be attributed to prejudicial perceptions of old age. Dyson claims that alcohol misuse among older people is a neglected issue within mental health care. While it could be argued that the incidence of alcohol misuse is underestimated in all age groups, older people are notably absent in policy priorities. For example, the Alcohol Harm Reduction Strategy for England focuses on young binge drinkers and alcohol-dependent people of working age. Mental health and alcohol misuse are closely related and can interact through a cycle whereby stressors or mental health needs can increase alcohol consumption which, in turn, can affect mental health. Mixing alcohol with some prescribed drugs can be particularly dangerous for older people. Specialist services are limited, and the number of older people accessing these is low, but older people who do access treatment are able to alter their drinking patterns. Another neglected area includes post-traumatic stress disorder (PTSD), labelled as ‘shell shock’, ‘battle fatigue’ or even ‘weak willed’, which was common during and after the two World Wars. It was first identified by the psychiatrist WH Rivers working at Craiglockhart hospital in Edinburgh during the First World War. Working with soldiers suffering from psychological trauma, he developed the phrase war neurosis. However, it was not until the latter part of the 20th century when research documented the extreme psychological reactions to major disasters that the underlying psychological processes developed. Now conceptualised as a catastrophic stressor outside the range of usual human experience, PTSD is now more widely recognised among older people, and a range of psychotherapeutic and pharmacological treatments are available.

There is perhaps a view in society that ideas around stress and psychological trauma are alien to older people, and that the ‘older generation’ just ‘get on with it’. However, this is a likely stereotype with no real supporting evidence. There are also groups of older people whose mental health needs are commonly under-recognised. These include older people who are homeless and those in prison.

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