Older Mind Matters

Discrimination or inclusion: age inclusive mental health services for older adults

This was the topic of a lively debate held at an old age psychiatry meeting I attended in June. I was asked to support the motion (ie that it is discriminatory).

Equality does not mean treating everyone the same but is about ensuring that people are treated fairly and equitably according to their needs.” I took this quotation from an audit tool - link to it here. One of the problems involved in becoming aware of age discrimination is the development of the myth that, if something different is done for someone because of their age, this means that they are being discriminated against. In actual fact if necessary allowances are not made for age-related disadvantage discrimination will result.

As a group older people differ from younger people and some will have very different needs. For example we know that “health status score declines with age” and the prevalence of dementia rises sharply with age (eg see the WHO SAGE study, Global Health and Ageing, WHO, 2011). Recently there has been concern that drug treatments are not tested in groups which properly represent the older population so that we don’t know enough about the risks and benefits of new drug treatments for older people: Watts wrote recently in the British Medical Journal: “just as children are not physiologically identical to adults neither are very elderly people equivalent to those decades their junior”.

There are psychological differences with age. Older adults draw more on expertise, knowledge and well practised routines of behaviour, may have slower reaction times, and may have had to adapt to a range of age-related losses, for example.

The social context of older people is also different. Across the world the number and percentage of older people living alone is rising in most countries, coupled with limited mobility, frailty and declines in physical and cognitive functioning in later life these changes result in decreased social interaction, which itself may have psychological consequences such as loneliness.

Thus older people differ psychologically, physiologically and in terms of social context: dealing with complex multiple co-morbidities in combination with social issues is very different to treating younger people, and a skillset found in elderly care medicine but of far less relevance elsewhere.

So older adults’ needs are distinct from younger people and to lump everyone into a single so-called age inclusive service is to deprive older people of the specialist services they rightly require (and, if we are brutally honest, is financially driven).

4 comments (Add your own)

1. Derek Beeston wrote:
As well as Age Inclusive services I think 'Age Appropriate' services would also be a good idea. This is only my opinion but I often witness the 'infantilisation' of older people by health care staff. Could it be that when faced with a confused elderly person some people ( often good kind and caring people) revert back to what worked with their children - and find they it works - it then becomes 'how we do things around here.' However successful the strategy might be I've never met a child that's lived for 80+ years! Here are some of my personal highlights from the last few years-

- older people sitting in a circle throwing bean bags to each other to the music of 'Nellie the Elephant' being spurred on by an over zealous Health Proffessional who berated an elderly gentleman because he did not want to join in.

- A group of elderly patients 'painting' on butchers paper with 'powder paints' and then having their work pinned to the wall, just like when they were at infant school.

Wolfensberger and others talk about the importance of 'Age Appropriateness' in services. There is also the concept of the 'Culturally Valued Analogue' that basically states that when you're about to do something with or for a patient one should aim to do it in the most culturally valued way possible. Sadly this is rarely the case in older peoples services. Here's something to think about as well as age inclusive and appropriate should services for older people be more 'gender' appropriate too - I have long noticed that older males seem to quickly become 'feminised' in an in patient setting - is this because nearly all the carers are female. An example - most men I know ( including older men) stand up to urinate, but within a few days/weeks of being an in patient They are being sat down for a wee! Why?

On the main point of age inclusiveness it will be interesting to see how the IAPT
Impacts On older peoples access to 'mainstream' therapies?

Ihave written this onmy phone as a text so apologies for typos.

Fri, July 27, 2012 @ 2:33 PM

2. Michael wrote:
Hi all,

I agree entirely that services which are 'offered' to older people ought to be both age inclusive and age appropriate. However, I think the choices we offer people in terms of interventions are somewhat limited and based on far too many assumptions e.g. older people enjoy bingo and listening to war time music!

I think it is important to offer specialist services who understand the physiological, psychological and social changes which affect older people, which are therefore age appropriate.

As far as activities go, we need to ask older people more what they feel may be therapeutic and could work for them. To this end, we perhaps should be aiming more on upstream interventions. These interventions are also very easy to make age inclusive.This is cost effective, reduces stigma and gives the secondary specialist older people's services the capacity to concentrate on those who need their skills most. Unfortunately, "invest to save" are dirty words in the current financial climate.

In my view improved partnership working is the way to go with services being commissioned to work together towards a common goal - keeping people out of hospitals and care homes where possible and living life until death.

Wed, August 1, 2012 @ 1:59 PM

3. Victoria wrote:
Hi Everyone
I agree with the improved partnership idea but agencies may be reluctant to engage and prefer their own in-house provision.

I am also curious about the silence I perceive when talking about services for older adults and comparable to issues of rce that make people feel uncomfortable. I raised this with a colleague and she suggested that maybe people don't like talking about getting old.

Its safe to say that services for older people are gendered in some culture, hence more likely to hear of women's group than men's group. This apparent division may suggest that men may grieve differently from women and/or have less emotional needs in later life.

Perhaps the idea of home service may be included because of issues of loneliness, isolation and mobility. When a partner/relative passes away, ill and/or recovering from illness, home visit may be supportive of emotional needs along side practicalities. This is particularly so when well wishers have gone and the bereaved left to mourn, sometimes alone.

I wondered if there is such thing as olympic for older adults as 30+ now seem to signify old age in sports.

Thu, August 2, 2012 @ 4:43 PM

4. Susan Mary wrote:
Victoria you might be interested in a clip from a film called Autumn Gold about older athletes training for the track and field World Masters Championships see this link http://www.youtube.com/watch?v=T5GhmvuNAZI and this link here http://www.world-masters-athletics.org/ will take you to the World Masters Athletics website.

I agree with your comments about the lack of psychological therapies for older people and the need to try to find ways to talk about things which we seem to find easier to ignore. Even where psychological services don't actively exclude older adults they don't seem to acknowledge and address their needs.

Thu, August 2, 2012 @ 8:02 PM

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