Mental Health Care For Older People Research Articles

Challenges and opportunities in strengthening primary mental healthcare for older people in India: a qualitative stakeholder analysis

BackgroundPrimary mental healthcare (PMHC) allows for complex mental health issues in old age to be addressed. India has sought to improve PMHC through legislation, strategies and programmes. This study analyses the challenges and opportunities involved in strengthening PMHC for older persons in India from the perspectives of key stakeholders.MethodsSemistructured interviews were conducted with 14 stakeholders selected from the PMHC system in India and analysed using thematic analysis. First, the analysis was organizationally structured in accordance with the six WHO mental health system domains: (1) policy and legislative framework, (2) mental health services, (3) mental health in primary care, (4) human resources, (5) public information and links to other sectors, and (6) monitoring and research. Second, for each building block, challenges and opportunities were derived using inductive coding.ResultsThis study highlights the numerous challenges that may be encountered when attempting to strengthen age-inclusive PMHC. Among these challenges are poor public governance, a lack of awareness and knowledge among policy-makers and other stakeholders, and existing policies that make unrealistic promises to weak primary healthcare (PHC) structures with an excessive focus on medicalizing mental health problems. Thus, the mental health system often fails to reach vulnerable older people through PHC. Established approaches to comprehensive, family- and community-oriented PHC support attempts to strengthen intersectoral approaches to PMHC that emphasize mental health promotion in old age. Targeting the PHC workforce through age-inclusive mental health education is considered particularly necessary. Experts further argue that adequate monitoring structures and public spending for mental health must be improved.ConclusionsIn this study, we aim to elaborate on the mental healthcare developments that may serve to achieve equity in access to mental healthcare in India. Coordinated and collaborative efforts by public and private stakeholders involved in the care of older persons, both with and without lived mental health experiences, as well as their families and communities, are necessary to bring the vision of those policies for PMHC to fruition. The findings presented in this study can also inform future research, policies and practice in other low- and middle-income countries.

Workshop 4: Cognitive Assessment For Older People in Daily Clinical Practice – A Primer

The world faces a rapid population aging. Based on the World Health Organization (WHO) estimates, number of individuals older than 60 years is expected to double by 2030. With this demographic shift, non-communicable diseases are on the rise in the older population, especially neurocognitive disorders (NCD). Globally, 10 million new cases of dementia are detected every year according to the WHO (2019) data. Mild Cognitive Impairment (MCI) has an even greater prevalence of 15-20% with a conversion rate of 5-10% each year. NCD are not only progressive, but are associated with impairment of functioning, reduced autonomy, behavioral challenges, altered quality of life and caregiver burnout.In light of the same, brief, tailored and culturally sensitive cognitive assessments need to be an integral component of routine mental healthcare for older people. However, training and validation related to such rating scales are often lacking, there exists ambiguity in their interpretation and their use is limited to tertiary settings. Further, various challenges in their use such as effect of education, ceiling effects, linguistics and patient comfort are often not taken into account.With this background, the current interactive workshop will involve-Understanding the various domains of cognitive assessments in older people-Clinical nuances for early detection of cognitive deficits-Familiarity with the basic rating scales (screening and batteries) for assessing cognitive deficits in older adults-Bedside lobar assessments∗This workshop intends to make the participants comfortable and interested in using structured cognitive assessments and clinical evaluation of cognitive deficits as a routine component of their clinical care for older adults.

Primary mental healthcare for older people in India: between stigmatization and community orientation

BackgroundQuestions of equitable access to primary mental healthcare (PMHC) for older persons in India have been examined mostly in terms of the coverage of services, although perceptions of mental health and old age and social norms at the community level should be considered in the shaping of PMHC approaches. The present qualitative study, therefore, examined how social perceptions and norms of mental health in old age are and should be considered in the design and implementation of primary healthcare approaches in India.MethodsA secondary thematic analysis of semi-structured interviews with key stakeholders (n = 14) of PMHC in India was conducted.ResultsFour key themes emerged from the analysis, in which social perceptions and norms were discussed: (1) family participation and low threshold access to mental healthcare, (2) the position of community health workers as an important pillar of old age and mental health-sensitive community-based care, (3) the role of social cohesion and traditional values in fostering a positive and supportive community environment for old age mental health, and (4) the empowerment of communities, families and older persons through mental health education.ConclusionsPMHC, with its focus on mental health promotion, could be an important anchor for combatting negative attitudes about mental health and old age. The findings presented in this study can inform age-sensitive policies and programmes for mental health in India and could inform future research on the subject.

The effects of the COVID-19 virus on mental healthcare for older people in The Netherlands.

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Updated College position statement on mental healthcare for older people

Updated College position statement on mental healthcare for older people

A dreamed cooperation: Stakeholder query in Flemish Limburg concerning cooperation in the field of mental healthcare for older people

This study is an extensive stakeholder query on cooperation in the field of mental healthcare for older people. Cooperation is a key theme in the current policy on mental healthcare in Flanders which is an application of the socialisation of care. The consultative platform SPIL recruited representatives of the primary healthcare through local consultative platforms (POP) and other relevant actors. This qualitative study used the appreciative inquiry in focus groups. There were 12 focus groups with a total of 110 participants, asked to dream of an ideal cooperation. Results show a great willingness to work together effectively with a central role for the patient. Participants seek knowledge, expertise and practical support from each other. They request a consult feature to know where to turn to. The main premise to cooperation is knowing each other, for which time and space is needed. A joint patient record is another request. No great new projects are requested. Focus must go to further elaboration of working together.

Improving the network management of integrated primary mental healthcare for older people in a rural Australian region: protocol for a mixed methods case study

IntroductionAn integrated approach to the mental healthcare of older people is advocated across health, aged care and social care sectors. It is not clear, however, how the management of integrated...

Effects of an anger management and stress control program on smoking cessation: a randomized controlled trial.

The purpose of this study was to investigate the effects of a cognitive behavioral therapy-oriented anger management and stress control program on smokers' quit rates. Of 2348 smokers, 350 were randomly allocated into study and control groups (n = 175 each). An individualized therapy cessation technique was selected for each participant (combination of behavioral counseling, nicotine replacement therapy, and/or pharmacotherapy). The participants in the control group attended a standard quit program, whereas the study group also received an additional 5-session (90 minutes each) cognitive behavioral therapy-oriented program aimed at improving their anger and stress coping skills. At the beginning of the study, both groups were asked to complete the Trait Anger Scale (TAS) of the State and Trait Anger Scale and the Self-Confident (SCS) and Hopeless (HS) subscales of the Stress Coping Styles Inventory; pretest smoking status of both groups and their coping skills were compared with each other as soon as the program ended (post-test results) and after 3 and 6 months (first and second follow-up tests). Although there was no difference between pretest scores on the TAS (P = .234), SCS (P = .130), and HS (P = .148) subscales, post-test results indicate that the study groups' TAS and HS scores decreased and SCS scores increased (P < .001), whereas there was no change in the control group (P > .05). The study group had a better quit level after 6 months compared with the control group (44% vs 27.4%; P < .001). The anger management and stress control program was found to have a significant effect on cessation (odds ratio, 2.09; 95% confidence interval, 1.14-3.85). The anger and stress coping skills program may increase the success of quitting smoking.

Seasonality of Depression Referrals in Older People

Seasonal affective disorder is becoming more widely recognised as a prevalent mood disorder in the adult population. However, few studies have investigated the link between sunlight exposure and mood in the elderly. Referrals to the community Mental Health Care for Older People (MHCOP) in the Hackney and City area, were screened for the number of patients referred with depression in three separate years (2007, 2009 and 2011) in order to determine whether more referrals were made to the service during darker months of the year (October to March) than in the lighter months of the year (April to September). When data from the three years was combined, we found no significant increase in the number of referrals to the MHCOP in the darker months (Chi squared value 1.375, p value (2 tailed) 0.2409). We observed no statistically significant seasonal pattern of referrals, this suggests that depression in older people is not more prevalent in darker months of the year.

Using action research to address the mental health needs of older people: a reflection and discussion of real‐world problems

Action research provides an opportunity to implement and understand the process of change in practice settings, as well as develop theoretical insights into complex social situations. The provision of mental healthcare for older people within the general hospital is one such situation, and this paper presents a discussion and reflection on the use of action research in this setting. The background to the project is described, followed by a discussion of three major issues that emerged for us: the extent to which we were able to promote democracy and maintain and demonstrate democratic behaviour, the problems and pitfalls of operationalising grounded theory methodology within an action research approach, and the challenges of developing an authentic and credible account of the care of older people with mental health needs. This paper aims to add to a discourse regarding action research and will be of value to researchers using this approach across a range of health, social care and educational settings.