Older Adult Mental Health Research Articles

Perceiving Greater Ageism in Barriers to Mental Healthcare Relates to Poorer Mental Health for Older Adults

ABSTRACT Objectives Older adults underutilize mental healthcare, and ageism as a potential barrier has been under-researched. As ageism comes both from external sources and is internalized by older adults, we examined the prevalence of external and internalized ageist barriers to help-seeking and how depressive and anxiety symptoms differed based on how strongly older adults endorsed these ageist barriers. Methods A sample of 247 older adults completed measures online to assess barriers to mental healthcare (BMHSS-R), depressive symptoms (CES-D), and anxiety symptoms (GAD-7). Results Barriers representing internalized ageist stereotypes about older adult mental health were endorsed more frequently than external ageist barriers. Older adults endorsing ageist barriers to care reported significantly more depressive and anxiety symptoms than those not endorsing these barriers. Conclusions Ageism, particularly internalized beliefs that poor mental health is typical in older adulthood, was reflected in older adults’ perceptions of barriers to seeking mental healthcare. Both internalized and external ageist barriers to care negatively influence well-being. Clinical implication To support older adult mental health, clinicians should dispel inaccurate, ageist stereotypes about older adult mental health internalized by their clients and work to increase and then communicate their openness and ability to provide competent mental healthcare to older adults.

Identifying complex emotional and relational needs of service users in Later Life CMHTs within the Greater Manchester Mental Health NHS Foundation Trust

The Community Mental Health Transformation Agenda places a focus on supporting adults and older adults with severe and enduring mental health difficulties, including care for older adults with complex emotional and relational needs (CERN). Current research has paid little attention to CERN in later life. Studies suggest that older adults with CERN present differently to younger adults. This means services may not be identifying and meeting the needs of these individuals. The aim of this scoping exercise was to understand the prevalence of CERN in older adult community mental health services in Greater Manchester. Data was collected on 347 service users under the Care Programme Approach with later life community mental health teams in Greater Manchester. Data was gathered from the Trust electronic record system and interviews with care co-ordinators. Findings revealed that services users had high levels of complex need, including high levels of service use and high levels of risk, especially for self-neglect. Findings aligned with scoping exercises conducted in other Trusts and provided a better understanding of the needs of this population.

Economic impact of a vision-based patient monitoring system across five NHS mental health trusts.

A vision-based patient monitoring system (VBPMS), Oxevision, has been introduced in approximately half of National Health Service (NHS) mental health trusts in England. A VBPMS is an assistive tool that supports patient safety by enabling non-contact physiological and physical monitoring. The system aims to help staff deliver safer, higher-quality and more efficient care. This paper summarises the potential health economic impact of using a VBPMS to support clinical practice in two inpatient settings: acute mental health and older adult mental health services. The economic model used a cost calculator approach to evaluate the potential impact of introducing a VBPMS into clinical practice, compared with clinical practice without a VBPMS. The analysis captured the cost differences in night-time observations, one-to-one continuous observations, self-harm incidents, and bedroom falls at night, including those resulting in A&E visits and emergency service callouts. The analysis is based on before and after studies conducted at five mental health NHS trusts, including acute mental health and older adult mental health services. Our findings indicate that the use of a VBPMS results in more efficient night-time observations and reductions in one-to-one observations, self-harm incidents, bedroom falls at night, and A&E visits and emergency service callouts from night-time falls. Substantial staff time in acute mental health and older adult mental health services is spent performing night-time observations, one-to-one observations, and managing incidents. The use of a VBPMS could lead to cost savings and a positive return on investment for NHS mental health trusts. The results do not incorporate all of the potential benefits associated with the use of a VBPMS, such as reductions in medication and length of hospital stay, plus the potential to avoid adverse events which would otherwise have a detrimental impact on a patient's quality of life.

Understanding resilience: Lifestyle-based behavioral predictors of mental health and well-being in community-dwelling older adults during the COVID-19 pandemic

BackgroundChanges in sleep, physical activity and mental health were observed in older adults during early stages of the COVID-19 pandemic. Here we describe effects of the COVID-19 pandemic on older adult mental health, wellbeing, and lifestyle behaviors and explore predictors of better mid-pandemic mental health and wellbeing.MethodsParticipants in the Adult Changes in Thought study completed measures of lifestyle behaviors (e.g., sleep, physical activity) and mental health and wellbeing both pre-pandemic during regular study visits and mid-pandemic via a one-time survey. We used paired t-tests to compare differences in these measures pre- vs. mid-pandemic. Using multivariate linear regression, we further explored demographic, health, and lifestyle predictors of pandemic depressive symptoms, social support, and fatigue. We additionally qualitatively coded free text data from the mid-pandemic survey for related comments.ResultsParticipants (N = 896) reported significant changes in mental health and lifestyle behaviors at pre-pandemic vs. mid-pandemic measurements (p < 0.0001). Qualitative findings supported these behavioral and wellbeing changes. Being male, never smoking, and lower pre-pandemic computer time and sleep disturbance were significantly associated with lower pandemic depressive symptoms. Being partnered, female, never smoking, and lower pre-pandemic sleep disturbance were associated with higher pandemic social support. Pre-pandemic employment, more walking, less computer time, and less sleep disturbance were associated with less pandemic fatigue. Participant comments supported these quantitative findings, highlighting gender differences in pandemic mental health, changes in computer usage and physical activity during the pandemic, the value of spousal social support, and links between sleep disturbance and mental health and wellbeing. Qualitative findings also revealed additional factors, such as stresses from personal and family health situations and the country’s concurrent political environment, that impacted mental health and wellbeing.ConclusionsSeveral demographic, health, and lifestyle behaviors appeared to buffer the effects of the COVID-19 pandemic and may be key sources of resilience. Interventions and public health measures targeting men and unpartnered individuals could promote social support resilience, and intervening on modifiable behaviors like sleep quality, physical activity and sedentary activities like computer time may promote resilience to fatigue and depressive symptoms during future community stressor events. Further research into these relationships is warranted.

Single case experiment evaluating the effectiveness of an adapted cognitive behavioural therapy intervention for an older adult with a fear of falling

Aim:A single case experiment was carried out for a 77-year-old woman who was referred to the older adult community mental health team for support with anxiety related to a fear of falling.Method:An AB design was implemented, using an adapted cognitive behavioural therapy graded exposure intervention to target her anxiety and fear of falling.Results:There was an overall reduction in the client’s anxiety and an increase in her activity levels.Conclusion:The adapted intervention resulted in decreased anxiety, psychological distress, and a fear of falling and an increase in the frequency of her walking.Consent:The client was provided with information about the purpose of the write up for this case study. She kindly provided informed written consent for the case study to be published within an academic journal. Some demographic details have been amended to protect her identity.

Exploring clinicians’ experience of using Behavioural Family Therapy within an older adult community mental health service

This service evaluation summarises the experience of staff offering Behavioural Family Therapy (BFT) in a community mental health setting for older people. Semi-structured interviews were conducted to gather staff views and a Template Analysis was used to summarise feedback. This evaluation indicates that BFT were seen as beneficial to Older Adults (OA) across a range of mental health problems and adaptations were needed to support this patient group and their families.

Adverse Event Reporting in Older Adult Mental Health: A Theme Analysis

Adverse Event Reporting in Older Adult Mental Health: A Theme Analysis

A Quality Improvement Project to Investigate How Addenbrooke's Cognitive Examination-III (ACE-III) Training Improves the Accuracy of ACE-III Scoring in an Older Adult Community Mental Health Team

A Quality Improvement Project to Investigate How Addenbrooke's Cognitive Examination-III (ACE-III) Training Improves the Accuracy of ACE-III Scoring in an Older Adult Community Mental Health Team

Quality Improvement Project: Lithium Monitoring in an Older Adult Community Mental Health Team

Quality Improvement Project: Lithium Monitoring in an Older Adult Community Mental Health Team

Venous Thromboembolism (VTE) Risk Assessment in an Older Adult Mental Health Inpatient Ward

Venous Thromboembolism (VTE) Risk Assessment in an Older Adult Mental Health Inpatient Ward

Optimizing Older Adult Mental Health in Support of Healthy Ageing: A Pluralistic Framework to Inform Transformative Change across Community and Healthcare Domains.

This paper describes a pluralistic framework to inform transformative change across community and healthcare domains to optimize the mental health of older adults in support of healthy ageing. An extensive review and analysis of the literature informed the creation of a framework that contextualizes the priority areas of the WHO Decade of Health Ageing (ageism, age-friendly environments, long-term care, and integrated care) with respect to older adult mental health. The framework additionally identifies barriers, facilitators, and strategies for action at macro (social/system), meso (services/supports), and micro (older adults) levels of influence. This conceptual (analytical) framework is intended as a tool to inform planning and decision-making across policy, practice, education and training, research, and knowledge mobilization arenas. The framework described in this paper can be used by countries around the globe to build evidence, set priorities, and scale up promising practices (both nationally and sub-nationally) to optimize the mental health and healthy ageing trajectories of older adults as a population.

Extended Reality and Older Adult Mental Health: A Systematic Review of the Field and Current Applications

Extended Reality and Older Adult Mental Health: A Systematic Review of the Field and Current Applications

Scanning the horizon: How might the psychological needs of the older adult population change in the recovery stage of the Covid-19 pandemic? Part two: Covid-19 and PTSD

This document was developed by clinical psychologists working in community older adult mental health services during Covid-19. Born out of discussions about what the profession should expect during the recovery phase, the present authors decided to write a document to inform and guide those working in psychological services on identifying and working with changes in the population’s mental health needs. This document focuses on the likely role of clinical psychology and is structured in two parts. The second part addresses the potential for patients to experience post-traumatic stress disorder (PTSD) and how we can assess and treat PTSD in these populations.

Scanning the horizon: How might the psychological needs of the older adult population change in the recovery stage of the Covid-19 pandemic? Part one: Covid-19 and complicated grief

This document was developed by clinical psychologists working in community older adult mental health services during Covid-19. Born out of discussions about what the profession should expect during the recovery phase, the present authors decided to write a document to inform and guide those working in psychological services on identifying and working with changes in the population’s mental health needs. This document focuses on the likely role of clinical psychology and is structured in two parts. The first part highlights the possibility of an increase in the prevalence of complicated grief before outlining how to work psychologically with it.

The Effects of the Built Environment on the Mental Health of Older Adults: A Case Study in Hangzhou, China.

This study examines the association between the built environment and mental health among older adults by exploring the potential pathways through the perceived built environment, social interaction, and environmental pollution. Research data were collected from 1405 older adults aged 60 years and older in 30 residential neighborhoods of Hangzhou, China, in 2022. The participants' evaluation of the perceived built environment, social interaction, and environmental pollution were assessed. Mental health was measured by the 12-item Short-Form Health Survey. The built environment was measured through an evaluation of density, diversity, design, destination accessibility, distance to transit, and the age-friendly environment. Structural equation models were established based on 300-m, 500-m, and 800-m buffers from the entrance of residential neighborhoods. The propensity score method was employed for sensitivity analysis. With regard to older adult's mental health, there were significant direct effects of the accessibility of health services, shopping services, and bus stops. A robust mediating effect of perceived built environment was displayed on the relationship between land use mix and mental health of older adults. Social interaction exhibited robust mediating effects between the age-friendly environment, the number of bus stops, and mental health of older adults. This study provides empirical experience for related research on the built environment and mental health as well as policy implications for urban planners focusing on community planning.

The experiences and perspectives of older adult mental health professional staff teams when supporting people with young-onset dementia.

Background. The diagnosis of young-onset dementia presents significant challenges both for the person and their families, which often differ from the challenges faced with late-onset dementia. Evidence of the experience of service users and carers tends to reveal a negative appraisal of the care received, citing longer diagnosis times, poor clinician knowledge and lack of age-appropriate care. However, evidence looking into staff experiences of supporting someone with young-onset dementia is relatively scarce. The aim of this study was to explore the experiences and reflections of health and social care staff who support people with young-onset dementia within older adult mental health services, and whether their knowledge of the systems they work in could reveal the existence of barriers or facilitators to young-onset dementia care. Methods. Health and social care professionals working with people and carers with young-onset dementia across England were remotely interviewed between September and December 2021. Data were analysed using inductive thematic analysis. Findings. Sixteen staff members were interviewed. Three themes were constructed with six sub-themes. The first theme related to the perception of greater complexity around young-onset dementia support. The second theme describes staff fears around their ability to effectively support people with young-onset dementia, including the perception that young-onset dementia requires specialist input. The final theme describes systemic and structural inefficiencies which provide additional challenges for staff. Conclusions. Providing effective support for people with young-onset dementia and their families requires adjustments both within the clinician role and mental health services. Staff considered young-onset dementia support to be a specialist intervention and felt the services they work for are suited to generic mental health and dementia provision. Findings are discussed with recommendations relating to developing a standardised model of dementia care for young-onset dementia which recognises and responds to the unique experiences of young-onset dementia.

Evaluating the effectiveness of trauma-informed care training delivered to staff in community Older Adult Mental Health Services

PurposeBy older adulthood, the majority of individuals will have experienced at least one traumatic event. Trauma-informed care (TIC) is proposed to improve effectivity of health-care provision and to reduce likelihood of services causing retraumatisation. This study aims to assess the effectiveness of staff training in TIC in older adult services.Design/methodology/approachTIC training was delivered across eight Older Adult Community Mental Health Teams in the same UK organisation. Questionnaires were administered before and after training: a psychometrically robust measure, the Attitudes Related to Trauma-Informed Care, was used to assess TIC-related attitudes, and a service-developed scale was used to measure changes in TIC competence. Data was analysed using linear mixed effects modelling (LMM). Qualitative data regarding the impact of training was gathered one month after training through a free-text questionnaire.FindingsThere were 45 participants, all of whom were white British. LMM on pre- and post-data revealed that staff training significantly increased competencies across all measured TIC domains. Overall, staff attitudes were also significantly more trauma-informed after training. Qualitatively, staff identified time as the only additional resource required to deliver the skills and knowledge gained from training.Practical implicationsTraining was found to be effective in increasing TIC-related skills and attitudes. Organisations aiming to become trauma-informed should consider staff training as one aspect of a wider development plan.Originality/valueTo the best of the authors’ knowledge, this paper is the first to examine TIC training for staff working in Older Adults Mental Health Services. Recommendations for services aiming to develop a trauma-informed culture have been provided.

Monkeypox Emergence Post-COVID: Insight into Egyptian Older Adult's Awareness, Concern, and Mental Health.

Aim: To identify Egyptian older adults' awareness, concerns, and mental health about the monkeypox outbreak. Background: In light of the ongoing COVID-19 pandemic, monkeypox disease is receiving more attention. The monkeypox virus outbreak has posed a global concern, especially to older adults with comorbidities. Natural disasters, and endemic affect older persons' mental health. Design: A cross-sectional descriptive design was followed. Methods: 254 older adults were recruited from three outpatient clinics using consecutive sampling using four tools. Results: 74.0% of older study participants were unaware of monkeypox. Gender, level of education, residence, worry about contracting monkeypox infection, and mental distress are predictors of awareness about monkeypox (p < .001). Worry of contracting monkeypox infection was common among female participants (p = .038), highly educated (p = .001), who had a low level of awareness and high level of mental distress (p = .001 for both). Conclusion: Awareness of monkeypox was associated with worry and mental distress. Gerontological nurses have a vital role in contacting older adults and providing care and education that decreases worry and preserves minds and feelings, improving their quality of life. Establishing a national strategic planning and crisis prevention framework to alleviate psychological distress and prevent mental health issues from deteriorating in this group is crucial.

BUILDING FOUNDATIONAL COMPETENCIES IN OLDER ADULT MENTAL HEALTH: VIRTUAL AND IN-PERSON TRAINING

Abstract Designed to develop foundational knowledge competencies for generalist clinicians, this program was created by a team of geropsychologists, geriatric social workers, geriatric psychiatrists, and neuropsychologists, who reviewed competencies of multiple mental health disciplines, and identified 14 key areas of knowledge for clinicians. Content was created by Rush faculty, externally peer-reviewed, and developed into two versions. The 14-hour online version includes knowledge checks and national expert videos to provide multiple perspectives and voices of experience. Of the first 176 learners in the online version, 96.8% rated the overall program as excellent, with strong agreement (97.4 – 98.3%) that the training was applicable to practice, expectations were met, and learners had intention to apply the knowledge. All learners are required to achieve a minimum of 75% on knowledge post-test to complete each module. The three-day in-person program provided 25 diverse clinicians representing every HHS region with didactic content, interactive exercises, discussion, and a simulated patient experience to practice skills with live expert feedback. Participants demonstrated 14% improvement in knowledge (p&amp;lt;.01). Didactic lectures were rated 100% extremely or very helpful; 82% rated group learning exercises extremely helpful; 100% rated the simulation lab as extremely or very helpful. Balance between activities and match with learning style were rated good to very good. All participants rated the likelihood of recommending the program to a colleague as extremely or very likely. Evaluation of skill implementation is ongoing. Implications for expanding generalist competencies in older adult mental health will be discussed.

The relationship between older adults’ perceptions of ageing and depression: a systematic review

PurposePerceptions of ageing towards the self and towards others can positively and negatively impact an older adult’s mental wellbeing. This paper aims to consolidate literature examining the relationship between perceptions of ageing and depression in older adults to inform both practice and policy for older adult mental health services.Design/methodology/approachQuantitative research articles examining perceptions of ageing and depression in older adults were identified through searches on three electronical databases, alongside forward and backwards citation searches. A total of 14 articles involving 31,211 participants were identified.FindingsGreater negative attitudes towards ageing were associated with higher levels of depressive symptoms and greater positive attitudes towards ageing were associated with lower levels of depressive symptoms or higher levels of happiness. However, the causal direction of this relationship could not be determined. Studies demonstrated that perceptions of ageing also act as a moderator in the relationship between depression and health status, hopelessness and personality traits. Future research should attempt to examine the relationship between perceptions of ageing and depression in older adults to attempt to identify the causal direction of this relationship.Originality/valueThis is the only systematic review the authors are aware of consolidating literature which explores the relationship between older adults’ perceptions of ageing and depression. It is hoped that these findings will be able to inform both policy and practice to improve older adults’ care and support for depression.