|
Older people and mental health
Please give feedback on this information
Copyright note for Mind factsheets: Both individuals and organisations are welcome to print and photocopy any complete factsheet from the 'Information' section of Mind's website. Organisations are free to distribute them to service users and colleagues, but must ensure they always use the latest version of the factsheet, as available on the website, at the time of distribution.
This factsheet is for older people, but it is also relevant to their carers, relatives and friends. It explores how older people can maintain good mental health, and gives information on mental distress with an emphasis on the issues that may affect older people.
The factsheet contains details of other publications that may be useful, and also gives details of other organisations that may be able to provide further information or support. All Mind publications cited are available from the Mind Publications Unit and Mind's website, unless otherwise stated.
Throughout this factsheet 'older people' refers to those aged 65 and over, although many of the issues covered, such as retirement, may be relevant to people under 65.
The contact details of all organisations and publications mentioned in the body of this factsheet can be found in the 'Useful contacts and resources' section at the end of this factsheet.
Introduction
Life changes
Retirement
Bereavement
Keeping healthy and staying active
Exercise for physical and mental well-being
Diet and nutrition for physical and mental well-being
Sleep
Social life
Family life
Staying mentally active - learning opportunities
Sexuality
Spirituality
Mental health issues
Depression
Dementia
Dementia or depression
Other mental health problems
Diverse groups
Black and minority ethnic older people
Older lesbians, gay men and bisexual men and women
Older people and caring
Older people as care givers
Older people as care receivers
Useful contacts and resources
Introduction
Growing old is a natural process that produces a range of reactions in different people. You may feel positive about it, you may feel some dread or anxiety, or you may have mixed feelings.
Older people, no less than other age groups, can live their lives in ways that protect and promote their mental health, in the context of social and personal wellbeing. Some of the information in this factsheet may be familiar to you; some of it may help to explode negative myths about old age and mental health. We hope this factsheet will bring to your attention the useful resources and ideas that can help you make the most of later life.
Life changes
Retirement
It is easy to under-estimate the impact retirement can have. It may be that your work was central to your life. It may have provided not only an income and a structure to your day, but also a sense of purpose, status, and perhaps a social network. Equally, you may have been looking forward to retirement over many years; you may have details of retirement planned out or want to find out more about the opportunities retirement can offer.
What may be the adverse effects of retirement?
Retirement rates high up on the scale of stressful life events, along with bereavement and divorce. On retirement, it is not unusual to experience mixed feelings. On one hand, retirement may have been something that you have looked forward to; on the other hand, you may feel numb, sad, rejected, or depressed. If you have been made redundant or forced into early retirement, then you may feel shocked, hurt and angry, as well as afraid of what the future may hold.
Some people have feelings of joy and freedom at the start of retirement, only to find that these are replaced after a few weeks by feelings of boredom, low self-esteem and emptiness. Society's attitudes to older people can contribute to low morale.
Retirement can have an impact on your relationships and you may find it harder to cope with spending 24 hours a day with your partner than you may have thought. You may feel anxious about the future, and worried about maintaining your standard of living.
What opportunities can retirement offer me?
Depending on the individual, life during retirement may be more or less similar to earlier life in terms of occupations, interests and aims. However, most people find that they have far more free time during retirement, even if they had not been previously occupied by full-time employment. This increase in leisure time can be used to pursue the opportunities on offer for continued social, intellectual and spiritual development.
If you have not already done so, a key step is to decide your goals and to plan towards them. Consider a variety of ideas and options and discuss them with family and friends until you have worked out a future for yourself that feels right for you. If you have a partner, it would be useful to involve him or her in these discussions. If you are still working, it is worth finding out if your employer provides a retirement preparation programme; these usually consist of seminars, workshops and useful information for future reference.
Whatever you choose to do, most older people, no less than younger adults, find that it is important to keep or develop interests, stay (or become more) active and develop a regular structure to their day. Age Concern publishes a comprehensive handbook, Your guide to retirement that will be available at your local Age Concern branch or at your local library. This covers all aspects of retirement, including finances, travel and holidays, health, and community involvement. Many of these aspects are also covered in the 'Keeping healthy and staying active' section above.
Ageism within Western society has led to a prevalent belief that quality of life inevitably declines with age. This need not be the case and organisations such as Age Concern, Help the Aged and Mind are campaigning to ensure that the potential of the retirement years is more widely known and realised in individuals' lives. Old age, like every other stage of life, has its specific challenges but these can be addressed by older people themselves, with the help of friends, family and supportive organisations. Much lies within the power of older people, individually and collectively, to make their retirement a comfortable and fulfilling stage of life.
Bereavement
We all experience bereavement and loss at some time in our lives. As an older person, you are likely to have seen the loss of people close to you over the years, such as a partner, family members or friends.
How may bereavement affect me?
Grief may come out in many different ways, often with powerful, frightening and confusing feelings. There is a usual pattern of emotional progress through grief: starting with disbelief or denial, moving through guilt and anger and culminating in acceptance and peace. Of course, no two people's experiences of bereavement are alike and many complex factors influence the grieving process. If we attempt to avoid grief, we could be unable to live fully for the rest of out lives, and could be storing up mental distress for ourselves later on.
What can help me cope with bereavement?
Talking to friends and family who also knew the person who has died can help. Alternatively, you may prefer to find support from a community nurse, health visitor or social worker. If you belong to a formal religion, you could find support from within your church, mosque, temple or synagogue.
Family doctors who have cared for the person during their last illness can be in a position to help. Through their profession, they are familiar with the reality of death and how it can affect people. This can often make them good people to talk to. Doctors can also make a referral for counselling, or they may offer you medication. Minor tranquillisers or antidepressants are sometimes given. Although these drugs can ease the symptoms of mental distress that has come about through bereavement, they do not address the cause of the symptoms. It is also worth being aware that drugs have some adverse effects and that minor tranquillisers can be addictive.
The Benefits Agency employs specially trained bereavement officers who can provide information and support around benefit entitlements.
Many organisations are available to help you during bereavement. Mind has also published a booklet on this subject, Understanding bereavement.
Keeping healthy and staying active
Exercise for physical and mental well-being
Exercise has many positive benefits for physical and mental health. The benefits of exercise on specific conditions such as depression will be covered later in this factsheet. You can also read more about the wider benefits of exercise in the Mind guide to physical activity.
As we age, there is a change in our physical ability. This can include loss of bone density (especially in women), loss of muscle tone and joint problems. However, the extent of these changes differs from person to person and medical evidence suggests that much physical decline is not the inevitable result of ageing but of long-term sedentary living. Such physical decline can be halted and even reversed by taking regular exercise.
You may already take exercise and there is no reason why this should change as you grow older. There are no forms of exercise that are considered unsuitable for older people, provided that the exercise is tailored towards your level of fitness and takes into account any health or mobility problems you may have.
If you have not taken exercise for many years, or wish to take up a new form of exercise, it is important arrange a check-up with your GP. Some GPs can prescribe exercise at local leisure centres as a form of treatment for an existing health problem, and can advise you on which form of exercise might be suitable for you.
Your local Age Concern may also be able to advise and some of their branches run activities involving exercise. Contact the Age Concern Information Line for details. Age Concern also produces a detailed factsheet aimed at older people entitled Staying healthy in later life.
Diet and nutrition for physical and mental wellbeing
If you eat well, you are likely to feel healthier, stay active for longer and protect yourself against illness. As well as helping you stay in good general health as you get older, a healthy diet can do much to prevent falls and to reduce the risk of osteoporosis and fracture.
Many older people have been preparing tasty, nourishing meals for themselves and others over many years. However, you may also face challenges to regular, healthy eating, such as decreased appetite, lack of transport to shops and services or living alone, perhaps after the death of a partner or spouse who had been responsible for preparing meals.
If you get used to missing meals, or eating unhealthily, you may start to feel tired, depressed and cold. To keep well and to keep energy levels up, good regular eating patterns are important. The link between nutrition and mental health is complex and you can find out more about this in the Mind guide to food and mood.
If you are experiencing problems with your diet or appetite, you may want to consider seeing a dietician. They are professional health workers skilled in assessment and management of problems with diet and nutrition. Dieticians may work in local GP surgeries, health centres and hospitals. If you feel you would benefit from this service, ask at your GP surgery to find out about getting a referral.
Help the Aged produce a factsheet entitled Healthy eating. It has been written in association with the Nutritional Advisory Group for Elderly People (NAGE) of the British Dietetic Association (BDA).
Sleep
Many people have difficulties sleeping and you may find that these problems increase with age. After the age of 50, the amount of sleep we need naturally declines and you may find that the average length of sleep each night falls to six hours or less. Even the occasional night without sleep does no lasting damage.
However, on-going insomnia or sleep disturbance can lead to tiredness, irritability and difficulty concentrating. When you frequently have problems sleeping you may incur what is known as 'sleep debt.' Sleep debt can affect intelligence and control of movement. It can also have a negative effect on metabolism and production of hormones. While you are in sleep debt you are more likely to make mistakes or to behave irrationally.
Long-term lack of sleep can be either a cause or a symptom of a mental health problem such as depression or anxiety. If you think this may be the case for you, it is important to consult your GP, who should help you identify the problem and possible solutions, referring you for further assessment if necessary.
Following basic 'sleep hygiene' measures can help you develop a regular sleeping pattern. These include avoiding caffeine in the evenings, going to bed and getting up at the same time each day, regular exercise and, if possible, avoiding naps during the day. Of course, these measures have different effects on different people; you may already know which, if any, have a beneficial effect on your own sleeping pattern.
If your difficulties sleeping do not respond to 'sleep hygiene' measures, your doctor may suggest a short course of sleeping tablets. Sleeping tablets can be useful in breaking a bad sleep pattern but should not be taken in the long-term because they become less effective over time and addiction may develop. You should be aware that, as an older person, you could have an increased sensitivity to the sleeping tablets, benzodiazepines. You may also be vulnerable to unwanted interactions between sleeping tablets and medication you take for other conditions.
Social life
The retirement years can bring a welcome release from some social commitments or obligations of earlier life. As many older people have found, time alone does not have to result in loneliness or isolation but can have emotional, intellectual and spiritual benefits that were harder to achieve in earlier life.
However, most people of all ages find that a social component is essential to their health and wellbeing. Retirement offers new opportunities to spend more time with loved ones, to extend your social networks – or to build new ones.
You may wish to participate more in activities and organisations you already enjoy. If you would like to try something new, Help the Aged produce a factsheet entitled Leisure ideas which gives information on topics such as community services, holidays, sport and volunteering. It also has a section on meeting new people and relationships. As with sport and physical activity, there is no social or leisure pursuit that is unsuitable for older people, provided that it takes into account your health, abilities and interests.
Volunteering
Many older people choose retirement years as a time to start voluntary work. Voluntary work can provide social and intellectual stimulation, the potential for new friendships and increased self-esteem through the effective use – and acquisition – of skills. Older volunteers can gain particular pleasure from using their life experience to benefit younger members of the community.
There is increased recognition in the voluntary sector of the skills and knowledge older people can bring their work: the Home Office has recently launched a two-year initiative, VITA, (Volunteering for the Third Age) aimed at recruiting and retaining older volunteers.
Age Concern's on-going programme of Intergenerational Activities was created to fulfil the unmet needs of children, young people and adults in the community through older adults' voluntary work. The recipients of these schemes include those in social isolation and mental distress. Older volunteers can undertake many roles, including teaching assistant, mentor and befriender. For more information about Intergenerational projects, contact Age Concern.
Family life
Research has repeatedly shown that contact with relatives and friends from different age groups is beneficial to the mental health of older people. Face-to-face, telephone and email contact take away the isolation that older people can experience, especially those who live alone. Practical difficulties that can cause mental distress, such as poverty and mobility problems, can be alleviated by friends' and relatives' assistance.
What is equally true, though less widely reported, is the beneficial effect on all age groups of interaction with older people. Older people are as likely to be givers as receivers of care (see Older people and caring, below). Research from the Woolworth's and Age Concern Survey 2003 shows that 75 per cent of British grandparents are involved in their grandchildren's lives and have a clearly defined role to play in their upbringing. The role can include that of carer, friend, confidant and tutor.
If you have no family members living nearby, or have lost touch with relatives over the years, this can be a source of distress, causing isolation and loneliness in later years. However, it is important to remember how many ways there are of keeping in touch, such as telephone and email.
Many older people use email and the Internet to keep in touch with relatives and even research their family history. Retirement years can provide the opportunities to re-establish old relationships or start new ones.
All public libraries and Age Concern centres now have computers with email facilities, and committed staff willing to teach you how use them. This is available at a low cost or is free of charge.
Staying mentally active – learning opportunities
Taking up learning opportunities at any age can enhance your life and help you feel healthier all-round.
There are a number of different options open to you if you are thinking about returning to some sort of education. Nearly all opportunities for learning are provided locally and will vary from area to area. Universities, colleges and local authority adult education centres offer a range of programmes, including short courses.
Libraries are a good resource for independent learners, as well as a source of local information. A factsheet from Age Concern entitled Leisure and learning provides signposts to local activities, including opportunities in the arts, in open learning and at local Age Concern branches.
The BBC's People's War campaign and local initiatives such as the Sixty Plus Intergenerational Computer Project are just two examples of the learning by older adults taking place across the UK.
There is a national adult learning helpline, called Learndirect, which gives information on all kinds of local learning opportunities.
The University of the Third Age (U3A) offers lifelong learning for older people and believes that we learn for the pleasure of it, and so no qualifications are required and none are given. Around the country, groups of people organise themselves for the purpose of learning. The subjects tackled vary with each U3A local group and the number offered will depend on the size and enthusiasm of the group.
Sexuality
Ageism within society can mean that older people are seen as being asexual, but both men and women can continue to have a satisfying sex life when they get older.
If you feel like it, there is no reason why sex should not continue into your old age. There are no limits, providing the desire is there for both partners. However, if you feel no sexual desire, or less than in earlier life, that should not be seen as a problem either.
If you live in residential care or supported accommodation, you may find that staff are not always supportive of close physical or sexual relationships between residents. Of course, this is not always the case and support for relationships can vary, depending on the attitude of the care provider.
Remember that as an older person, you are entitled to your sexuality. It is perfectly acceptable for you to have sexual feelings and for couples to have sexual feelings about each other. Both masturbation and sexual contact between consenting adults should not be seen as a problem. Studies show that over a third of women and nearly half of men aged 70 and above still masturbate and well over half of married men and women in that age range have sex with their spouse. Even when the desire and ability to have intercourse has declined, many older adults find that the need for touch and intimacy continues over many years.
The same applies to older people who are lesbian, gay or bisexual, although if you belong to this group, you may find the issues are slightly different for you. Please see the Diversity section in this factsheet.
Spirituality
Spiritually is about how we make sense of our past, our present and our future, whether this is within an organised religion, within another type of group, or as an individual.
Our spirituality embraces our ideas about who we are and what our purpose is in life. Many people of all ages experience their lives as having a spiritual dimension and this can have a major affect on our mental health.
Spirituality is often focused in particular areas for older people, who may have faced bereavement and the inevitability of death but who also experience the joy of significant milestones and life events. Many older people strive for 'reconciliation' with others and with God, for the meaning of their own lives in the context of a greater whole.
If you experience distress about any of these issues, support is often available from places of worship such as mosques, churches, synagogues and temples. Most organised religions offer their pastoral care services to those of any faith or none.
If you do not belong to an organised religion but want to talk about spiritual matters, you may find talking to a counsellor helpful. (See Counselling.)
Mental health issues
The most common mental health problems found in older people are depression and dementia. There is a widespread belief that these problems are a natural part of the ageing process but this not the case: only 20 per cent of people over 85, and 5 per cent over 65, have dementia; 10-15 per cent of people over 65 have depression. It is important to remember that the majority of older people remain in good mental health until the end of their days.
What is depression?
Depression is a debilitating condition and the most common mental health problem in the UK. At its mildest, depression manifests itself in a persistent low mood and in physical tiredness, making the tasks of everyday life feel more difficult and less enjoyable or worthwhile. Major depression involves feelings of hopelessness and helplessness, at its most severe leading to suicidal thoughts and actions.
Symptoms and causes
The symptoms of depression include insomnia or sleep disturbance, loss of appetite, low energy/fatigue, poor concentration, low mood, agitation, feelings of guilt and hopelessness and the inability to derive interest or pleasure from activities you had previously enjoyed.
There is no one single cause of depression. Some people are more prone to depression than others for a range of possible reasons, including family background and painful past experience.
Certain life events and social situations can trigger a depressive episode, lead to further deterioration or make recovery more difficult. These include physical illness, major life changes (such a moving house or retirement), poverty, isolation, bereavement, relationship breakdown and being the victim of a physical or sexual attack.
Depression and later life
Depression affects proportionately more older people than any other demographic group. This is because older people face more events and situations that may trigger depression: physical illness and debilitating physical conditions, bereavement, poverty and isolation.
As an older person experiencing depression, you may find that your symptoms are mistaken for other ailments, perhaps when you visit the GP's surgery. This is because symptoms can often differ from those experienced in younger age groups. These symptoms of depression in later years, such as agitation and anxiety, can be confused with Parkinson's disease or Alzheimer's disease. They may also be confused with thyroid disorders, strokes or heart disease, or as a side effect of medication (which they can sometimes be). However, if you have depression it can prevent or delay recovery from other illnesses and injuries.
If you think you may have depression which has been misdiagnosed by your GP, you have the right to discuss these concerns with your GP and, if necessary, to get a second opinion from another GP. It is also your right to ask for a comprehensive assessment, which would involve specialists in psychiatry and neurology.
If you are aged 75 or over, depression may cause a metabolic imbalance due to poor diet and sleep. In addition, it can suppress immunity, making you potentially more prone to infections.
Suicide
In some people, depression can lead to suicide. The factors that cause an older person to consider suicide may be different from those of a younger person. For example, chronic illness and pain, loneliness or decline in mobility may cause despair. Being highly dependent on others may lead a person to think that the only autonomy they have left is to decide whether to take their own life or not.
Warning signs that depression may be leading to suicidal intentions include:
- loss of interest in things or activities that are usually enjoyable
- cutting back social interaction, self-care and grooming
- breaking medical regimens, e.g. going off diets, prescriptions etc.
- experiencing or expecting a significant personal loss, e.g. a spouse
- feeling hopeless and/or worthless (who need's me?)
- putting affairs in order, giving things away, or making changes in wills
- stock-piling medication or obtaining other lethal means.
Other clues include a preoccupation with death or a lack of concern with personal safety. Goodbyes such as 'This is the last time that you'll see me' or 'I won't be needing any more appointments' should raise concern. The most significant indicator is an expression of suicidal intent.
Mind produces a booklet entitled How to help someone who is suicidal.
Age of onset
Although depression can have its onset in the later years, it can also strike anyone at any stage of life. If you are an older person who has had recurrent or chronic depression since earlier life, you may be familiar with its causes and alert to your symptoms. You may have learnt the best ways to manage or recover from your condition over many years. However there may also be other ways to alleviate depression that you might find helpful.
What can help alleviate depression?
Depression is not a natural or unalterable mental state for any personality, temperament or stage of life. The vast majority of people who have depression make a full recovery after appropriate treatment. As an older person, you will be just as responsive to treatment as a younger person will. However, there are aspects of some medical interventions that may have different effects on an older person.
Medication
Antidepressant medication is the most commonly prescribed treatment for depression. Antidepressant drugs may not deal with the causes of depression, but may lift your mood so that you are capable of making changes in your life that will aid your recovery.
Antidepressants can cause side effects and withdrawal symptoms; see Mind's booklet, Making sense of antidepressants, for details. These effects may be compounded by the age-related changes to the metabolic system, which can lead to medication accumulating in the body.
You may experience interactions between antidepressants and medication you are taking for physical conditions. It is also worth being aware that some medication prescribed for physical conditions can actually cause depression. These include beta-blockers and other blood pressure medication, some heart drugs, steroids and sedatives. If you are concerned about any of these issues, the United Kingdom Psychiatric Pharmacy Group will be able to help you further.
Counselling
Talking about your feelings, fears and negative thoughts, as well as how to manage them, can help to alleviate depression. If you are feeling very low, you may feel you are unable to communicate at first. Counselling can be useful as a sole treatment or in addition to antidepressants. For more detailed information, see Mind's booklets Understanding talking treatments and Making sense of counselling.
Unfortunately, as an older person, you are less likely to be referred to counselling services by your GP. You can ask your GP to refer you to a counsellor or contact the British Association for Counselling and Psychotherapy for a list of counsellors in your area. Your local Mind association may also offer counselling. (To find your local Mind association, you can call MindinfoLine on 0845 766 0163, Mon-Fri 9.15am-5.15pm or see the Mind in your area section of Mind's website).
ECT (Electroconvulsive therapy)
This controversial treatment involves passing an electric current through one or both sides of the brain, while under anaesthetic. ECT may be suggested if you have severe depression that is not responding to treatment. For detailed information about ECT, see Mind's booklet, Making sense of ECT.
Traditionally ECT has been given to older people due to the adverse effects of tricyclics, an older class of antidepressants, on the cardiovascular system. However, new types of antidepressants are now available, as well as other treatments, and so this argument has become invalid.
Creative faculties and coordination can be affected by ECT. There are also risks connected to the anaesthetic. As an older person, ECT could put you at a greater risk of suffering heart problems, strokes and falls.
Alternative, complementary and herbal medicine
Many people have found that alternative and complementary therapies have had aided recovery from depression. Such therapies include, but are not limited to massage, aromatherapy, yoga and homeopathy. See The Mind guide to massage, The Mind guide to yoga and Making sense of homeopathy.
Herbal medicines have also been used successfully to treat depression, in particular St John's Wort (Hypericum). If you are considering taking herbal medicine, it is important to consult your doctor to ensure that it will not cause harmful interactions with other medicines you take. For more information, see Mind's booklet Making sense of herbal remedies and factsheet St John's Wort – Hypericum perforatum.
Preventive measures
Although we do not have a full understanding of depression as yet, there are steps we can take to reduce the risk of developing depression. These have been mentioned in this factsheet under the Keeping healthy and staying active section. Looking after our physical, emotional and social wellbeing is likely to lift our mood, enhance our self-esteem and foster the sense that we are meaningfully connected to the world we live in. This is the best defence against depression and small steps in these areas mark the way to lasting recovery.
Dementia
Dementia is the name given to a group of diseases that affect the normal working functions of the brain. This can lead to a decline of mental ability, affecting memory, thinking, problem-solving, concentration and perception.
What are the causes?
Alzheimer's disease is the most common form of dementia; it is the progressive and irreversible destruction of neurons in the brain. Researchers believe that onset is caused by a combination of ageing, lifestyle and genetics and that there is no single cause of Alzheimer's disease.
Other, less common forms of dementia may be caused by a lack of oxygen to the brain, head injury, pressure on the brain (e.g. from a tumour), hydrocephalus (fluid build up between the brain and brain lining), neurological disease (for example, Parkinson's disease), infection (for example, AIDS), vitamin deficiency or long period of excessive alcohol consumption.
What are the symptoms?
The symptoms of dementia vary according to the stage of the illness. In the early stages, dementia can be difficult to diagnose; the person will experience small changes to their everyday functioning, such as concentration, decision-making and short-term memory.
In the middle stages, the person will become more confused and forgetful, especially about people's names and recent events; they may also become upset, angry or aggressive more easily.
In the late stages, the person will become unable to remember familiar faces and objects. They will become unable to express themselves or understand what is being said to them. They will be unable to carry our personal hygiene tasks and may become incontinent. They may also need to use a wheelchair or become bedridden.
What can help alleviate dementia?
The irreversible nature of dementia makes it very different from other forms of mental distress. The illness cannot be halted or reversed. The exceptions to this are the forms of dementia related to vitamin deficiency (which can be treated with supplements) or head injury (which can be treated with surgery).
Anti-dementia drugs, such as Aricept and Reminyl, may be given to alleviate the symptoms of dementia, but they cannot cure it. These drugs were originally recommended in the NICE (National Institute for Clinical Excellence) guidelines of 2001. However, NICE is currently reviewing this advice, claiming that there are doubts as to the effectiveness of these drugs. Both drugs do have the support of the Alzheimer's Society, but access to them via NHS services cannot be guaranteed.
NICE is due to publish new guidelines on the treatment of dementia in February 2007.
Early positive results have been obtained from research into new treatments for dementia. Gene therapy that consists of transplanting genetically engineered tissue into the brains of Alzheimer's patients has been shown to slow the progress of the disease. Vitamin B supplements have had a similar effect on some patients, though more research is needed in this area. Light therapy, music, massage, aromatherapy, therapeutic touch and multisensory stimulation have been shown to decrease the agitation and aggression associated with dementia.
What can prevent dementia?
Although there is no certain way to prevent dementia, evidence suggests that simple lifestyle changes can help to reduce vulnerability: this includes following a healthy diet, giving up smoking and avoiding excessive alcohol consumption. Regular physical exercise and supplements, like Gingko Biloba, improve circulation and therefore blood flow to the brain. (It is important to consult your doctor before taking such medication). Keeping your mind agile, by doing activities such as crosswords or puzzles, may also be helpful.
What support is there for carers?
If you are caring for someone with dementia you may be entitled to financial and practical help at a local level. What you are actually entitled to will depend on your personal circumstances and what is offered by your local social services. Such assistance may include home helps or meals-on-wheels. Day Centres, offering care and therapeutic activities for people with dementia, may be run by local health authorities, social services or voluntary organisations.
As the illness progresses to its later stages, the person with dementia will need increased personal assistance with everyday activities such as washing, bathing and dressing. The Alzheimer's Society provides resources that give information and advice on how to give this assistance in a sensitive and effective way.
In time, you may find that the person with dementia needs full-time care in a residential setting. It is a good idea to plan for this as far as possible in advance: this will reduce financial and other practical difficulties in the future and will enable the person with dementia to have the greatest input into any decisions made. How much you pay for residential care will depend on your situation and the area you live in (see Mind's factsheet Supported housing).
Caring for someone with dementia can be physically and emotionally exhausting and it is important to remember your own needs as a carer. You will need on-going support, as well as regular breaks. Draw on friends and other family members for the practical and emotional help they can give.
You may also want to consider respite care, where the person with dementia goes into a hospital or care home for a few days or weeks. Local voluntary organisations may provide services in your area, such as day centre and carers support groups. Local branches of Age Concern are good sources of information advice and support. Useful organisations at national level include Help the Aged, the Alzheimer's' Society and Carers UK.
Dementia or depression?
Depression is more common in older people than dementia and doctors have sometimes misdiagnosed older people who have depression, or other forms of mental distress, as having dementia. The symptoms that can be misdiagnosed include forgetfulness, lack of concentration and loss of thinking ability. In fact, someone with depression is likely to be aware of these problems and be able to discuss them, as someone with dementia is not. For more information see Mind's factsheet Confusion, depression or dementia? The need for a comprehensive assessment.
Other mental health problems
It is beyond the scope of this factsheet to give details of the full range of mental health problems that older people may experience. Indeed, this range is as wide for older people as it is for any other age group.
Rarer mental health problems that affect older people are anxiety and late-onset schizophrenia. These conditions may have different causes and symptoms for older people than for other age groups. If you would like further information on these conditions, see Mind's booklets, Understanding anxiety and Understanding schizophrenia. For late onset schizophrenia, you might also find it useful to read Recent advances in psychogeriatrics by Tom Arie.
Diverse groups
Older people are no more homogeneous than any other age group. Although they may share issues common to the ageing process, age may not be their strongest feature of self-identity. You may identify more strongly with other social groups, united by a common culture or experience. If you identify with a group that is a minority in society, you may have issues specific to that group that give you a different experience of being an older person.
Black and minority ethnic older people
If you are an older person belonging to a minority ethnic group, you may find accepting old age in Britain difficult, perhaps because of racism experienced in earlier years. Racism may be a reality in your life now.
You may have had to use mental health services (and other services) which differ from your lifestyle and do take your culture into account. Some people have experienced racism within these services and you may not feel 'safe' using them.
If you are looking for information and/or support specific to your particular group, you may wish to contact some of the organisations listed at the back of this factsheet.
Older lesbians, gay men and bisexual men and women
As an older gay, lesbian or bisexual person, you may have solid support networks that have developed over the years. You may, however, find that you feel isolated, perhaps because your partner has died, or because you have simply lost touch with others.
You may feel comfortable telling others about your sexuality, but it may be that you feel unable to share your experiences. This could be because you grew up at a time when there was a great deal of stigma attached to being gay. Some older lesbians and gay men have in the past been given damaging treatments to 'cure' their homosexuality, and you may have been part of this group.
Some older gay people share supported accommodation or residential care with heterosexual people. If you are in this group, you may find that you are comfortable being open about your sexuality. However, you may feel the need to hide your life experiences because you wonder how others might react.
There are social networks geared towards the needs of older gay and lesbian people. Becoming part of such a network can give you the opportunity to discuss the concerns you have, share knowledge and experience with others and work out practical solutions. You may be familiar with national level networks, such as Kenric. Age Concern's Opening Doors service gives details of groups at local level, as well providing useful publications and other information resources. Contact your local branch or see the Age Concern website for details.
Older people and caring
Older people make up the biggest proportion of care givers and care receivers in the UK. As an older person you are likely to play one or both of these roles at different times.
Older people as care givers
As a carer, the support you give can range from offering emotional support (by listening and showing appreciation) to providing day-to-day practical help. Carers can also advocate on behalf of the person they care for. This can mean helping the person to stand up for their rights to treatment, benefits, housing etc. or helping with communicating the person's needs and views to the professionals.
You may feel you don't need any outside help, but getting outside support can greatly reduce the stresses.
If you are caring for someone with a mental health problem in the community, then you have the right to request a Community Care Assessment under the NHS and Community Care Act 1990, for that person. Anyone can ask for an assessment for a person who 'appears to need services'. If the person you are caring for agrees, social services should visit to determine what the level of need is and what services should be provided (including residential care if this seems necessary). There is, however, no automatic right to services – it depends on the results of the assessment.
As a carer you can ask for your needs to be assessed at the same time (under the Carers Recognition and Services Act 1995). The services you might receive (if the assessment recognises that you are in need of them) might include help at home and respite care to give you a break.
Whether you are caring for someone with a physical or a mental health problem, it can be a difficult experience, with emotional, as well as practical costs. The emotions roused will depend on the nature and duration of the caring relationship: you may be caring for a partner or spouse, for an adult relative (perhaps your child) or for your grandchildren; the personal, social and health problems that impact on the caring relationship can be multiple and complex. As a carer, it is important to look after your own physical and mental health in ways that have been described in the 'Dementia' section above.
Despite the challenges involved, the caring relationship can be a rewarding one. Care giving can be reciprocal, with both parties caring for each other and gaining something positive from the experience.
There are several organisations that provide useful information and support on being a carer: Age Concern, the Alzheimer's Society and Carers UK. Mind has also published the booklet How to cope as a carer and the factsheet Carers.
Older people as care receivers
As we get older, we develop different care needs. We may need to adapt our lives to meet these needs and care for ourselves in new ways. It may also mean accepting 'care' in the sense of practical and emotional support given by an unpaid carer. This care may come from a partner or spouse, other adult relative, friend or neighbour.
Most older people do not wish to be passive recipients of care but to make well-informed choices, with support from family members and loved ones. There are many resources that can help you do this: your GP and other health professionals you come into contact with can be valuable sources of advice and support; Help the Aged and Age Concern provide information about your options for housing, benefits, how to cope with a range of health problems, as well as guides to health and social services.
You might find it helpful to obtain and discuss this information with your carer. You can then develop a care plan that takes into account your respective capabilities and needs.
In the event that your health problem, or your carer's health, is likely to deteriorate, it is important to plan for your future care needs. At what point will your carer need additional support? Could residential care be an option for the future? Should you think about making an advance statement or living will? Planning for these eventualities is likely to increase peace of mind and foster a sense of personal empowerment.
If you are receiving long-term care for the first time, or receiving it from a new person, this may change important relationships and cause you emotional distress. Carers UK, Age Concern and associations for specific illness (for example, the Alzheimer's Society and BACUP) can give you advice on how to cope with these changes and develop your relationships in a positive way for the future. GPs and the other health professionals you come into contact with can provide useful advice and support as well as directing you to other local sources of help. You may also want to consider counselling, either individually or as a couple or group, to understand and resolve these issues.
Useful contacts and resources
Older People, General
Age Concern Cymru
Ty John Pathy, 13/14 Neptune Court, Vanguard Way, Cardiff CF24 5PJ
tel: 029 2043 1555, fax: 029 2047 1418
email: enquiries@accymru.org.uk
web: www.accymru.org.uk
Age Concern England
Astral House, 1268 London Road, London SW16 4ER
tel: 0800 00 99 66 (Information Line)
web: www.ageconcern.org.uk
BBC People's War
www.bbc.co.uk/dna/ww2
Contact the Elderly
15 Henrietta Street, London WC2E 8QH
tel: 0800 716 543 fax: 020 7379 5781
website: www.contact-the-elderly.org
Help The Aged (England)
207-221 Pentonville Road, London N1 9UZ
tel: 020 7278 1114, fax: 020 7278 1116
email: info@helptheaged.org.uk
website: www.helptheaged.org.uk
Help the Aged Cymru
12 Cathedral Rd, Cardiff CF11 9LJ
Tel: 02920 346 550 fax: 02920 390 898
email: infocymru@helptheaged.org.uk
website: www.helptheaged.org.uk
Learndirect
Tel: 0800 100 900
website: www.learndirect.co.uk
Sixty Plus Intergenerational Computer project
1 Thorpe Close, London W10 5XL
tel: 020 8969 9105, fax: 020 8969 5936
email: info@sixtyplus.org.uk
website: www.sixtyplus.org.uk
University of the Third Age (U3A)
26 Harrison Street, London WC1H 8JG
tel: 020 7837 8838, fax: 020 7837 8845
email: national.office@u3a.org.uk
website: www.u3a.org.uk
VITA (Volunteering in the Third Age)
website: www.vitavolunteering.org.uk
Mental health
Alzheimer's Society
Gordon House, 10 Greencoat Place, London SW1P 1PH
tel: 020 7306 0606 fax: 020 7306 0808
email: enquiries@alzheimers.org.uk
website: www.alzheimers.org.uk
Alzheimer's Society Wales Office
4th Floor, Baltic House, Mount Stuart Square, Cardiff CF10 5FH
tel: 029 2043 1990, fax: 029 2043 1999
email: rows@alzheimers.org.uk
British Association for Counselling and Psychotherapy
ACP House, 35-37 Albert Street, Rugby, Warwickshire CV21 2SG
tel: 0870 443 5252 fax: 0870 443 5160
email: bacp@bacp.co.uk
website: www.bac.co.uk
CANDID – Counselling and Diagnosis in Dementia
National Hospital for Neurology and Neurosurgery,
Queen Square, London WC1N 3BG
tel: 020 7829 8773, fax: 0870 132 0447
email: enquiries@dementia.ion.ucl.ac.uk
website: www.dementia.ion.ucl.ac.uk
Counselling and Involuntary Tranquilliser Addiction (CITA)
The JDI Centre, 3-11 Mersey View, Waterloo, Liverpool L22 6QA
tel: 0151 932 0102 (Information Mon to Fri 10.00am - 1.00pm)
Insomnia Helpline – Medical Advisory Service
tel: 020 8994 9874 (5pm-10pm weekdays)
Parkinson's Disease Society
215 Vauxhall Bridge Road, London SW1V 1EJ
tel : 020 7931 8080, helpline: 0808 800 0303 (freephone Monday-Friday 9.30am-5.30pm)
fax: 020 7233 9908/7963 9360
email: enquiries@parkinsons.org.uk
website: www.parkinsons.org.uk
Samaritans
The Upper Mill, Kingston Road, Ewell, Surrey KT17 2AF
tel: 08457 90 90 90, fax: 020 8394 8301
email: admin@samaritans.org or jo@samaritans.org
website: www.samaritans.org
United Kingdom Psychiatric Pharmacy Group (UKPPG)
62, Park Hill, Moseley, Birmingham B13 18DT
fax: 0121 434 3270
email: contact@ukppg.org.uk
website: www.ukppg.org.uk
Mind publications
Mind factsheet 2003, Confusion, depression or dementia? The need for a comprehensive assessment.
Mind booklet 2003, How to cope with sleep problems.
Mind booklet 2004, Making sense of antidepressants.
Mind booklet 2004, Making sense of counselling.
Mind booklet 2003, Making sense of ECT.
Mind booklet 2004, Making sense of herbal remedies.
Mind booklet 2004, Making sense of sleeping pills.
Mind booklet 2004, Mind guide to food and mood.
Mind booklet 2004, Mind guide to physical activity.
Mind booklet 2004, Mind guide to spiritual practices.
Mind factsheet 2002, St John's Wort – Hypericum perforatum.
Mind factsheet 2004, Suicide factsheet.
Mind booklet 2005, Understanding anxiety.
Mind booklet 2004, Understanding dementia.
Mind booklet 2005, Understanding depression.
Mind booklet 2005, Understanding schizophrenia.
Mind booklet 2004, Understanding talking treatments.
Other publications
Arie, T. 1992, Recent Advances in Psychogeriatrics, Churchill Livingstone.
Bereavement
Compassionate Friends
53 North Street, Bristol BS3 1EN
tel: 0117 953 9639, helpline: 08451 23 23 04
email: info@tcf.org.uk website: www.tcf.org.uk
Cruse Bereavement Care
126 Sheen Road, Richmond, Surrey TW9 1UR
helpline: 0870 167 1677, fax 020 8940 7638
email: helpline@crusebereavementcare.org.uk
website: www.crusebereavementcare.org.uk
National Association of Bereavement Services
2 Plough yard, London EC2A
tel: 0207 247 1080, fax: 0207 247 0617
National Association of Widows
3rd Floor, 48 Queens Road, Coventry CV1 3EH
tel/fax: 0845 838 2261
email: info@nawidows.org.uk
Mind publications
Mind booklet, 2005, Understanding bereavement
Carers and Caring
Carers UK
20-25 Glasshouse Yard, London EC1A 4JS
tel: 020 7490 8818, fax: 020 7490 8824
email: info@ukcarers.org
website: www.carersonline.org.uk
Carers Wales
River House, Ynysbridge Court, Gwaelod y Garth, Cardiff CF15 9SS
tel: 029 2081 1370, fax: 029 2081 1575
email: info@carerswales.demon.co.uk
Mind publications
Mind factsheet, 2004, Carers' factsheet: how to access services, information for carers.
Mind booklet, 2003, How to cope as a carer.
Mind booklet, 2004, How to help someone who is suicidal.
Black and ethnic minority groups
African Caribbean Disablement Association
14 Warner Road, London E17 7DY
tel: 020 8521 6429 (Mon to Wed 10am-4pm)
website: http://rdlogo.com/cwp/acda/
Afro-Caribbean Mental Health Association
35-37, Electric Avenue, London SW9 8JP
tel: 020 7737 3603
AWETU (All Wales Black and Minority Ethnic Mental Health Group)
41a Lower Cathedral Road, Riverside, Cardiff CF 11 6LW
tel: 029 2039 4141, fax: 029 2064 4615
email: awetu@nascre.net
website: www.awetu.org.uk
Chinese Mental Health Association
Oxford House, Derbyshire Street, London E2 6HG
tel/fax 020 7613 1008
email: info@cmha.org.uk
website: www.cmha.org.uk
Confederation of Indian Organisations
5 Westminster Bridge Road, London SE1 7XW
tel: 020 7928 9889, fax: 020 7620 4025
website: www.cio.org.uk
Jewish Bereavement Counselling Service (JBCS)
8/10 Forty Avenue, Wembley HA9 8JW
tel: 020 8385 1874, fax: 020 8385 1856
email: jbcs@jvisit.org.uk
website: www.jvisit.org.uk/jbcs/
London Chinese Health Resource Centre
Queen's House, 1 Leicester Place, London WC2H 7BP
tel: 020 7287 0904
London Irish Women's Centre
59 Stoke Newington Church Street, London N16 0AR
tel: 020 7249 7318 (Mon to Fri 9.30am-5pm)
email: info@liwc.co.uk
website: www.barnet.gov.uk/a-z/index.php3?go=3000925
Nafsiyat (Inter-Cultural Therapy Centre)
262 Holloway Road, London N7 6NE
tel:020 7686 8666, fax:020 7686 8667
Mind publications
Mind factsheet, 2003, Mental health in translation
Mind factsheet, 2002, The African Caribbean community and mental health in Britain.
Mind factsheet, 2003, The mental health of Chinese and Vietnamese people in Britain.
Mind factsheet, 2001, The mental health of Irish born people in Britain.
Mind factsheet 2003, The mental health of the South Asian community in Britain.
Lesbian, gay and bisexual interest
Gay and Lesbian Legal Advice (GLAD)
helpline: 020 7837 5212
Kenric (for lesbians)
BM KENRIC, London WC1N 3XX
tel: 0115 9663638
email: kenric@yahoogroups.com
Lesbian and Gay Bereavement Project
Counselling Department, Lighthouse West London,
111-117 Lancaster Road, LondonW11 1QT
tel: 020 7403 5969 (Mon, Tues and Thurs 7pm-10.30pm)
Stonewall Housing Advice Line
2a Leroy Business Centre, 436 Essex Road, London N1 3QP
tel: 020 7359 6242, advice line: 020 7359 5767 (Mon, Thurs and Fri 10-1, Tues and Wed 2-5pm)
fax: 020 7359 9419
email: info@stonewallhousing.org
website: www.stonewallhousing.org
Mind publications
Mind factsheet, 2003, Lesbians, gay men and bisexuals and mental health.
This factsheet was written by George Stewart and Jackie Golding, Mind, January 2003 and updated by Rachael Twomey, Mind, July 2005.
|