MENTAL HEALTH AND OLDER PEOPLE

MENTAL HEALTH AND OLDER PEOPLE

World Mental Health Day, October 10 2013

World Federation for Mental Health

World Mental Health Day October 10 2013

TABLE OF CONTENTS

1. Mental health of older adults, addressing a growing concern

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MENTAL HEALTH OF OLDER ADULTS

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2. A day to reflect on the mental health and wellbeing of older people around the world

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3. More about dementia and older adults

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4. A guide to mental wellness in older age: Depression and older adults

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5. The role of social interventions and rehabilitation in the care of older adults

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6. Managing complexity and multimorbidity in older adults: Time to act

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7. Healthy ageing: Keeping mentally fit as you age

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8. Mental health services for the elderly in Thailand

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9. Person centered care for older adults - the "culture change" movement

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10. Grief and older adults

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CAREGIVERS, FAMILY & OLDER ADULTS

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11. Caring for the Alzheimer's disease patient

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12. Collaborating with families in the case of elderly patients

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13. Fact sheet: Taking care of you: Self-care for family caregivers

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14. Caregivers of older adults: Challenges and support

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Foreword

World Mental Health Day was initiated by World Federation for Mental Health (WFMH) in 1992 to highlight the importance of mental health. The WFMH Board of Directors of WFMH has chosen "Mental Health and Older Adults" as the theme for World Mental Health Day on 10th October 2013.

The theme highlights the lengthening span of the life course which in many developed countries encompasses more years at work, more years of an active lifestyle in retirement, and a growing cohort of "oldest old" people in their 80s and 90s. This is creating a new concept of "old age." In lower-income countries citizens often have shorter lifespans, and receive limited help as they age. The promotion of good mental health is an important part of the World Mental Health Day theme, as is attention to the mental health problems that older citizens may experience.

Many adults enjoy vigorous activity as they age and remain in the workforce longer. Once retired they may contribute to society as volunteers and often provide family support such as caring for grandchildren or for an infirm spouse or relative. Social connections have been recognized as a positive factor in promoting the wellbeing of older adults, and strategies to strengthen a network of such connections are very valuable.

Some key facts: ? The proportion of the world's people reaching

old age is growing dramatically as a consequence of success in improving health care and living standards. ? According to the World Health Organization the proportion of the world population over 60 years will double between 2000 and 2050, from around 11% to 22%. ? Within the cohort of older adults, more people are living to be over 80 and 90. ? Women predominate among those reaching extreme old age, as they have longer life spans on average.

? Older people often have several health problems at once; long-term conditions such as heart conditions, cancer and diabetes are known to place people at risk for mental disorders, and a number of them will experience depression and anxiety.

? Substance abuse involving alcohol and drugs is an issue that is often ignored.

? Dementia is a rising problem as more people live into extreme old age.

World Mental Health Day 2013 aims to encourage governments and organizations around the world, in countries at all income levels, to look at the mental health issues experienced by older people in their communities and to consider their needs for support and services. Improvements in provisions for care require careful planning, advocacy, and the involvement of concerned individuals.

I would like to express my appreciation for all those who have contributed to WFMH's promotional material for World Mental Health Day 2013 and, as President of the World Federation for Mental Health; I am making a personal appeal to you to support this year's theme of Mental Health and Older Adults in whatever way you can.

Let the elderly have a voice, a place and dignity.

Prof. George Christodoulou President World Federation for Mental Health

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Mental Health of Older Adults, Addressing

A GROWING CONCERN

M.T. Yasamy, T. Dua, M. Harper, S. Saxena World Health Organization, Department of Mental Health and Substance Abuse

Background The world population has never been as mature as now. Currently, the number of people aged 60 and over is more than 800 million. Projections indicate that this figure will increase to over two billion in 2050. People aged 60 can now expect to survive an additional 18.5 to 21.6 years (1). Soon the world will have a higher number of older adults than children. Contrary to common sense perceptions, the majority of older people live in low- and middleincome countries, and some of the fastest rates of ageing are occurring in these areas (2, 3).

The United Nations uses the benchmark of 60 years of age or above to refer to older people (UNFPA, 2012). However, in many high-income countries, the age of 65 is used as a reference point for older persons as this is often the age at which persons become eligible for old-age social security benefits (1, 2). This higher age category is less appropriate to the situation in developing countries including Africa where life expectancy is often lower than that in high-income countries (4).

Older adults face special health challenges. Many of the very old lose their ability to live independently because of limited mobility, frailty or other physical or mental health problems and require some form of long-term care. Early on, in the beginning of the millennium, it became clear in the USA that about 20% of adults aged 55 and over suffer from a mental disorder (5). Subsequently, global statistics showed this to be an almost universal problem (6). Mental health problems of older adults are under-identified by health care professionals and older people themselves, and older people are often reluctant to seek help.

Underlying factors of mental health problems in older adults A multitude of social, demographic, psychological, and biological factors contribute to a person's mental health status. Almost all these factors are particularly pertinent amongst older adults.

Factors such as poverty, social isolation, loss of independence, loneliness and losses of different kinds, can affect mental health and general health. Older adults are more likely to experience events such as bereavements or physical disability that affect emotional well-being and can result in poorer mental health. They may also be exposed to maltreatment at home and in care institutions (7). On the other hand, social support and family interactions can boost the dignity of older adults, and are likely to have a protective role in the mental health outcomes of this population.

There are more older women worldwide than older men. This difference increases with advancing age and has been called "feminization of ageing". Older men and women have different health and morbidity patterns and women generally have lower income but better family support networks (1). On the other hand both depression and Alzheimer's disease are more prevalent among women (8).

Intergenerational solidarity is declining, especially in high-income countries. In some low- and middleincome countries a grandparent is increasingly more likely to be living with a grandchild. These so called "Skipped Generation" living arrangements are becoming more common because of economic migration, and in some societies as a consequence of HIV/AIDS related deaths. The impact of this on the

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