IMPROVING MENTAL HEALTH & WELL BEING IN LATER LIFE: EVERYBODY’S BUSINESS
Download
1 / 24

- PowerPoint PPT Presentation


  • 124 Views
  • Uploaded on

IMPROVING MENTAL HEALTH & WELL BEING IN LATER LIFE: EVERYBODY’S BUSINESS (INCLUDING YOURS!) OCT 31 ST 2008. Alisoun Milne, Senior Lecturer in Social Gerontology, University of Kent a.j.milne@kent.ac.uk. MENTAL HEALTH IN LATER LIFE: WHY EXPLORE IT?.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about '' - joben


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Slide1 l.jpg

IMPROVING MENTAL HEALTH & WELL BEING IN LATER LIFE: EVERYBODY’S BUSINESS (INCLUDING YOURS!)OCT 31ST 2008

Alisoun Milne, Senior Lecturer in Social Gerontology, University of Kent

a.j.milne@kent.ac.uk


Mental health in later life why explore it l.jpg
MENTAL HEALTH IN LATER LIFE: WHY EXPLORE IT? EVERYBODY’S BUSINESS

  • Old age is not a stage of life associated with ‘inevitable decline’ of health

  • Chronic ill health affects only a minority of older people; much can be done to ameliorate both risks & symptoms

  • But… defining & conceptualising ‘mental health’ in later life is not straightforward

  • Its links to the broader constructs of ‘well being’ and ‘quality of life’ are little explored

  • By illuminating these we may extend understanding of mental health in later life & expose opportunities for promotion


Mental health in later life is it important l.jpg
MENTAL HEALTH IN LATER LIFE: IS IT IMPORTANT? EVERYBODY’S BUSINESS

  • Good mental health is as important in later life as at any other stage of life

  • Everyone has mental health needs whether or not they have a diagnosis of mental illness

  • Our mental health has a powerful influence on how we feel & act

  • … In fact it is central to overall health and well being & has a profound impact on quality of life

  • Mental health is routinely identified by older people themselves as pivotal to ‘ageing well’ (Bowling, 2005)


Mental health in later life what is it l.jpg
MENTAL HEALTH IN LATER LIFE: WHAT IS IT? EVERYBODY’S BUSINESS

  • Research consistently identifies that:

    • Having a role; good social relationships with family, friends & neighbours; an adequate income, being physically fit & living in a supportive neighbourhood, are promoting of mental health

    • Deteriorating health, loss of independence, loneliness, fear of death, living in poor housing & neighbourhood and decreased income are undermining of mental health

    • The negative impact of losses & physical illness are key risk factors (Godfrey and Denby, 2004)

    • How well an older person adjusts to late life challenges is a key factor in determining ongoing mental health (Victor, 2005)


Mental health in later life how can it be defined l.jpg
MENTAL HEALTH IN LATER LIFE: HOW CAN IT BE DEFINED? EVERYBODY’S BUSINESS

  • WHO (2003) defines mental health as: ‘a state of well being whereby individuals recognise their abilities, are able to cope with the normal stresses of daily life and make a contribution to their families and communities’

  • Older people consider mental health to be characterised by: a sense of well being, the ability to make and sustain relationships, and the ability to meet the challenges and circumstances which later life brings

  • The Mental Health Foundation views good mental health as the ability to: develop emotionally, creatively, intellectually and spiritually; initiate, develop and sustain mutually satisfying personal relationships; face problems, resolve them and learn from them; are confident and assertive; are aware of others and empathise with them; use and enjoy solitude; play and have fun; laugh, both at themselves and at the world (2006)


Mental health quality of life l.jpg
MENTAL HEALTH & QUALITY OF LIFE EVERYBODY’S BUSINESS

  • Considerable synergy exists between those issues that contribute to good mental health and those that promote ‘quality of life’

  • QoL is a concept encompassing emotional, social, psychological, and health related, domains - broadly it encapsulates ‘how good’ a person’s life is overall

  • Recent work identifies the following dimensions as the ‘building blocks’ of QoL: ‘having an optimistic outlook & psychological well being, having good health & functioning; having good social relationships, preventing loneliness; maintaining social roles; living in a neighbourhood with good community facilities & that feels safe; having an adequate income; and maintaining a sense of independence & control over one’s life’ (Bowling, 2005)


Mental health qol 2 l.jpg
MENTAL HEALTH & QoL (2) EVERYBODY’S BUSINESS

  • QoL is a dynamic & multi-level construct reflecting macro - societal, meso - community, and micro - family & individual, influences

  • It is also a collection of objective and subjective dimensions which interact together (Lawton, 1991)

  • Of particular note is the concept of ‘psychological capital or well being’ which subsumes the dimensions of ‘mental health’, ‘life satisfaction’, and ‘self efficacy’

  • ‘Self efficacy’ is a particularly important factor in the promotion of mental health: contributes to enhancing ability to adapt to change & challenge (Godfrey & Denby, 2004)

  • Dovetails with emerging evidence about ‘resilience’ across the life course: underpins ‘disability paradox’


Mental health successful ageing l.jpg
MENTAL HEALTH & SUCCESSFUL AGEING EVERYBODY’S BUSINESS

  • ‘Successful ageing’ is a concept closely aligned to that of quality of life (Livingstone et al, 2008)

  • Literature tends to define successful ageing as the ‘avoidance of physical or cognitive impairment’, neglecting the possibility of positive adaptation

  • Tends to prioritise physical health domains over those related to ‘resilience’, self efficacy or mental health

  • Whatever the distinctions between QoL & successful ageing concepts are often conflated by older people

  • In a recent study older people identified ‘successful ageing’ as incorporating: being able to adapt to continuous physical change; engaging in relationships; maintaining independence; having enough money to participate; fulfilling desires and personal objectives; & taking part in meaningful activity (Reed et al, 2003)


Mental health quality of life successful ageing l.jpg
Mental health, Quality of life & Successful ageing EVERYBODY’S BUSINESS

  • There is considerable common ground between the conceptual & theoretical constructs of mental health, quality of life & successful ageing

  • Whilst ‘mental health’ may be viewed as a narrower construct than its ‘parent’ frameworks, it is an much a product of quality of life as it is a component

  • Whatever the differences, there is broad agreement that mental health is: an equally important part of QoL as physical health, & is intrinsically bound up with a range of dimensions that both directly and indirectly impact upon it

  • The next step is to extend understanding about the determinants of mental health, a key stage on the path to improving it (Age Concern, 2007)


Determinants of mental health risks protective factors l.jpg
DETERMINANTS OF MENTAL HEALTH - RISKS & PROTECTIVE FACTORS EVERYBODY’S BUSINESS

  • In order to explore the determinants of mental ill health in later life it is useful to draw upon a framework that conceptualises risks to mental health as being located in three broad spheres: Background factors; Stressors; & Protective/Vulnerability factors

  • Framework illuminates the links between macro level societal factors, meso level community issues & micro level family or individual resources

  • Also accommodates the life course perspective

  • Further, building up a coherent understanding of risks & protective factors will help inform the development of strategies to prevent mental ill health & promote mental health


Background risk factors stressors protective vulnerability factors l.jpg
BACKGROUND RISK FACTORS, STRESSORS & PROTECTIVE/ VULNERABILITY FACTORS

  • Background Risk Factors:

    • Age, gender & ethnicity

    • Socio-economic situation

  • Stressors:

    • Previous experience of mental ill health

    • Experience of loss, such as ill health or disability

    • Specific life events e.g. bereavement

    • Key points of transition in the ageing process such as retirement

  • Protective/Vulnerability Factors:

    • Personal/psychological

    • Social relationships & social support

    • Environmental factors


Background risk factors socio economic situation l.jpg
Background risk factors: Socio-economic situation VULNERABILITY FACTORS

  • Living in poverty provokes stress & loss of control over life; it is a specific risk factor for loneliness, depression & exclusion (Victor, 2009)

  • Being poor reduces an older person’s capacity to make choices, & participate & undermines independence

  • Two million older people live in poverty in the UK: older women, carers & ethnic minority elders are at particular risk

  • Conversely, having access to a reasonable income has a positive impact on mental health & well being

  • Provides the means to take advantage of opportunities to feel safe & supported ,& facilitates social inclusion

  • Older people with money also tend to live in nicer neighbourhoods & are less exposed to crime and environmental decay

  • Money can also cushion the effect of loss, EG: the negative impact of a disability may be mediated by access to private treatment or alternative therapy


Background risk factors stressors protective vulnerability factors13 l.jpg
BACKGROUND RISK FACTORS, STRESSORS & PROTECTIVE/ VULNERABILITY FACTORS

  • Background Risk Factors:

    • Age, gender & ethnicity

    • Socio-economic situation

  • Stressors:

    • Previous experience of mental ill health

    • Experience of loss, such as ill health or disability

    • Specific life events e.g. bereavement

    • Key points of transition in the ageing process such as retirement

  • Protective/Vulnerability Factors:

    • Personal/psychological

    • Social relationships & social support

    • Environmental factors


Stressors loss ill health disability l.jpg
STRESSORS: LOSS – ILL HEALTH & DISABILITY VULNERABILITY FACTORS

  • Losses accumulate in later life, especially very old age

  • 26% of people aged 50 to 64 in Britain report a long term illness or disability; this is the case for 74% of people aged 85+; key causes are musculoskeletal illness & cardiovascular disease

  • Physical ill health & disability are the most consistent risk factors relating to depression among older people

  • Rates of depression are approx double compared with healthy counterparts; estimated that 70% of new cases of depression in older people are related to poor physical health

  • Highlights the fact that it is not age per se which creates vulnerability but the impact of disability &/or chronic illness which are simply more common amongst older people

  • Further, that it is specifically their role in increasing immobility, reducing opportunities to go out & undermining independence that create mental health problems

  • Higher levels of education appear to be ‘protective’ (Victor, 2005)


Background risk factors stressors protective vulnerability factors15 l.jpg
BACKGROUND RISK FACTORS, STRESSORS & PROTECTIVE/ VULNERABILITY FACTORS

  • Background Risk Factors:

    • Age, gender & ethnicity

    • Socio-economic situation

  • Stressors:

    • Previous experience of mental ill health

    • Experience of loss, such as ill health or disability

    • Specific life events e.g. bereavement

    • Key points of transition in the ageing process such as retirement

  • Protective/Vulnerability Factors:

    • Personal/psychological

    • Social relationships & social support

    • Environmental factors


Protective vulnerability factors social relationships social support l.jpg
PROTECTIVE/VULNERABILITY FACTORS: SOCIAL RELATIONSHIPS & SOCIAL SUPPORT

  • There is considerable evidence to suggest that engagement in family, social & community life promotes mental health

  • Involvement in meaningful activities & having relationships with other people, meets a range of social & emotional needs: for intimacy, companionship & enjoyment (Godfrey & Denby, 2004)

  • Higher levels of social support are known to act as a buffer against depression

  • Where age related losses, such as those related to a disability, impact on social engagement & social relationships, mental health may be threatened.

  • Having a role in the local neighbourhood, volunteering, or taking a class are all identified as protective of mental well being

  • Community facilities, civic and social opportunities & accessible leisure & educational resources all protect against isolation & exclusion & enhance opportunities for participation


Promoting mental health in later life securing well being l.jpg
PROMOTING MENTAL HEALTH IN LATER LIFE - SECURING WELL BEING SOCIAL SUPPORT

  • The framework: makes visible the dimensions of later life that contribute to mental well being & provides a lens through which to identify & explore them

  • It also acknowledges the role of the life course & the interlocking & overlapping nature of many of the issues

  • … And foregrounds the fact that the determinants of mental health are located at a number of different ‘levels’ within the individual & their family; the community; & wider society

  • These can helpfully be conceptualised as concentric circles extending from the individual outwards

  • It axiomatic that interventions to promote mental health need to be directed at each ‘level’


Mental health promotion circles of influence l.jpg

hhhhhh SOCIAL SUPPORT

Society/National

hhhhh

Community & Neighbourhood

Mental Health promotion: circles of influence

Individual & Family



Socio cultural model mental health successful ageing l.jpg

Dynamic of gains to Quality of life

and losses

  • Socioeconomic situation

  • Material

  • circumstances

  • Social & physical

  • environment

  • Personal resources

  • Individual

  • Social network: family &

  • friends

  • Community

  • Meaning of the experience

  • Cultural and normative

  • expectations

  • Constraints and

  • opportunities

Socio-cultural Model: Mental Health & Successful Ageing

Stimulates adaptive

behaviour

(selection compensation optimisation)

Successful ageing


Socio cultural model of successful ageing l.jpg
Socio-cultural model of successful ageing to Quality of life

  • SCIE E-LEARNING OBJECTS ‘Introduction to mental health of older people’

  • See Model link = http://www.scie.org.uk/publications/elearning/mentalhealth/index.asp


A note on dementia l.jpg
A note on Dementia ….. to Quality of life

  • The framework has considerably more explanatory power in relationship to functional mental ill health than for organic disorders

  • BUT … dementia, especially vascular dementia, does have some roots in disadvantage: poverty, diet, level of education

  • Even with Alzheimer’s disease there is recent evidence that environmental factors do play a role: smoking, & high blood pressure & high cholesterol levels in mid life increase the risk (Alzheimer's Society, 2007)

  • Also vascular disease predisposes people to AD as well as to vascular dementia

  • Although more work is needed, suffice to say that dementia does not entirely overwrite life course & socio-cultural influences


Conclusion l.jpg
Conclusion to Quality of life

  • Mental health is both a part of, and intrinsically bound up with, overall well being; identified by older people as a pivotal dimension of quality of life

  • Mental health outcomes are a product both of life course issues & current access to resources

  • Threats to mental health exist in a number of domains; as do protective factors - role of mental health promotion is to bolster protection & address risks

  • Effective promotion of older people’s mental health requires action across a range of different areas at a number of levels

  • Poor mental health is not inevitable in old age; much can be done to reduce the incidence & impact of mental ill health & promote mental health


References l.jpg
references to Quality of life

  • Age Concern (2007) Improving services and support for older people with mental health problems, London, Age Concern

  • Age Concern & Mental Health Foundation (2006) Promoting Mental Health & Well Being in Later Life, London, Age Concern

  • Alzheimer’s Society (2007) Dementia UK, Alzheimer’s Society, London

  • Bowling, A (2005) Ageing Well: Quality of Life in Old Age, Open University Press, Berkshire

  • Godfrey, M & Denby, T (2004) Depression and Older People, Policy Press, Bristol

  • Livingstone, G., et al, (2008) Successful ageing in adversity - the LASER longitudinal study, Journal of Neurology, Neurosurgery & Psychiatry, 79: 641-645

  • Milne, A (2009) Mental Health & Well Being, in T. Williamson (Ed) Older People’s Mental Health Reader. Mental Health Foundation & Pavilion Publishing, Brighton

  • Milne, A and Williams, J (2000) Meeting the Mental Health Needs of Older Women: Taking Social Inequality into Account, Ageing and Society, Vol. 20, No. 6 pp 699-723

  • Office for National Statistics (2004) Focus on Older People, ONS: London

  • Social Care Institute for Excellence e-learning ‘An introduction to mental health of older people’ - http://www.scie.org.uk/publications/elearning/mentalhealth/index.asp

  • Victor, C (2005) The Social Context of Ageing, A Textbook of Gerontology, Routledge, Abingdon

  • Victor, C., et al (2009) The Social World of Older People: Understanding Loneliness and Social Isolation in Later Life, McGraw Hill