ausdoc . |
com . au |
|
2
X JUNE MONTH library at www . ausdoc . com . au / therapy-update
|
2022
2023
|
|
The key aspects of falls prevention
appear in table 3 .
Mental illness
It is estimated that nearly 10 % of
people aged over 65 experience mental illness . 38 These figures increase substantially for those living in residential aged care , with estimates indicating that between 27 % and 50 % of residents experience depression . 39 , 40 Other cohorts of older people experience mental illness at higher rates , including those with dementia and chronic
41 , 42 pain .
Mental illness in older people is under-recognised and undertreated , and may have significant and sometimes life-threatening consequences , including suicidal ideation . 10
Consistent with the principles underpinning healthy ageing , good mental health is also a product of the interaction between an individual and their environment . The WHO defines mental health as a “ state of wellbeing in which an individual realises his or her own abilities , can cope with the normal stresses of life , can work
|
productively and is able to make a contribution to his or her community ”. 20 This definition aligns with the healthy ageing paradigm that recognises inherent capacity and the positive contribution older people make to society through participation .
SCREENING There are several tools used to screen for depression in older people . The Geriatric Depression Scale ( GDS , see figure 3 ) is commonly used , available and validated in multiple languages and countries , and applied in hospitals , residential aged care and community settings . 43
The scale comprises 15 questions about how the person has felt over the past week , requiring yes or no answers and can be administered by an interviewer or filled out by the older person .
Minimal training is required to use this tool and it can be used with people who have dementia — an important consideration given the co-occurrence of dementia and depression in older people . For people with probable and suspected severe cases of dementia , the Cornell
|
MANAGEMENT According to the RACGP Silver Book , pharmaceuticals are not recommended as first-line treatment in older people , and need to be used carefully and regularly reviewed . 45 Several non-pharmacological interventions to promote good mental health in older people are suggested : physical activity ; mind – body , psychological and psychosocial , multi-component interventions ; technology-based , arts-based , and social support interventions ; companion animal interventions ; carer interventions ; and suicide prevention interventions ( see box 5 ).
The key focus areas relevant to mental illness appear in table 3 .
Dementia
Dementia is an umbrella term to describe a broad range of degenerative neurological brain conditions that result in the loss of memory , rationality , social skills and physical functioning . Population estimates indicate there are about 487,500 Australians living with dementia . Without a significant medical breakthrough that figure is expected to increase to one million by 2058 . 60 There has recently been
|
Box 5 . Non-pharmacological interventions to promote good mental health
• There is strong evidence that regular physical activity can reduce the risk of depression and improve older people ’ s mental wellbeing . 46-48 Physical activity has also contributed to maintaining good mental health in older people during the COVID-19 pandemic . 49
• Psychological / psychosocial interventions such as CBT , problem-solving therapy and reminiscence therapy reduce depression and anxiety and improve quality of life . These therapies tend to work better in combination .
48 , 50
• Used to treat a variety of chronic diseases , mind – body interventions such as yoga , mindfulness-based stress reduction and meditation interventions are effective in reducing depressive symptoms . 51
• Technology-based interventions can be effective in reducing depressive
52 , 48 symptoms in older people akin to other segments of the population . However , this area is relatively nascent with evidence still emerging . Interventions such as internet-based CBT have been shown to improve depression symptoms in older people . 52
• Social support interventions such as social robots , laughter therapy , reminiscence therapy and horticultural therapy , can decrease feelings of loneliness and social isolation and improve quality of life . 53 , 54 Such interventions are useful for both prevention and response interventions for the mental health of older adults in community and healthcare settings .
• Arts-based interventions show positive effects in improving mental health outcomes in older people , particularly for reducing depression , anxiety and /
55 , 56 or improving quality of life .
• Psycho-educational interventions in patient – carer dyad relationships show considerable promise in reducing depressive symptoms , and there is emerging evidence that animal-assisted interventions can reduce depressive symptoms in older people . 57-59
|