IMPROVING MENTAL HEALTH & WELL BEING IN LATER LIFE: EVERYBODY’S BUSINESS (INCLUDING YOURS!) OCT 31...
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IMPROVING MENTAL HEALTH & IMPROVING MENTAL HEALTH & WELL BEING IN LATER LIFE: WELL BEING IN LATER LIFE: EVERYBODY’S BUSINESS EVERYBODY’S BUSINESS (INCLUDING YOURS!) (INCLUDING YOURS!) OCT 31 OCT 31 ST ST 2008 2008 Alisoun Milne, Senior Lecturer in Social Alisoun Milne, Senior Lecturer in Social Gerontology, University of Kent Gerontology, University of Kent [email protected][email protected]
IMPROVING MENTAL HEALTH & WELL BEING IN LATER LIFE: EVERYBODY’S BUSINESS (INCLUDING YOURS!) OCT 31 ST 2008 Alisoun Milne, Senior Lecturer in Social Gerontology,
IMPROVING MENTAL HEALTH & WELL BEING IN LATER LIFE:
EVERYBODYS BUSINESS (INCLUDING YOURS!) OCT 31 ST 2008 Alisoun
Milne, Senior Lecturer in Social Gerontology, University of Kent
[email protected]
Slide 2
MENTAL HEALTH IN LATER LIFE: WHY EXPLORE IT? 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
Slide 3
MENTAL HEALTH IN LATER LIFE: IS IT IMPORTANT? 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)
Slide 4
MENTAL HEALTH IN LATER LIFE: WHAT IS IT? 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)
Slide 5
MENTAL HEALTH IN LATER LIFE: HOW CAN IT BE DEFINED? 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)
Slide 6
MENTAL HEALTH & QUALITY OF LIFE 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 persons 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 ones life (Bowling, 2005)
Slide 7
MENTAL HEALTH & QoL (2) 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
Slide 8
MENTAL HEALTH & SUCCESSFUL AGEING 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)
Slide 9
M ENTAL HEALTH, Q UALITY OF LIFE & S UCCESSFUL AGEING 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)
Slide 10
DETERMINANTS OF MENTAL HEALTH - RISKS & PROTECTIVE FACTORS
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
Slide 11
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
Slide 12
B ACKGROUND RISK FACTORS : S OCIO - ECONOMIC SITUATION 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 persons 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
Slide 13
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
Slide 14
STRESSORS: LOSS ILL HEALTH & DISABILITY 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)
Slide 15
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
Slide 16
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
Slide 17
PROMOTING MENTAL HEALTH IN LATER LIFE - SECURING WELL BEING 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
Slide 18
M ENTAL H EALTH PROMOTION : CIRCLES OF INFLUENCE hhhhhh hhhhh
Individual & Family Community & Neighbourhood
Society/National
Slide 19
P ROMOTING MENTAL HEALTH IN L ATER LIFE A DDRESSING THREATS TO
Q UALITY OF LIFE Domain Elements of Quality of Life Risk
FactorsInterventions Individual & family Physical health
Personal/social Relationships Social Activities Loss of health Loss
of function/restrictedness Loss of role/ connectedness/belonging
Community facilities/resources Outreach activities Befriending
initiatives (for housebound elders) CommunityParticipation &
engagement Quality of physical environment High levels of
crime/fear of crime Lack of engagement Poor physical/social
environment Inadequate services Enhancing social & physical
capital (neighbourhood improvement schemes) Improved public
transport, social & preventive services Visible police
activity/crime prevention schemes National/SocietalMaterial
resources for a comfortable old age Inclusion Poverty
Marginalisation/exclusion Policy commitment to an adequate state
pension Enhance access to benefits/advice Social exclusion
initiatives
Slide 20
S OCIO - CULTURAL M ODEL : M ENTAL H EALTH & S UCCESSFUL A
GEING Socioeconomic situation Material circumstances Social &
physical environment Dynamic of gains and losses Meaning of the
experience Cultural and normative expectations Constraints and
opportunities Personal resources Individual Social network: family
& friends Community Stimulates adaptive behaviour (selection
compensation optimisation) Successful ageing
Slide 21
S OCIO - CULTURAL MODEL OF SUCCESSFUL AGEING SCIE E-LEARNING
OBJECTS Introduction to mental health of older people See Model
link = http://www.scie.org.uk/publications/elearning/mentalhealth
/index.asp
http://www.scie.org.uk/publications/elearning/mentalhealth
/index.asp
Slide 22
A NOTE ON D EMENTIA .. 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 Alzheimers 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
Slide 23
C ONCLUSION 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
peoples 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
Slide 24
REFERENCES 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
Alzheimers Society (2007) Dementia UK, Alzheimers 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 Peoples 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.asphttp://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