Specialist mental health interventions in aged care facilities: a brief review
Little is known about the effectiveness of specialist mental health care interventions in aged care settings. This is predominantly due to the small number of initiatives in operation and the aged care system in Australia being under considerable strain. This brief examination seeks to review the limited knowledge there is in relation to this topic. Both academic and non-academic sources of literature will be reviewed in this piece and some suggestions for best practice will be generated.
- Prevalence: The literature would indicate that depression is a reality in aged care settings with a prevalence range of between 30 and 50 percent.
- Attitudes to help seeking: Mellor et al. (2008) state that older adults in aged care are not expecting treatment for mental health issues and are reluctant to discuss mental health with health professionals.
- Previous research: While some research on specialised interventions for residents with depression has been conducted in aged care settings, the feasibility of these studies has greatly impacted their numbers. The literature reviewed indicates that the prevalence depression is a concern in aged care settings that requires appropriate intervention.
- Best practice: Important considerations for best practice include: the set of cultural beliefs of the cohort, the life experience of each individual, the reconceptualization of the self in residential aged care settings, and the structural considerations of residential facilities.
Studies have found that there is a high prevalence of depression in aged care settings, some estimates place this figure between 30 and 50 percent (see for example Lyne et al., 2006, Bourgeois et al., 2012, Bellis and Williams, 2008). One study on the incidence of anxiety reported that the prevalence of threshold and subthreshold anxiety disorders was 19.4% and 11.7% respectively (Creighton et al., 2018). The use of psychotropic drugs among aged care residents is both prevalent and varied. In the European context the prevalence is anywhere between 42 and 80% (Helvik et al., 2017). A study by McSweeney and O'Connor (2008) found that even when residents were given antidepressant medication, they continued to meet the diagnostic criteria for depression at 6-month follow-up. An exploratory study, conducted in the US, that looked at the barriers to access for mental health treatment in culturally diverse older adults found that lack of understanding about mental health issues, stigma and cultural differences around mental health, fear and distrust of treatment systems, and financial and transport difficulties were all contributors that negatively impacted access to mental health for this cohort (Choi and Gonzalez, 2005). Conversely, they found that encouragement and support from their families and adult children, bilingual clinicians, and assisted transportation were all contributors to higher levels of access to mental health services (Choi and Gonzalez, 2005).
It is important to acknowledge that the current cohort of older adults, in any country, will have life experiences and belief systems that, when compared to the present ones, may contradict or go against the prevailing set of beliefs. Tailoring, therefore, means more than just adjusting to each resident as a patient it means familiarising oneself with their history and belief system to modify interventions accordingly (Laidlaw et al., 2004). Mellor et al. (2008) note that older adults in aged care do not expect to receive treatment for mental health issues and that they believe discussing emotional symptomatology with their GP is inappropriate. This raises the issue of how best to deal with resident’s expectations of appropriate service delivery and how to train staff to identify symptoms when residents are not self-reporting.
A systematic review of recommendations for staff education and training in relation to mental illness in older people in aged care settings revealed that the key features that positively influence mental health training and education are:
- The curriculum content should be planned with the audience
- The education should be directed towards the audience so that the learning needs of the community are met
- The training should be focused on the needs of the residents who are being cared for
- The materials must address the model of care within the facility
- The training should be provided at times that suit the audience (Moyle et al., 2010)
Even at the lower end of current estimations the number of people affected by depression is high and requires appropriate intervention in aged care settings. This review attempted to provide a brief account of the limited research that has been done in the field to provide some principles for best practice. When thinking about the models for psychological interventions with residents in aged care facilities best practice suggests personalised interventions are best. Laidlaw et al. (2004) emphasise the need for individualised treatment that factors in client specific variables such as intergenerational relationships, sociocultural context, beliefs, changes in role, and overall health. This model is supported by later research carried out in the Australian context (see for example Bhar et al., 2015).
BELLIS, A. D. & WILLIAMS, J. 2008. The Cornell Scale for Depression in Dementia in the context of the Australian Aged Care Funding Instrument: A literature review. Contemporary Nurse, 30, 20- 31.
BHAR, S. S., SILVER, M., CAMPBELL, J., LAWSON, M., O' BRIEN, S. & REHM, I. 2015. Counselling Older Adults Living in Residential Aged Care Settings: Four Illustrative Case Studies. Australian Psychologist, 50, 141-147.
BOURGEOIS, J., ELSEVIERS, M., BORTEL, L., PETROVIC, M. & VANDER STICHELE, R. 2012. The Use of Antidepressants in Belgian Nursing Homes. Drugs & Aging, 29, 759-769.
CHOI, N. G. & GONZALEZ, J. M. 2005. Barriers and Contributors to Minority Older Adults' Access to Mental Health Treatment: Perceptions of Geriatric Mental Health Clinicians. Journal of Gerontological Social Work, 44, 115-135.
CREIGHTON, A. S., DAVISON, T. E. & KISSANE, D. W. 2018. The prevalence, reporting, and treatment of anxiety among older adults in nursing homes and other residential aged care facilities. Journal of Affective Disorders, 227, 416-423.
HELVIK, A.-S., BENTH, J., WU, B., ENGEDAL, K. & SELBÆK, G. 2017. Persistent use of psychotropic drugs in nursing home residents in Norway. BMC Geriatrics, 17.
LAIDLAW, K., THOMPSON, L. & GALLAGHER-THOMPSON, D. 2004. COMPREHENSIVE CONCEPTUALIZATION OF COGNITIVE BEHAVIOUR THERAPY FOR LATE LIFE DEPRESSION. Behavioural and Cognitive Psychotherapy, 32, 389-399.
LYNE, K. J., MOXON, S., SINCLAIR, I., YOUNG, P., KIRK, C. & ELLISON, S. 2006. Analysis of a care planning intervention for reducing depression in older people in residential care. Aging & Mental Health, 10, 394-403.
MCSWEENEY, K. & O'CONNOR, D. 2008. Depression among newly admitted Australian nursing home residents. International Psychogeriatrics, 20, 724-37.
MELLOR, D., DAVISON, T., MCCABE, M. & GEORGE, K. 2008. Professional carers’ knowledge and response to depression among their aged-care clients: The care recipients’ perspective. Aging & Mental Health, 12, 389-399.
MOYLE, W., HSU, M. C., LIEFF, S. & VERNOOIJ-DASSEN, M. 2010. Recommendations for staff education and training for older people with mental illness in long-term aged care. Int. Psychogeriatr.