Canada and Europe, which includes data on the proportion of older adults with impairment, need for service and current use of services (Blazer et al., 2007). Mental health risk factors in ageing Multiple physical, social, psychological and biological factors combine to determine the level of mental well-being in a person. The physical health conditions that accompany advancing years further complicate the experience and presentation of mental disorders, which are frequently misdiagnosed as physical disorders or treated as medically unexplained symptoms. There is a bidirectional impact between physical disorders and mental disorders. For instance, people with heart disease often have higher levels of depression, and untreated depression in older persons with heart disease contributes to poorer outcome. Medication for treating mental illness can also have an unwanted effect on physical health and, vice-versa, treatment for physical disorders can trigger mental health conditions. For the older person, in addition to the usual social determinants of health, the loss of mobility and independence, together with loneliness, isolation, adverse life events and the negative impacts of economic disadvantage after retirement from gainful employment, combine to increase the risk of mental disorder. The psychological distress from bereavement, and combined social and personal changes are potent risk factors for the development of mental disorders in older persons, even in those of previously robust constitution. In the Asia-Pacific region, traditional living arrangements and family roles are rapidly changing. Risk for depression can increase when traditional and cultural supports and coping structures, or familiar environments, are removed. Understanding social changes and social isolation is an important part of healthy ageing policy frameworks. Studies have shown that social isolation can increase the risk of poor mental health and suicide, while having strong human bonds can be protective against it (Steptoe et al., 2013). As extended family networks wane and more modern trends in marriage, family and individualism evolve, the fastest growing segment of the population will be increasingly dependent on public or private institutions for support (Menon and Melendez-Nakamura, 2009). Factors such as globalisation, economic and technology advances also have an important impact on the mental health of older people and provision of services. For example, rising incomes, along with public and private pension systems, have allowed people to retire based on their age, rather than any health-related problem (WHO, 2011). Loss of relevance and social identity, lack of affordability of appropriate health services, and inadequate financial and other services may occur within largely invisible, deeply entrenched and often accepted forms of ageism within communities in our region. Access to comprehensive social protection that enables people to cope with life and health risks is not available to 80 per cent of the global population (ibid). Specifically, there can be a variety of barriers to recognising mental health issues in older persons, who are likely service users, and providing the appropriate social support services. These barriers may include lack of recognition of psychological distress, limited training and poor working conditions (Davison et al., 2009). Vulnerability to neglect and abuse, and lack A g e i n g a n d me n t a l h e a l t h of access to health care further aggravate the older person’s sense of well-being, control and autonomy, contributing to the development and continuation of mental distress and disorder. Key approaches, treatment and care strategies Effective treatments for mental disorders in LMICs in the Commonwealth are available (Ng, 2013). However, a specific treatment for dementia is yet to be developed and, for late-life depression, treatment is complex and less accessible in LMICs, where generally newer psychotropic medications with fewer side effects may not be readily available. Interventions may need to prioritise early diagnosis so as to promote timely and optimal physical and psychological management. Support for older people with mental health problems and their carers, families and communities should be provided. As well as promoting selfmanagement and self-determination, preventive interventions should include education on chronic illness, behavioural activation, cognitive restructuring, problem-solving skills training, group support and life review (Fiske et al., 2009). Accessible and affordable community-level primary care for older persons is essential. Planning for long-term care in the community should be parallel with acute care. The Technical Consensus Statement on the Organisation of Care in Psychiatry of the Elderly, jointly published by the World Health Organization (WHO) and the World Psychiatric Association Section in Psychiatry of the Elderly (WHO, 2007), sets out principles to guide the development and implementation of care for older persons with mental disorders. It is also important to enhance the health workforce capacity by addressing the quantity and skill mix of workers, enhancing their Mental health strategies • Training of health professionals in primary care and in the early identification and intervention of mental disorders in older people • Providing timely and accessible treatment for age-associated diseases occurring in late life, especially mental and neurological disorders as well as those relating to substance use • General and mental health services taking a holistic approach to supporting older people in valuing their life experiences and existing strengths to increase their levels of physical, mental and social well-being • Developing age-specific and sustainable health care and social policies for prevention, health promotion, early detection, early intervention and long-term care for older persons • Creating an ‘age-friendly’, non-discriminating society that values the role older people play in society and encouraging meaningful engagement in the community • Combating ageism and discrimination with consistent lifecourse approaches to programmes of de-stigmatisation of mental disorders • Restoring the value of the past and present positive contributions of older citizens to society Commonwealth Health Partnerships 2015 79
Commonwealth Health Partnerships 2015
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