Mental Health and Social Care Needs of Older People with Intellectual Disabilities

Background Older people with intellectual disabilities (ID) are a growing population but their age‐related needs are rarely considered and community services are still geared towards the younger age group. We aimed to examine the mental health and social care needs of this new service user group. Methods We identified all adults with ID without Down syndrome (DS) aged 65+ living in the London boroughs of Camden and Islington. The Psychiatric Assessment Schedule for Adults with a Developmental Disability (PASADD) checklist was used to detect psychiatric disorder, the Vineland behaviour scale (maladaptive domain) for problem behaviours and the Dementia Questionnaire for persons with Mental Retardation (DMR) to screen for dementia. Carers reported health problems and disability. Needs were measured with the Camberwell Assessment of Need for adults with Intellectual Disabilities (CANDID‐S). Results A total of 23 older people with ID (13 had mild ID and nine more severe ID) and their carers participated in the survey. In which, 74% had one or more psychiatric symptoms; 30% were previously known with a diagnosis of mental illness. One‐third of the older people screened positive for dementia (range: 17–44%, depending on sensitivity of DMR scores used). Three quarters of the group had physical health problems, 74% had poor sight, 22% had hearing loss and 30% had mobility problems. Carers rated unmet needs for accommodation (22%), day activities, and eyesight and hearing. The people with ID rated unmet needs to be social relationships (44%), information and physical health. Conclusion Older people with ID without DS have considerable prevalence of health problems and psychiatric disorders, including symptoms of functional decline and dementia. Such symptoms are often not recognised and further research into their needs is a priority.     

Older Women and Mental Health

The 1980s may well be remembered as the decade of the older woman. Older women, especially those aged 75 and older, are the fastest growing portion of the U.S. population. According to the 1980 census, 11.3 percent of the population are 65 or older and, within this group, there are half again as many women as there are men. Furthermore, over 40 percent of women aged 65 and older are living alone (U.S. Department of Commerce, 1978). The median yearly income for women 65 and older, as of 1980, was $4,226. More than 2.7 million older women live below the poverty line, with older women living alone overrepresented among this group (USDC, 1981). This large, growing and economically disadvantaged population is currently emerging from the invisibility it had been accorded in past decades.     

Exercise, Physical Function and Health Perceptions of Older People

Fifty-five predominantly sedentary older people (age range 65-87) were recruited to take part in a ten-week community-based exercise programme designed to improve physical function. Primary outcome measures were endurance walking, natural walking speed, chair rise time, standing balance, grip strength, back flexibility and shoulder flexibility. The effects of the exercise programme on self-perceived health status were also assessed using repeated applications of the Short Form-36 questionnaire. Fifty-five control subjects matched on sex, age and physical activity were also sent SF-36 questionnaires but did not take part in functional testing or group exercise activity.

At the end of the ten-week programme, all physical function measures except shoulder flexibility were significantly improved (p < 0.05). Effect sizes ranged from 0.25 to 0.82. All eight dimensions of the SF-36 health status instrument were unchanged in the control group and significantly improved in the exercise group. Effect sizes ranged from 0.26 to 0.93. This study demonstrates the efficacy of regular group exercise for improving physical functions and perceived health status in older people.     

The Impact of Leisure Participation on Mental Health for Older People with Depression: A Systematic Review

ABSTRACT

Aims: This systematic review aimed to discover whether participation in individually chosen leisure activities improved mental health for people aged over 65 who have depression. Methods: Twenty-six potentially relevant studies were identified from an electronic database review. Of these 12 met the inclusion criteria and scope of the review. Results: The current evidence base is relatively small, and includes a diversity of subject groups, subject situations, and study designs. In all cases, participants were either directed to choose from a number of leisure activities, or provided with a pre-designed program that did not allow for individual choice. Conclusion: Currently, there is insufficient evidence available to determine whether participation in individually chosen leisure activities improves mental health for people aged over 65 who have depression.     

Mental Health Nurses' Work with Family Caregivers of Older People with Depression: Review of the Literature

Australia, along with the rest of the world, is moving towards providing mental health services in the community rather than in hospital settings. This raises critical questions of what the impact of community-based care is on family members of people with mental illness, and how mental health care professionals, particularly mental health nurses, work with these family members to meet their needs. Considering the current trend of an increasingly aging population, the issue of late-life depression needs further attention, as it is known to be the most common mental illness in the elderly. The purpose of this article, therefore, is to paint a picture of family caregiving in the mental health arena, identify important roles that community mental health nurses play in this context, and address the significant gaps in the knowledge and nursing practice regarding community mental health nurses' work with families of older patients suffering from depression.     

Cam Perry,Heraclitus, and Hypnosis: An Appreciative Understanding

The authors summarize personal, intellectual, and social influences on Campbell Perry’s (1937–2003) life and research on hypnosis. His education in Australia reflected the influences of a public primary school, a prestigious private high school, and undergraduate and graduate work at Australia’s oldest university. His approach to hypnosis was influenced initially by Gordon Hammer and Philip Sutcliffe, and his life generally was influenced by John Anderson, the leader of the Libertarian Society, the intellectual core of a broader group known as the Push. This group reflected in part the thinking of the pre-Socratic Greek philosopher, Heraclitus, who taught that change was the only reality. The article summarizes Perry’s work on hypnosis and memory, and his contributions concerning uncancelled hypnotic suggestions, pain and surgery, and imagery and hypnotizability are summarized.     

Within-Person Pain Variability and Mental Health in Older Adults With Osteoarthritis: An Analysis Across 6 European Cohorts

Pain is a key symptom of osteoarthritis (OA) and has been linked to poor mental health. Pain fluctuates over time within individuals, but a paucity of studies have considered day-to-day fluctuations of joint pain in relation to affective symptoms in older persons with OA. This study investigated the relationship of pain severity as well as within-person pain variability with anxiety and depression symptoms in 832 older adults with OA who participated in the European Project on OSteoArthritis (EPOSA): a 6-country cohort study. Affective symptoms were examined with the Hospital Anxiety and Depression Scale, pain severity was assessed with the Western Ontario and McMaster Universities OA Index and the Australian/Canadian Hand Osteoarthritis Index, and intraindividual pain variability was measured using pain calendars assessed at baseline, 6, and 12 to 18 months. Age-stratified multiple linear regression analyses adjusted for relevant confounders showed that more pain was associated with more affective symptoms in older-old participants (74.1–85 years). Moreover, older-old participants experienced fewer symptoms of anxiety (ratio?=?.85, 95% confidence interval [CI], .77–.94), depression (ratio?=?.90, 95% CI, .82–.98), and total affective symptoms (ratio?=?.87, 95% CI, .79–.94) if their pain fluctuated more. No such association was evident in younger-old participants (65–74.0 years). These findings imply that stable pain levels are more detrimental to mental health than fluctuating pain levels in older persons.

Young People and AIDS Mental Health Promotion in Action

This article describes the development and implementation of a two part health promotion and primary mental health prevention program developed for junior high students. AIDS education was used as a vehicle for promoting the development of a responsible decision-making framework in the students. Both cognitive and affective learning strategies were used in the program. The reactions of the students, their parents, and the educational system are described.     

An Ecological Approach To Health Risk: A Case Study of Urban Elderly Homeless People

Abstract The purposes of this paper are: to describe an ecological approach to assessing health risk, and to apply the approach to a sample of elderly homeless within the context of a single day in a single urban setting. In the approach described, a method of progressive contextualization was used by adding different hazards to the risk profile in a single geographic area. The various hazards were applied to the same time and space frame, that of a 24-hour period and in the urban space used by elderly homeless people. Incorporated into the approach are the concepts of high-risk areas and space-time geography, and the theory of disease ecology. The spatial-temporal distribution of resources, factors in the natural environment (patterns of daylight and dark and ambient temperature) and factors in the human-created environment (traffic and crime patterns) were identified as important hazards within the urban environment. Homelessness itself, the effects of aging, the social milieu, and behavior patterns commonly seen in homeless people—particularly, alcohol abuse-were identified as important hazards for elderly homeless people. Each hazard's spatial-temporal pattern within the 24-hour period is discussed. Then the convergence of hazards forming an interactive effect is discussed. Finally, approaches to nursing interventions aimed at reducing risk are presented.     

The Impact of a Participatory Care Model on Work Satisfaction of Care Workers and the Functionality,Connectedness, and Mental Health of Community-Dwelling Older People

This study describes and evaluates an innovative program designed to reduce functional decline among seniors, using a participatory care approach and integrated health teams. The evaluation provides older people and community support workers (CSWs) with the opportunity to share their experiences of being involved with an innovative program to reduce functional decline (mobility, skin integrity, nutrition, mental health, continence) of older, community dwelling adults implemented by a Nursing Service in a major capital city in Australia. As part of the program, CSWs were trained to provide care that aimed to reduce functional decline, and improve the quality of life for the care recipients. Data were collected through in-depth interviews with older people receiving care and a focus group (FG) was conducted with CSWs. Seven themes emerged during data analysis: 1) functionality/independence; 2) prevention; 3) confidence; 4) connection; 5) the approach; 6) care plans; and 7) the role of the CSWs. The relationship built between care giver and receiver and the mutual respect facilitated through adopting a participatory care approach was crucial. This relationship-focused care contributed to improved functionality and consequently quality of life for the older person, and for the CSW professional it contributed to their development, improved satisfaction with their role, and increased pride in the difference they make in the lives of their clients. Opportunities for improvement of the program included ensuring that participants understood the rationale for all aspects of the program, including regular reminders, as well as the use of regular reviews of individual outcomes.