Helpful approaches to older people experiencing mental health problems: a critical review of models of mental health care

Abstract

Despite growing concerns for the mental health of the older generation most studies focus on mental health care for younger people and there is a lack of knowledge about helpful treatment approaches and models of care for older people. Therefore, the purpose of this review was to answer the question what health care approaches are most helpful for older people experiencing mental health problems. Databases from 2000 to July 2017 were searched with focus on outcome studies, experts' opinions and treatment descriptions. Critical interpretive synthesis was used to analyse and interpret the findings. Four main models of care were found: the medical-psychiatric model which mostly focuses on antipsychotic medication for the treatment of symptoms. Psychotherapeutic and social interventions take into consideration the psychosocial perspectives of mental health problems, but little research has been done on their lasting effect. Research indicates that psychotherapy needs to be adapted to the special needs of older people. Few old people have access to psychotherapy which limits its usefulness. Holistic or integrated models of health care have emerged in recent years. These models focus on both physical and psychosocial wellbeing and have shown promising outcomes. To reduce antipsychotic medication older people need to be given better access to psychotherapy and social interventions. This presupposes training health care professionals in such treatment methods. The holistic models need to be developed and studied further and given high priority in health care policy.

Risk factors for a decrease in high morale in very old people over a 5-year period: data from two Nordic countries

“…Considering the many other known negative effects, such as higher mortality risk (Bergdahl et al 2005), of depressive disorders in very old age, preventing depressive disorders is utmost important. Although knowledge regarding mental health care interventions targeting older people is limited, a recent review by Biering (2018) reports promising results when using holistic treatment models focusing on both health-related and psychosocial well-being. A holistic model of social and health care could potentially cover both the prevention of loneliness and depression, as well as support to those grieving the loss of a child, and should therefore be further developed and tested to prevent decreasing morale among very old people.…”

Factors associated with incidence of depressiveness among the middle-aged and older Estonian population

“…The proportion of the institutional population is relatively low in Estonia, 35 and was not specifically sampled. The incidence of depression is generally higher among an institutionalised population, 34 and our results might have differed had more people in this vulnerable position been included. Those in institutional settings could have higher unmet psychological needs with the potential to cause various forms of mental distress, such as depression.…”

“…From the public health perspective, our findings highlight the need to monitor middle-aged and older people with a history of previous depression or everyday activity limitations, while being mindful of gender differences. A helpful approach to mental health in old age has been proposed in the geriatric psychiatry literature, 34 which emphasises paying attention to how individuals are adjusting to the life changes that accompany old age in addition to symptoms of depressiveness. All parties – health professionals as well as informal networks – have a responsibility to find a balance between dignity, autonomy, capabilities, and degree of dependence for older people.…”

“…Those in institutional settings could have higher unmet psychological needs with the potential to cause various forms of mental distress, such as depression. 34 …”

“…Those in institutional settings could have higher unmet psychological needs with the potential to cause various forms of mental distress, such as depression. 34 The sample from a large population-level survey of middle-aged and older people enabled an in-depth analysis of different factors associated with the emergence of symptoms of depressiveness. The lack of differences in results between the weighted and unweighted samples suggests that the results are representative of the population aged 53+ years in Estonia.…”