- Mental Health Illness in Older People
- Diagnosing Mental Illness in Older Adults
- Penrose Health Action Plan
- ⚠️ Safety netting
- Assessing Physical and Mental Health in Older Adults
- Psychiatric presentations resulting from physical illnesses and medications
- Depression
- Anxiety Disorders
- Bipolar Disorder
- Psychotic Disorders
- Delirium
- Referring/Signposting Onward
Mental Health Illness in Older People
Mental health conditions in older people are not an inevitable part of ageing. However, older adults are susceptible to depression and other mental health disorders, for a number of reasons, including: the grief and loss of loved ones, chronic health conditions, or limited functioning that often accompanies aging.
Mental ill health in older people does not just mean dementia, but also other disorders such as depression, anxiety, schizophrenia, suicidal feelings, personality disorder and substance misuse.
The right diagnosis and the appropriate treatment can make all the difference. What is suitable and helpful for bereaved, active older people may not be suitable for individuals living with disabilities, frailty and/or dementia.
Diagnosing Mental Illness in Older Adults
Remember to:
- perform detailed review of medical history.
- ask about physical health symptoms.
- review prescription medications for markers of treatment burden.
Use STOPP Start Medication Review Tool to assess if patient is on appropriate medicine regime for their age.
Penrose Health Action Plan
⚠️ Safety netting
Always review any safeguarding concerns (see Adult Safeguarding).
If there is a change in status, then discuss with senior (GP or clinical meeting) and/or safeguarding lead.
Secondary and External services may be better placed to help/support patients than we are.
- Secondary services offer psychological treatments (e.g., interpersonal / psychodynamic therapies, CBT)
- External services in the community offer many options for social and psychological help through relationships with the wider service network (e.g. Social Prescriber, Befriender, Care Coordinator, Therapist, Lifestyle Coach, etc.)
We do not provide any form of psychotherapy within our surgeries.
Assessing Physical and Mental Health in Older Adults
Below is general information regarding observation, screening and assessing psychiatric illness in the context of potential physical/medication problems in older adults.
Perform risk assessment: If patient is high risk or in crisis → refer to crisis service, secondary MH service, and/or discuss with another professional (e.g. GP, PCMHT team) as appropriate.
Psychiatric presentations resulting from physical illnesses and medications
Depression
Anxiety Disorders
Bipolar Disorder
Psychotic Disorders
Delirium
Lithium has a narrow therapeutic window and should be monitored regularly. This is especially important in older adults, as dehydration and polypharmacy can rapidly affect lithium levels and may result in toxicity.
Lithium toxicity warrants discontinuation and urgent investigation. Consult our portal page Lithium Management for details of monitoring requirements.
Referring/Signposting Onward
Below are some services to which you can signpost/refer patients. More services can be found on the Penrose Portal in Mental Health Services Database.
- practice-primer.pdf (england.nhs.uk)
- ppp_mental_health_england.pdf (ageuk.org.uk)
- CentreforMH_MentalHealthInLaterLife-1.pdf (centreformentalhealth.org.uk)
- NHS England » Older people
- Recommendations | Multimorbidity: clinical assessment and management | Guidance | NICE
- Quality statement 1: Identifying those at risk of a decline | Mental wellbeing and independence for older people | Quality standards | NICE
- Older People’s Mental Health Competency Framework Report (e-lfh.org.uk)
- Support for carers | Age UK
- ps02-20-frailty.pdf (rcpsych.ac.uk)