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Older People’s Mental Health

The term ‘older people’ is up for interpretation as age is symbolic to the individual. According to the National Service Framework for Older People 2001, older people can be seen broadly in three different groups;

  • Entering old age – people who have completed their career in paid employment and/or child rearing may include people as young as 50 years.

  • Transitional phase – older people who are in transition between healthy, active life and frailty, often occurring in the seventh or eighth decade.

  • Frail older people – people who are vulnerable as a result of health problems such as stroke or dementia.

Becoming mentally ill is not an inevitable part of old age as anyone can suffer from a mental illness. However older people are more likely to experience mental illness, of which dementia and depression are the most common, as there are a number of issues such as chronic physical illness, disability, loss and bereavement, and retirement that are more likely to affect older people than their younger peers. Older people suffering with mental illness are more likely to end up in institutional care, recover less well from physical illness, and are more vulnerable to abuse (SCIE, 2007).

As discussed in ‘Dietitians in Mental Health’, having a mental illness in itself increases the risk of nutritional related physical health problems such as coronary heart disease, as does older age. Being of an older age also increases the risk of malnutrition:‘it is estimated that one in seven subjects aged 65 years and over in the general population has a medium or high risk of malnutrition’. The presence of mental illness and malnutrition have both separately been shown to be strong predictors of poor outcomes such as increased mortality, morbidity and length of hospital stay, all of which incurs cost and puts further pressure on health care resources (BAPEN n.d., NIMHE, 2005).

Older people with mental illness are cared for in a variety of settings; both as inpatients and outpatientsand within both general and mental health services. Care for older people with mental illness requires a multidisciplinary approach due to comorbidities often associated with this population, of which the role of the dietitian is invaluable.

Dietitian input within older people’s mental health services is diverse depending on the requirements of the care provider and the needs of the population, and may include:

  • Multidisciplinary Team Working

    • To be the nutritional specialist within the team

    • Advise other health professionals on nutritional aspects of care

    • Provide training to other health professionals on areas such as refeeding syndrome

    • Deliver joint training sessions such as how to fortify an altered textured diet with the Speech and Language Therapist

  • Service Users

    • Individual care planning to help optimise nutritional status

    • Group sessions such as cook and eat

  • Family / Carer

    • Individual and/or group education and support on areas such as balanced eating

  • Clinical governance

    • The development of local and national guidelines and policies

    • Advise catering such as on how best to meet nutritional requirements

    • Contributing to research and audit

    • The development of educational resources

In summary, the role of the dietitian in older people’s mental health services is fundamental in providing advice and support to those who use and provide the service, to ensure best care is provided in overcoming both mental and physical illness, so that optimal nutritional status can be achieved.

References

BAPEN (n. d.) The MUST report, [internet], MAG, Available from<http://www.bapen.org.uk/pdfs/must/must_exec_sum.pdf> [Accessed 11 July 2013]

 

Department of Health (2001), National Service Framework for Older People, Department of Health

 

National Institute for Mental Health (2005), Guiding Statement on Recovery, NHS

 

Social Care Institute for Excellence, (2007), An introduction to the mental health of older people, [Internet], Social Care Institute for Excellence, Available from <http://www.scie.org.uk/publications/elearning/mentalhealth/> [Accessed 11 July 2013]

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