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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Seniors and Mental Health Promotion

Penny MacCourt, MSW, PhD (ABD)

Reprinted from "Seniors' Mental Health" issue of Visions Journal, 2002, No. 15, pp.28-29

This article focuses on the findings of a report done for Health Canada about mental health promotion in relation to older adults. The study was based on a thorough literature review and a survey of key informants.

Introduction

The number of seniors is growing. Recent Statistics Canada figures estimate that 13% of the population is 65 years of age and older; by 2016, it is estimated that seniors will represent over 16% of the population. Equally important, the senior years constitute a time of life when the majority of health care use and expenditure occurs. Both physical and psychosocial well-being influence the demand for health services.

Mental health problems in late life usually occur in the context of medical illness, disability and psychosocial impoverishment. Individuals may experience age- or illness-related challenges — such as cognitive or sensory impairments, mobility issues or chronic pain — that limit their ability to function socially. Other challenges are retirement, widowhood, mental or physical illness of a spouse or other relative that leads to caregiving, and diminishment of their social support system through loss of peers to relocation, illness, caregiving or death. Many older adults remain in good mental health in spite of these challenges. For others, these challenges may lead to social and emotional isolation, sometimes depression, alcoholism and occasionally suicide. Additionally, such issues as lack of accessible transportation or low income may be barriers to maintaining good mental health for some seniors.

In order to promote and support the mental health of older adults as they face the challenges of aging, and to address mental health problems that occur, a mental health promotion approach is required. Health Canada defines mental health promotion as “the process of enhancing the capacity of individuals and communities to take control over their lives and improve their mental health. Mental health promotion uses strategies that foster supportive environments and individual resilience, while showing respect for culture, equity, social justice, interconnections and personal dignity.”

Literature Review

Although there is a large body of literature both on health promotion and on the prevention of mental illness, there is relatively little literature on mental health promotion, either in the general population or in the elderly. This reflects the fact that the concept of mental health promotion is relatively new.

There are several changes that occur as part of the normal aging process that may affect psychological and social well-being in seniors. These events affect the majority of seniors and include retirement, changes in income level, physical changes, and changes in social support networks. Seniors may respond to these events in many different ways. Some may see the changes as positive, for example, as an opportunity to build new relationships. Others may take the changes in stride and be relatively unaffected by them. Still others may become lonely, depressed, or suicidal as a result of the changes. It is important to understand why individuals are each affected differently by natural transitions. While it is known that some seniors fare better than others, why this occurs is not fully understood.

Numerous strategies, interventions and programs have been designed to improve the physical and/or psychosocial well-being of seniors, but little is known about why some programs are more successful than others.

There is still much that needs to be done to ensure that older individuals are as healthy as possible for as long as possible. Some of this must begin with developing and implementing research and policies designed to improve the psychological and social well-being of seniors.

In the research domain, there is a need to:

  • develop an inventory of community-based services, interventions, and programs that are designed to promote mental health in seniors

  • continue explorations of the impact of various determinants of health on the psychological and social well-being of seniors

  • identify appropriate indicators of success and outcome measures

  • develop longitudinal studies focusing on physical, psychological, social and emotional aspects of aging

  • develop appropriate ways to communicate information to a variety of audiences.

There is a need for programs that would:

  • prepare individuals for retirement, reduced incomes and loss of social contacts.

  • increase income levels.

  •  
  • continue to encourage and promote physical, psychological and social well-being.

  • target seniors at increased risk for health problems because of psychosocial barriers. .

Key Informant Survey

Forty-five key informants were interviewed (1) to develop an overview of how mental health promotion strategies are currently being used in Canada to address challenges to adults’ mental health as they age; and, (2) to identify factors that either facilitate or make it difficult to apply mental health promotion strategies to promote and support seniors’ mental health.

Findings and Issues Identified

  • Key informants provided many examples of strategies and approaches that promote and support seniors’ mental health. The approaches identified were community development, policy development, education, training and prevention.

  • Generally, informants from urban areas believed that there are adequate resources to assist elderly persons to cope with many of the challenges often associated with aging, or to facilitate their recovery from mental health problems/disorders. In rural and remote/northern regions, fewer of these supports were available, due to accessibility/transportation issues, lack of human resources to provide services, and not enough seniors to create need for programs.

  • In regards to programs to prepare aging adults for potential challenges, there were few of these reported by any of the participants with the exception of retirement programs, which were focused largely on finances.

  • There were fewer programs of any type to prepare seniors for potential mental health problems reported by respondents in the three territories.

  • Overall, relatively few programs were identified that specifically address barriers to good mental health, and those that were reported came from both rural, remote and urban parts of the country.

  • Nowhere was it reported that special strategies are being used to prevent older adults from taking their own life.

Issues that emerged from the key informant interviews are listed below:

  • Older aboriginals in the territories, and ethnoracial minority groups are unique populations requiring unique approaches.

  • Unique generational challengesface aboriginal and other ethnoracial groups.

  • There are different age groups within the age 65+ category, with different needs.

  • Access to appropriate support is limited in rural and remote areas.

  • Transportation is a barrier to accessing support.

  • Ageism and stigma of mental illness affect seniors directly and indirectly.

  • Caregiving is a risk to seniors’ mental health.

  • Poverty affects seniors’ access to supports.

  • Males have special needs that require special approaches.

  • Leadership in seniors’ mental health promotion is underdeveloped and under-supported.

  • Communication in the seniors’ mental health promotion field is limited.

  • Dissemination of knowledge about seniors’ mental health promotion strategies is limited.

  • Mandate and jurisdiction issues create barriers.

  • Partnership development is limited.

  • National frameworks and best practices for seniors’ mental health promotion are lacking.

  • Funding for seniors’ mental health promotion is limited.

  • Human resources — health care providers, volunteers and caregivers — are limited.

Future Directions

In order to further explore and to address the issues revealed about seniors’ mental health promotion, both research and policy development are required. The development and implementation of policies regarding the promotion of mental health in seniors must explicitly incorporate the basic principles of health promotion. For example, seniors need to be actively and meaningfully involved in the development, implementation, evaluation, and review of policies. If policies are designed for specific subgroups, members of these subgroups should be included as part of the process. Policies need to emphasize health promotion as well as the prevention of illness. Policies need to be developed and implemented collaboratively with the active and meaningful involvement of representatives from various public, private and not-for-profit sectors.

Conclusion

There has been much interest in the psychological and social well-being of seniors in recent years, and many successful applications of mental health promotion strategies to support seniors’ mental health. Nevertheless, there is still much that needs to be done to ensure that older individuals are as healthy as possible for as long as possible.

 
About the author
Penny MacCourt is the past President of the BC Psychogeriatric Association and was co-Chair of the Ministry of Health Services’ Elderly Mental Health Care Working Group. She is a clinician with the Seniors Outreach Team for Nanaimo Mental Health, Vancouver Island Health Authority.

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