Mental health in older people (including dementia)

Introduction

Mental health

Mental illness is the single largest cause of disability in the UK: at least one in four people will experience a mental health problem at some point in their life and one in six adults have a mental health problem at any one time and about one in 100 people has a severe mental health problem.

Improved mental health and wellbeing is associated with a range of better outcomes for people of all ages and backgrounds as well as cost savings: the costs of mental health problems to the economy in England have recently been estimated at a massive £105 billion, and treatment costs are expected to double in the next 20 years.

Outcomes include improved physical health and life expectancy, better educational achievement, increased skills, reduced health risk behaviours such as smoking and alcohol misuse, reduced risk of mental health problems and suicide, improved employment rates and productivity, reduced anti-social behaviour and criminality, and higher levels of social interaction and participation.

Dementia

The term 'dementia' describes a group of symptoms that include loss of memory, mood changes, and problems with communication and reasoning. Dementia is progressive, which means the symptoms will gradually worsen over time. There are many different conditions that lead to dementia, the most common of which are Alzheimer’s disease and vascular dementia.

The Dementia 2010 report revealed that the cost of dementia in the UK is twice that of cancer, three times as much as heart disease and four times as much as stroke. Dementia costs the UK economy £26 billion a year and family carers of people with dementia save the UK public purse over £12 billion a year. Early diagnosis and support for carers can therefore be key.

Key inequalities and risk factors

Mental health

  • Older people typically access mental health services less frequently than their working age counterparts
  • No health without mental health’ the national mental health outcomes strategy (Department of Health, 2011) makes it clear that social and other determinants of health can both cause and be the result of mental health problems including, for example, social isolation, particularly among older people
  • Who will love me when I’m 64? (Relate, June 2013) makes clear the importance of couple, familial and social relationships on mental health and the impact of significant life events (e.g. death, divorce, caring responsibilities) on the mental health of older people
  • Research by Stonewall report that older lesbian, gay, bisexual and transgender (LGBT) people are more likely than heterosexual peers  to have a history of mental ill health combined with other risk factors such as alcohol and drug misuse.  Gay and bisexual adult men are twice as likely to have been diagnosed with depression and anxiety than heterosexual men. Single older gay people are more than three times as likely to rate their mental health as ‘poor’ than those in a relationship and LGBT people are less likely to come forward for support with 2 in 5 older people lacking confidence that mental health services and 1 in 6 believing GPs would be able to understand and meet their needs
  • Co-morbidities – people with long-term conditions are more likely to experience mental health issues and those with both a physical and mental health condition face poorer clinical outcomes and a significantly lower quality of life than people with a physical health problem alone

Dementia

  • Age - The most significant risk factor for developing dementia is age: in Bracknell Forest, the largest population increase is predicted to be amongst those aged over 90 with the estimated increase between 2014 and 2030 is 113% (Stats.Share [Population] Population Projections Chart)
  • Gender - Dementia and Alzheimer’s disease was the leading cause of death for women aged over 65, with twice as many women (34,321) dying compared to men (17,177) (Stats.Share [Health and Wellbeing] Top Ten Causes of Death)
  • Ethnicity - There are over 11,500 people with dementia from black and minority ethnic groups in the UK
  • Disability - It is estimated that in 2011 in England, there were 1,191,000 people with a learning disability which is 2.2% of the population. 1 in 3 people with Down’s syndrome develop dementia in their 50s

At any one time, a quarter of people staying in hospital beds are people with dementia aged over 65

Two thirds of people with a diagnosis of dementia live in the community while one third live in a care home. 80% of people living in care homes have a form of dementia or severe memory problems

There are 670,000 carers of people with dementia in the UK. These unpaid carers save the UK economy £12bn every year and are vulnerable to inequalities in physical, mental, financial wellbeing

Facts, figures and trends

Many people are now living longer and healthier lives and so the world population has a greater proportion of older people.

Dementia

Dementia mainly affects older people over the age of 65, but it can affect people who are younger. The Alzheimer’s Society state that in the UK there are 17,000 younger people (aged under 65) living with dementia and that the number of people with dementia in the UK is forecast to increase to over 1 million by 2025 and over 2 million by 2051.

A recent national projection estimates the number of people living with dementia in the UK to be 850,000 in 2015. Projections for Bracknell Forest are as follows:

Source: Institute for Public Care (PANSI & POPPI databases) via Stats.Share [Health and Wellbeing] [accessed 15/08/2017]

The National Dementia Strategy (2009) states 'all people with dementia to have access to…. treatment, care and support as needed following diagnosis'.  The number of people with dementia recorded on GP practice registers in the Bracknell and Ascot Clinical commissioning group gives an indication of the concentration of the number of people in the Borough who have been diagnosed and who are now living with the condition:

There is no single consensus on the appropriate diagnostic tests that should be carried out in those with suspected dementia; however there is considerable similarity across the guidance. The NICE clinical guideline on dementia states that a basic dementia screen should be performed at the time of presentation to exclude potentially reversible or modifying cause for the dementia and to help exclude other diagnoses. The Department of Health Dementia Atlas  shows the percentage of new patients in Bracknell Forest with a dementia diagnosis who have had a blood test recorded 6 months before or after entering onto the practice dementia register to be 82.7% which is higher than the national average of 74.7%.

Having a close relative with dementia does not mean that dementia is inevitable. Everyone can reduce their overall risk of dementia by adopting a healthy lifestyle. A healthy lifestyle can also delay the onset of dementia by 5 years would reduce deaths directly attributable to dementia by 30,000 a year (Brookmeyer et al, 2007).

The impact of dementia on the individual and how they might better cope with the condition is highlighted in a short video on the council's YouTube channel:

YouTube video link

Depression

Rates of severe depression in older people, although not as high as rates of dementia, are still a cause for concern.

Source: Institute for Public Care (PANSI & POPPI databases) via Stats.Share [Population] [accessed 15/08/2017]

All too often, depression in older people is considered an inevitable part of life. It is for this reason that lower moods in older people are often overlooked.

It is predicted that 438 over 65s in Bracknell Forest suffer from severe depression. Often a result of social exclusion, isolation and mobility issues, depression can cause older people to suffer in silence without community or medical support.

Source: Institute for Public Care (PANSI & POPPI databases) via Stats.Share [Population] [accessed 15/08/2017]

This short video on coping with anxiety and depression is from the council's YouTube channel:

YouTube video link

Mortality

In 2016, there were 47,153 registered deaths attributable to dementia in England and Wales, an increase from 40,200 in 2014

Costs

In 2015-16, there were  11,125 hospital admissions where the primary diagnosis was dementia, compared to 12,061 in 2014-15 and 11,817 in 2013-14.  The majority of patients were women accounting for 57% of consultant episodes, which has been consistent over all periods.

In 2016, there were over 3.6 million items prescribed for dementia at a cost of £29.85 million compared to 3.3 million items prescribed at a cost of £32 million in 2014.

The expense to the UK economy of each person with dementia is £27,647 per year; more than the UK median salary (£24,700) (Alzheimer’s Research Trust).

Government and charitable spending on dementia research is 12 times lower than on cancer research. £590 million is spent on cancer research each year, while just £50million is invested in dementia research (Alzheimer’s Research UK).

Want to know more?

Dementia

National Dementia Strategy - Strategic framework for making quality improvements to dementia services and addressing health inequalities

Bracknell Forest Joint Commissioning Strategy for Dementia 2014-2019 – Describes national and local contexts, an assessment of needs including findings from public consultation and key priorities for service improvement including: greater public and professional awareness of dementia and those affected by it, earlier diagnosis and timely information and personalised support, consideration of transport needs to reduce social isolation, consideration of people with dementia in the new Bracknell town centre

Bracknell Forest Dementia Partnership Board - responsible for developing the dementia strategy and overseeing the delivery of the Action Plan to make sure support and services are delivered to people in need

Dementia Advisory Service – advice and information about the Memory Service and support for people with a diagnosis and their carers up until the point at which they need more formal support from a social worker or Community Psychiatric Nurse

Creating dementia friendly communities – see the Prime Minister’s Challenge on Dementia (March 2012) and how people with a diagnosis of dementia can be supported to remain independent for as long as possible in the communities in which they live

Dementia Handbook for Carers – Berkshire Healthcare Foundation NHS Trust resources to help answer questions people may have if a family member has Dementia or the symptoms of it

Mental Health

Healthy Minds Joint Commissioning Strategy for Mental Health 2013-2018 – Sets out the local situation, an assessment of needs and key priorities to help address issues and improve services and support for people with mental health issues.

Health matters: getting every adult active every day (Public Health England, 2016) – summary facts and figures, descriptions of  physical activity and how benefits extend beyond physical health to include mental wellbeing, and how it can be used in a number of care pathways for cancers, diabetes, dementia, cardiovascular disease, falls and hip fractures.

Improving the physical health of patients with serious mental illness – a practical toolkit (NHS England, 2016) - a practical toolkit for mental health trusts and commissioners, designed to help them improve the physical health of patients with serious mental illness, fully adaptable for health services to use locally.

The Bracknell Forest YouTube channel also has a number of short videos to view and share on reducing stigma by opening discussion about mental health: 

YouTube video link

 

This page was created on 1 April 2014 and updated in August 2017.  Next review date August 2018.

Cite this page:

Bracknell Forest Council. (2017). JSNA – Mental health older adults. Available at: jsna.bracknell-forest.gov.uk/ageing-well/keeping-well/mental-health-older-people (Accessed: dd Mmmm yyyy)Email to report a broken link on this page

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