Older adults’ mental health

This chapter covers the mental health needs of older adults in Cambridgeshire and Peterborough. We have broadly defined ‘older adults’ as people aged 65 and over, though we recognise that there is huge diversity within this age group in terms of health, lifestyle and support needs, and that people aged 65+ may not identify themselves as being ‘older’. This chapter of the mental health needs assessment will answer the following questions (Public Health England, 2019b):

what is the local prevalence of mental illness among older adults and how does this compare against the local demographic profile?
are there local inequalities in the prevalence of mental health problems among older adults?
how many older adults have long-term health conditions, and how many have one or more physical health conditions alongside a mental health condition?
how many older adults are in demographic groups that often have complex or extra mental health needs?
what are the common risk factors among older adults and how do these compare with the local demographic profile?
what community assets are available in the local area to improve older people’s mental wellbeing and resilience?
what local older adult mental health services are available and how does their use compare to need?
does social care provision meet the mental health needs of older adults?

The sections of this chapter cover: the wider context of older adults’ mental health, mental health need in Cambridgeshire and Peterborough, risk and preventative factors, an overview of the mental health system, interventions for both common mental health conditions and severe mental illness, practical and social interventions, and the evidence base for prevention.

Figure 1: Outline of older adults’ mental health chapter

This chapter focuses on common mental health conditions (anxiety disorders and depression), severe mental illness and mental health crisis. It also covers dementia prevalence and diagnosis pathways. The full chapter can be downloaded as a pdf, and the relevant datapacks on the estimation of mental health conditions and service use can be viewed below:

Key findings

Wider context: By 2031, almost 1 in 5 people in Cambridgeshire and Peterborough will be aged 65 or over (PHI team, 2023). It is predicted there will be an 88% increase in the number of people aged between 85+ from 2021 to 2041; and that the older adult population will be concentrated in Fenland, East Cambridgeshire and Huntingdonshire (PHI team, 2023).
Mental health need: Around 14% of older adults are currently live with a mental illness (GHDx, 2023), some of whom will have developed this illness for the first time in older age (Raffertys, 2013). It is predicted that over the next 15 years, the number of:
- Older adults with depression will increase by 26% in Cambridgeshire and 33% in Peterborough.
- Older adults with dementia will an increase of 41% in Cambridgeshire and 47% in Peterborough.
Overview of the mental health system: The mental health needs of older adults ‘have historically been under-recognised and under-treated’ in England (Mueller et al., 2017). Older people are less likely to access mental health support than other age groups, despite a similar proportion experiencing mental health conditions (Mueller et al., 2017; Stickland & Gentry, 2016).
- The SUN Network reports that older adults in Cambridgeshire and Peterborough face multiple barriers to accessing mental health support (Sidney, 2023b).
- Around 3 in 10 of patients registered with the Older People Mental Health Service in Cambridgeshire and Peterborough have a dementia diagnosis.
- Further work is needed to understand the capacity of the mental health system to meet the needs of an increasingly ageing population, in terms of funding, workforce and the extent to which the health and social care systems work well together. These factors are key for ensuring the older adults receive high quality mental health support (Davidson, 2021).
Common mental health conditions: Mental health conditions are as treatable in older people as they are for younger age groups (Raffertys, 2013; Rodda et al., 2011). There has been a recent focus on increasing the number of older people accessing Talking Therapies in Cambridgeshire and Peterborough (Cambridgeshire and Peterborough Integrated Care System, 2023).
Severe mental illness: There are a range of services providing specialist support to older adults with severe mental illness in Cambridgeshire and Peterborough. However, there is unequal service provision compared to the support available for younger adults.
- Over recent years, there has been increasing demand for older people’s mental health services and longer waits for older adults who present to A&E due to their mental health.
- More work needs to be done to listen to and record the experiences of older adults in relation to severe mental illness, particularly for older adults from marginalised groups.
Practical and social interventions: We know from the SUN Network that ‘getting out of the house’ and connecting with others is often vital to older people’s mental wellbeing. There are a range of voluntary and community organisations that support older adults in Cambridgeshire and Peterborough, including large organisations such as Age UK, to small community-based groups and activities.

Recommendations for future work

Wider context

Ensure that healthy ageing and the needs of older adults are embedded across local health and care system needs assessments and strategies.

Mental health need

Work with the primary care team to understand the age breakdown of people with severe mental illness in Cambridgeshire and Peterborough on the SMI register, and how this is likely to change over the next 10 years. This should be used to understand the long-term physical and mental health needs of older adults with a severe mental illness, and reasons for A&E attendance or hospital admissions in this group.

Prevention and risk factors

Work with local partners and communities to develop a healthy ageing strategy in Cambridgeshire and Peterborough, that includes dementia prevention
Ensure that mental health is a considered in local strategies looking at frailty and physical health needs of older people
Ensure that the commissioning of mental health and VCS services for older adults explicitly addresses health inequalities and meet the needs of our increasingly diverse older population
Further work is needed to understand whether the mental health needs of people in care homes are being met

Dementia

Investigate evidence-based screening criteria for frailty and dementia– considering the population benefit, cost to system, availability of services and impacts on individuals including risk of harm.
Improve recording of ethnicity in dementia diagnosis data.
Replicate Strategy Unit Analyses for Cambridgeshire and Peterborough: Changes in Dementia Incidence, Prevalence, Severity and Mortality
Evaluate the strengths and weaknesses in access to pre- and post-diagnostic support for dementia.
Build relationships across the ICS and develop communications to improve health inclusion for people living with dementia (as suggested in Raising the Barriers: An Action Plan to Tackle Regional Variation in Dementia Diagnosis in England).
Consider the cost effectiveness of developing a dementia support team for individuals with dementia that require less intensive support.
Continue to monitor the extent to which memory assessment clinics meet NICE guidance around the identification of sensory impairments
Previous local research found that 22% of care home managers in Cambridgeshire and Peterborough expressed difficulty in accessing mental health reviews and assessments in 2018 (Cambridgeshire and Peterborough Older People’s Mental Health Delivery Board, 2018). This research should be repeated to assess if there are currently barriers to accessing mental health reviews.
Investigate how a local pathway could be developed for people with alcohol-related dementia/brain damage.
Investigate the proportion of people in the population who develop dementia who attend memory assessment services, using primary care, hospital and death certificate data.

Overview of mental health system

Consider the Royal College of Psychiatrists recommendation that age 70 should be part of the criteria for specialist older adults’ mental health services, rather than age 65
Analyse the capacity of older adults’ mental health services (in terms of workforce and inpatient beds), relative to growing population growth and need
Improve recording of ethnicity across older people’s mental health services.
Continue to develop lived experience from a range of older adults, including those severe mental illness and those from Asian backgrounds which is a current gap.
Review if all health services are confident in the ability of their services to make reasonable adjustments for disabled older adults, including older adults with frailty, cognitive impairment and/or sensory impairments.
Review professionals’ knowledge of older people’s mental health across the health and social care system using the Older People’s Mental Health Competency Framework and support teams to develop their own strategies to address any gaps.

Interventions for common mental health conditions

Understand how many older adults access mental health support from primary care

Interventions for severe mental illness

As a result of the Peterborough Exemplar project, new mental health services have been introduced for adults under the age of 65, such as the Psychological Skills Services (PSS) and the Primary Care Mental Health Service (PCMHS). Evaluate the impact of these changes on older adults and if this offer could be extended to support this age group.
Evaluate the offer for older adults with complex emotional needs in Cambridgeshire and Peterborough
Understand referral rates, capacity and caseload of crisis teams in Cambridgeshire and Peterborough, by age group
Investigate the reasons behind long wait times for older adults attending Accident and Emergency for mental health-related reasons (including workforce, bed availability and Mental Health Act assessments) and how wait times could be reduced.
Investigate mental health inpatient provision for older adults in Cambridgeshire in more detail, including:
- Number of beds per size of the older adult population.
- Occupancy, bed days when clinically fit for discharge and readmission rates.
- The seasonality of admission rates.
- Potential unmet need, in terms of waiting times for admission and use of out of area beds.
Explore options for building on the learning from the JET team and extending the model.

Practical and social interventions

Review the local support offer for people caring for someone with dementia, including if these are accessible to everyone.
Continue to investigate the extent to which older people access mental health support from voluntary and community sector organisations.
Continue to map and investigate if community support is accessible to older people across all areas of Cambridgeshire and Peterborough

References

Full list of references is included at the end of this chapter.

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