Evidence base for prevention
Compared to other age groups, there is comparatively little research into approaches to prevent functional mental illness in older adults (McDaid et al., 2019). Although some interventions for working-age adults may be applicable to this age group, it is also important to consider:
- The accessibility of interventions, as older adults are more likely to experience physical health conditions, frailty and sensory impairment.
- How the prevention of mental health conditions could fit within wider efforts to promote ‘healthy ageing’ (World Health Organization, 2020). This could address common preventative factors for mental health conditions, dementia and frailty, such as physical activity.
- Approaches to prevent mental illness in specific settings, for example in care homes.
The sections below are based on multiple reviews, which consider different types of prevention in older adults:
Primary prevention
A recent review looked at the evidence around community-based interventions to address risk factors for poor mental health in older adults (Lee et al., 2022):
- There are different types of community-based interventions, including direct support to form social connections, system approaches to improving the wider environment, and connector interventions to promote access and engagement with activities.
- Some research suggested that several direct support and connector interventions had a positive impact on mental health. However, conclusions were limited due to low quality evidence and a lack of long-term outcomes.
A review of economic evidence around prevention of mental illness found (McDaid et al., 2019):
- Evidence that a stepped care approach reduced anxiety and depression in older adults and was cost-effective.
- Psychological and social interventions had a small but significant impact on depression prevalence.
- Some interventions targeted at older adults at greater risk of depression can be effective.
Secondary prevention
Some small studies show evidence that interventions can prevent depression in older adults with depressive symptoms (Cuijpers et al., 2015).
Tertiary prevention
Falls are a leading cause of morbidity and mortality in older people. A 2013 review identified 22 studies evaluating fall prevention interventions for older people with mental health conditions, a minority of which showed statistically significant reduction the number of falls (Bunn et al., 2014). There is some evidence supporting social skills training to improve social functioning of older adults with severe mental illness (Smart et al., 2020).
Additional resources
- NICE guidelines on older people: independence and mental wellbeing and mental wellbeing of older people in care homes
- The Mental Health Foundation’s report on the economic case for investing in the prevention of mental health condition highlights the economic evidence for prevention for older adults.
References
Full list of references is included at the end of this chapter.