This chapter provides a discussion of issues

related to the mental health needs of older

Americans, including a demographic profile
of the nations elderly population, the
mental health problems that tend to be more
prevalent among them, mental health and
aging dilemmas that concern policy makers
as well as service providers, and efforts to
give heightened attention to these challenges
and to provide programmatic and policy
responses.

Abstract
Only very few studies document a positive effect of social support
on mental health. However, the contact with ones children might be of a
different quality as compared to that with friends or neighbours. Based on
the international comparative data of the Survey of Health, Ageing and
Retirement in Europe (SHARE), we analysed how the number of children,
their proximity and the frequency of contact between elderly parents and
their children affect the mental health of the elderly. In view of decreasing
fertility rates in Europe, this determinant of mental health is of special
importance, as we might expect mental health to deteriorate if it is true that
the existence of and contact with children has a positive effect on the mental
health of their parents. Our results indicate a protective function of children.
On the one hand, childless people had higher levels of depression; on the
other hand, few contacts with children also had a negative effect on the
mental health of elderly parents. Moreover, family status had a strong
protective effect on mental health: elderly people who lived with a spouse or
a partner had the lowest levels of depression. When limiting the analysis to
persons without a partner, divorce seemed to have a stronger effect on
depressions as compared to widowhood. Furthermore, the presence of a
spouse or partner had a much stronger protective effect on the mental health
of elderly than the presence of or the contact with children. Among the ten
countries participating in SHARE, Spain, Italy and France had high levels of
depression whereas the elderly in Denmark seemed to be least depressed.

One in five older persons suffers from a diagnosable

psychiatric illness and the number of persons
age 65 and older with a psychiatric disorder will
more than double over the coming decades.
These disorders can substantially impair functioning
and can result in unnecessary hospitalizations
and nursing home placement, poorer health
outcomes, and increased rates of mortality. For
example, older persons who suffer from depression

have worse outcomes after medical events

such as hip fractures, heart attacks, or cancer, and
individuals who are age 75 and older have the
highest suicide rate of any age group.
Fortunately, there have been dramatic
advances in our understanding of these disorders
over the last decade and major gains in developing
new treatments. Effective treatments are now
available for most of these disorders, resulting in
increased functioning and greater quality of life.
Yet all too often older persons with psychiatric
illnesses fail to receive treatments and services
that they need. Family members are often left
with the task of sorting out a confusing array of
providers, treatments, and systems of care, without
access to basic information. This guidebook
provides consumers and family members with
useful, practical information on psychiatric problems
in late life and the array of available treatments
that can help. This guide also promotes
involvement of families as an informed member
of the treatment team, along with the physician
and other health care providers. Finally, the
guidebook includes important information on
prevention and wellness. For example, social supports
and remaining mentally and physically
active in senior years can help to prevent depression,
and even improve memory.
Being informed is a first step toward achieving
better health.

Executive Summary
The purpose of this document is to serve as a guide for health authorities
in designing, developing, implementing and evaluating services that
maximize
quality of life for elderly people who have complex and challenging mental
health problems. It is anticipated these activities will be reflected in the
health
authorities' planning.
The demographic profile of British Columbia's population will change
significantly over the next three decades. During that time it is estimated
the elderly population will increase by 121 per cent, compared to an increase
in the under 19 population of 11 per cent. If efficient, effective and
innovative

approaches to providing care are not developed, the resulting service

pressure
will reach crisis proportions for the baby boom generation of about 1,186,000
seniors in 2026. Studies show the prevalence of mental health problems
affecting elderly people is between 17 and 30 per cent: McEwan, et al
(1991),1
suggested 25 per cent as a reasonable figure.
The Principles of Elderly Mental Health Care 2 and nine key elements,
considered
vital to the provision of mental health care for the elderly, provided the core
principles and assumptions upon which the recommendations made in this
document were founded.
The Principles of Elderly Mental Health Care were developed to guide the
design
of the service system and the delivery of care. They are:

.
.
.
.
.
.

client and family centred;

goal oriented;
accessible and flexible;
comprehensive;
specific services; and
accountable.

EXECUTIVE SUMMARY
Primary care services
and programs are
the backbone of elderly
mental health care

vi
The key elements considered vital to the provision of mental health care are:

.
.
.
.
.
.

health promotion and early intervention;

education;
family support and involvement;
psychosocial rehabilitation and recovery;
environmental milieu (i.e. housing);
integrated and continuous services;

.
.
.

quality improvement and evaluation processes;

volunteers, mentors and peer counselors; and

advocacy and protection.

Primary care services and programs are the backbone of the elderly mental
health care system. Professionals with specialized knowledge and skills
in geriatric care who work in the secondary and tertiary care sectors only
provide care to those elderly people whose problems are more complex
or challenging than can be accommodated in the primary care system.
They also provide consultation to many primary care providers to divert
referrals from the secondary or tertiary system.
The formal service system for elderly mental health care consists of:
Primary
Preventive, diagnostic and therapeutic health care provided by general
practitioners and other health care providers, such as home nursing,
home support or, upon direct request by patients/clients, placement
in a facility.
EXECUTIVE SUMMARY
Community outreach mental
health teams constitute
the foundation of mental
health care services at
the secondary care level

vii
Secondary
Specialized preventive, diagnostic and therapeutic care usually requiring
referral from a primary source. Includes outreach community-based
teams, inpatient elderly mental health care, day hospital services
and outpatient clinics.
Tertiary
Highly specialized services including professional/technical skills,
equipment or facilities usually requiring referral from a secondary
source. Includes inpatient services, university research clinics and rural
and remote community outreach.
Community outpatient/outreach mental health teams, whether hospital
or community-based, and inpatient elderly mental health care constitute
the foundation of the elderly mental health care system at the secondary
care level.
To be effective, an elderly mental health care service should remain closely
connected to psychiatric expertise. This expertise is traditionally found in
the mental health service structure. Effective elderly mental health care also
requires the development of a formalized collaborative relationship with
home
and community care.3 Home and community care provides and/or
coordinates

many direct, in-home and residential services for elderly people, many of
whom
have complex mental health or behavioural issues. Elderly mental health
care
services provide specialized expertise in support of clients with more
complex
mental health or behavioural issues and their caregivers in a variety of care
settings. Defining the organizational relationship should be done locally,
taking into account the needs of the population, existing resources and the
size
and location of the community. The need for a formalized collaborative
relationship is also required with adult mental health and inpatient services.