Health
Half of Australia's aged care residents experience depression.It's clear how their mental health can be improved
Helen* describes moving into senior housing last year as “very sudden and traumatic”.
Helen, 90, a former clinical psychologist, said there was nothing wrong with the facility itself or the people there, who were both “very nice people.” ABC RN's Life Matters.
“But this isn't home,” she says.
“Moving from a two-bedroom house to a one-bedroom house is really hard…I left behind furniture, a lot of clothes, memorabilia and books.
”[There] It was a terrible feeling of abandonment, sadness, loss, and the feeling that I had left behind my humanity, my independence, my ability to make my own decisions. ”
Helen experienced depression after moving to an aged care facility and noticed that others there were also showing “various signs of depression”.
“Many people sit quietly and cry for days after they arrive,” she says.
“I see it here every day.”
Helen and her co-residents are part of the Australian population with the highest risk of depression in the country.
“Currently, around half of all residents in aged care facilities have significant symptoms of depression,” said psychologist Tanya Davison, lead researcher on the study. new researchpublished by the government's National Health and Medical Research Council (NHMRC) on Psychotherapy in Aged Care.
“This is about four times the rate seen in the general elderly population,” she says.
“And now six out of 10 elderly care recipients are prescribed antidepressants.”
Professor Davison says this is an approach that is “clearly” not working.
Alternatives that have been proven to improve mental health outcomes do exist. So why isn't it more popular?
Why are depression levels high?
Professor Davison explains that there are multiple factors that put people in aged care at risk of depression.
“People with complex medical conditions, people who have experienced bereavement or bereavement, and people who may have cognitive impairment or dementia.” [or] Frailty – These factors are all reasons why people need aged care, but they are also important risk factors for depression. ”
Another big problem is This is how many seniors move into senior housing.
“That's very difficult for many people,” Professor Davison says.
“It is often poorly planned. In many cases, the time and effort required for relocation is very limited, which is associated with poor adjustment to care for older people.”
Additional risk factors such as social isolation and loneliness exist in daily life in nursing homes.
”[People] They are excluded from their communities and previous sources of social participation. They often report being bored and having no activities to do. [that are] It's personally meaningful to them,” Professor Davison said.
“It's not uncommon to see people sitting in their rooms most of the day just staring at the TV.”
therapeutic effect
When Helen moved to an aged care facility, she felt surrounded by strangers and struggled to find someone to talk to.
“It's very hard to find some kind of common history between people who are together, and I found that really difficult,” she says.
She sought and paid for support from her own psychiatrist, which she says greatly helped her “express some of the grief and loss that is part of what has been going through me.”
She said she has “overcome” her depression since starting sessions with a psychiatrist.
Professor Davison said recent research into psychotherapy in aged care, including a review of a randomized trial of 873 older people with depression, reflected Helen's experience.
“We found that people who received psychotherapy had less depression than people who only received usual care,” she says.
Sunil Bahl is director of the Wellbeing Clinic Support Services for Older People at Swinburne University and co-author of the NHMRC study.
He said that while there were limitations to the research, such as “the methodological rigor was not very strong” in some of the historical studies reviewed, the message was clear.
“Psychotherapy was much more effective than usual care…We absolutely need to offer more therapy,” he says.
“This review and decades of experience show that psychotherapy does work.
“Our review shows that 2 to 12 sessions may be sufficient to bring about improvement, which speaks to the feasibility of this particular approach.”
What is the holdup?
There are several reasons why psychotherapy is less accessible to older people.
One is funding.
“For a long time, people living in aged care facilities have not been able to access the same funding for psychotherapy as everyone else, and there are still disparities when it comes to funding,” Professor Davison says.
Residents of aged care facilities will be able to receive Medicare-subsidized treatment through mental health plans “only in very special circumstances”.
“You need a referral to a psychiatrist, but unfortunately very few people see one.”
In fact, from 2012 to 2017; less than 3 percent Australian aged care residents with a mental health condition who used Medicare-funded mental health services, including GPs, psychiatrists and health professionals.
“There are some other [mental health] There are schemes available, but they are very small at the moment,” says Professor Davison.
“So we need to look at ways to provide more funding and improve access.”
Age discrimination poses another hurdle.
“There is a misconception that older people are not interested in psychotherapy. [that] They probably don't have the psychological insight or cognitive flexibility to benefit,” Professor Davison says.
“But, of course, this study and many others show that this is simply not the case. Psychotherapy is just as effective for older people.”
She said there was a need to “improve the training of mental health workers who work with older people to increase the number of professionals available” and “improve skills for detection and response within residential aged care facilities”. We also need to pay attention to this.'' Responding to residents with depression. ”
“Currently, aged care workers are very poorly trained in mental health,” she says.
“A dire need”
Helen wants to ensure that other elderly care residents have access to the same professional support that she herself sought.
“I have always felt strongly that there is a dire need for some type of counseling for people receiving elderly care,” she says.
She believes the state should provide counseling to people both before and after they enter an elderly care facility.
She says depression is normal for residents like her.
“That shouldn't be normal,” she says.
From 2018 onwards Royal Commission into the Quality and Safety of Aged CareProfessor Davison said there was “a good amount of awareness” of mental health issues among residents of aged care facilities.
In 2018, the federal government Improving access to psychological services in elderly care facilities Professor Davison said the initiative was “a very welcome and step in the right direction”, but noted that “it only serves around 3,000 Australians a year”.
She said the government was making significant efforts to improve the quality of aged care and retain staff.
“We are truly at the point of major reform across the aged care sector,” she says.
But the study has potential drawbacks, Professor Davison says.
“Mental health doesn’t get a lot of attention.”
She says there are “some signs” that mental health will become more of a priority It complies with a new set of quality standards that the government is currently developing for the aged care sector.
“The details have not yet been finalized, but it is clear that we are focusing on more things.” [on mental health] These newly proposed standards do things that have never been done before.
“So I hope we're moving in the right direction.” [path]. Given the massive reforms underway, now is a great time to really get this right. ”
Minister for Health and Aged Care Mark Butler and Minister for Aged Care and Sport Annika Wells have been contacted for comment.
*Names have been omitted to protect privacy.
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