Selected best practices 17
CATEGORY 4: Care unit interventions Name of the project (country
code) This project instructs us to
PSYCHOSOCIAL INTERVENTION IN AN
ELDERLY CARE UNIT (EL) offer enjoyment, assess functioning, psycho-social stimulation, prevent stress and depression, enforce better adjustment to the setting, improve social resources, orientation to time and place by providing the residents with regular recreational activities
PREVENTION OF DEPRESSION IN
RESIDENTIAL HOMES (NL) improve conditions for good management with depressive residents by counselling and training given to the personnel
ERSÄNG BEHANDLINGSCENTER (S) relieve symptoms, increase social contacts and quality of life, prevent relapse into psychiatric ill-ness by designing an individual treatment plan and group discussions
In addition to the general objectives, there were a number of additional factors to be taken into account within this sector. Firstly, older people are far more likely to expe-rience individual losses (suffer from bereavement, diminished social contacts, and facing retirement) and among the most dramatic such losses are loss of health and loss of functional abilities in activities of daily living.
Older people are, as shown by many studies, often faced with decline in cognitive functions which may lead to considerable need of adjustments in their everyday living environments. There may also be an increased need for external help caused by physical ailments such as those due to injuries in which external circumstances such as darkness, coldness and slipperiness may have a distinctive role to play. Comor-bidity in general, is also quite common.
It turned out that quite a few projects focused on prevention of depression, or anxiety as such (there were, however, a couple of outstanding exceptions to this general tendency) while a vast majority of the projects were more general in scope. Hence,
as one of the national partners summarized, three key themes emerged in the proj-ects:
1. relationship between mental health and physical health, 2. importance of social support and social networks, 3. opportunities for participation and inclusion.
Other fundamental issues arising from the collection were those of empowerment, maintenance of independent living for as long as reasonable and combating of age-ism.
It can also be noted that the range of the projects delivered was quite wide: some were strictly research-oriented, while others were of a more practical nature. A gen-eral observation was that a majority of the projects were tailored to meet real needs of older people.
5.4 Conclusions
Health of an individual may be regarded as a result of an extremely complex interplay between biological, psychological and social factors. All these factors are modified by personal experiences and by behaviour. They are also affected by the physical, so-cial and cultural environments along the whole lifespan of the individual.
This project also tackled coping mechanisms which are developed during the entire lifespan. This poses specific challenges to the earlier phases of development, which modifies behaviour during later life. For example, problem solving skills and social skills are excellent examples here. Good command of both skills is a great asset for example in acquiring a good balance in life and for increasing the quality of life. This talent is formed and maintained throughout life and there may be very practical measures to teach such skills, as witnessed by some of the received projects. In the frame of primary prevention, coping can be viewed as improving coping abilities of people who are currently without a mental disorder, such as depression, but are be-lieved to be at risk of developing a particular disorder.
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Individuality of older people
It is important to recognize that the group of older people is by no means homogene-ous. Some people are well enough, highly capable in functioning in their everyday life and independent up to a very great age. In contrast, it is evident that the number of people with neurodegenerative diseases is increasing. Therefore, it is unjust and even impossible to address older people as a single category of persons.
One important - yet seemingly neglected - stage concerning this sector is the transi-tion period from working life to retirement. Although this was mentransi-tioned specifically in the guidelines for the project at the beginning, only one such project was received.
Certainly there are large individual differences when facing this phase of the lifespan and the attitudes for example towards approaching retirement. As this is a very cru-cial and potentially problematic point in an individual's life, more projects focusing specifically in this transition are called for.
Level and scope of the projects and interventions
It became clear in this project that the projects collected were based in the main on a local level. This leads inevitably to the fact that they only reach a limited number of the population at any one time. In contrast, some projects had been ongoing for sev-eral years, thus were able to include a very large number of potentially vulnerable older people.
One question linked to this is whether the effective projects could be carried out with similarly good results in another setting or country. Are the projects dependent on cultural settings, local circumstances or even the individual characteristics of the pro-viders. This topic is one of many which are currently under intensive discussion among the health promotion professionals.
Importance of social aspects and active participation
The majority of the projects selected underlined the significance of social contacts and social participation of the people in this age group. This was clearly stated in al-most all descriptions despite the nature of the initial target group or setting or the presence of depression or related disorder at an earlier phase of life. The
endorse-ment of the importance of social contacts should take place wherever older people are living, whether in their own homes or in residential homes.
In this context it is also worth mentioning that the recommendations and conclusions arising from the discussions in the European Conference on Promotion of Mental Health and Social Inclusion (Tampere, 1999) are still indeed timely. On that occasion, it was noted that the key factor in health promotion in older age is active participation of older people themselves. Other factors to be taken account of are
· to combat ageism (that is any sort of discrimination based on age),
· to promote autonomy and self-empowerment,
· to facilitate social support, social integration and social participation and
· to reduce social isolation.
Actions at the policy level
A lot more needs to be done in order to ensure that mental health promotion activities are firmly incorporated in the health policies of all Member States of the European Union. The lack of national level mental health policies in many of the participating countries is valid proof of this need18. It is of paramount importance that mental health policies are formulated such that they also address genuinely the special needs of older people. Consequently, there is a need to focus as well on the imple-mentation and evaluation of the policies.
A number of other initiatives such as the International Plan of Action on Ageing and the subsequent political declaration presented in the Second United Nations World Assembly on Ageing of 200219 are tackling many of the issues that older people face.
For example, this declaration discusses actions on three priority directions, one of which is 'advancing health and wellbeing into old age'.
Another large-scale world-wide initiative is the "Active Ageing - A policy framework"
which formed the contribution of the World Health Organization to the above-mentioned UN World Assembly. Health is one pillar in this framework the two others are participation and security. The policy proposal on mental health is to "promote
18 It may also be that such policies may have escaped the collection performed within this project.
19 An International Plan of Action on Ageing 2002 - The Valencia Report
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positive mental health throughout the life course by providing information and chal-lenging stereotypical beliefs about mental health problems and mental illness."
Complementary elements in strategy formulation
The overall aim of this project was to develop promotion and prevention strategies for older people and the basic elements of such strategies were discussed within the sector's group of experts.
Based on these discussions, the following list of pertinent targets/topics is presented
· legislation,
· poverty,
· reduction of anxiety and depression,
· loneliness,
· the role of age peers,
· intergenerational support,
· transitions in society,
· role of antidepressants,
· ageism,
· physical health,
· nursing homes,
· training of the professionals,
· equality,
· social inclusion,
· care and support structures, and
· the role of the family carers.
Recommendations
To promote mental health of older people and to prevent their mental health prob-lems, the following cutting edge actions are recommended:
1. Stop discrimination by age and acknowledge the heterogeneity of older people 2. Promote personal autonomy and possibilities for independent living to the fullest
possible extent.
3. Provide adequate means to endorse social participation in all relevant settings.
In order to accomplish the above, it is essential to ensure that valid and effective mental health promotion interventions are available for improving the quality of life of older people, and there needs to be firm commitment to allocate resources to these activities.
In promotion of mental health, and health promotion in general, constructive dialogue between policy makers and researchers is crucial. This communication needs to be strengthened to achieve balanced understanding of, for example, the significance and value of the contemporary discussions of evidence-based methods.
Effective interventions at the individual as well as at the community level are avail-able and ready for extensive implementation. Consequently, it is recommended that 4. the access of older people to effective psychological therapies should be
im-proved (regular screening for depression introduced in the UK seems to be an adequate step in that direction; however screening alone is not enough)
5. vulnerable risk groups should be reached by special programs
6. an increase in the social participation of older people should be promoted 7. available evidence-based methods aimed at preventing and reducing physical
morbidity, impairment, and at increasing mobility should be applied to older people
8. help and support programmes for those in crisis situations (e.g. bereavement, wish to die) should be available and visible in the community. Older people should be encouraged to make use of them
9. training of professionals working with older people should include adequate amounts of gerontological education
10. interventions targeting major risk factors, such as social isolation and physical ill-health, should be available for all European citizens
A social policy for older people including these issues would be expected to reduce the negative impact of many of the problems.
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Literature
Commission of the European Communities
- Communication from the Commission to the Council, the European Parliament, the Eco-nomic and Social Committee and the Committee of the Regions. "The future of health care and care for the elderly: guaranteeing accessibility, quality and financial viability". Brussels 05.12.2001 COM (2001) 723 final
- Report from the Commission to the Council, the European Parliament, the Economic and Social Committee and the Committee of the Regions. "Report requested by Stockholm Euro-pean Council: Increasing labour force participation and promoting active ageing". Brussels 24.01.2002 COM (2002) 9 final
The series of EC health reports:
- The health of older people in the European Union: Current state and future trends, Athens 1999
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