Safeguarding seniors' mental health

Following the release of a research report on mental health of older Australians, industry body COTA is calling for a national strategy and improved literacy and education around evidence-based coping strategies.

The COVID-19 pandemic and lockdowns had profound impacts on the mental health and wellbeing of people aged 75 and over.

To better understand how people aged 75 and over managed during the pandemic and lockdowns, and to what extent, if at all, their mental health and wellbeing were affected, in October 2021 we surveyed over 1100 older Australians. We wanted to hear directly from older people, so we conducted in-depth interviews and focus groups, and received written submissions.

What did we find?

Older people experienced loneliness, fear, loss of social connections, loss of sleep and appetite, worsening mental health and reduced physical activity, leading to cognitive decline. Even people who reported their mental health was not affected reported some symptoms, to varying degrees.

One-third of older Australians reported their mental health was adversely affected by the pandemic and lockdown measures. Of these,

• 88% did not receive support from a mental health professional or mental health service
• 30% felt more isolated when services moved online
• 62% relied on a community or health services visitor to check on them during lockdowns
• 20% had no one to talk to during periods of lockdowns
• 61% noticed mood changes
• 61% became less physically active
• 8% could not get the help they needed (compared to less than 1% of those whose mental health stayed the same).
   

These impacts were not experienced equally. Our research shows that older women, those with caring responsibilities, older people living with disability, older people from CALD communities, people in residential aged care, people living with dementia — were particularly vulnerable to mental distress.

Older Australians, even those who considered themselves unaffected by the pandemic, described themselves as living with ‘worry’ and ‘stress’; of experiencing sadness, loss, lack of sleep and appetite; of distress; but rarely ‘depression’ or ‘anxiety’, for example. This points to the stigma associated with mental illness and seeking support for mental ill health as a barrier to receiving support. Older Australians emphasised resilience and ‘getting on with it’; yet this minimisation, along with the lack of appropriate mental health services, has devastating mental health impacts on older Australians.

What makes a difference to older Australians?

There is a need to ensure that the strategies that people aged 75 and over asked for — strong social connections, the right information, access to social support and services, age-informed mental health expertise and engagements with community-based organisations — are in place, adequately funded and accessible to all.

We also need to reiterate the right of older people to adequate and appropriate mental health services, and that this should inform any crisis response.

Mental health care needs to be culturally informed, safe, responsive and appropriate, particularly for groups where the concept of mental health is an unfamiliar one. Most older people reported that they were unaware of services for mental health and services for older people experiencing distress during the pandemic.

Our findings reinforce the need for culturally safe models of mental health education and support, integrated into existing service provision.

People need help — they need to know who they can talk to but will not ask for it in public. If you build trust, then they will talk about anything. Older people need to be comfortable and feel confident, not confronted. The language of mental health does not work, and diagnostic labels do not translate easily, and may have no cultural or language equivalent. They will hide mental health issues to avoid family conflict and make them feel more comfortable.

The long-term mental health impacts of the pandemic are undetermined. COTA Australia’s research suggests that to mitigate these and prevent long-term mental ill health, improved mental health literacy and education around evidence-based coping strategies and resilience building are urgently needed.

Action required

• There is a need for a National Older Persons Mental health strategy with targets and indicators, and that is properly resourced, monitored and evaluated.
• Prioritise a trained, professional aged care workforce. We need care staff to be trained in first aid mental health — to at least be aware of the signs of distress in older people they work with, and to know where and how to refer people. In our research, the understanding of mental health varied from facility to facility, provider to provider and staff member to staff member. A focus on crisis management seemed to override other issues. Staff providing care and service providers to older people need training and education in mental health awareness.
• Promote and normalise mental health services and language among older people.
   

If we are serious about older people’s mental health and wellbeing, not only in times of national crisis, we need to make it a health priority. We need to prioritise the importance of preventative work with the mental health of older people. The full mental health impacts of lockdowns are still unfolding. All older Australians have the right to an adequate standard of health care, and this includes mental health care and services. This is not an optional luxury for times of economic affluence but a fundamental right and social necessity.

This research captured the lived experience of Australians aged 75 and over during the COVID-19 pandemic. It amplified the voices of a group of Australians whose specific mental health and wellbeing needs are often dismissed. Our sample of older Australians, while one of convenience, showed that the mental health impacts of the pandemic and lockdowns were profound for this cohort, may be long term and require targeted responses and initiatives. COTA Australia will also continue to advocate for appropriate, accessible and comprehensive mental health services that meet the needs of older Australians.

*Patricia Sparrow, CEO, COTA Australia, and Maria Katsabanis, Engagement Lead, COTA Australia.

Image credit: iStockphoto.com/SeventyFour