3.3.1 Specialist Aspects of Assessment of Mental Health in Older People
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Specialist Aspects of Assessment of Mental Health in Older People
Assessment of mental health in older people requires a comprehensive evaluation of physical, psychological, social, and environmental factors. The assessment process should be tailored to the individual’s needs, and a multidisciplinary team approach is often required. The following are some of the specialist aspects of the assessment of mental health in older people in the UK:
- Cognitive assessment: Assessment of cognitive function is an essential aspect of the evaluation of older people with mental health problems. The Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are commonly used screening tools to detect cognitive impairment.
- Physical health assessment: A thorough physical examination is essential in the assessment of mental health in older people, as many physical conditions can have an impact on mental health. This includes assessment of vital signs, cardiovascular system, respiratory system, gastrointestinal system, and neurological system.
- Medication review: Many older people are prescribed multiple medications, which can interact with and cause adverse effects. A medication review is essential to identify potential interactions and ensure that medications are being used appropriately.
- Psychosocial assessment: Psychosocial assessment includes the evaluation of social and environmental factors that may contribute to mental health problems in older people. This includes an assessment of the living situation, social support, financial situation, and any recent life changes or stressors.
- Risk assessment: Risk assessment is an essential aspect of the evaluation of older people with mental health problems. This includes assessment of suicide risk, risk of self-harm, risk of harm to others, and risk of neglect or abuse.
- Assessment of capacity: Assessment of capacity is essential in the evaluation of older people with mental health problems. This includes an assessment of the person’s ability to make decisions regarding their care and treatment.
- Screening for depression: Depression is a common mental health problem in older people. Screening for depression should be performed as part of the mental health assessment.
- Cultural and linguistic considerations: Older people from different cultural and linguistic backgrounds may have different beliefs and values regarding mental health. Assessment should take into account these cultural and linguistic considerations.
Specialist Aspects of Assessment of Mental Health in Older People:
| Aspect of Assessment | Description |
| Cognitive assessment | Evaluation of cognitive function using screening tools such as MMSE and MoCA. |
| Physical health assessment | Thorough physical examination to identify any physical conditions that may impact mental health. |
| Medication review | Review all medications to identify potential interactions and ensure appropriate use. |
| Psychosocial assessment | Evaluation of social and environmental factors that may contribute to mental health problems. |
| Risk assessment | Assessment of suicide risk, risk of self-harm, risk of harm to others, and risk of neglect or abuse. |
| Assessment of capacity | Evaluation of the person’s ability to make decisions regarding their care and treatment. |
| Screening for depression | Screening for depression using validated screening tools. |
| Cultural and linguistic considerations | Assessment takes into account the person’s cultural and linguistic background. |
What Happens to the Brain as it Ages?
| Neurobiological Changes in Aging | Age | Brain Regions Affected | Change Observed |
| Brain Weight Reduction | 30-70 years | – | 5% decrease |
| 80 years | – | 10% decrease | |
| 90 years | – | 20% decrease | |
| MRI Changes | – | Hippocampus, Association Cortices, | Reduction in grey and white matter, reduced volume |
| Cerebellum | |||
| Cortical Blood Flow Decrease | – | Frontal and Temporal Lobes, Thalamus | Decreased blood flow |
| Nerve Cell Loss & Reductions | – | Cortex, Hippocampus, Substantia Nigra, | Nerve cell loss, reductions in dendrites & synapses |
| Purkinje Cells of Cerebellum | |||
| Tau Protein Accumulation | – | Hippocampus, Entorhinal Cortex | Formation of NFTs |
| Senile Plaques | – | Neocortex, Amygdala, Hippocampus, | Presence of extracellular amyloid & neuritic processes |
| Entorhinal Cortex | |||
| Lewy Bodies | – | Substantia Nigra, Locus Caeruleus | Intracellular inclusions |
| Hirano Bodies | – | New Hippocampal Pyramidal Cells | Presence of Hirano bodies |
| Amyloid Deposits | – | Superficial Cortical and Leptomeningeal | Widespread β-amyloid & A4 amyloid deposits, patchy within the cortex |
| Vessels, Cortex |
Reference:
- Royal College of Psychiatrists. (2019). Our approach to old age psychiatry. Retrieved from https://www.rcpsych.ac.uk/become-a-psychiatrist/choose-psychiatry/subspecialties/old-age-psychiatry/our-approach-to-old-age-psychiatry
- British Geriatrics Society. (2018). Best Practice Guide for the Management of Older People with Co-morbidities, 2nd edition. Retrieved from https://www.bgs.org.uk/resources/best-practice-guides-for-the-management-of-older-people-with-co-morbidities-2nd