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Mental Health and Successful Ageing
Introduction
As is clear from the previous sections, mental health is influenced by an interaction of factors that cross the boundaries between an older person’s physical, psychological and social functioning as well as between the individual and the context within which they live.
This part of the learning object will outline a model. These are abstract in that you cannot touch, see or easily measure them but they are nevertheless important in helping us understand an issue that is complex and/or has many parts.’) that explores how the different elements of an older person’s life and situation impact on mental health and how they promote or undermine ‘successful ageing’.
The model is made up of five elements:
- Socioeconomic situation (Material circumstances, social and physical environment)
- Social and personal resources (Individual, social network - family and friends -community)
- Meaning of the experience
- Dynamic of gains and losses (Cultural and normative expectations, constrainits and opportunities)
- Successful ageing
Items 1-3 stimulate adaptive behaviour (selection, compensation, optimisation) and they all contribute towards:
Each of the five elements will be described in turn and its relevance to mental health highlighted.
The model presented here was developed by Godfrey and Denby (2004) drawing on the concept of ‘successful ageing’ (Baltes and Baltes, 1990). Ageing is understood to be a dynamic process involving both opportunities for personal development and growth and adjustment to loss and change.
It recognises that whilst older people are engaged in adapting to the physical, social, interpersonal and psychological stages that accompany ageing, the resources and opportunities available to them are shaped by the wider social context within which they live (Baltes and Carstensen, 1996). They also vary considerably from person to person; hence there is considerable diversity in how individuals do – or do not – manage late life challenges.
The next few slides explore the different parts of the model, what each element refers to and what the risks to mental health are. The role of protective factors in reducing risk is also highlighted.
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Edna
At the end of each description of a part of the model you will have the chance to hear from 75-year-old Edna. She will bring the issues to life through her personal story. It’s important to meet Edna before we embark on our journey around the model and around Edna’s life.
“ Hello, my name is Edna Wilson. I am 75 years old, a widow and live on an estate in Rotherham in - what was a council house. I have lived here for many years; I brought my two children up here and worked in the local shop. Although my health is not as good as it was, I do enjoy life most of the time, and try and get out and about. I have struggled with being on my own - I have been widowed for ten years but am better than I used to be and my daughter and son are good at making sure I am not on my own too much. I do the bingo once a week and go into town with my friend Norma on Fridays. I like to read and still keep in touch with folks at the WRVS (Women's Royal Voluntary Service), where I used to volunteer. Things are very different now than they used to be though; sometimes I feel as if I come from a different planet. What with computers and that. I try to keep up mind you and my grandchildren help there. I think my life is pretty normal really.”
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Socioeconomic situation
Poverty is a known risk factor for depression. It contributes to physical ill health and reduces an older person’s opportunities to take part in social or leisure activities, make choices and enhance their material and social quality of life. It directly contributes to isolation and loneliness.
Those living in poverty are also known to be at higher risk of crime and are more likely to live in environments that can feel unsafe.
Further, higher numbers of older people on low incomes live in inadequate housing and spend a disproportionate part of their income on basic amenities such as heating (Age Concern and Mental Health Foundation, 2006). Impoverished older people, especially women, are also far less likely to own a car; this severely constricts their independence.
Conversely having access to a reasonable occupational pension enhances quality of life. It ensures that an older person is able to access enjoyable pursuits, not worry about whether they can afford things and offers ‘peace of mind’. This has a positive affect on levels of anxiety and stress.
Older people with money also tend to live in nicer neighbourhoods, feel safer and are less exposed to crime and environmental decay.
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Socioeconomic situation
Money can also cushion the negative impact of loss. Physical ill-health, particularly chronic pain and disability, is commonly associated with old age, especially those aged over 80 years. A decent income ensures that the older person can buy aids and adaptations, can choose to receive private treatment or alternative therapy and access private transport.
Bereavement is another common loss linked with later life. Widowhood is a particular challenge. Whilst money cannot resolve grief, it facilitates access to support and can soften the harder edges of loss. For example, being able to take a long promised holiday.
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Socioeconomic situation
Read the transcript of Edna telling us how these issues affect her life. As you read think about think about which of the statements listed below are true:
- Edna is very comfortable financially
- Edna has a degree of financial security, but she’s not well off
- Edna does not have any social contact now her husband has passed away
- Edna has a few mobility problems, but is relatively fit
- Edna has lots of spare cash
- Edna need never worry about money
- Edna can afford to buy aids and adaptations
‘I wouldn’t say I was well off but I do get my husband’s pension from the factory where he worked for 40 yrs and I don’t have to scrimp and save like some do. I mean I have enough to enjoy myself. I went on holiday last year with my friends from the old folks club that I go to on Thursdays down the church hall. That was great fun; I might do it again later this year. I buy myself ready meals from Marks and Spencer’s sometimes to save cooking. They are expensive but they are very good and ideal for one person!
I can’t drive and in any event would struggle to pay for a car what with the petrol and the maintenance and all that. My husband used to drive but since he’s gone I take the bus to the doctors or the shops; I will occasionally take a cab if the weather’s really bad. It is a bit of a trek on the bus into town; it takes two bus journeys. Mind you I often go with my friend Norma and we have a coffee in town and a laugh; sometimes we meet up with two other old friends and have a nice pub lunch. That cheers me up. Of course I’m not as fit as I used to be. I have a hip problem and am waiting for an op to have a replacement hip done. Really it can be very painful sometimes especially in cold weather. I can’t wait to have the op. My friend had both hers done and she’s right as rain now; even goes swimming. I was thinking of buying a few aids and that to help me manage around the house – y’ know those things called tap turners that help you turn on the tap for the bath & there’s a pincer type thing that you can get to help you pick things up like clothes on the bed or the newspaper. I s’pose if I got really bad I’d get one of those showers that you sit in; they look nice and not that much to have put in either. Thank god, I’m alright up top tho. No amount of money can help you really if you’ve got Alzheimer’s.
Y’know we bought this house when Mrs Thatcher was prime minister. It was a council house then. That was the best thing we ever did. I know it costs to repair the guttering and that sort of thing but its mine. I like that. If I was really stuck for money I’d sell the house; it’s something to fall back on if you know what I mean. It gives me peace of mind and that’s really important particularly at my age.’
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Socioeconomic situation
You should have identified the following issues that affect Edna’s life
- Edna has a degree of financial security, but she’s not well off.
- Edna has a few mobility problems, but is relatively fit.
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Social and personal resources
There is considerable evidence to suggest that engagement in family, social and community life promotes mental health. Involvement in meaningful, interesting and fun activities, and being linked with others in relationships meets a wide range of social and emotional needs: for intimacy, companionship, stimulation and enjoyment (Godfrey & Denby, 2004).
Higher levels of social support, specifically frequency of contact with friends, act as a buffer against depression. Where age related losses impact on social engagement and social relationships, mental health may be threatened.
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Social and personal resources
Having a role in the local neighbourhood such as being a volunteer or a School Governor, or running a club is routinely identified as fulfilling (Help the Aged, 2004). This is particularly the case where the older person can employ work-related skills and feel ‘useful’.
Community facilities, civic and social opportunities and accessible leisure and educational resources all protect against isolation and exclusion of older people and enhance opportunities for engagement. Taking a computer course or joining an aqua fit class provides activity, learning and may facilitate new relationships.
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Social and personal resources
Spiritual belief in a higher being and membership of an accepting faith community can have positive effects on mental health and well-being (Mentality, 2004).
Personal capacities such as determination, strength of will, optimism and enjoyment of a challenge also protect against mental decline. This is particularly notable when an older person is faced with difficulties such as caring for a partner, disability or widowhood.
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Social and personal resources
Edna’s situation illustrates well the importance of community and social contacts. As you read the transcript identify 5 facts from the list below that Edna mentions about her life.
- Doesn’t know neighbours
- Finds it hard sometimes to be on her own
- Good neighbours
- Crime often prevents her going out
- Local area not as much a community as it was
- Opportunity to participate in social activities
- Not enough contact with family and friends
- Regular visits from family
‘Things have changed on my estate. When my children were young it was a nice place; there was work to be had and places to run around for the kinds. In those days there was a feeling of community round here, shops and a GP’s surgery. That’s mostly gone now. I do think the estate has got tatty; that can be depressing – I think the council should sort that out and tidy things up, the graffiti for one thing. I am lucky tho. My daughter lives close by and my son a few miles away. I see them twice a week at least and I still mind my grandson occasionally when my daughter works. It’s good, it keeps me in touch with young people. I still miss my husband, god bless him, even though he passed away in 1998. You’d think I’d have got used to being on my own by now but we’d been together for 45 years and shared a heck of a lot. I don’t miss some things mind you; I can watch what I like on the telly, go out when I want and smoke a cigarette without him going on about it all the time.
My daughter says I should get somewhere smaller but I like it here. I know I find the stairs a challenge but my friends are here and I have lovely neighbours who will help out if needs be. I managed to lock myself out the other week and they took me in, gave me a cuppa and phoned a locksmith as well as my daughter. I might not get that if I moved. Also I know where everything is here and if I need to get aids or a shower put in I can do it my way and when I want. And there’s the club and I was half thinking of taking up yoga; I see some woman’s started classes down the church hall. It’s meant to be for older people; once the hip’s done I’ll ask Norma if she wants to come with me.’
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Social and personal resources
You should have identified the following issues from the list:
- Finds it hard sometimes to be on her own
- Good neighbours
- Opportunity to participate in social activities
- Local area not as much a community as it was
- Regular visits from family
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Meaning of the experience
Ageing is experienced variously and diversely. Differences exist at the level of the individual and between groups, cultures and populations. The meaning of ageing, the impact of loss and the management of age-related challenges are mediated (affected or impacted upon)by a range of cultural and normative - or widely accepted - expectations.
Older women for example may be less likely to ask for help from health or social care services as they often view themselves as ‘natural carers’ and copers. Conversely, older men who live alone in later life may find it hard to ‘join in’ with social activities or clubs perceiving these to be primarily for women. Many older women also expect to be widowed and alone for a period at the end of their life; this is not the case for the current cohort of older men
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Meaning of the experience
Older people from ethnic minorities may also find it harder to access services. This is partly a consequence of lack of awareness of their availability and that they may be culturally unsuitable.
Most older people expect to experience some kind of illness or loss, particularly in advanced old age. Research reveals considerable resilience in dealing with ill health, bereavement and disability amongst a wide range of older citizens; this is sometimes accompanied by anger and despair at the restrictions these impose (Godfrey and Denby, 2004).
Later life offers opportunities for growth and development as well as challenge. Noted advantages include: increased self-acceptance and confidence, the easing of domestic responsibilities and more time for leisure and social activities (Help the Aged, 2004).
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Meaning of the experience
Assumptions about what is ‘right’ and normal are made by both wider society and older people themselves. Age discrimination plays a particularly powerful role in defining what is ‘acceptable’. It has a negative impact on mental health and acts as a multi-level barrier to opportunity (Age Concern and Mental Health Foundation, 2006).
Age discrimination can lower self-esteem, contribute to a lack of value, underpins a lack of respect and reduces quality of life. It can also limit access to vital services such as health care and opportunities to get involved and participate in civic and community life (Social Exclusion Unit, 2004). It can lead to feelings of worthlessness and despair (Age Concern and the University of Kent, 2005).
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Meaning of the experience
Age discrimination is the most common type of prejudice experienced by older people. In particular it is experienced in relation to access to health and social care, welfare benefits, education, financial and retail services and through their portrayal in advertising and the media (Help the Aged, 2004).
Age discrimination can also intersect with other dimensions of social inequality such as gender, race or disability to produce multiple disadvantage. Older women for example report that they feel ‘overlooked’ and ‘useless’. This reflects the ‘double discrimination’ of sexism and ageism combined(Moriarty, 2005).
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Meaning of the experience
Read the transcript of Edna as she shares with us aspects of her life that are relevant to this section. As you read put the 4 statements below in the order that she talks about them.
- Edna values her freedom
- TV makes her feel older and she thinks there should be glamorous older women on TV
- Edna thinks people are intolerant of the old
- Edna used to be quite a ‘looker’, but now just looks ‘old’
‘Its true that I am slower than I used to be; its the arthritic hip that’s the main problem but there are other things too. Sometimes I feel I can hardly get up in the mornings cos of the stiffness in most of my joints. People don’t have the patience y’know. It takes me a little while to get on the bus. Sometimes I can almost hear people thinking ‘silly old bag, what’s the use of her?’. You sort of feel you don’t have a right to be on the bus or anywhere really. I was quite a looker when I was young and no shortage of fellas! After about 45 it’s ‘downhill all the way’ for us women! My Duncan - my husband - he sort of kept his looks for longer. Not sure how really... Distinguished they used to say he was, I was just well... old.
And there’s all this pressure to be young.... or at least look young. My god, if I bought all the creams and that, that they advertise on the telly I’d be bankrupt. No idea if they work or not but they do make me feel ever so old. You hardly never see a really glam older women on the TV do you... one that actually looks her age I mean? Still mustn’t grumble, life is what you make it to a large extent and I do feel I am lucky really. I mean you just have to get on with it. My lot is really no worse than most folks. I am widowed and have some health problems; but that’s to be expected at my age. I like going to the old people’s club and I can do what I like with myself; no one to answer to and I know what I like. If I want to stay in and watch some soppy old film of a Sunday I’ll just do it! I would quite like to learn French; now I’d never have said that a few years ago. Its having gone there a few times with the Club, I did OK in the shops. I don’t think Duncan would have liked that. I don’t care what people think of me doing things now tho. Nothing to lose see.’
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Meaning of the experience
Edna discusses the statements in the following order:
- Finds it hard sometimes to be on her own
- TV makes her feel older and she thinks there should be glamorous older women on TV
- Edna thinks people are intolerant of the old
- Edna used to be quite a ‘looker’ but now just looks ‘old’
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Dynamic of gains and losses
The process of ageing can be viewed as a process of adjustment which incorporates gains as well as losses - A process whereby the older person minimises losses and maximises gains through adaptation, mastery and effective coping strategies. The model you are reviewing incorporates three processes of adaptation: selection, compensation and optimisation.
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Dynamic of gains and losses
Selection is about making choices and readjusting ‘individual goals’. It may involve an older person disabled by arthritis moving from a two-storey house to a bungalow so that they no longer need to use stairs. If the bungalow is near a close relative who may be called upon in the event of a fall, all the better. Their goal of maintaining their independence is thus achieved.
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Dynamic of gains and losses
Compensation occurs when specific capacities are lost or reduced below the level required for adequate functioning. It refers to the use of alternative methods to achieve a goal. These can include acquiring new skills or securing technical or other resources outside of the individual. Examples of the latter might be a hearing aid or getting help with the housework.
Finally, optimisation refers to enriching and augmenting reserves and resources in order to support selection and compensation.
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Dynamic of gains and losses
Where one aspect of an older person’s life is problematic he or she may use another component of their lives to mediate the effects of these difficulties. Strengths or gains in one area can be used to counterbalance deficits in another. Achieving a balance will promote or at least maintain mental health (Godfrey and Denby, 2004).
For example, money may be used to purchase aids and adaptations to counteract the effects of a decline in physical health. The older person can join a club to alleviate a sense of isolation.
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Dynamic of gains and losses
Read the transcript as Edna shares with us aspects of her life that are relevant to this section. As you read put the 4 statements below in the order that she talks about them.
- Assistive aids such as the ‘tap turner’
- A private nurse
- A computer
- A stair-lift
- A shower you can sit in
- Getting involved with the church again
- A gardener
- A cleaner
‘In the end it’s all about balance really. As I’ve said I know I am beginning to slow down but I just tell myself to take my time, no reason to rush. Also I have decided to buy some of those aids I talked about earlier - the tap turner and ‘helping hand’ - they’ll make life easier to manage. I’ve been to Social Services and they’ve advised me what I need. I might even get a cleaner to help out with the housework. I’d never have done this in the old days; Duncan wouldn’t hear of it and anyway I’ve always done my own housework. But I think the time has come to accept that if I’m to carry on living here and do the things I want to do I may need help with some of the practical tasks like housework. Maybe the garden too. My daughter is always on at me to consider getting one of those showers you sit in. I may need to do that soon as I do struggle with the shower now. I worry about falling; that’d take away the worry wouldn’t it? It would also make for a more comfortable life and why not.... what am I keeping my money for?
I may start going back to church. I used to go years ago when the kinds were young and we all did. I go to things at the church hall but funnily enough not the church itself. I used to believe; perhaps I still do deep down. There’s got to be meaning to life. In any event I could do to see what the church has to offer. It used to do coffee mornings and charity work. I’d like to get involved in that again; I enjoyed it when I did it in the past.’
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Dynamic of gains and losses
You should have identified the following statements:
- Assistive aids such as the ‘tap turner’
- A shower you can sit in
- Getting involved with the church again
- A gardener
- A cleaner
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Successful ageing
The model we have explored here provides a framework for considering the dimensions of life and situation that contribute to mental well-being and to the wider concept of successful ageing.
The interlocking and overlapping nature of those issues that impact on mental health have been made visible. That some of the determinants are located at the level of the individual, some the family or community and some at the level of social policy or society is also important.
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Successful ageing
A number of reports in recent years have emphasised the need to focus on successful ageing, and active ageing. The World Health Organisation states: ‘Active ageing is the process of optimising opportunities for health, participation and security in order to enhance quality of life as people age’ (WHO, 2003).
Social policy initiatives also endorse successful ageing. For example, ‘Opportunity Age’ (2005), a strategy produced by the Department of Work and Pensions (2005), promotes well-being and independence for older people and aims to ensure that later life is active and fulfilling; it recognises the contribution older people make to families, communities and UK society.
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Successful ageing
The importance of mental health as a core component of overall well being and successful ageing is also increasingly widely recognised. It is a key aspect of health and a legitimate goal of the individual, the community, social policy and welfare services.
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Successful ageing
Now listen to Edna rounding off her personal story.
“ .....Of course when you get to my age you are bound to have some aches and pains and your friends are starting to die and all of that. But on the other hand I’ve had a full life, I still enjoy a lot of things and although I am scared about getting really ill or getting Alzheimer’s I try and look on the positive side and overall I don’t have a bad time of it. I still do quite a lot and have a laugh. Well that’s what I think anyway”.
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Successful ageing
Edna’s story illustrates well how the different aspects of a person’s life and context affect their mental health. It also offers an example of how effectively many older people manage the ageing process and the challenges that later life often brings.
Her story also demonstrates how interlinked the issues that affect mental health are and how important it is to view an older person’s experiences in a holistic way. Particular account needs to be taken of the individual’s perspective of their life and situation; what is a problem for one person is simply a new challenge for another.
Successful ageing takes many forms. There is no recipe for it but there may be ways to face some of the inevitable difficulties positively and to adapt well. That achieving good mental over the whole of a person’s lifespan is not only possible but probable is a key message.