Much is said about the necessity for care plans to support physical health in ageing Australians. Care plans are a vital part of giving autonomy, setting goals and articulating a person’s wishes in relation to health maintenance and improvement.
The same goal-orientated, person-centred values-based care model can support better mental health outcomes. Indeed, many of the emotional, social, financial and physical considerations that impact mental health are addressed in a values-based care plan.
According to date from the ABS in 2020 on intentional death, men over 85 have one of the highest suicide rates in Australia. The WHO states one in five over 60s have a mental health condition or some kind of neurological disorder. We have to talk about mental health with a generation that often ducks the conversation due to stigma by understanding the risk factors.
Let’s look at some of those risk factors and how the right care plan can help support the mental health needs of ageing Australians
Changes to mobility
Changes to mobility, sight and hearing experienced by older Australians can influence almost every facet of their lives. Homes that were once comfortable and welcoming may now seem unsafe and difficult to maintain or navigate. The grand driveway, the large garden and those stairs to the upper level become fall hazards, exhausting physical labour and frustrating reminders of the ageing process. The convenience of driving changes through a loss of confidence and/or licence. Simple tasks become increasingly difficult, inviting shame and a deep sense of loss over one’s autonomy.
This loss of mobility signals a loss of independence, freedom and choice. It may mean downsizing and moving away from cherished memories and neighbourhood friends. And with it, what is familiar is lost alongside that sense of confidence and invulnerability many older Australians pride themselves on.
Experiencing ageism and ableism
It’s difficult to ignore the social and psychological impacts of ageing in society. Especially in a culture where youth is prized. In Australia, we forget the impact that ageing can have on the individual’s confidence.
According to statistics collected by the Australian Institute of Health and Welfare, 50% of people over the age of 65 have a disability, increasing the likelihood of intersecting with systemic ableism and ageism.
And let’s not forget that the physical world surrounding all people with disabilities reflects an unrealistic position of health. Add to that “OK Boomer” as an insult for someone clueless, out-of-step and out-of-touch, and it soon becomes difficult to ignore the ageism in society.
Sadly, this ageism and ableism is present in how the individual views themselves.
Australia has a difficult and uneven relationship with physical disabilities and mental health conditions. Despite the changes to attitudes and awareness in recent years, there is still an undercurrent of the assumption that disability or ageing is synonymous with a lack in productivity. And to be unproductive in society is a burden. We foster a culture that gives rise to health influencers that are pro-health at best and health-shamers at worst. This creates a culture where our elderly is still incredibly reluctant to talk about the physical, emotional and psychological impacts of the changes they experience.
Increased exposure to loss
As we age, we experience loss more and more. From the loss of independence through to death and grief, it can almost feel as though the world of opportunity is shrinking. The loss of a partner can have a profound impact not only for the space created in a loving unit but also because it brings one’s own mortality into a much sharper focus.
Ageing comes with retirement – and for some, this may be an unwelcome event where fulfillment and purpose are hard to come by. This lack of formalised productivity and purpose may be difficult to reconcile in previously powerful, applied people.
Then there is the loss of health, mobility, financial independence, control over one’s destiny and more to consider. The less an ageing person feels able to do for themselves, the greater chance of losing identity.
And this can continue a downward trend that fortifies a sense that there is much to lose and not an awful lot to gain.
Changes in power dynamics
Families change dynamics and with it, the roles. Children move away to study and start families of their own. Or conversely, elders become more and more reliant on their adult children.
With a reduction in independence and increased reliance comes the potential for neglect and forms of indirect and direct abuse. Indeed, one in six older Australians report they experience elder abuse in a given year. All of which can have a profound impact on the mental health of ageing Australians as they grapple with this new order.
Challenges in self-advocacy
As we age, it becomes increasingly difficult to self-advocate. Recognition that care should develop a far more individualised and person-centred approach to ageing in Australia is evident in the quality assurance standards identified in the Royal Commission. Each facility and organisation involved in providing care services are working towards ensuring this a better outcome on a personal level.
However, we cannot ignore that our cultural and systemic approach to aged care has devalued self-advocacy in the past. And that some groups, such as women, people with disabilities, LGBT and Indigenous communities may be accustomed to marginalised and groomed not to speak up when appropriate.
This, coupled with the lack of opportunity to take control, make choices and take risks with one’s own body and lifestyle can and does impact mental health over time. The less autonomy, freedom and choice a person has, the higher the drain on resilience and optimism to get a person through. And that drain can create a profound impact over time.
And these risk factors exist without considering further impacts such as:
- Pre-existing mental health conditions
- The impacts of life-altering, life-limiting or life-ending diagnosis
- Cultural exclusion and the lack of safe pathways for LGBTQIA and Indigenous elderly within mainstream services
- Pre-existing social exclusion, financial hardship or other risk factors
- Social isolation generally
How can care plans help with mental health?
Care plans address the emotional, social, financial, practical and physical needs of the individual and gives a practical, step-by-step blueprint to maintaining the lifestyle of a person. As we’ve mentioned previously, care plans are not only important to people with high dependency needs or who may lose capacity. They are the blueprint to maintaining someone’s lifestyle, health and mental health right through the ageing cycle.
The opportunity exists to lay the groundwork for anticipating issues and spotting changes in mood with a robust care plan. Even the process of inviting someone to articulate their wishes into a care plan encourages the individual to think about what they want their future to look like. And this level of thought in turn gives them the ability to design a future where they feel control, autonomy and have a greater understanding of what it involves.
Beyond the thoughtful nature of a care plan, you have a document that is prompting someone to design activities and ideas that includes cognitive stimulation, physical movement and social interaction. And to think deeply about what kind of future they would like for themselves. All of which are the bedrock for sound mental health.
The sorts of items to include in a care plan that promote mental health include:
- Goals and achievements to unlock. Consider quarterly, yearly and longer goals as a means of looking forward to the future
- Explaining what autonomy looks like in relation to support. Knowing where a person feels most in control over their body, life and day-to-day activities can help maintain optimism
- Identifying the right network of supports. Charting what support looks like and when it’s needed and what and who it involves can give a sense of control
- Defining where dignity and risk meet. By understanding the risks worth taking for an individual, you can avoid engaging in paternalistic or patronising care
- Documenting what preferable and necessary exercise, mental stimulation, emotional engagement and social activity looks like
- Creating strategies to meet changes in mental health. By addressing moments when mental health may ebb and flow, prevention and management become easier for all concerned
Talking about care needs can aid in detecting early warnings signs of stress and/or acquired mental health conditions. Opening the door to thoughtful, in-depth and regular conversations about what it means to have a meaningful, productive and enjoyable life can highlight the ability to influence the future. And this can give back a sense of pride, autonomy and encourage forward-thinking behaviours.