Chapter 3 explores the contribution of the lifecourse approach and social gerontology to understanding mental health outcomes in later life. It also explores the role played by health and social inequalities. By bringing these perspectives together the Chapter makes visible the ways in which lifecourse inequality and adversity e.g. childhood abuse, create and/or amplify risks to mental health in later life. It also exposes the embedded and structural nature of causative mechanisms. Health inequalities have profound implications for mental health. People from disadvantaged socioeconomic backgrounds suffer disproportionately from common mental disorders, such as depression, across the whole lifecourse. They are also exposed to higher levels of chronic psychosocial stress which, independently and additively, undermines mental wellbeing. These effects are cumulative over the longer term and in more unequal societies; also by exposure to discrimination and oppression. These arguments challenge the dominance of the ‘inevitable decline’ model of ageing exposing a more nuanced complex set of intersecting risks to mental health that are structurally located and socially produced. The role of policy in addressing health inequalities and their social determinants was a key dimension of mental health policy until 2011; since then it has become increasingly uncoupled from the policy agenda.
{"title":"The life course, inequalities and mental health in later life","authors":"A. Milne","doi":"10.2307/j.ctvwrm494.9","DOIUrl":"https://doi.org/10.2307/j.ctvwrm494.9","url":null,"abstract":"Chapter 3 explores the contribution of the lifecourse approach and social gerontology to understanding mental health outcomes in later life. It also explores the role played by health and social inequalities. By bringing these perspectives together the Chapter makes visible the ways in which lifecourse inequality and adversity e.g. childhood abuse, create and/or amplify risks to mental health in later life. It also exposes the embedded and structural nature of causative mechanisms. Health inequalities have profound implications for mental health. People from disadvantaged socioeconomic backgrounds suffer disproportionately from common mental disorders, such as depression, across the whole lifecourse. They are also exposed to higher levels of chronic psychosocial stress which, independently and additively, undermines mental wellbeing. These effects are cumulative over the longer term and in more unequal societies; also by exposure to discrimination and oppression. These arguments challenge the dominance of the ‘inevitable decline’ model of ageing exposing a more nuanced complex set of intersecting risks to mental health that are structurally located and socially produced. The role of policy in addressing health inequalities and their social determinants was a key dimension of mental health policy until 2011; since then it has become increasingly uncoupled from the policy agenda.","PeriodicalId":201017,"journal":{"name":"Mental Health in Later Life","volume":"176 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124348037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Positive mental health is a prerequisite for a good quality of life across the whole lifespan. It is an overarching concept, which intersects with a number of related concepts, psychological wellbeing, successful ageing and quality of life. Good mental health is increasingly understood as a combination of an individual’s personality, environment and lifecourse; it is also dynamic. Older people consider it to be characterised by: a sense of wellbeing, capacity to make and sustain relationships, ability to meet the challenges which later life brings, and ability to contribute both economically and socially. Mental health is viewed as equally important as physical health. Research identifies the core dimensions of mental health, and its sister concepts, as: resilience, remaining active and involved, having a purpose or role, being able to engage in social relationships, independence, keeping fit, having an adequate income, autonomy and self-efficacy. Survey evidence consistently shows that more than 85 per cent of older people have ‘good’ quality of life. One of the challenges of assessing and measuring quality of life, and related constructs, is capturing the intersection between the subjective and the objective. The promotion of mental health is increasingly recognised as a legitimate goal of social policy.
{"title":"Mental health, psychological well-being, successful ageing and quality of life","authors":"A. Milne","doi":"10.2307/j.ctvwrm494.8","DOIUrl":"https://doi.org/10.2307/j.ctvwrm494.8","url":null,"abstract":"Positive mental health is a prerequisite for a good quality of life across the whole lifespan. It is an overarching concept, which intersects with a number of related concepts, psychological wellbeing, successful ageing and quality of life. Good mental health is increasingly understood as a combination of an individual’s personality, environment and lifecourse; it is also dynamic. Older people consider it to be characterised by: a sense of wellbeing, capacity to make and sustain relationships, ability to meet the challenges which later life brings, and ability to contribute both economically and socially. Mental health is viewed as equally important as physical health. Research identifies the core dimensions of mental health, and its sister concepts, as: resilience, remaining active and involved, having a purpose or role, being able to engage in social relationships, independence, keeping fit, having an adequate income, autonomy and self-efficacy. Survey evidence consistently shows that more than 85 per cent of older people have ‘good’ quality of life. One of the challenges of assessing and measuring quality of life, and related constructs, is capturing the intersection between the subjective and the objective. The promotion of mental health is increasingly recognised as a legitimate goal of social policy.","PeriodicalId":201017,"journal":{"name":"Mental Health in Later Life","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115454021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In broad terms there are two sets of age-related risks to mental health. The first set are those arising directly from experiences and losses common to later life, including physical ill health and/or disability, being a carer, retirement, and bereavement. These are associated with impaired psychological wellbeing and heightened risk of depression, particularly amongst older people with few economic or social resources. The second set of risks arise from ageism and age discrimination, and their intersection with other types of discrimination such as sexism for older women. Direct and indirect discrimination is widespread; it is located in all areas of society including health and social care services. It is profoundly damaging to older peoples’ psychological wellbeing and is associated with fear, helplessness, low self-esteem, anxiety and depression. It is also linked to exclusion, marginalisation and abuse. In recent years there have been efforts to ensure that older people are overtly included in policies intended to improve the population’s physical and mental health; this includes access to treatments e.g. for depression. There has also been a focus on addressing age discrimination in specific arenas e.g. in employment and mental health services. These initiatives have had mixed success.
{"title":"The impact of age-related risks and inequalities on mental health in later life","authors":"A. Milne","doi":"10.2307/j.ctvwrm494.10","DOIUrl":"https://doi.org/10.2307/j.ctvwrm494.10","url":null,"abstract":"In broad terms there are two sets of age-related risks to mental health. The first set are those arising directly from experiences and losses common to later life, including physical ill health and/or disability, being a carer, retirement, and bereavement. These are associated with impaired psychological wellbeing and heightened risk of depression, particularly amongst older people with few economic or social resources. The second set of risks arise from ageism and age discrimination, and their intersection with other types of discrimination such as sexism for older women. Direct and indirect discrimination is widespread; it is located in all areas of society including health and social care services. It is profoundly damaging to older peoples’ psychological wellbeing and is associated with fear, helplessness, low self-esteem, anxiety and depression. It is also linked to exclusion, marginalisation and abuse. In recent years there have been efforts to ensure that older people are overtly included in policies intended to improve the population’s physical and mental health; this includes access to treatments e.g. for depression. There has also been a focus on addressing age discrimination in specific arenas e.g. in employment and mental health services. These initiatives have had mixed success.","PeriodicalId":201017,"journal":{"name":"Mental Health in Later Life","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121536069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chapters 8 & 9 focus on dementia. There is growing evidence of links between lifecourse inequalities and dementia. These are a mixture of structural issues such as poor education; mental health issues such as persistent mid-life depression; and physical conditions such as diabetes. Age related risk factors include social isolation and loneliness. These links reinforce the ‘accumulation of risks’ thesis and suggest that the causes of dementia are more complex and situated than is traditionally believed. In community-based populations, depression is estimated to affect about a fifth of people with Alzheimer's disease and a third of those with vascular dementia; up to half of care home residents with dementia have depression. Dementia produces high rates of anxiety symptoms particularly restlessness, agitation and fear; delirium is relatively common. The issues that protect quality of life of people with dementia are: psychological wellbeing, autonomy, having a meaningful role, acceptance, agency, promotion of selfhood and identity, relationships, financial security, and religious beliefs. Pre-dementia attributes such as personality type and how well a person adjusts to their diagnosis have a stronger influence on quality of life than having the condition per se. Most work capturing the perspectives of people living with dementia is done with those in the earlier stages.
{"title":"The mental health and well-being of people living with dementia","authors":"A. Milne","doi":"10.2307/j.ctvwrm494.14","DOIUrl":"https://doi.org/10.2307/j.ctvwrm494.14","url":null,"abstract":"\u0000 Chapters 8 & 9 focus on dementia. There is growing evidence of links between lifecourse inequalities and dementia. These are a mixture of structural issues such as poor education; mental health issues such as persistent mid-life depression; and physical conditions such as diabetes. Age related risk factors include social isolation and loneliness. These links reinforce the ‘accumulation of risks’ thesis and suggest that the causes of dementia are more complex and situated than is traditionally believed. In community-based populations, depression is estimated to affect about a fifth of people with Alzheimer's disease and a third of those with vascular dementia; up to half of care home residents with dementia have depression. Dementia produces high rates of anxiety symptoms particularly restlessness, agitation and fear; delirium is relatively common. The issues that protect quality of life of people with dementia are: psychological wellbeing, autonomy, having a meaningful role, acceptance, agency, promotion of selfhood and identity, relationships, financial security, and religious beliefs. Pre-dementia attributes such as personality type and how well a person adjusts to their diagnosis have a stronger influence on quality of life than having the condition per se. Most work capturing the perspectives of people living with dementia is done with those in the earlier stages.","PeriodicalId":201017,"journal":{"name":"Mental Health in Later Life","volume":"111 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127355992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
One of the implications of an ageing population is the growing number of people aged 85 years and over. This cohort is increasingly described as belonging to the fourth age: a life stage that ‘demarcates experiences that occur at the intersection of advanced age and impairment’. The fourth age intersects with frailty: a biomedical status characterised by multiple impairment, decline and dependency.26 per cent of those aged 85 years and over are considered to be frail. The losses and challenges that accompany the fourth age, including becoming frail, can be conceptualised as transitions. Physical, psychological and experiential transitions tend to multiply in the fourth age and to co-occur. The fourth age, frailty and transitions intersect in a complex and mutually reinforcing way posing a profound challenge to mental health and psychological wellbeing. Autonomy, agency, dignity, independence, identity, choice and control are all threatened. Older people’s accounts draw attention to a need to accommodate both change and continuity and to preserving selfhood. A discourse dominated by a focus on ill health and frailty tends to obscure the influence of the lifecourse, including inequalities, on health outcomes. A policy and practice focus on ‘managing frailty’ is a key example.
{"title":"The fourth age, frailty and transitions","authors":"A. Milne","doi":"10.2307/j.ctvwrm494.13","DOIUrl":"https://doi.org/10.2307/j.ctvwrm494.13","url":null,"abstract":"One of the implications of an ageing population is the growing number of people aged 85 years and over. This cohort is increasingly described as belonging to the fourth age: a life stage that ‘demarcates experiences that occur at the intersection of advanced age and impairment’. The fourth age intersects with frailty: a biomedical status characterised by multiple impairment, decline and dependency.26 per cent of those aged 85 years and over are considered to be frail. The losses and challenges that accompany the fourth age, including becoming frail, can be conceptualised as transitions. Physical, psychological and experiential transitions tend to multiply in the fourth age and to co-occur. The fourth age, frailty and transitions intersect in a complex and mutually reinforcing way posing a profound challenge to mental health and psychological wellbeing. Autonomy, agency, dignity, independence, identity, choice and control are all threatened. Older people’s accounts draw attention to a need to accommodate both change and continuity and to preserving selfhood. A discourse dominated by a focus on ill health and frailty tends to obscure the influence of the lifecourse, including inequalities, on health outcomes. A policy and practice focus on ‘managing frailty’ is a key example.","PeriodicalId":201017,"journal":{"name":"Mental Health in Later Life","volume":"2014 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128142905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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