For many older Australians, help with their health seems to be the hardest thing to ask for. Psychologist Claire Adams decided to find out why.
OlderAustralians with chronic health conditions are at significant risk of developing mental health issues, but many are reluctant to seek the relevant support.
As we grow older, we are more likely to be living with chronic health conditions like cardiovascular disease, respiratory disease, diabetes and arthritis. But not all health problems are physical.
Older adults with chronic disease are significantly more likely to experience anxiety and depression than older adults without chronic disease – but, according to new research from Edith Cowan University (ECU), more than 40 per cent of seniors with chronic disease are unlikely to seek mental health support when they need it.
It was while working with a group of seniors with chronic obstructive pulmonary disease, and observing a reluctance from many of them to seek help for anxiety and depression, that psychologist Claire Adams decided to investigate the help-seeking intentions of older adults living with chronic conditions.
“The number of older people who don’t intend to seek help for their mental health is a real concern,” she says. “With this study, I wanted to look at why that is – why don’t people intend to seek treatment? We need to address this issue and encourage people to ask for help when they need it.”
Reasons for reluctance
The study involved 107 people aged 65 years and over, from both independent living facilities and the wider community. Of the 41 per cent who said they would not seek help for mental health conditions, Claire found three main reasons for their reluctance.
Skepticism about the benefits of mental health support
“One of the main reasons people don’t seek help is that they don’t think it’s a useful thing to do,” Claire says.
“If people don’t see the benefit in seeking treatment, they’re not going to do it. Part of the problem is that people don’t really know what to expect. They have a vague notion of mental health treatment – they’ve heard of the term and of various therapies, but they don’t really know what that means. There’s an uncertainty there. They’ll think, ‘Okay, if I do go and seek treatment, what will happen?’ They’re uncomfortable about disclosing any mental health concerns they might have, because they’re not sure what will come from that, and whether it will actually be worthwhile for them.
If people don’t see the benefit in seeking treatment, they’re not going to do it.
“There has been a shift away from the stigma around mental health over the years, but there does still seem to be a need for further attitudinal change.”
A perceived lack of support from family or friends
“If people don’t think there’s anyone there to support and encourage them through the process of seeking help, that can be a major deterrent,” Claire says.
“The study looked solely at the perceptions of older adults with chronic conditions. It’s their perception that they wouldn’t receive support from their family and friends – in reality, that may not actually be the case. Sometimes, people think they’re more isolated than they are. We need to have more conversations about mental health, so family members and friends can talk about it freely and share their support.”
A belief that they are incapable of accessing services
“If people think they’re incapable of seeking help, they’re less likely to do so,” Claire says.
“I thought concerns about cost might be a major issue, or access to transport, but what was more likely to influence help-seeking was the belief that they don’t have the capability to seek help. This can be for various reasons – they might not know what steps to take, or they might have physical impairments that make it harder. Again, it’s a matter of perception, so the study only took the older person’s view of themselves into account; not their actual physical capabilities.”
The difficulty of diagnosis
Claire says that the overlap between mental health symptoms, physical symptoms of chronic disease and the side effects of medication can make it difficult for older adults with chronic disease to self-identify their mental health issues in the first place.
“That’s one of the reasons it can be so hard to determine accurate rates of anxiety and depression in older people,” Claire says. “To some degree, people need to identify the symptoms in themselves, and that can be really hard for people with chronic disease.
“For instance, someone living with respiratory disease might think that their shortness of breath is a consequence of their physical health, but it can also be a symptom of anxiety. It’s the same for people with heart disease – they might think increased heart rate or sweating is because of the problem with their heart, but these can be symptoms of anxiety as well. Distinguishing between them can be difficult, not only for the patient, but for the health professional.”
The first step is the hardest
While there is a reluctance among many older people with chronic conditions to seek help for anxiety and depression, Claire found that those who have used mental health services in the past are more likely to use them again in the future.
“That’s a positive result,” she says, “because it suggests that people who have actually used mental health services have found them helpful and beneficial. It’s a good reflection on our mental health system, and it shows that once people move past their initial trepidation and take that first step to seek help, they’re far more likely to continue to do so.”
People who have actually used mental health services have found them helpful and beneficial.
Claire believes the best way to encourage older people to seek help is to empower them with accessible information on how to identify mental health issues, and what treatment and therapy might look like.
“We have to make sure that older people have the information they need to make informed decisions about their own health,” she says. “They need to know what options are available to them, and why it’s important to seek help if they need to.
“The next step is to consult with healthcare providers and consumers to develop some kind of intervention that addresses this need for education and leads to an attitudinal change.
“We have an ageing population, so if the problem isn’t addressed, it’s only going to compound and get worse. It’s important that we do something now; that we bridge that gap and start having those conversations.”