Asking the experts: Using the lived experience of older adults with depression to inform policy and practice
Among the many valuable findings from my doctorate study into the self-management of depression in older age, there are two findings that continue to frustrate:
- The first pertains to my topic: the stereotype that depression is a normal part of ageing. As you get older, you may have less to be happy about
- The second is a broader issue: the frequent underrepresentation of older adults in research, policy development and service design. As you get older, you may have less to contribute
Let’s consider these points.
As with many other developed countries, depression among older adults in Australia is a major public health challenge. Although depression is a serious condition at any age, it is a significant and complex problem for older adults. Left undiagnosed and untreated, it often produces adverse physical effects and a decline in overall functioning, and is associated with a loss of independence, greater self-neglect, increased risk of dementia, and increased risk of early death, including death by suicide (Sutin et al., 2013). Given these facts, it may not be surprising that many people—including older adults themselves—erroneously expect depression to be a normal part of ageing (Law, Laidlaw, & Peck, 2010). Many health professionals also consider depression as an inevitable consequence of age. It isn’t. And while there is extensive work that focuses on the clinical aspects of depression, less is known about the ways in which older adults living in the community experience depression (to date, research has focused on depression in residential care) (see, for example, Franck, Molyneux, & Parkinson, 2016; Stargatt et al., 2016). Even less is known about how they manage their depression and the support they’d like to help them optimise their quality of life. We must involve older adults in this process.
Referring to the second point, few would disagree that our research-policy-practice discourse should reflect the lived experience of those who navigate public and private health services, in their efforts to optimise their wellbeing. Research into disease burden and health costs is central to service planning and funding. Australia is well served by population research, but health studies typically focus on narrowly defined health conditions or behaviours. Within the current context, a more holistic approach to mental health research and services would reflect the influences of everyday life, individualised care and the role people play in their own care and recovery. Better practice approaches are based on involving people with lived experience in the design, delivery and evaluation of mental health policies and services. Tapping into the lived experience of people with mental health issues has gained prominence at all levels of policy and practice. Unfortunately, ageist attitudes continue to fuel the common assumption that older adults are less functional or capable, or have little to contribute. As a result, older adults with depression face the double whammy of mental health issues and age. In the medical setting, data show that health care professionals frequently patronise older patients, listen less to their views, give less time to the interview and attribute symptoms to age rather than to treatable conditions (Haralambous et al., 2009). Four out of thirty-two participants in my study reported that their health care professional had fallen asleep during their consultation! If this is happening in a one-on-one consultation with someone who should be a trusted source of support, how can research and policy makers expect older adults to feel that their views and experiences are valued?
But there is good news, too, with older adults increasingly making themselves heard, often by joining community and advocacy groups that are growing in influence. Our commitment to improving participation in the ageing and mental health spheres could be demonstrated by involving older adults in setting the policy agenda, and engaging with those who are directly affected by research, policy or practice decisions. A study by the National Ageing Research Institute (2013) found that older adults are highly motivated to participate in research and rate depression as a priority research topic. As we work towards reducing (in an ideal world, overcoming!) negative stereotypes of ageing and mental health, we can begin to represent the breadth and diversity of the increasingly ageing population in our work. In so doing, we can improve our understanding of how the facets of their everyday lives influence their mental health, and the active roles they can play towards optimising their quality of life. We could access the services of organisations such as National Seniors Australia and COTA Australia, who provide research and consultancy services from the perspective of older adults to government, business and universities.
Whatever our role in the research-policy-practice environment, we should actively support older adults to share their experiences, so that we might learn from their wisdom. After all, we’re all getting older and, if we’re reading blogs such as these, we want to have our voices heard.
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Meg Polacsek is a PhD Candidate with the College of Health and Biomedicine at Victoria University. Her research explores how older adults with depression self-manage their illness in order to optimise wellbeing. She can be contacted at meg.polacsek@live.vu.edu.au and more information about her research is available at http://www.megsresearch.com/home.
References
Franck, L., Molyneux, N., & Parkinson, L. (2016). Systematic review of interventions addressing social isolation and depression in aged care clients. Quality of Life Research, 25(6), 1395-1407. doi:10.1007/s11136-015-1197-y
Haralambous, B., Lin, X., Dow, B., Jones, C., Tinney, J., & Bryant, C. (2009). Depression in older age: A scoping study. Retrieved from https://www.beyondblue.org.au/docs/default-source/research-project-files/bw0143---nari-2009-full-report---minus-appendices.pdf?sfvrsn=4
Law, J., Laidlaw, K., & Peck, D. (2010). Is depression viewed as an inevitable consequence of age? The "understandability phenomenon" in older people. Clinical Gerontologist, 33(3), 194-209. doi:10.1080/07317111003773627
National Ageing Research Institute. (2013). What older people want: Outcomes from a consultation with older consumers about their priorities for research in ageing. Retrieved from Melbourne:
Stargatt, J., Bhar, S. S., Davison, T. E., Pachana, N. A., Mitchell, L., Koder, D., . . . Helmes, E. (2016). The availability of psychological services for aged care residents in Australia: A survey of facility staff. Australian Psychologist. doi:10.1111/ap.12244
Sutin, A. R., Terracciano, A., Milaneschi, Y., An, Y., Ferrucci, L., & Zonderman, A. B. (2013). The trajectory of depressive symptoms across the adult life span. JAMA Psychiatry, 70(8), 803-811. doi:10.1001/jamapsychiatry.2013.193