7.2 Old age mental health service provision

Principles

• Access follows need, not an unexplained age cut-off, and care aims at function and quality of life using the least restrictive option that works.

The pathway and the team

• Primary care, memory services, community teams, crisis care, hospital liaison, inpatient units, care homes and palliative care form one coordinated pathway, and people may use several at once.

• Memory services give multidisciplinary assessment and diagnosis, and a diagnosis should open the way to support rather than end the pathway.

• The team includes geriatric medicine, physiotherapy, occupational therapy, specialist dementia nurses such as Admiral Nurses, speech and language therapy and pharmacy.

Supporting family carers

• Carer support works when it is multicomponent: it combines active-learning education with emotional support and respite, and is offered flexibly at different points over time.

• A single measure, such as written information alone or referral to a peer group, is not enough.

• Ask about the carer's sleep, health, isolation and willingness to go on caring, because a household can be close to breakdown while the cognitive score stays stable.