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Mental wellbeing and independence in older people

About

What is covered

This pathway covers the commissioning of services by local government and other local providers to help promote and protect mental wellbeing and independence of older people.
It is estimated that by 2035, an estimated 23% of the UK population will be 65 years or older Office for National Statistics 2012. With factors such as cognitive decline, depression, and age-related physiological changes being common among an ageing population, this pathway aims to highlight the intervention programmes that are important for raising awareness of older peoples' mental wellbeing and independence among professionals, older people, their carers, family and the wider community.
This pathway also focuses on the role of activity interventions to support the mental wellbeing of older people.

Updates

Updates to this pathway

5 December 2016 Mental wellbeing and independence for older people (NICE quality standard 137) added.
16 December 2015 Major update on publication of older people: independence and mental wellbeing (NICE guideline NG32).
3 November 2015 Link to NICE pathway on social care for older people with multiple long-term conditions added.
12 December 2013 Mental wellbeing of older people in care homes (NICE quality standard 50) added.

Professional responsibilities

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Short Text

Everything NICE has said on promoting mental wellbeing and independence in older people over 65 in an interactive flowchart

What is covered

This pathway covers the commissioning of services by local government and other local providers to help promote and protect mental wellbeing and independence of older people.
It is estimated that by 2035, an estimated 23% of the UK population will be 65 years or older Office for National Statistics 2012. With factors such as cognitive decline, depression, and age-related physiological changes being common among an ageing population, this pathway aims to highlight the intervention programmes that are important for raising awareness of older peoples' mental wellbeing and independence among professionals, older people, their carers, family and the wider community.
This pathway also focuses on the role of activity interventions to support the mental wellbeing of older people.

Updates

Updates to this pathway

5 December 2016 Mental wellbeing and independence for older people (NICE quality standard 137) added.
16 December 2015 Major update on publication of older people: independence and mental wellbeing (NICE guideline NG32).
3 November 2015 Link to NICE pathway on social care for older people with multiple long-term conditions added.
12 December 2013 Mental wellbeing of older people in care homes (NICE quality standard 50) added.

Sources

NICE guidance and other sources used to create this pathway.
Mental wellbeing of older people in care homes (2013) NICE quality standard 50

Quality standards

Mental wellbeing and independence for older people

These quality statements are taken from the mental wellbeing and independence for older people quality standard. The quality standard defines clinical best practice for mental wellbeing and independence for older people and should be read in full.

Mental wellbeing of older people in care homes

These quality statements are taken from the mental wellbeing of older people in care homes quality standard. The quality standard defines clinical best practice for mental wellbeing of older people in care homes and should be read in full.

Quality statements

Identifying those at risk of a decline

This quality statement is taken from the mental wellbeing and independence for older people quality standard. The quality standard defines clinical best practice for mental wellbeing and independence for older people and should be read in full.

Quality statement

Older people who are at risk of a decline in their independence and mental wellbeing are identified by service providers.

Rationale

The risk of older people experiencing a decline in their independence and mental wellbeing will be influenced by certain life events and circumstances. Staff from a range of services could be given the skills to identify when these events and circumstances occur and to intervene to reduce that risk. Data from local health and social care services and an identified ‘local coordinator’ can also be used to estimate the number of older people who are not in regular contact with services but who may be at risk.

Quality measures

Structure
Evidence of local arrangements that ensure older people who are at risk of a decline in their independence and mental wellbeing are being identified by service providers.
Data source: Local data collection.
Outcome
a) Number of older people identified as at risk of a decline in their independence and mental wellbeing.
Data source: Local data collection.
b) Incidence of mental health conditions among older people identified as being at risk of decline.
Data source: Local data collection.
c) Incidence of admission to supported care facilities among older people identified as being at risk of decline.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as local authorities, local NHS providers, housing organisations, fire and rescue services, and voluntary organisations) ensure that their staff in contact with older people can identify those at risk of a decline in their independence and mental wellbeing. They could do this by using data from sources such as local health and social care services to estimate the number who may be at risk of a decline in their independence and mental wellbeing, and by using an identified ‘local coordinator’ (such as village or town agents or community navigators).
Health, public health and social care practitioners (such as GPs, community nurses and occupational therapists) are aware of factors that are likely to increase the risk of decline in an older person’s independence and mental wellbeing.
Commissioners (such as clinical commissioning groups and local authorities) commission services that work in collaboration to identify older people who are at risk of a decline in their independence and mental wellbeing.
Older people benefit from being identified as at risk of a decline in their independence and mental wellbeing because they will be helped to prevent this decline.

Source guidance

Definitions of terms used in this quality statement

Older people
People aged 65 or older.
Older people who are at risk of a decline in their independence and mental wellbeing
Older people who have experienced any of the following:
  • partner died in the past 2 years
  • are a carer
  • live alone and have little opportunity to socialise
  • recently separated or divorced
  • recently retired (particularly if involuntarily)
  • unemployed in later life
  • low income
  • recently experienced or developed a health problem (whether or not it led to admission to hospital)
  • had to give up driving
  • age-related disability
  • aged 80 or older.
[Adapted from NICE’s guideline on older people: independence and mental wellbeing, recommendation 1.5.3]

Physical activity for older people

This quality statement is taken from the mental wellbeing and independence for older people quality standard. The quality standard defines clinical best practice for mental wellbeing and independence for older people and should be read in full.

Quality statement

Older people most at risk of a decline in their independence and mental wellbeing are offered tailored, community-based physical activity programmes.

Rationale

Encouraging older people to be physically active, using tailored programmes such as walking schemes, can improve their independence and mental wellbeing as well as their physical health. It also means they are more likely to be able to leave their own home and take part in vocational and social activities. This reduces the risk of loneliness and social isolation.

Quality measures

Structure
Evidence of local arrangements to ensure tailored, community-based physical activity programmes are in place for older people most at risk of a decline in their independence and mental wellbeing.
Data source: Local data collection.
Process
Proportion of older people most at risk of a decline in their independence and mental wellbeing who take part in tailored, community-based physical activity programmes.
Numerator – the number in the denominator who take part in tailored, community-based physical activity programmes.
Denominator – the number of older people most at risk of a decline in their independence and mental wellbeing.
Data source: Local data collection.
Outcome
a) Change in physical activity among older people.
Data source: Local data collection.
b) Incidence of mental health conditions among older people identified as being at risk of decline.
Data source: Local data collection.
c) Incidence of admission to supported care facilities among older people identified as being at risk of decline.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as local authorities, local NHS providers and voluntary organisations) ensure that tailored, community-based physical activity programmes are in place for older people most at risk of a decline in their independence and mental wellbeing.
Health, public health and social care practitioners (such as GPs, community nurses and occupational therapists) are aware of, and offer, tailored community-based physical activity programmes for older people most at risk of a decline in their independence and mental wellbeing.
Commissioners (such as clinical commissioning groups and local authorities) commission community-based physical activity programmes tailored for older people most at risk of a decline in their independence and mental wellbeing.
Older people most at risk of a decline in their independence and mental wellbeing are offered community-based physical activity programmes that reflect their preferences to improve their physical and mental wellbeing.

Source guidance

Definitions of terms used in this quality statement

Tailored community-based physical activity programmes
Physical activity programmes for older people that reflect their preferences and are delivered in a community setting and include:
  • mixed exercises of moderate intensity (for example, dancing, walking, swimming)
  • strength and resistance exercise, especially for older people living with frailty
  • toning and stretching exercises.
Older people
People aged 65 or older.
Older people most at risk of a decline in their independence and mental wellbeing
Older people with at least 1 of the following risk factors:
  • live alone and have little opportunity to socialise
  • low income
  • recently experienced or developed a health problem (whether or not it led to admission to hospital)
  • aged 80 or older.
Or at least 2 of the following risk factors:
  • partner has died in the past 2 years
  • carer
  • recently separated or divorced
  • recently retired (particularly if involuntarily)
  • unemployed in later life
  • had to give up driving
  • have an age-related disability.
[Adapted from NICE’s guideline on older people: independence and mental wellbeing, recommendation 1.5.3 and expert consensus]

Equality and diversity considerations

Physical activity programmes need to take into account any mental health conditions and learning or physical disabilities that the person may have. Any written information provided should be accessible to people with additional needs, such as physical, sensory or learning disabilities.

Social participation

This quality statement is taken from the mental wellbeing and independence for older people quality standard. The quality standard defines clinical best practice for mental wellbeing and independence for older people and should be read in full.

Quality statement

Older people most at risk of a decline in their independence and mental wellbeing are offered a range of activities to build or maintain social participation.

Rationale

Participating in a range of activities, including one-to-one and group-based activities, can improve or maintain older people’s mental health and wellbeing, by preventing loneliness and social isolation. Providing a range of activities increases the likelihood that the older person will find something that interests them and so will continue to participate.

Quality measures

Structure
Evidence of local arrangements to ensure a range of activities are in place to build or maintain social participation in older people most at risk of a decline in their independence and mental wellbeing.
Data source: Local data collection.
Process
Proportion of older people most at risk of a decline in their independence and mental wellbeing who take part in activities to build or maintain social participation.
Numerator – the number in the denominator who take part in activities to build or maintain social participation.
Denominator – the number of older people most at risk of a decline in their independence and mental wellbeing.
Data source: Local data collection.
Outcome
a) Proportion of older people and their carers who use services and report that they have as much social contact as they would like.
Data source: Local data collection. Data can be collected nationally in the Adult social care outcomes framework 2015–16, 1I.
b) Incidence of mental health conditions among older people identified as being at risk of decline.
Data source: Local data collection.
c) Incidence of admission to supported care facilities among older people identified as being at risk of decline.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as local authorities, local NHS providers and voluntary organisations) ensure that a range of activities are in place for older people most at risk of a decline in their independence and mental wellbeing to build or maintain their social participation.
Health, public health and social care practitioners (such as GPs, community nurses and occupational therapists) are aware of, and offer, a range of activities for older people most at risk of a decline in their independence and mental wellbeing to build or maintain their social participation.
Commissioners (such as clinical commissioning groups, local authorities and NHS England) commission a range of activities to enable older people to build or maintain their social participation.
Older people most at risk of a decline in their independence and mental wellbeing are offered a choice of activities to build or maintain their social participation to help prevent loneliness and social isolation.

Source guidance

Definitions of terms used in this quality statement

Activities to build or maintain social participation
Group or one-to-one activities for older people that aim to prevent loneliness and social isolation. Group activities could include:
  • Singing programmes, in particular those involving a professionally-led community choir.
  • Arts, crafts and other creative activities.
  • Intergenerational activities. For example, helping with reading in schools or young people providing older people with support to use new technologies.
  • Multicomponent activities. For example, lunch with the opportunity to socialise and learn a new craft or skill in a community venue.
One-to-one activities could include:
  • Programmes to help people develop and maintain friendships. For example, peer volunteer home visiting programmes, programmes to learn about how to make and sustain friendships, or befriending programmes based in places of worship.
  • Befriending opportunities that involve brief visits, telephone calls or the use of other media.
  • Information on national or local services offering support and advice by telephone and other media.
Older people should also be made aware of the value and benefits of volunteering. It provides the opportunity to socialise, have an enjoyable experience and help others to benefit from their experience, knowledge and skills.
[NICE’s guideline on older people: independence and mental wellbeing, recommendations 1.2.1, 1.3.1 and 1.4.1]
Older people
People aged 65 or older.
Older people most at risk of a decline in their independence and mental wellbeing
Older people with at least 1 of the following risk factors:
  • live alone and have little opportunity to socialise
  • low income
  • recently experienced or developed a health problem (whether or not it led to admission to hospital)
  • aged 80 or older.
Or at least 2 of the following risk factors:
  • partner has died in the past 2 years
  • carer
  • recently separated or divorced
  • recently retired (particularly if involuntarily)
  • unemployed in later life
  • had to give up driving
  • have an age-related disability.
[Adapted from NICE’s guideline on older people: independence and mental wellbeing, recommendation 1.5.3 and expert consensus]

Equality and diversity considerations

Offers of one-to-one or group-based activities need to take into account any mental health conditions and learning or physical disabilities that the person may have. Any written information provided should be accessible to people with additional needs, such as physical, sensory or learning disabilities.

Participation in meaningful activity

This quality statement is taken from the mental wellbeing of older people in care homes quality standard. The quality standard defines clinical best practice in mental wellbeing of older people in care homes and should be read in full.

Quality statement

Older people in care homes are offered opportunities during their day to participate in meaningful activity that promotes their health and mental wellbeing.

Rationale

It is important that older people in care homes have the opportunity to take part in activity, including activities of daily living, that helps to maintain or improve their health and mental wellbeing. They should be encouraged to take an active role in choosing and defining activities that are meaningful to them. Whenever possible, and if the person wishes, family, friends and carers should be involved in these activities. This will help to ensure that activity is meaningful and that relationships are developed and maintained.

Quality measures

Structure
Evidence of local arrangements to ensure that older people in care homes are offered opportunities during their day to participate in meaningful activity that promotes their health and mental wellbeing.
Data source: Local data collection.
Outcome
a) Feedback from older people in care homes that they are offered opportunities to take part in activity during their day.
Data source: Local data collection. Adult Social Care Outcomes Toolkit. The following documents from the toolkit include questions about choice and control, social participation and involvement, occupation and dignity: CHINT3 care home interview schedule and CHOBS3 care home observation schedule.
The Personal Social Services Adult Social Care Survey (England). This survey collects data on service users’ views and opinions over a range of outcome areas, including satisfaction with social care and support and quality of life. Appendix F of this report provides a link to model questionnaires.
b) Feedback from older people in care homes that they have taken part in activity during their day that is meaningful to them.
Data source: Local data collection. Adult Social Care Outcomes Toolkit. The following documents from the toolkit include questions about choice and control, social participation and involvement, occupation and dignity: CHINT3 care home interview schedule and CHOBS3 care home observation schedule.
The Personal Social Services Adult Social Care Survey (England). This survey collects data on service users’ views and opinions over a range of outcome areas, including satisfaction with social care and support and quality of life. Appendix F of this report provides a link to model questionnaires.

What the quality statement means for organisations providing care, social care, health and public health practitioners, local authorities and other commissioning services

Organisations providing care ensure that opportunities for activity are available and that staff are trained to offer spontaneous and planned opportunities for older people in care homes to participate in activity that is meaningful to them and that promotes their health and mental wellbeing.
Social care, health and public health practitioners ensure that they offer older people in care homes opportunities during their day to participate in spontaneous and planned activity that is meaningful to them and that promotes their health and mental wellbeing.
Local authorities and other commissioning services ensure that they commission services from providers that can produce evidence of activities that are undertaken within the care home and can demonstrate that staff are trained to offer spontaneous and planned opportunities for older people in care homes to participate in activity that is meaningful to them.

What the quality statement means for service users, family, friends and carers

Older people in care homes have opportunities during their day to take part in activities of their choice that help them stay well and feel satisfied with life. Their family, friends and carers have opportunities to be involved in activities with them when the older person wishes.

Source guidance

Definitions of terms used in this quality statement

Care homes
This refers to all care home settings, including residential and nursing accommodation, and includes people accessing day care and respite care. [Expert consensus]
Meaningful activity
Meaningful activity includes physical, social and leisure activities that are tailored to the person’s needs and preferences. Activity can range from activities of daily living such as dressing, eating and washing, to leisure activities such as reading, gardening, arts and crafts, conversation, and singing. It can be structured or spontaneous, for groups or for individuals, and may involve family, friends and carers, or the wider community. Activity may provide emotional, creative, intellectual and spiritual stimulation. It should take place in an environment that is appropriate to the person’s needs and preferences, which may include using outdoor spaces or making adaptations to the person’s environment. [Adapted from SCIE guide 15, Choice and Control, Living well through activity in care homes: the toolkit (College of Occupational Therapists) and expert consensus]
Mental wellbeing
Mental wellbeing includes areas that are key to optimum functioning and independence, such as life satisfaction, optimism, self-esteem, feeling in control, having a purpose in life, and a sense of belonging and support. [Adapted from the Mental health improvement programme, background and policy context (NHS Health Scotland)]

Equality and diversity considerations

Staff working with older people in care homes should identify and address the specific needs of older people arising from diversity, including gender and gender identity, sexuality, ethnicity, age and religion.
When tailoring activities to the needs and preferences of older people, staff should be aware of any learning disabilities, acquired cognitive impairments, communication and language barriers, and cultural differences. Staff should have the necessary skills to include people with cognitive or communication difficulties in decision-making (from Dignity in care [SCIE guide 15]: Choice and control). Staff should ensure that they are aware of the needs and preferences of older people who are approaching the end of their life.
When collecting feedback from older people about whether they have been offered opportunities for meaningful activity, staff should consider using alternative methods for older people who find it difficult to provide feedback. For example, tools such as Dementia Care Mapping can be used, and/or feedback from people who are considered suitable to represent the views of the older person, such as family members, carers, or an advocate.

Personal identity

This quality statement is taken from the mental wellbeing of older people in care homes quality standard. The quality standard defines clinical best practice in mental wellbeing of older people in care homes and should be read in full.

Quality statement

Older people in care homes are enabled to maintain and develop their personal identity.

Rationale

It is important that staff working with older people in care homes are aware of the personal history of the people they care for and respect their interests, beliefs and the importance of their personal possessions. Older people should be involved in decision-making and supported and enabled to express who they are as an individual and what they want. They should be able to make their own choices whenever possible. Enabling older people to maintain and develop their personal identity during and after their move to a care home promotes dignity and has a positive impact on their sense of identity and mental wellbeing.

Quality measures

Structure
Evidence of local arrangements to ensure that older people in care homes are enabled to maintain and develop their personal identity.
Data source: Local data collection.
Outcome
Feedback from older people in care homes that their personal identity is respected.
Data source: Local data collection. Adult Social Care Outcomes Toolkit. The following documents from the toolkit include questions about choice and control, personal cleanliness and comfort, social participation and involvement, occupation and dignity: CHINT3 care home interview schedule and CHOBS3 care home observation schedule.
The Personal Social Services Adult Social Care Survey (England). This survey collects data on service users’ views and opinions over a range of outcome areas, including satisfaction with social care and support and quality of life. Appendix F of this report provides a link to model questionnaires.

What the quality statement means for organisations providing care, social care, health and public health practitioners, local authorities and other commissioning services

Organisations providing care work to embed a culture built on dignity and choice in care homes and ensure that staff are trained to work in partnership with older people in care homes in order to enable them to maintain and develop their personal identity.
Social care, health and public health practitioners work with older people in care homes to tailor support and opportunities to their needs and preferences, with the aim of maintaining and developing their personal identity.
Local authorities and other commissioning services ensure that they commission services from providers that can produce evidence of the actions they have taken to embed a culture of dignity and choice, and that staff are trained to work in partnership with older people in care homes in order to enable them to maintain and develop their personal identity.

What the quality statement means for service users

Older people in care homes are given support and opportunities to express themselves as individuals and maintain and develop their sense of who they are.

Source guidance

Definitions of terms used in this quality statement

Care homes
This refers to all care home settings, including residential and nursing accommodation, and includes people accessing day care and respite care. [Expert consensus]

Enabled

‘Enabled’ refers to actions taken by staff working with older people in care homes to ensure that older people can maintain and develop their personal identity. This may include using life history to tailor support and opportunities to the needs and preferences of the individual. Staff should ensure that older people are able to choose their own clothes, have their most valued possessions with them and choose where to sit while they are eating. It may be necessary to adapt the older person’s environment and provide access to outdoor spaces. Staff should facilitate social inclusion by promoting and supporting social interactions and access to social networks, involvement with the community, and existing and new relationships. [Adapted from Dignity in care (SCIE guide 15), Choice and control and Social inclusion, and expert consensus]
Personal identity
This refers to a person’s individuality, including their needs and preferences, and involvement in decision-making in all aspects of their life. Maintaining a sense of personal identity can involve using life history to maintain and build a meaningful and satisfying life, as defined by the person themselves. Central to personal identity is the feeling of having a purpose in life, feeling valued, having a sense of belonging and a feeling of worth. Relationships, including those with family, carers and friends, are an important aspect of a person’s identity and can have a significant impact on mental wellbeing. An individual’s personal identity may change as their circumstances alter. [Adapted from Personalisation: a rough guide (SCIE guide 47), My Home Life: Promoting quality of life in care homes, ‘Voice, choice and control’ in care homes (Joseph Rowntree Foundation); and expert consensus]

Equality and diversity considerations

Staff working with older people in care homes should identify the specific needs arising from diversity, including gender and gender identity, sexuality, ethnicity, spirituality, culture, age and religion.
When ensuring that older people are enabled to maintain and develop their personal identity be aware of any learning disabilities, acquired cognitive impairments, communication or language barriers or cultural differences. Staff should ensure that they are aware of the needs and preferences of older people who are approaching the end of their life.
When collecting feedback from older people about whether they have been enabled to maintain and develop their personal identity staff should consider using alternative methods for older people who find it difficult to provide feedback. For example, tools such as Dementia Care Mapping can be used, and/or feedback from people who are considered suitable to represent the views of the older person such as family members, carers, or an advocate.

Recognition of mental health conditions

This quality statement is taken from the mental wellbeing of older people in care homes quality standard. The quality standard defines clinical best practice in mental wellbeing of older people in care homes and should be read in full.

Quality statement

Older people in care homes have the symptoms and signs of mental health conditions recognised and recorded as part of their care plan.

Rationale

Mental health conditions are highly prevalent among older people in care homes, but are often not recognised, diagnosed or treated. Ageing with good mental health can make a key difference in ensuring that life is enjoyable and fulfilling. The recognition and recording of symptoms and signs of mental health conditions by staff who are aware of the role of the GP in the route to referral can help to ensure early assessment and access to appropriate healthcare services.

Quality measures

Structure
Evidence of protocols to ensure that staff are trained to recognise the symptoms and signs of mental health conditions in older people, and record them in their care plan.
Data source: Local data collection.

What the quality statement means for organisations providing care, social care, health and public health practitioners, local authorities and other commissioning services

Organisations providing care ensure that staff are trained to be alert to the symptoms and signs of mental health conditions in older people in care homes and to record them in a care plan.
Social care, health and public health practitioners look for symptoms and signs of mental health conditions and record them in the older person’s care plan.
Local authorities and other commissioning services commission services from providers that can produce evidence of protocols for training staff to be alert to the symptoms and signs of mental health conditions in older people in care homes and to record them in a care plan.

What the quality statement means for service users

Older people in care homes are cared for by staff who recognise the symptoms and signs of mental health conditions (such as depression and anxiety) and record them in their care plan.

Source guidance

Definitions of terms used in this quality statement

Care homes
This refers to all care home settings, including residential and nursing accommodation, and includes people accessing day care and respite care. [Expert consensus]
Mental health conditions
These include common mental health conditions such as depression, generalised anxiety disorder and social anxiety disorder, and may also include dementia and delirium. People may have more than one mental health condition at a given time. (See the NICE guidelines on dementia (NICE clinical guideline 42), depression in adults (NICE clinical guideline 90), depression in adults with a chronic physical health problem (NICE clinical guideline 91), delirium (NICE clinical guideline 103), common mental health disorders (NICE clinical guideline 123) and social anxiety disorder (NICE clinical guideline 159) for more information.)
Recognised
Recognised in this context relates to staff observing and recognising the symptoms and signs of mental health conditions, and sharing information and concerns with healthcare professionals, including GPs. Staff should be continually alert to new or worsening symptoms and signs. Observation of behaviour should happen on an ongoing basis and in response to the presentation of relevant symptoms. [Expert consensus]
Trained staff
This refers to staff who have been trained to recognise and record the symptoms and signs of mental health conditions when caring for older people. Staff should be alert to the presentation of new symptoms and signs and aware of existing conditions. Staff should also be competent in recognising when older people need a referral for assessment and management of the mental health condition. [Expert consensus]

Equality and diversity considerations

When looking for symptoms and signs of mental health conditions, be aware of any learning disabilities, acquired cognitive impairments, communication and language barriers, sensory impairment and cultural differences. Staff should ensure that they are aware of the needs and preferences of older people who are approaching the end of their life.
It is important that staff are aware that older people in care homes have the same right to access healthcare as people living independently in the community. This is stated in the NHS Constitution.

Recognition of sensory impairment

This quality statement is taken from the mental wellbeing of older people in care homes quality standard. The quality standard defines clinical best practice in mental wellbeing of older people in care homes and should be read in full.

Quality statement

Older people in care homes who have specific needs arising from sensory impairment have these recognised and recorded as part of their care plan.

Rationale

Mild but progressive sight and hearing losses are a common feature of ageing and may go unnoticed for some time, but can have a serious effect on a person’s communication, confidence and independence. The recognition and recording of needs arising from sensory impairment by staff who are alert to the symptoms and signs and aware of the role of the GP in the route to referral can help to ensure early assessment and access to appropriate healthcare services. For older people in care homes this is essential to improve their quality of life and avoid isolation, which can have a detrimental effect on mental wellbeing.

Quality measures

Structure
Evidence of protocols to ensure that staff are trained to recognise specific needs arising from sensory impairment in older people, and record these needs as part of their care plan.
Data source: Local data collection.
Process
Proportion of older people in care homes who have regular sight tests.
Numerator – the number of people in the denominator who have had a sight test within the past 2 years.
Denominator – the number of older people in care homes.
Data source: Local data collection.

What the quality statement means for organisations providing care, social care, health and public health practitioners, local authorities and other commissioning services

Organisations providing care ensure that staff are trained to be alert to specific needs arising from sensory impairment in older people in care homes and to record them in a care plan.
Social care, health and public health practitioners are alert to and recognise specific needs arising from sensory impairment in older people in care homes and record them in their care plan.
Local authorities and other commissioning services commission services from providers that can produce evidence of protocols for training staff to be alert to specific needs arising from sensory impairment in older people in care homes and to record them in a care plan.

What the quality statement means for service users

Older people in care homes are cared for by staff who recognise needs that occur because of sight or hearing problems and record these as part of their care plan.

Source guidance

Definitions of terms used in this quality statement

Care homes
This refers to all care home settings, including residential and nursing accommodation, and includes people accessing day care and respite care. [Expert consensus]
Recognised
Recognised in this context relates to the recognition by staff working with older people in care homes of the needs arising from sensory impairment and the sharing of information with healthcare professionals, including GPs. Staff should be continually alert to new and existing needs. This should involve monitoring of existing impairments and recognition of new sensory impairments. This is likely to include ensuring regular sight and hearing checks are arranged, cleaning glasses, and changing hearing aid batteries, or referral to an appropriately trained professional. [SCIE research briefing 21 and expert consensus]
Regular sight test
Adults are normally advised to have a sight test every 2 years. However, in some circumstances, the ophthalmic practitioner may recommend more frequent sight tests, for example in people who:
  • have diabetes
  • are aged 40 or over and have a family history of glaucoma
  • are aged 70 or over. [NHS Choices]
Sensory impairment
Sensory impairment most commonly refers to sight or hearing loss. It includes combined sight and hearing loss, which is frequently referred to as dual sensory impairment or deafblindness. [Adapted from Basic Sensory Impairment Awareness (NHS Education for Scotland) and Social care for deafblind children and adults (Department of Health)]
Trained staff
This refers to staff who have been trained to recognise and record the symptoms and signs of sensory impairment when caring for older people. Staff should be aware that there are many different types of sight and hearing loss, with a large variation in the degree of impairment. Staff should also be competent in recognising when older people need a referral for assessment and management of the sensory impairment. [Expert consensus]

Equality and diversity considerations

Sensory impairment is common in older people. It is frequently perceived as an expected feature of ageing rather than as potentially disabling. It is important that sensory impairment is not considered as acceptable for older people in care homes. This may need to be emphasised during training to increase awareness and recognition of sensory impairments.
When looking for signs or symptoms of sensory impairment, be aware of any learning disabilities, acquired cognitive impairments, communication and language barriers, and cultural differences. Staff should ensure that they are aware of the needs and preferences of older people who are approaching the end of their life
It is important that staff are aware that older people in care homes have the same right to access healthcare as people living independently in the community. This is stated in the NHS Constitution.

Recognition of physical problems

This quality statement is taken from the mental wellbeing of older people in care homes quality standard. The quality standard defines clinical best practice in mental wellbeing of older people in care homes and should be read in full.

Quality statement

Older people in care homes have the symptoms and signs of physical problems recognised and recorded as part of their care plan.

Rationale

Physical problems can cause discomfort and affect activities of daily living, participation in social activities and independence, and therefore mental wellbeing. The recognition and recording of the symptoms and signs of physical problems by trained staff who are aware of the role of the GP in the route to referral can help to ensure early assessment and access to appropriate healthcare services. This is essential to improve the quality of life and mental wellbeing of older people in care homes.

Quality measures

Structure
Evidence of protocols to ensure that staff are trained to recognise the symptoms and signs of physical problems in older people in care homes, and record them as part of their care plan.
Data source: Local data collection.

What the quality statement means for organisations providing care, social care, health and public health practitioners, local authorities and other commissioning services

Organisations providing care ensure that staff are trained to be alert to symptoms and signs of physical problems in older people in care homes and to record them in a care plan.
Social care, health and public health practitioners look for symptoms and signs of physical problems in older people in care homes and record them in their care plan.
Local authorities and other commissioning services commission services from providers that can produce evidence of protocols for training staff to be alert to the symptoms and signs of physical problems in older people in care homes and to record them in care plans.

What the quality statement means for service users

Older people in care homes are cared for by staff who recognise the symptoms and signs of physical problems (such as pain, dizziness, problems with walking, constipation and continence problems) and record them in their care plan.

Source guidance

Definitions of terms used in this quality statement

Care homes
This refers to all care home settings, including residential and nursing accommodation, and includes people accessing day care and respite care. [Expert consensus]
Physical problems
Examples of physical problems that could potentially affect a person’s wellbeing include, but are not limited to:
  • joint and muscular pain
  • undiagnosed pain
  • incontinence
  • dizziness
  • constipation
  • urinary tract infection
  • reduced ability to move without support
  • unsteady gait. [Expert consensus]
Recognised
Recognised in this context relates to the recognition by staff working with older people in care homes of physical problems and the sharing of information with healthcare professionals, including GPs. Staff should be continually alert to new physical problems and should monitor existing physical problems. [Expert consensus]
Trained staff
Trained staff refers to staff who have been trained to recognise and record the symptoms and signs of physical problems when caring for older people. Staff should be alert to the presentation of new symptoms and competent in recognising when older people need a referral for assessment and management of physical problems. [Expert consensus]

Equality and diversity considerations

When identifying an older person’s needs arising from physical problems, be aware of any learning disabilities, acquired cognitive impairments, communication and language barriers, and cultural differences. Staff should ensure that they are aware of the needs and preferences of older people who are approaching the end of their life.
It is important that staff are aware that older people in care homes have the same right to access healthcare as people living independently in the community. This is stated in the NHS Constitution.

Access to healthcare services

This quality statement is taken from the mental wellbeing of older people in care homes quality standard. The quality standard defines clinical best practice in mental wellbeing of older people in care homes and should be read in full.

Quality statement

Older people in care homes have access to the full range of healthcare services when they need them.

Rationale

Older people in care homes typically have greater and more complex health needs than those living in the community, and these needs can affect their wellbeing if they are not addressed. Many care home residents experience problems accessing NHS primary and secondary healthcare services, including GPs. It is important that care homes have good links with GPs and referral arrangements, so that services can be accessed easily and without delay when they are needed. This is essential to prevent unmet healthcare needs from having a negative impact on mental wellbeing.

Quality measures

Structure
Evidence of referral arrangements to ensure that older people in care homes are given access to the full range of healthcare services when they need them.
Data source: Local data collection.
Outcome
Feedback from older people in care homes and from their family, friends and/or carers that they are satisfied with the care they have received.

What the quality statement means for organisations providing care, social care, health and public health practitioners, local authorities and other commissioning services

Organisations providing care ensure that they work in partnership with healthcare organisations to implement effective arrangements for access to primary, secondary, specialist and mental health services for older people in care homes.
Social care, health and public health practitioners facilitate access to primary, secondary, specialist and mental health services for older people in care homes by referring the person to the required service when they need it.
Local authorities and other commissioning services commission services from providers that can produce evidence of arrangements with local healthcare organisations which facilitate access to primary, secondary, specialist and mental health services for older people in care homes.

What the quality statement means for service users

Older people in care homes can see their GP and use hospital services when they need them.

Source guidance

Definitions of terms used in this quality statement

Care homes
This refers to all care home settings, including residential and nursing accommodation, and includes people accessing day care and respite care. [Expert consensus]
Healthcare services
These include primary care, and acute and specialist physical and mental health services. [GP services for older people living in residential care: a guide for care home managers. (SCIE guide 52)]

Equality and diversity considerations

When deciding if access to healthcare services is needed, staff working with older people in care homes should be aware of any learning disabilities, acquired cognitive impairments, communication and language barriers, sensory impairment, and cultural differences. Staff should ensure that they are aware of the needs and preferences of older people who are approaching the end of their life.
It is important that staff are aware that older people in care homes have the same right to access healthcare as people living independently in the community. This is stated in the NHS Constitution.

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

Professional responsibilities

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Supporting information

Glossary

the ability to make choices and to exercise control over your life. This includes being able to live independently with or without support
emotional and psychological wellbeing including self-esteem and the ability to socialise and cope in the face of adversity; also being able to develop potential, work productively and creatively, build strong and positive relationships with others and contribute to the community
programmes for older people involving a range of topics, settings, media and activities; a programme could include, for example, lunch with the opportunity to socialise and learn a new craft or skill in a community venue or it could involve a physical activity, such as a dance class, gardening or walking group, plus printed information on the benefits of physical activity
aims to enable people who have physical, mental and/or social needs, either from birth or as result of accident, illness or ageing, to achieve as much as they can to get the most out of life
people aged 65 or over

Paths in this pathway

Pathway created: November 2012 Last updated: December 2016

© NICE 2016

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