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Adult mental health

Mental wellbeing and the experiences of older people in hospital

13 February 2017

This post is based on a paper that appears in the first issue of The Student Doctor Journal, an imprint of Cardiff University Press.

As the population ages, we will likely see greater numbers of older people in hospitals. Complex care needs and multiple co-morbidities can prolong older patients’ time in hospital. As those in later life represent an increasing proportion of the hospital population, I believe there is a need for wider exploration of the experiences of older patients in hospital.

Last year, I spent some time comparing the clinical outcomes of acutely unwell, older people with dementia admitted to different ward environments: single rooms and traditional multi-bed wards. Whilst my project focused on empirical, measurable clinical outcomes, I frequently wondered how these 100 patients would have described their time in hospital; how it made them feel.

Many of the patients I encountered had spent months in hospital; most on the same ward, and many in the same beds. Most patients had relatively poor mobility and all had cognitive impairment in varying degrees.

I imagined myself in the place of some of these patients as they approached their sixth, seventh, eighth months on the wards. If I were immobile, consigned to my bed in a single room with the sole company of a puzzle book and television, I would likely become bored within a few days. After a few weeks, with limited social interaction, I might begin to feel quite isolated. Fortunately, the likelihood of people in their early twenties spending many months in hospital is reasonably low. If I were to find myself in this position, my mood would almost inevitably suffer.

Besides age, there are social, cultural, and numerous other factors which may influence personal experiences of hospital, but if my mental wellbeing would suffer under these quite common circumstances, why wouldn’t that of somebody fifty years my senior?

Depression, though common in older individuals, is often under-reported. Symptoms of deteriorating mental health, such as weight loss and fatigue, can be attributed to existing medical disorders. In the one hundred acutely unwell older people with dementia I observed after admission to two different NHS hospitals, rates of comorbid, diagnosed depression were 26 and 34 %. I fear that in patients such as these, prolonged periods of admission may have even more marked consequences.

With health and social care resources strained, the modest question of whether older people feel lonely in hospital may seem trivial. However, if elderly patients do experience loneliness, isolation or indeed any sustained challenges to mental wellbeing, there is surely the potential for this to pose more clinically significant challenges to their overall mental health in hospital too.

Experiences of hospital vary; I am wary of further postulation or of drawing conclusions about the hospital experiences of a diverse section of the hospital population.  As the general population continues to both grow and age, I believe the social and potential psychological consequences of hospitalisation are worthy of ever more attention. With wider exploration, investigation and discussion, I hope to be able to speak with more certainty of the nature of older generations’ hospital experiences.

Caitlin Young is an undergraduate in medicine doing an intercalary year in neuroscience.