Promoting positive mental wellbeing for older people

A quick guide for registered managers of care homes

Mental wellbeing is about life satisfaction, optimism, self-esteem, feeling in control, having a purpose and a sense of belonging and support.

Older people, including those living in care homes, often experience depression, loneliness and low levels of satisfaction and wellbeing. Taking part in meaningful activities, maintaining and developing personal identity, and getting the right help for any health conditions and sensory impairments have been identified as key to improving mental wellbeing.

I have care and support that enables me to live as I want to, seeing me as a unique person with skills, strengths and personal goals
Making it Real, 2018

Personal identity

It is essential to a person’s wellbeing and dignity that they are seen as an individual with experiences, aspirations and opinions. Each person should feel valued and be offered opportunities and support to express themselves. They should be able to continue to develop a sense of who they are and what they want.

Care staff can help by working in partnership with the person to:

  • Find out what is important from their personal history, interests and beliefs and tailor the support and opportunities offered accordingly.
  • Make sure they have the chance to choose their own clothes and where to sit when eating, and to have their most valued possessions around them.
  • Provide any support needed to make choices and decisions.
  • Help the person maintain existing relationships and to develop new ones.

Meaningful activity

Always giving people a choice of activities that motivate them, and that offer the chance to learn new skills and increase independence, can help people to stay well and feel satisfied with life.

Care staff should enable people to consider:

  • Physical, social and leisure activities, including activities of daily living.
  • Both structured and spontaneous activities, individually or in groups, and involving family and friends.
  • Making links with the wider community and trying relevant activities or groups.
  • Emotional, creative, intellectual and spiritual stimulation.
  • Positive risk taking, including going outdoors or adapting the indoor environment, to achieve their goals.
  • Getting involved in delivering staff training, and developing information, policies and procedures.

Be aware of any individual needs as a result of a learning disability, cognitive impairment, communication and language difficulties, and cultural differences.

Ask people how they feel about the opportunities offered to them. If they find it difficult to give feedback, think about using staff observation or gathering views from family members, friends or advocates.

Health and mental wellbeing

To help people maintain and improve their wellbeing, care staff should be trained and supported to:

  • Be aware of any mental health conditions, sensory impairments or physical problems that a person already has.
  • Look for any changes in how the person usually is, and any signs or symptoms of new conditions.
  • Record observations in the person’s care plan.
  • Share information and concerns with healthcare professionals, including the person’s GP.
  • Know when and how to make a referral to the relevant healthcare services.

Sensory impairment

Loss of sight and hearing can be very disabling, but these are often seen as an expected part of ageing and may go unnoticed. These impairments can significantly affect a person’s communication, confidence and independence, so it is essential to provide support to avoid the person becoming isolated.

Make sure that care staff:

  • Have an awareness of the different types of sight and hearing loss and how they affect people.
  • Help people keep their glasses clean and change their hearing aid batteries.
  • Arrange regular sight and hearing checks.

Mental health conditions

Having good mental health enables people to feel that life is enjoyable and fulfilling. Older people in care homes may have one or more mental health conditions, including depression and anxiety, but they are often not recognised, diagnosed or treated. Be alert to the possibility that people may develop these conditions and ensure care staff have the training and support to recognise signs and symptoms.

Consider asking people directly:

  • Have you felt down, depressed or hopeless, or had little interest or pleasure in doing things?
  • How often in the last 2 weeks have you felt nervous, anxious or on edge; or not been able to stop or control worrying?

If a person answers positively to either or both these questions, consider referring them to an appropriate professional for a mental health assessment.

Physical difficulties

Physical conditions can cause discomfort and affect a person’s ability to undertake daily living tasks, join in with social activities and stay independent. This is likely to affect their mental wellbeing. Care staff should look out for physical difficulties such as:

  • joint, muscular or undiagnosed pain
  • incontinence
  • dizziness
  • constipation
  • urinary tract infections
  • difficulty in moving
  • unsteady walking.

Access to healthcare

Care homes are part of the community and people who live in them have the same right to healthcare as anyone else in the community. To promote people’s wellbeing and ensure their physical and mental health needs are addressed, care home managers should:

  • Work in partnership with healthcare organisations and professionals.
  • Make sure referrals are made when needed.
  • Expect ongoing monitoring and review of existing conditions, as well as access to the full range of primary, secondary, specialist and mental health services.
  • Consider how both practice and care home nurses can facilitate joint working and share up-to-date knowledge and skills with other staff, and with people and their families.

Further information

Mental wellbeing of older people in care homes – NICE quality standard, setting out the priority areas for improvement including statements to help you improve quality and information on how to measure progress. The tools and resources page includes a film to help organisations use this quality standard.

GP services for older people living in residential care: a guide for care home managers – SCIE

Activity provision: making activity count – Skills for Care

People’s experience in adult social care services – NICE guideline

Making it Real – Think Local, Act Personal

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This content has been co-produced by NICE and SCIE and is based on NICE’s quality standard on mental wellbeing of older people in care homes.

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