Nurse education is critical when it comes to the identification of mental health issues or signs of elder abuse within nursing homes, according to mental health specialist, Dr Kieran Kennedy.

“Nurses have an absolutely vital role within aged care residences when it comes to ensuring our elderly are supported mentally and feeling safe,” says Dr Kennedy.

“Nurses hold the unique position of spending significant time with residents and getting to know them well - for this reason alone, their input, thoughts and observations are key to identifying when someone might be struggling or not feeling safe.”

But with aged care nurses already under immense pressure, being able to effectively identify the signs of mental ill-health can be challenging.

“While education and awareness on these issues is, thankfully, more prominent now, many nurses and health care professionals feel they haven’t had the training or exposure to these situations that they might like or need.

“It’s important to let your employer know if this is the case for you, as many training programs or educations sessions can be made available or arranged.”

There are myriad mental health challenges that professionals working within an aged care setting need to be aware of, says Dr Kennedy.

“The period of life can come with many positives and good moments, but many living within aged care homes are moving through significant challenges, and life changes too, and these can, and do, have a very real impact on mental health.

“Conditions such as depression and anxiety remain high here, particularly if there are physical health challenges, isolation, or loneliness.

“Impacts of adjustment to new circumstances, the loss of loved ones or family, and health issues can also lead to something called an Adjustment Disorder, where mood, anxiety or behavioural symptoms develop in direct relation to a sudden change or challenge.”

“It’s important to know too that physical health conditions can and do have a very real impact on our health of mind as well.”

But while mental health challenges are common, they frequently go unnoticed, undiagnosed, and therefore, untreated, in aged care facilities.

“This is likely down to multiple factors, but it is important to know that mental health conditions don’t always present the same in elderly patients compared to younger age groups,” says Dr Kennedy.

“Depression, for example, can often be more subtle in elderly individuals - rather than presenting with overt sadness or despair, an elderly person might present with increased irritability or a subtle change in sleep.”

Complexity is another contributing factor as to why signs might be missed.

“It’s not uncommon for elderly individuals to have a number of different physical health conditions, medications and support needs all at the one time, and this can make noticing changes, remembering to ask about mental health, or focusing on mental health challenges complicated.

“Patients and healthcare professionals are often - for no fault of their own - more likely to focus on the obvious physical health issues and care needs.”

Historically, says Dr Kennedy, mental health support and care have been neglected within aged care health systems. This, combined with low staff to resident ratios, means subtle changes and challenges are frequently missed.

While less common than mental health challenges, elder abuse, mistreatment, and neglect also take place within aged care facilities, and can easily go unnoticed, however the consequences can be dire.

“There’s no one size fits all, and many forms of abuse and mistreatment occur, but elder abuse includes much more than just clearer forms of physical or sexual abuse or trauma,” says Dr Kennedy.

“Subtle forms of abuse and mistreatment occur commonly too, and this can include psychological and emotional abuse, neglect of basic care needs, and financial manipulation or abuse.”

Dr Kennedy says the elderly are at far higher risk than their younger counterparts, which is why it’s crucial that nurses are aware of what it is, and how they can help.

“Observation of how someone is generally acting, speaking and feeling is vital to picking up mental health struggles, or when abuse might be going on, and nurses have a vital place here,” he says.

“Watching out for any notable or sudden changes in how a resident is behaving, feeling or thinking is really important, as is then feeling comfortable to ask more about it and dive a little deeper.”

Dr Kennedy says nurses must understand the important role they play in observing and collecting initial information, as well as providing feedback to doctors and other health professionals involved in a patient’s care.

“As well as watching out for changes and signs, asking how someone is feeling, if they’re feeling safe, and other aspects of mental health should become just as standard as the attention we pay to the physical,” he says.

Alongside direct contact and observation of residents themselves, observing any concerning interactions between residents, residents and employees, or residents and visitors is important too, particularly when it comes to picking up elder abuse.

“This is something that can be really tricky for everyone, nurses included,” says Dr Kennedy.

“Signs of change and struggle can often be subtle or not quite what we’d expect - so picking things up can be hard and never a point of blame or shame on staff.

“Many nurses are made to feel that asking that little bit more or inquiring about mental health symptoms or struggles isn’t a part of their role, and that can add an extra element of difficulty here.

“However, it’s in everyone’s best interest for nurses to feel comfortable and confident to look out for, ask and talk about aspects of mental health and elder abuse.

The Australian Institute of Health and Welfare and the Australian Institute of Family Studies both offer a range of online resources.