Best Practice Guidelines: The Issue


Depression is the most common mental health problem for older adults and has profound negative impacts on all aspects of their life, not to mention the impact on family and the community. Despite its prevalence, depression should not be considered a normal part of aging. It is important that clinicians be aware of the prevalence of depression, the challenges of diagnosis and the complexity of caring for older adults who are often also medically ill. It is also vital that clinicians realize that depression in the elderly is treatable and that treatment can result in major functional, social and health gains.

Excerpt From National Guidelines for Seniors’ Mental Health ; January 2009.

Suicide Prevention - Resource

In 2002, 430 Canadians 65 years of age or older (361 men and 69 women) died as a result of “intentional self-harm” (Statistics Canada, 2002). Older men are at especially high risk for suicide. The 1997 suicide rate for older Canadian men (23.0/100,000) was nearly twice that of the nation as a whole (12.3/100,000) (Statistics Canada, 2005). It is widely believed that published suicide rates underestimate the total number of deaths by suicide, due, in part, to the stigma of suicide and other social pressures that may lead family members and health professionals to avoid labeling deaths as suicides. In equivocal cases, coroners might be less likely to consider the death of an older adult as suicide (Ohberg & Lonnqvist, 1998). Approximately one thousand older adults are admitted to Canadian hospitals each year as a consequence of intentional self-harm, but it is not known how often older people in Canada harm themselves without being admitted to hospital.

The lethal potential of self-harm behaviour increases with advancing age (Krug et al., 2002; United States Department of Health and Human Services, 2001). Hanging and firearm use were the most common means of suicide among older men in Canada in 2002 (see Appendix B) (Statistics Canada, 2002). In older women, self-poisoning and hanging were the two most common methods. The lethal potential of suicidal behaviour in later life is demonstrated by the ratio of suicidal behaviour to deaths by suicide. In the general population instances of non-lethal self-harm are approximately 20 times more common than suicide itself. In older adults, this ratio is less than four to one (Conwell et al., 1998; McIntosh et al., 1994). As the older population greatly increases over the coming decades in Canada (Statistics Canada, 1999), there will likely be a greater number of older lives lost to suicide.

Excerpt from National Guidelines for Seniors’ Mental Health : Suicide Prevention. Retrieved Jan 2009.


Delirium is a common and serious condition encountered in older persons. This guideline deals primarily with its prevention and acute management, but it is important to note that delirium has long-term consequences. Compared to similarly aged individuals, older hospitalized persons who are delirious have a worse prognosis. They have prolonged lengths of hospital stay, worse functional outcomes, higher institutionalization rates, increased risk for cognitive decline and higher mortality rates (Leentjens & van der Mast, 2005; Rockwood, 2001). In many cases, delirium is not recognized or is misdiagnosed as another condition such as dementia or depression. The occurrence of delirium is not inevitable.

Excerpt From National Guidelines for Seniors’ Mental Health : Assessment and Treatment of Delirium. Retrieved January 2009.

Mental Health Issues in Long Term Care Homes - Resource

In Canada, the number of seniors receiving care in LTC homes has risen from 203,000 in 1986 to 240,000 in 1996 (National Advisory Council on Aging, 1999) and this number is continuing to increase. Projections for 2031 suggest that the number of LTC beds will triple or even quadruple.

The literature suggests that there is an extremely high prevalence of mental disorders among nursing home residents. Depression is extremely common (15% – 25% of residents have symptoms of major depression) as is the prevalence of psychosis (ranging from 12-21%). Individuals with dementia suffer from cognitive impairment (usually consisting of memory impairment) may also have behavioural symptoms which include agitation, aggression, wandering, etc. Due to the high prevalence of mental disorders, studies have demonstrated limited availability of psychiatric and mental health services for residents living in Canadian LTC homes (Conn & Silver, 1998; Conn et all, 1992

Excerpt From National Guidelines for Seniors’ Mental Health : Mental Health Issues in Long Term Care Homes
(Focus on Mood and Behaviour Symptoms) Retrieved January 2009.

Guidelines for Elderly Mental Health Care Planning For Health Authorities - Resource

In 1998, in British Columbia, an ad hoc committee of practitioners and Ministry of Health staff involved with issues of aging and mental health of older people came together to develop the Best Practices document. Members of the working group reviewed the literature, undertook consultations and focus groups with caregivers, family members, professional service providers and community members at large in order to learn and to ensure that the information in the document was realistic and valid. The document was repeatedly edited and changed to incorporate feedback from reviewers of early drafts, and the final version was published by the Ministry of Health and circulated to all Health Authorities in British Columbia in 2002.

Excerpt From Guidelines for Elderly Mental Health Care Planning, BC Ministry of Health (2002) ; January 2009.

Best Practice Guideline Resources

Registered Nurses’ Association of Ontario. (2014). Screening for Delirum, Dementia and Depression in the Older Adult.