In this blog post Rosie Mason, a Link Worker for the North East and North Cumbria Integrated Care Board’s ‘Waiting Well’ programme shares some of the learning from the Ways to Wellness PROSPeR Project after six months of delivery.

Anxiety and depression

Waiting Well is run by the NHS in the North East and North Cumbria, and helps patients who are waiting for planned care. As part of this, the Ways to Wellness PROSPeR project supports patients who are waiting for hip and knee surgery. We offer non-medical support throughout our clients’ journey, from waiting to after the operation.

Working with this group of patients, we have noticed that many of them were displaying symptoms of anxiety and depression.

Waiting for any operation is difficult and can bring about or worsen feelings of anxiety and depression. One member of the PROSPeR team noted:

It may be several illnesses which have taken their toll over the years causing the depression, meaning individuals feel they have to ‘cope’ and often say it’s ‘what getting old is like’". Thomas Lovedawn, PROSPeR Link Worker

Many patients stated they had been living with long term anxiety and depression which has impacted their quality of life, capacity to work, see friends, do exercise, and even see family. One patient aged 86, had a fall in her home and as a result she became increasingly anxious about leaving her house with fears that she might fall again.

Dizziness and vertigo are common complaints in older patients we work with and present often debilitating symptoms making the individuals scared to leave the house.” Thomas Lovedawn, PROSPeR Link Worker

In the patients we work with pain is one of the major contributors to their low mood. Pain reduces sleep and the lack of a good night’s sleep exacerbates depression, anxiety, and pain. This is the vicious cycle our patients often tell us they are living with.

Challenging Stigma

When you think of someone with ill mental health – perhaps you think of a young adult. Depression can affect 1 in 5 older people living in the community, and 2 in 5 living in care homes (Royal College of Psychiatrists, Sept 2014). Any physical illness can trigger depression. As we age, we face a potential increase in both physical and mental health concerns. These can be sudden, like a fall or a stroke, or long term and disabling like cataracts or osteoarthritis.

It is evident that some individuals mask feelings of depression because of the belief “depression isn't a real illness”. In these circumstances individuals risk isolating themselves further from their community.

Depression and anxiety are both real illnesses.

Having a Link Worker that can listen with empathy, provide support and recognise depression and anxiety as a barrier to engaging in other activities can help patients independently take steps towards helping themselves.

Supporting patients

Having a Link Worker means that depression and anxiety can be discussed and reflected on. Reflection is an important part of meeting with patients. Link Workers have dedicated time and training to be aware of depression symptoms and the skills and qualities to listen and openly discuss with compassion.

Awareness of depression and anxiety in elderly people is important in being able to effectively support people.

Because of reduced mobility and high levels of pain, in most circumstances our patients have stopped working, meaning they have less disposable income. Additionally, many do not fully understand the benefits they are entitled to receive.

Sitting with patients to support them with working out safe and appropriate logistical arrangements, for shopping visits or attending groups. Helping them find suitable interventions to manage their conditions, or discussing groups they can visit regularly. These are the most effective tools we have in supporting and easing their depression and anxiety.

Helping our PROSPeR patients feel heard and safe is key to the work we do.

Things take a whole lot more effort. People that are suffering with pain lose can risk losing interest in socialising or enjoying the simple things - like cooking, because the pain and low mood take over.” Thomas Lovedawn, PROSPeR Link Worker

People can forget how to best find things locally, feel too overwhelmed to manage things and lose sight of what matters most to them. Link Workers work with patients, supporting them to think about what matters most to them, and finding effective and sustainable ways of taking steps towards those things.