Growing older in secure mental health care: the user experience

The proportion of older adults using secure forensic psychiatric services is rising. Research is needed to examine the experience of older service users and evidence how adult services can adapt to meet their needs. To explore user experiences of being an older adult in secure forensic services. Thematic analysis of interviews and observations of weekly routines conducted with fifteen service users aged 50 and over residing in a low and medium secure NHS unit in England. User experiences of ageing and age-related needs are reported using five themes: age-related identities; ward environments; participation in activities; management of physical health; and ageing futures. Older adults living with people their own age reported more social integration than those on wards dominated by younger adults. Most wished to self-manage their physical health needs with the support of primary care staff. Older adults were reluctant to identify as “old” or “vulnerable”. Some older adults downplayed their changing care needs. Placement of older people in adult secure services requires awareness of the age balance of the ward. A culture of inclusivity, sensitivity and respect for older persons’ agency is key to collaboratively meeting additional care needs and discharge planning.

使用法医精神科安保服务（secure forensic psychiatric services）的老年人比例正在上升。当前亟需开展相关研究，以审视老年服务使用者的体验，并验证成人安保服务如何调整以适配其需求。本研究旨在探索老年群体在法医精神科安保服务中的使用体验。研究对英格兰一所中低安保等级的英国国民保健署（NHS）院区中15名50岁及以上的服务使用者开展访谈，并对其日常周度作息进行观察，随后采用主题分析法进行数据分析。研究围绕五大主题呈现了老年使用者的衰老体验及与年龄相关的需求：年龄相关身份认同、病区环境、活动参与、身体健康管理及衰老未来展望。与同住同龄人的老年人相比，居住在以年轻群体为主的病区的老年人社交融入度更高。多数老年人希望在基层医疗人员的支持下自主管理自身健康需求。老年群体不愿被界定为“老年人”或“弱势群体”，部分老年人会淡化自身不断变化的照护需求。将老年人安置于成人安保服务病区时，需关注病区的年龄结构平衡。营造包容、敏感且尊重老年人自主能动性的文化氛围，是协同满足额外照护需求并做好出院规划的关键。