At the other end of the lifespan, older adults also have unique needs in relation to relapse prevention. Older people living in the community tend to have the best mental health across the lifespan, but those in aged care and other supported accommodation settings are at increased risk of mental health problems (DeLeo et al 2001). Older adults may have experienced a lifetime of chronic or relapsing mental illness, or had recent onset of mental illness as the result of a significant stressor such as bereavement or physical ill health. Generally, however, mental illness in older age tends to be more chronic in nature. To ensure appropriate relapse prevention for older adults, consideration must be given to the chronicity of the mental illness as well as developmental needs at this stage of the lifespan.

Differentiating mental disorders from 'normal' aging has been one of the more important achievements of recent decades in the field of geriatric health (US Surgeon General 1999). Appropriate diagnosis of physical and mental conditions is essential at this stage of the lifespan, but there are many factors that can impede this. Consequently, depression, Alzheimer's disease, harmful alcohol use, anxiety, late-life schizophrenia, and other conditions can go unrecognised, untreated or misdiagnosed, with severely impairing and sometimes fatal outcomes (US Surgeon General 1999). Better diagnosis of both mental and physical health conditions and greater awareness of mental illness symptoms among older people are priorities.

Older adults who have experienced a lifetime of chronic or relapsing mental illness have special needs. These people are often "uniquely disabled by a combination of personal, social, mental and physical health disadvantage" (Jolley, Kosky & Holloway 2004 p27), having spent a large portion of their adult life in mental hospitals. With the move toward community care, these older people have been discharged into the community, but are at risk of not having their needs met because of the lack of effective partnerships between psychiatry, rehabilitation and aged care. The Royal College of Psychiatrists has produced guidelines to highlight the special needs of these people, who they call 'graduates', to define and encourage good practice in the management of mental disorder for people who have suffered from enduring or episodic severe mental disorder throughout adulthood and are now reaching old age (Jolley, Kosky & Holloway 2002). As noted earlier, the notion of 'recovery' can be, paradoxically, traumatic for these people, and needs to be sensitively approached along with the related issues of relapse prevention and rehabilitation.

I don't know why you think I am going to recover now. I've been sick all my life and in and out of hospital for 40 years. I've had every sort of drug and a whole lot of different psychiatrists and doctors and none of them have done any good. And now you tell me that I'm supposed to recover. —Consumer
To facilitate understanding of the risk and protective factors for relapse in later life, it has been argued that successful ageing is contingent upon three elements: avoiding disease and disability, sustaining high cognitive and physical function, and engaging with life (Rowe & Kahn, 1997). These are, therefore, factors to be considered in terms of providing support and rehabilitation services for older people to reduce risk and increase the protective factors for mental health. Common risk factors for mental health for older adults are bereavement, social isolation and poor physical health. Bereavement is a well-established risk factor for depression, and peer support groups have been found to be helpful in this regard (US Surgeon General 1999). Social isolation is a significant problem for many people who have experienced mental illness, and one that becomes particularly acute with ageing. Finding appropriate ways to engage older people with each other and with the wider community through day programs and social activities need to be prioritised.
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Support groups for older people with mental illness and their families are likely to be helpful in that participating in such groups can reduce feelings of isolation, increase knowledge, and promote coping efforts. Little research has been undertaken on the efficacy of support groups for older people, however, and has generally been limited to support for carers and those who have been widowed, rather than to older people who have experienced mental illness.

Maximising physical health through appropriate diet, exercise, sleep, medical check-ups and medication review is also paramount. The essential role of general practice is evident in this context for older people. GPs are the main source of health care for older people and often the only health contact that older people actively seek (AIHW 2002). Dealing with the complex array of physical and mental health problems of older people with mental illness is a special challenge for general practice.

There is a high risk of suicide associated with mental illness for older people, both those who have long-term illness and those who have a late-onset disorder. While suicide is a serious risk at all stages of the lifespan for people with mental illness, it requires special consideration as a psychosocial risk factor for wellbeing in old age (De Leo et al 2001).

In terms of timely access to clinical and non-clinical services to support the wellbeing of older adults who have experienced mental illness, aged care and disability support services for older people are not geared toward those who have experienced mental illness; rather, they are more suited to the frail aged and those with dementia (AIHW 2003). An understanding of psychiatric disability is, however, being recognised as an increasing priority for services provided for this age group. Currently, however, availability of and easy access to services for older people with mental illness are often lacking, and these people's complex needs are not being met by the mental health, general health, disability or aged care sectors.

Subsequently, an unreasonable burden falls on family and carers. Late-life mental disorders pose special difficulties for the family members who assist in providing care (Light & Lebowitz, 1991). Carers may be old and frail themselves, or have other demanding responsibilities. There is an urgent need for appropriate respite and day care alternatives for older people with ongoing mental health problems.

I am caring for my elderly father as well as my brother. They both have schizophrenia. I also have two kids to look after and I'm a single mother. I don't have a life at all for myself. It all revolves around them. There's no-one else ... this is a full-time job, but I don't get paid. —Carer
It is important to recognise that the cultural and linguistic diversity of Australia's older population is increasing, and due to different 'waves' of migration there are cohorts of older people from culturally and linguistically diverse communities that will peak in their aged care needs at different time points. Consequently, the ongoing mental health needs of these older Australians from different cultural groups must be considered (Klimidis & Minas 1998). Older people from Aboriginal and Torres Strait Islander backgrounds who have experienced mental illness are likely to be profoundly disadvantaged in multiple ways that increase the likelihood of relapse.