As the title suggests, Alisoun Milne's exploration of mental health in later life takes a lifecourse approach which is set within the context of critical gerontology. This book successfully captures the complex and intersectional impact of personal, social and structural influences throughout the lifecourse, and their cumulative effect on mental health in later life. It also locates ageing within a broad cultural, political and economic framework. The span of this book is considerable, and Milne deftly describes and synthesises significant and wide-ranging material across (UK) public policy, theory and research throughout.
The first four chapters lay the critical, theoretical, conceptual and lifecourse foundations for the rest of the book. Chapters 5–7 address three aspects of the lifecourse that have a specific and significant impact on mental health in later life: socio-economic status; abuse, mistreatment and neglect during later life; and experiences during the ‘fourth age’. Given the implications for later life and health-care policy, it is not surprising that the following two chapters are dedicated to dementia. The final chapter reviews promotion and protection of good mental health and prevention of mental ill-health across the lifecourse, with the conclusion offering a way forward in responding to the issues raised throughout the book.
Milne conceptualises mental health as an outcome of biological, psychological, social and environmental aspects of the lifecourse. Specific influences explored in the book include gender, childhood adversity and socio-economic status, with particular emphasis on their additive, intersectional effect on the individual over the lifecourse and the subsequent impact in later life. Given the critical stance of the author, it is not surprising that inequality is a theme that weaves throughout. Milne addresses inequality experienced by older people, where inequality experienced during the lifecourse intersects with inequality experienced in later life. This represents an unfortunate ‘double whammy’ for older people, where the culmination of lifecourse-related risks and inequalities (e.g. poor health, poverty and education) meet those unique to later life (e.g. ageism and age discrimination in the workplace and within health and social care services). However, Milne distinguishes between poor mental health throughout the lifecourse and that which is unique to later life. For example, the continuation of depression experienced during earlier stages of the lifecourse into later life, and late onset depression experienced by a person living with dementia facing a loss of agency and identity.
A multi-dimensional lifecourse lens is not only trained on inequality and risks to mental health, but also constructs of successful ageing and wellbeing, reflected in an increasing focus on living well in later life. Milne is keen to point out that mental ill-health is not inevitable during later life, proposing that, whilst this period of the lifecourse may be characterised by loss and decline, it may also be a time of opportunity and growth.
There are many strengths in the book, but I shall outline three that struck me personally. The first is Milne's commitment to listening to the voices and lived experiences of older people themselves. The second is Milne's overview of the different approaches to conceptualising dementia and their effects on how people with dementia are viewed and treated, which is highly recommended. Her explanation sheds significant light on the broader social and cultural influences on the mental health of people with dementia. The third is the repeated application of critical analysis to policy that affects people in later life. There is a tendency for UK health policy to reflect scientific, biomedical constructs of ageing and Milne addresses this throughout the book, but specifically in the conclusion where she outlines the need for policy to appreciate the impact of the lifecourse on mental health in later life.
The very few limitations in this book are more than adequately addressed by the author. There is a lot more to say about race and sexuality, for example, and the topics within the book are very much grounded within a UK context. This book is recommended for practitioners across public mental health, primary and secondary National Health Service services, social care, residential and nursing care, and dementia care. Those dedicated to addressing the rights and needs of older people, people with dementia and carers will also find this book informative. It is an especially important read for those involved in developing or implementing policy that impacts people during later life and those involved in research.
