Addressing the Mental Health problems in the Elderly

Human ageing, a progressive loss of adaptability in an individual, is due to a complex interplay between psychosocial and biological factors.  Longevity (living long years) is not always a blessing, says Dr. S. Nambi, Psychiatrist.

Old age has always been fraught with problems that are intensified by the pressures of modern society and the changing attitudes.A definition of “ageing” depends upon how it is viewed from different perspectives. In India, it has been conventional to take the 60th year as the point of turning old.

The proportion of the people aged 60 or above has increased in India, largely through improvement in sanitation and public health.  Those above the age of 60 constitutes 7% of the total population of India (above 7 crores), this significant increase in the elderly population is a universal phenomenon.  This achievement, however, also possesses one of the greatest challenges in the coming decades; Managing the well being of elderly people who, by the year 2025, will make up more than 20% of the world population.

The greying of the population is likely to be accompained by major changes in the frequency and distribution of physical and mental disorders, and the inter relationship between these two type of disorders.

Mental health problems among elderly people are frequent and can be severe and diverse.  It is estimated that the prevalence of mental disorders among the elderly is 89 per 1000.  Depression, “The down Mood State” along with other negative symptoms is the most frequent mental health problems faced by elderly.

It is estimated that around 6% of the elderly population suffers from the severe depressive disorder.  Dementia a deteriorating disorder of all mental functions is the next common mental health problem in elderly.  Around 4% of the elderly above 60 suffer from Dementia.  Apart from these two mental disorders, other psychiatric disturbances like delirium (acute confusional state due to infection, injury or intoxication), delusional disorders ( a disorder with suspicion and other behavioural problems) are also seen in the elderly.

Also read: Need for promoting mental health in schools 

Depression in the elderly

Some people have the mistaken idea that is normal for the elderly to feel depressed.  The fact is not so sometimes, though when depression develops it may be a normal part of ageing.   Depression in the elderly, undiagnosed and untreated, causes needless suffering for the family and for the individual who could otherwise live a fruitful life.  When he or she does go to the doctor, the symptoms described are usually physical, for the elder person is often reluctant to discuss feelings of hopelessness sadness, loss of interest in normally pleasurable activities, or extremely prolonged grief after a loss.

The three important factors associated with depression in old age are:

  1. Emotional factors
  • Feeling lonely
  • Dissatisfaction
  • Self- pity
  1. Physical factors
  • Deterioration in health
  • Difficulty in self- care
  • Difficulty in mobility
  • Sensory deficits
  1. Socioeconomic factors
  • Widowed state
  • Loss of social status
  • Loss of income
  • Retirement
  • Bereavement

Associated medical Illness, loss of income and self esteem and “Left alone insecure feeling” are the commonest causes of depression in elderly.  The children, because of education or employment leave the house and make the parents feel much depressed.  People call this as “Empty nest” syndrome.

Another important problem that the elderly fact in the urban area is the children after their technical qualification settles down in America leaving the parents alone here in India.  This predisposes to severe depression in the elderly. This is popularly known as “PICA” (Parents in India, Children in America) Syndrome.

The common features of depression in elderly are:

  1. sadness or “Empty ness”.
  2. Hopelessness, pessimism or guilt.
  3. Helplessness or worthlessness.
  4. Inability to make decisions.
  5. Inability to concentrate or forget fullness.
  6. Multiple vague bodily complaints e especially aches and pains.
  7. Loss of interest in routine activities like reading a newspaper, watching TV.
  8. Loss of energy and drive.
  9. Sleep
  10. Poor appetite.
  11. Restlessness agitation, irritability.
  12. Suicidal ideas.

Treatment:

A depression in elderly should be recognised at the earliest and treatment should be initiated actively.  Treatment includes medication (antidepressants) and psychotherapy (talking to people to understand their problems and guide them to have the positive attitude for life) other steps to minimise depression in elderly are.

  1. Regular health check up.
  2. Appropriate treatment of associated medical illness.
  3. Proper planning of retirement.
  4. Encouraging the youngsters to adhere to traditional values and join family system.
  5. Engaging old people in religious and other recreational activities.
  6. Low cost healthy insurance scheme for the elderly.

Also read: Beating stress blues in the work place

Dementia in elderly

Dementia is a major public health problem in old age. It is the disorder of the brain with a deterioration of all mental faculties.  Dementia is a dying but qualitative and quantitative change in intellectual functions.

 In dementia, there is impairment and decline in memory, intelligence, personality, judgement, decision-making power, disturbance in orientation and associated with behavioural problems.  The memory problem is mainly for the recent events.  New learning is affected and as dementia advances, they are not in a position to identify kith and kin.  They have wayfinding difficulty.  Their behaviour problems include uninhibited behaviour, suspicion, restlessness agitation, irritability and sleep disturbance.  Dementia is a progressive deteriorating and disability disabling disorder.  The two most common types of dementia are,

  1. Alzheimer’s dementia
  2. Vascular (multi-infarct) dementia.

Management of dementia in elderly

Drugs have a limited role to play in the management of dementia.  Some of the newer drugs may be of hopeful to improve the cognitive functions (memory, attention and concentration) of the brain.  Drugs may also help in alleviating the associated behavioural problems. A psychosocial intervention like behavioural technique, activity engagement physical exercise and organizations of dementia care services is of much help in the management dementia in elderly.

These problems create a high level of suffering not only to the elderly people themselves, but also their relatives.  In many instances family members have to sacrifice much of their personal life to dedicate themselves to the ill relative.  The burden thus created for families and communities is high, and more often than not, inadequate health care resources leave patients and their families without the necessary support.

Many of these problems could be dealt with efficiently but most countries have no policies, programmes or services prepared to meet these needs.  A prevailing double stigma – attached to mental disorders in general and to the end of life in particular does not help in facilitating access to necessary assistance.

The right to life and the right to quality of life calls for profound modifications in how societies see their elders, and for breaking associated taboos.  The way societies organise themselves to care for the elderly is a good indicator of the importance they give to the dignity of the human being.

Also read: All about the Mental Healthcare Bill

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