Dr. Andrew Mohanraj

The world population is maturing very quickly and soon we will have a higher number of older adults than children. Since women live longer than men, at any given time, there are more older women worldwide than older men. This difference further  increases with advancing age.

Many people do live a long and happy life without any mental health problems. Therefore, despite the usual perception of elderly people being sad, slow and forgetful, mental disorders are not an inevitable consequence of aging.

Nevertheless, it is important for all stakeholders  especially health care service providers, policy planners and care givers  to realize that older adults face special health challenges, especially so since people are living longer. Many of the very old lose their ability to live independently because of limited mobility, frailty or other physical or mental health problems and may  require some form of long-term care.

Poverty, social isolation, loss of independence, loneliness and bereavement  can affect mental health of older adults. They may also be exposed to maltreatment at home and in care institutions.  This maltreatment  is often seen in shoddy  and unmonitored old age homes that have  mushroomed in our country  in recent years. This type of abuse includes; physical,  psychological and  financial abuse. This leaves the elderly victims feeling abandoned and suffer, in the loss of dignity and self respect .

On the other hand,  strong policies regarding health care for the elderly , social support and  active family interactions can boost the dignity and self worth of older adults.

Changes in the social role of the elderly can  have an impact on their wellbeing.

In many developed and developing countries  older adults are now in better health compared to a decade or two ago .  Retirement age has been increased in many of these countries.  Older people are  now expected and are able to make important contributions to society as active participants in the work force or as family members. Any responsible society should  know the importance of  harnessing the wisdom and potential of its older citizens.

What are the specific mental health issues to be addressed in old age?

Dementia

This  is a syndrome involving deterioration in memory, thinking, behaviour and the ability to perform everyday activities. This is not a normal phase of aging  although  as we progress into old age it is not uncommon to experience more frequent episodes of forgetfulness .Older adults report lapses in memory such forgetting the name of a movie they just watched. They might also be vulnerable to confusion when they try to recall complex experiences. If such lapses in memory has a negative impact on the execution of normal activities of daily living or jeopardizes interpersonal relationships, then the older adult may just be suffering from Alzheimer’s disease which is the most common form of Dementia.

This ongoing deteriorating decline of the brain and its activities will profoundly effect the quality of life of the sufferers and their care givers as well. Although no absolute  cure is available, much can be done for people with dementia through pharmacological and non pharmacological interventions. Medications like choline esterase inhibitors may retard further deterioration of  memory and thinking skills . Therefore early detection is important . Many studies have demonstrated that people who engage in intellectually stimulating activities, such as social interactions, chess, crossword puzzles, and playing a musical instrument can significantly lower their risk of developing Alzheimer’s disease  and other forms of dementia.

Depression

Many people feel  that symptoms of depression are normal features of aging. This is not true. Some others  view mental illness as a sign of weakness and unlikely to admit to facing problems..

Sometimes, it is difficult to detect symptoms of depression among senior citizens. One of the earliest manifestations would be a loss of interest in pleasurable activities. This could be very ordinary activities like reading the newspapers first thing in the morning or watching the eight o’clock news. Sudden disinterest in such routine activities should ring alarm bells.

Older people may not even complain of feeling sad. They may express depression through complaints of physical symptoms like pain  or body ache. Social factors underlie depression in older people  especially the loss of a spouse, social isolation , boredom, financial problems or even retirement which  is perhaps one of the most significant of life events. Retirement  brings on a new role which is often difficult to accept. Retirees are often treated lightly and made to feel unwanted or worthless.

The misery of depression can cause  impaired mental and social functioning leading to hopelessness and suicide. The risk of suicide is especially high among older single men .

Older people also sometimes feel overtly anxious and become panicky easily. This overt fear or anxiety may also be the initial symptom of depression in the elderly . It may get so out of control that it interferes with their ability to execute even small chores. The good news is that depression in the elderly  can be easily  treated through appropriate medications and  psychotherapy but  family and social support are also crucial .

What  can  be done?

The promotion of healthy aging  is an important role for all societies. Early recognition , diagnosis and treatment of mental disorders that are common in old age are important to prevent avoidable suffering and disabilities. Care for older adults with mental illness requires sensitivity and relational skills to help the older person achieve and maintain highest possible level of function and wellbeing .

Participation in meaningful activities, strong personal relationships and good physical health are key factors. Poverty, unemployment or under employment is a risk factor for the mental ill-health of older adults and needs to be taken into consideration  It is the duty of a responsible society to prevent the  maltreatment of the elderly . Primary health and community care and social service sectors need to be educated  and supported to deal with elderly abuse. In this regard appropriate legislation  and punitive action against those who abuse or neglect the elderly must be enforced.

The plight of the older adult  receive increasing these days, but often the needs of those who care for the elderly are forgotten. Older adults with dementia and depression commonly receive support from spouses, other family members or friends.

Caregivers  are themselves challenged  by the burden of care giving. They, in turn  battle  emotional stress and often ,financial stress as well. The psychological well -being of care givers  must be addressed as depression has been found  to be common among them.

Policy makers must  take into account  and plan for the significant social and economic implications in terms of direct medical costs and social costs involving the care of older citizens embarking on the “golden” years  of their lives. Synergistic efforts by civil society, non-governmental and non-profit organizations, and public-private partnerships could facilitate the realistic  implementation of health promotion strategies for older adults.