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Need for focus on mental health of older persons

N.N. Raju
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October 10 is observed as Mental Health Day . This year, the theme given by the World Mental Health Federation is ‘Mental Health and Older Adults’.

Psychiatric illness becomes more common with advancing age because of higher prevalence of systemic diseases such as hypertension and diabetes, which can cause organic abnormalities resulting in behavioural disturbances in older adults.

To make matters worse, the elderly are subjected to emotional stress and loss, which include death of spouse, siblings and friends; mistreatment by family members; loss of occupation and income; deterioration of health, and decline in interactions. It is no secret that the world is greying.

The current estimates suggest that the population above 60 in India is almost 100 million. Community surveys indicate the prevalence of psychiatric disorders is higher in people above 60 than in those below it.

The commonest are depression, dementia, and anxiety each amounting to nearly 10 per cent of those who crossed 60 years of age. Prevalence of mental illness increases sharply after 75.

Depression is the commonest psychological syndrome that is encountered in old age. Loss of interest in day-to-day activities, lack of pleasure, reduced sleep and appetite, hopelessness and increased lethargy are some of the common symptoms of depression. Some also develop abnormal beliefs like delusions and hallucinations of somebody harming them or something is rotting.

Many believe that death is the only solution and hence express suicidal ideas often.

Cognitive decline like loss of memory, attention, and concentration only worsens the outlook.

Dementia is an acquired global impairment of intellect and memory, often accompanied by changes in personality, mood and behaviour that is usually progressive and irreversible.

The most common types of dementia are Alzheimers Disease and Vascular Dementia. Alzheimers Disease accounts for two-thirds of dementia. The onset is gradual and the first symptom is forgetfulness of events occurred a few seconds before. Gradually other changes like decline in self care and change in personality set in.

People forget to recognise their family members and surroundings. In the late stages, soiling the clothes and aggressive behaviour may be noticed.

Reactions to stress and loss may produce fear and apprehension in later stages of life. The idea of living in isolation is dreadful to many. Bereavement and loss of near and dear may exacerbate the conditions of underlying tension and apprehension.

Unfortunately, there are hardly any specialised geriatric centres and the emphasis on training of disorders in old-age is negligible.

The Indian Government has launched a program — ‘National Program for Health Care of Elderly (NPHCE), but its implementation has been tardy.

A national institution exclusively for geriatrics is required and it should be made mandatory for each medical institution to have a separate department of geriatrics.

It is hoped that the ambitious National Mental Health Program (NMHP) would find some place for the hapless senior citizens of the country.

( The author is Superintendent, Government Hospital for Mental Care, Visakhapatnam. He can be reached at 9849111505, e-mail: drnnraju@yahoo.com)


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