Geriatric Mental Health: There is considerable and appreciable improvement in health care services in India since 1950s and as a result there is an increased life expectancy and longevity.
And hence, the population segment of older citizens have almost doubled leading to a phenomenon known as “grey tsunami”. As per estimates, this population of people above the age of 60 years is expected to reach 20.8% of total population by the year 2050 (absolute number 347 million).
Problems faced by elderly people
With rapid demographic shift along with an increased tilt towards urbanisation, industrialisation and infrastructural developments, the need of elder care has increased considerably. The issues of the elderly of today are absolutely different from those in the 1960s. The new India has newer challenges in all walks of life, and so are the issues of the elderly.
Once considered an extended adulthood with more personalised family care, nowadays, with most of the children living in nuclear set ups and working in different geographical zones, the elders are living in their ancestral homes with little or no personal, personnel, social, emotional and economic support & care. Such a breakdown of the traditional Indian family system has led to increased incidence of mental health issues in the elderly.
The Longitudinal ageing study in India (LASI) reported that approximately 75 million elder persons in India suffer from chronic health conditions increasing the load of morbidity. This group of population is highly prone to psychological and mental health issues, mostly due to cerebral pathologies, other long-standing illnesses, social isolation, decrease in economic independence and functional losses.
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Mental health issues of senior citizens
As per a recent epidemiological survey, there is a huge burden of mental health issues in the elderly accounting for almost 21% (some surveys have reported even 60% in rural areas). The mental disorders most commonly diagnosed in the elderly in India include dementia and mood disorders, depression in particular. Other disorders include anxiety disorders, sleep disturbances, drug and alcohol abuse, delirium and psychosis. Suicide, especially because of depression, occurs more frequently in the older persons and adds to this burden.
But depression is a regularly missed as a diagnosis (or misdiagnosed as a “normal ageing sadness”) especially in this group. Dementia is also a silent epidemic in the elderly population and is multifactorial in risk assessment. Uncontrolled diabetes, female sex, high cholesterol levels, high blood pressure, depression, urban living and lack of exercise are some major risk factors behind increasing psychological illnesses.
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As of today, there is an incredible requirement of focusing on providing systematic and compassionate mental health services to the elderly in India. There are hardly any dedicated mental health trained professionals for the geriatric population and most of the services are limited to acute care at tertiary care institutions in big cities. Most of the public health hospitals and rural centres have lack of staff, inaccessibility and inequitable distribution. Another major hurdle is lack of insurance coverage to mental illnesses.
How to help elderly people?
The focus should be on primary care, preventive medicine and rehabilitative services. The elderly should receive their due attention from policy makers across public and private stakeholders. Awareness needs to be spread regarding mental health issues, specific needs of the geriatric population and availability of services in this regard. Manpower training to foster care as professional caregivers is the need of the hour with the development of memory care clinics, organised home care services, helplines, recreational facilities and assisted living communities. The key is to provide accessible, affordable and acceptable mental health services to the Indian elderly.
Dr Charu Dutt Arora, Consultant Physician & Head, Palliative Care & Senior Care Expert, Amerihealth Home Health Care Asian Hospital, Faridabad.
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