PSYCHIATRIC PROBLEMS OF THE ELDERLY
Nothing can remain static in this world. This is true for the human body too. Biologically speaking the aging process starts the moment we come into this world. The regulatory activities start slowing down with age and brings about an increased vulnerability to illness and decreasing adaptability to environmental stresses and strains.
India is graying and by the tun of the century there will be around 80 million Indians above the age of 60 years. Life span has increased from 32 years in 1947 to 54 years in 1980 and 62 years presently.
Psychosocial factors increasing vulnerability to mental or emotional illness.
- Female sex — More elderly women than men are prone to developing psychological problems.
- Widowed state — Recent death of spouse, loss of companionships, income etc.
- Unemployed condition leading to insecurity and dependency on others.
- Low social class — Lack of awareness, leading to neglect of problem.
- Living alone for nuclear families — Social isolation, Inability to cope.
- Physical illness or disability.
- Sensory deficit — Impaired vision or hearing.
- Special stressors — Retirement, loss of status, fall in income, loss of health, lack of purpose in life etc.
PSYCHIATIRC DISORDERS IN OLD AGE
Depression : In spite of strong family bonds and cultural practices that revere the aged, depression still ranks as the most prevalent psychiatric illness of the aged, which is more common amongst women than in men. The common symptoms are sad mood, sleep disturbance, anxiety, excessive preoccupation about one’s body or health, feelings of worthlessness, loss of purpose in life, suicidal ideation, loss of energy, loss of pleasure in usual activities, poor appetite etc. These symptoms may range from mild to very severe. Sometimes, depression can also be ‘masked’ and present mainly with various bodily complaints such as pains and excessive preoccupation with bodily functions. At times depression in old people is associated with serious physical illness and may show a blend of depression, anxiety, irritability and attention seeking behavior. After ruling out the presence of any physical illness, the depression can be treated through a course of anti depressants under the careful supervision of a psychiatrist. Psychotherapy is a powerful tool to help the person identify and deal with life stresses or other conflicts, relating to self esteem and self concept.
Anxiety Disorders : This is usually associated with depression and hopelessness about the future espcially related to death and dying. Guilt feelings may also arouse anxiety. Lack of a productive life may lead to apprehensions about economic sustenance. Previously existing anxiety traits can also worsen at this age leading to restlessness, tremor of hands and poor sleep. Treatment includes anti anxiety drugs and supportive psychotherapy.
Hyprochondriases :This is also mostly associated with primary depression, probably due to greater self centeredness and proneness to physical illness, leading to unnatural preoccupation with bodily functions, especially of digestion, evacuation, bones and joints. Psychologically these may represent an unconscious expression of the person’s emotional dependency needs and a cry for emotional support.
Paranoid Disorders : Present in nearly 10% of psychiatric patients over 60 years, more commonly in women. Prominent features are persistent feelings of being persecuted by people around him or her, or intense feelings of jealously, or bizarre complaints involving organs or parts of the body (like insects crawling over), or even hallucinatory voices. Stressful circumstances, family breakdown, isolation and sensory deficits are associated with paranoid disorders.
They respond well to antipsychotic drugs with a careful monitering of side effect by a psychiatrist. Some may require hospitalization if the the person is non cooperative or a nuisance to others.
Organic Mental Syndrome : Sometimes certain mental symptoms are present when there is any kind of injury, infection or metabolic changes in the brain (which regulates all our behaviors). Two such important conditions are :—
(1) Delirium which is characterized by confusion, disturbance of attention, disorientation and perceptual distortions such as illusions and hallucinations. Speech is incoherent, sleep is disturbed and the person is restless.
(2) Dementia (Alzhermer’s disease, Multi infarct Dementia) which is characterized by loss of intellectual or cognitive functions leading to gradual deterioration of social and occupational functioning and, an inability to care for oneself. The main features are increasing forgetfulness, difficulty in finding words while speaking, inability to carry out even simple activities of daily living, errors in judgement and disorientation to persons, place or time.
In both these above conditions, a through examination and investigations under the supervision of a neurologist who also coordinates the medical treatment is absolutely necessary. Constant care, supervision and help to carry out daily activities is must, as these people may eventually become incapable of taking care of themselves. With better standard of living and medical breakthroughs there is life beyond sixties.
Today old age does not necessarily spell death, disease and despair. if one plans for old age economically and psychosocially and seek early treatment if problems arise, there is life beyond sixties.