| India has grayed. There are more than 100 million Indians now above the age of 60 years. Life span has increased from 32 years in 1947 to around 65 years now. With better standard of living and medial breakthroughs, there is life beyond sixties. Nothing remains static in this world and this is true for the human body too. Biologically speaking the aging process starts the moment we come into this world.
Nearly 50% of the aged have some physical ailment or sensory deficit. Besides these universal aging associated deficits, the brain itself undergoes changes, loss of vast number of neurons leading to slowing down of thinking process and mental alertness. However, an elderly person who continues to be physically active and mentally alert can retard this aging process to some extent and reduce associated physical and psychological problems. Absence of any useful, goal directed activity and dull, inactive mind hastens disability. Personality and mood changes such as increased irritability, self centeredness, social withdrawal or feelings of insecurity and neglect worsen these changes.
Moreover in the present day period of rapid urbanization and changes, breakdown of the joint family system, migration of youth to other cities and abroad, inadequate living space and generation gap have had a particularly telling effect on the elderly who get marginalized and sadly neglected, falling an easy prey to a host of illnesses or diseases. The insecurity of living in hostile/uncaring society is a constant source of fears and anxiety.
There are some psychosocial variables leading to increased mental and emotional problems in the elderly.
• Female sex and widowed state.
• Unemployment or retirement leading to dependency on others.
• Living alone causing feeling of neglect, loneliness, social isolation.
• Physical illness or disability and Sensory deficit
• Special stressors - Retirement, loss of status, fall in income, loss of health, unavailability of loved ones and lack of purpose in life.
PSYCHIATIRC DISORDERS IN OLD AGE
A. Depression: In spite of strong family bonds and cultural practices that revere the aged, depression still ranks as the most prevalent psychiatry illness of the aged, which is more common amongst women than in men. 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 aches 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.
Treatment:
• Thorough physical exam and routine investigations to rule out presence of a physical illness or side effect of certain medication.
• Anti depressant drugs may be the treatment of choice in most cases, under the supervision of a psychiatrist.
• Psychotherapy to identify life stresses, areas of conflicts and social support to help the person cope better with his or her problems and crises.
B. Anxiety disorders: This is usually associated with depression and hopelessness about the future especially related to death and dying or personal/ family security. 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 or supportive psychotherapy or relaxation techniques including breath management and meditation.
C. Paranoid Disorders: Present in nearly 10% of psychiatric patients over 60 years, more commonly in women. Prominent features are persistent feelings of being presorted 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) - often to delusional proportions and many a times even complain of hallucinatory voices..
D. Organic Mental Syndrome: Sometimes certain mental symptoms are presented when there is any kind of injury, infection or metabolic changes in the brain which regulates all our behaviors. Two such important conditions are:
• Delirium which is characterized by confusion, disturbance of attention, disorientation and perceptual distortions such as illusions and hallucinations..
• Dementia (Alzheimer’s disease, Multi Infarct Dementia) which is characterized by loss of intellectual or cognitive functions which leads to gradual deterioration of social and occupational functioning and an inability to care for oneself..
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