Dr.Shivani Salil

My grandmother is turning 85 and my daughter is the most excited about it. Her excitement is contagious but somehow the ‘birthday girl’ isn’t catching it yet. Far from it, she seems rather unhappy. She was a very independent woman but age finally is having its way. After her husband’s death few years ago, she chose to live on her own. We were skeptical but wise enough to respect her choices. Unfortunately as her sense of hearing and sight diminished, it was a risk we weren’t willing to take. So reluctantly she moved in with us and her best ally and friend now is my nine year old daughter who sneaks in her favorite candies thinking that no one is watching. As much as this gladdens me, I do miss MY grandmother who looks like my daughter’s great grandmother but is a different person altogether. Of course the physical changes are attributable to age but when did that talkative woman become so quiet? Sometimes I can almost see a shell she withdraws into. I naively look for the bright eyed adventurous lady but find a somewhat rigid and scared person instead.

In a country where mental health is any way a neglected zone, expecting people to bother about mental health of the elderly is probably too much to expect. But the numbers that the WHO factsheet throws at you are alarming. Take a look:

  • Between 2015 and 2050, the proportion of the world’s population over 60 years will nearly double, from 12% to 22%.
  • Neuropsychiatric disorders among the older adults account for 6.6% of the total disability for this age group.
  • Approximately 15% of adults aged 60 and over suffer from a mental disorder.

Mental health and emotional well-being are as important or rather more important in older age as at any other time of life. It’s like the writing on the wall that we cannot ignore. Like my grandmother, most old people find themselves lonely, depressed, anxious and stressed out. Old age creeps in silently and changes their bodies and their psyche as well. Limited mobility, chronic pain, frailty or other mental or physical problems that need long-term care contribute to their troubles. To top all of this are stressors such as bereavement, a drop in socioeconomic status with retirement, or a disability. Their self-esteem gradually erodes as they find themselves losing control over day to day stuff.Depression, dementia, substance abuse and late-onset psychosis are some of the problems that our senior citizens face. There is a strong inter relation between mental and physical health. Medical conditions like heart disease are linked to higher rates of depression and conversely an untreated depression in an older person with heart disease negatively affects the outcome of the physical disease.

We may not admit to it but there is also the aspect of elder abuse- including physical, sexual, psychological, emotional, financial and material abuse; abandonment; neglect; and serious losses of dignity and respect. Current evidence suggests that 1 in 10 older people experience elder abuse.

Society needs a major mindset change with regards to the elderly. Their contribution cannot be measured in terms of productivity. We need to realize that their contribution is in BEING THERE. Paradoxically when they need more love we tend to ignore them. We are living such mechanical lives that unless we reconnect with our roots and our older relatives, we’ll end up as autobots. It is extremely desirable that the younger family members learn to adapt and adjust with them and listen to all their grievances with care and attention. If you think you are doing them a favor then try spending some time with them. Talking to the elderly gives you a sense of connect with your identity. Their presence is stabilizing and what your children will learn at their knee, no classes can replace that learning. Little children feel warm and secure in their presence. The children who grow up around older relatives turn into warm, empathetic individuals with a stable mindset to match it. So do YOURSELF a favor and spend time with them. Do not laugh away their concerns and anxieties. Give weightage to their words. Your children will follow you and be motivated build a relation with them. Involve the children in the care giving to the elderly.

As you try to connect to their level, also introduce them to your world. They feel a little less lost and though it takes patience but it’s well worth it. It was a pleasure watching my daughter teaching my father how to make a power point presentation. She was so proud to share her recently acquired skill and my father was all ears to her. It was a mutual confidence building exercise. What with the boom of social networking sites, hold their hand through the basics and let them discover the virtual world. Encourage them to take walks in the nearby open spaces. You’ll be surprised, relieved and happy when they make new friends. All of this just helps them find focus in their life and also promotes active and healthy ageing. Often I have encountered a sadness in their eyes that seem to be just waiting for their end. The health providers and society needs to be more receptive to the specific needs of older populations. Geriatrics, the branch of medicine that deals with older age group, needs to be given due importance. The health system has to be essentially equipped in preventing and managing age-associated chronic diseases including mental, neurological and substance use disorders.

he government has to take it up as a policy so that long-term and palliative care is a sustained effort. An appropriate and supportive legislative environment based on internationally accepted human rights standards is required to ensure the highest quality of services to old people with mental illness and their caregivers. With the geriatric population on the rise, age-friendly set ups and hospices are the need of the hour so that the elderly can have a dignified life. It requires creating living conditions and environments that support wellbeing and allow people to lead healthy and integrated lifestyles. Financial schemes that may give a monthly dividend should be brought out and people should be encouraged to invest in them so that in their old age dwindling finances should not force them to do what they don’t want to. Old age is like everything else. To make it a success you have to start young. To promote mental health, strategies are needed which will ensure that the elderly have the necessary resources to meet their basic needs. It could mean.

  • A supportive housing policy and schemes promoting community life
  • Social support for older populations and their caregivers
  • Programmes that target vulnerable groups like those who live alone or the rural populations who anyway have limited access to services

If the society is involved in geriatric care, a prompt recognition and treatment of mental disorders becomes possible. Interventions in terms of counselling and/ or medication may be required. An early diagnosis helps in optimal management. Regular checkups also help in timely diagnosis and treatment of accompanying physical illness, if any.

We all need to remember that our elderly are here today but will be gone tomorrow. And also that old age is a finality for all of us. We don’t have to imagine ourselves in their shoes, soon we WILL BE in their shoes. Treat them the way we would want to be treated.