KASHMIR: In the backdrop of 10th October

"The day 10th October is the 21st  anniversary of mental health day. Twenty years back Richard Hunter thought of telling the world that there is no health without mental health and he proclai...

"The day 10th October is the 21st  anniversary of mental health day. Twenty years back Richard Hunter thought of telling the world that there is no health without mental health and he proclaimed 10th October as mental health day to focus the world attention on improved care for mental health issues. The world woke up to the reality of mental health and 10th October has become the regular affair world over to recognize and register the epidemic of mental health problems. The theme of World Mental Health Day in 2013 is "Mental health and older adults".
To age is to grow, and decline at the same time; aging is a biological reality with its own processes  most of them still not in our control. With improving global health aged population is increasing steadily. The world will soon have a unique demographic spectacle; those aged 65 and more will outnumber those aged less than 5. The world population of 60yrs and above is estimated to reach 2 billion by 2050  and has already doubled since 1980.This is undoubtedly a cause to rejoice for GLobal health initiatives but these celebrations may be premature if we do not brace up to these new shifts in the demographics. Older people make important contributions to society as family members, volunteers and as active participants in the workforce. The wisdom they have gained through life experience makes them a vital social resource.But with this demographic shift come the challenges and most of this challenges are to health care. It is important to prepare health providers and societies to meet the specific needs of older populations.With age we lose ability to live independently because of restricted mobility,loss of vigour and declining cognitive functioning.
Along with these global demographic trends are enormous social upheavals with globalisation, urbanisation , declining of family as unit.which will mean fewer people to care for aging population within the families.
The  definition of 'health' with regard to old age is a subject of debate. There is a consensus that health in old age cannot meaningfully be defined as the absence of disease because the prevalence of diagnosable disorders in elderly populations is high. Instead, health is considered to be multifaceted: The diagnosis of disease should be complemented by assessment of discomfort associated with symptoms (e.g., pain), life threat, treatment consequences (e.g., side effects of medication), functional capacity and subjective health evaluations (Borchelt et al., 1999). Furthermore, Rowe & Khan (1987) suggested that the health of subgroups of older adults be defined in terms of their status relative to age and cohort .Non communicable diseases  are the commonest afflictions of elderly population,among them neuropsychiatric disorders are the commonest.20 percent of elderly do have some neuropsychiatric illness severe enough to cause disability.Depression and dementia are the commonest but good proportion of elderly have anxiety disorders .Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time. As well as the typical life stressors common to all people, many older adults lose their ability to live independently because of limited mobility, chronic pain, frailty or other mental or physical problems, and require some form of long-term care. In addition, older people are more likely to experience events such as bereavement, a drop in socioeconomic status with retirement, or a disability. All of these factors can result in isolation, loss of independence, loneliness and psychological distress in older people. Mental health then impacts the physical health and vice versa and this vicious circle usually has devastating effects on elderly.
Depression is a common affliction of of old age and in contrast to the factors responsible in younger age like genetic and psychological predisposition, negative life events depression of old age is usually linked to physical ailments disability and frailty. The other important factors is loneliness which is a subjective, negative feeling related to the person's own experience of deficient social relations. That subjective experience usually come from deficient external factors like social networking, social support etc or psychological and personality factors leading to aloofness. Loneliness besides being important cause for depression substantially increases risk of suicide and suicide attempts in elderly. Loneliness also contributes significantly to deaths because of other physical causes. Loneliness of elderly is also of concern to our culture. The conflict created empty nests wherein parents pushed their kids out of Kashmir for safety concerns. These kids were brought up in alien cultures, there chances of coming back decreased with every passing day because of employability and adjustability in own culture,the net is majestic mansions with lonely elderly…..Empty Nest.
Loss and grief are integral part of aging, from loss of mobility to independence and to loss of loved ones, elderly do experience these losses at higher frequency than young population. Thus do contribute to depressive morbidity, in-spite of what DSM tells us I strongly feel that grief and mourning are part of our normal being and not diseases and only when they result in complete loss of joy and pleasure and result into sense of pervasive despair rather than sense of purpose and hope that the distinction between two gets blurred. I also see role of our spiritual being, which is innate to our culture and hence our very being helping us mourn and grieve without getting depressed.
Elderly maltreatment is increasingly being recognised as an important mental health issue of aging.There is very scarce data about this problem from under developed and developing world ,but is increasingly being recognised in developed world in more than 7percent of aged population. WHO defines Elder maltreatment as a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.when we look at our changed urbanised breaking culture and this definition maltreatment seems to be plenty without mechanisms of redressal.
Elie Wiesel said that without memory there is no culture. Without memory there is no civilisation, no society, no future. And one of the consequences of changing demographics is lot of elderly population with fading memories -dementia as it is called is not part of normal aging it is a clinical syndrome that effects memory, behaviour and thinking and hence the routines. Dementia is a global epidemic projections indicate that the number of people with dementia will continue to grow, developing  countries will experience the greatest growth. The total number of people with dementia worldwide is estimated at more than 35million and is projected to nearly double every 20 years, to nearly 70 million in 2030 .The total number of new cases of dementia each year worldwide is nearly 7.7 million, implying one new case every four seconds. Ask the families who have patient with dementia ,it is overwhelming for patients but it is no less burden on families. Dementia effects families physically socially ,economically and psychologically as well.
The problems are plenty but do we have solutions. The focus of our health care system is still communicable diseases, below 5, maternal and child health, the focus has to remain as we still have lot to do in these priority areas , but we cannot be oblivious to the changing realities of health .
Aging society and its mental health consequences are a reality and we need to refocus our health agendas to fit in needs of changing society. From lessening loneliness to preventing elderly abuse to early detection and diagnosis of depression and dementia the tasks are many. All stake holders need to be involved and a public health approach is the only way forward to improve care and quality of elderly population.The complete dissociation between need and planning is reflected in the fact that we still do not have geriatric health facility even at tertiary care centres of state. The policy makers need to wake up to the new realities and priorities and act now. By all what we have done in health till now has achieved the goal of adding years to life expectancy,but what we need to do now is to add life to these years.
Dr Arshad Hussain is assistant professor department of psychiatry, Govt Medical College Srinagar

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