The World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”.
Because mental health is vital to overall health and well-being, it must be acknowledged and treated in senior citizens, with the same urgency as physical health.
For this reason, mental health is becoming an increasingly important part of the public health mission. Senior Citizens face special physical and mental health issues which need to be addressed on priority. Societal modernization and nuclear family norm has brought breakdown in family value system and the framework of family support.
Due to many reasons, children move to urban areas and even outside the state, sometimes leaving their ailing parents alone at home. If the parents move with their children, they are sometimes unable to adjust to the new environment.
The change in the family structure and increasing intolerance among children results in the senior citizens losing their relevance and significance in their own home.
Indifferent behaviour of children, especially after their marriage increases feelings of loneliness and worthlessness among their respective parents.
Being harsh and detached with elderly parents tends to be detrimental for their mental wellbeing and results in their physical deterioration as well.
In some cases, senior citizens are discriminated on the basis of their age, which is called ageism. In one of the case studies a principal of a reputed Government college post retirement was compelled by his family members to take a private job.
He was appointed as principal in one of private colleges, it was a nightmarish experience for him. During harsh winter he was without a heating arrangement and when he resisted the young arrogant chairman insulted him in- front of staff and fired him for being old. After being insulted, as he reached home he got a stroke and became handicapped.
With the passage of time his own children got irritated because he was now a physically dependent patient. So they confined him to his bedroom and restricted his social interaction with the excuse “Daddy is ill”.
His mobile phone was confiscated and food was served to him in his bedroom. He died as an unsung hero; his certificates, PhD thesis, huge collection of books was sold to the scrap seller by his children.
Studies in primary care settings point to a higher prevalence of depressive disorders amongst the senior citizens with chronic comorbid diseases. All these factors make the senior citizens more prone to psychological problems.
Even though depression is the commonest psychiatric disorder in the senior citizens, it is often misdiagnosed and under-treated. Perhaps due to the misconception that depression is part of ageing, rather than a remediable condition.
In the absence of treatment, there will be significant clinical and social implications in the lives of the senior citizens, as depression has a tendency to be chronic or recurrent. Depression is more than just a low mood.
Rather, it is a condition in which one may experience persistent sadness, withdrawal from earlier enjoyed activities, difficulty in sleeping, physical discomfort, and feeling “slowed down. Risk factors for late-onset depression include widowhood, physical illness, elder abuse, abandonment and neglect.
Love and care of children serves as a major support system for the ageing parents and results in reduced risk of their mental and physical illness. Social support is also instrumental in the wellbeing of elderly.
An action research was conducted by the investigators on senior citizens for which “An Anxiety and Depression module for senior citizens” was developed.
One of the questions in this module was “How often do you get the social and emotional support you need?” The response options included: “always”, “usually”, “sometimes”, “rarely”, or “never.” Significant number of retired senior citizens reported that they were not receiving the support they needed or expected.
Second question was “In general, how satisfied are you with your life?” The response options included: “very satisfied”, “satisfied”, “dissatisfied”, or “very dissatisfied.”.
Significant number of senior citizens reported they are not satisfied with their life and they were feeling disillusioned. They wake up in the morning without any direction or compass.
Many senior citizens adjust and accept the changes during the process of ageing. But some senior citizens have trouble adjusting these inevitable changes, predisposing them to depression and anxiety.
Some of the warning signs (checklist for identification of mental disorders in senior citizens) include (a) Mood swings or emotional oscillations (b) A change in eating or sleeping habits (c) Withdrawing from the people and activities one enjoys (d) Feeling bizarrely confused, forgetful, angry, upset, worried, or scared (e) Feeling numb or like nothing matters (f) Having unexplained aches and pains (g) Feeling sadness or hopelessness (h)Smoking, drinking, or using drugs more than usual (i) Anger, irritability, or aggressiveness (j) Having thoughts and memories that you cannot get out of your head (k) Hearing voices or believing things that are not true (l) Thinking of harming self or others.
Usually, senior citizens need a listening ear, care and acknowledgment from the family. Effective primary level mental health care for senior citizens is crucial. It is equally important to focus on long-term care and concern for senior citizens suffering from mental disorders.
An appropriate and supportive family and social environment based on internationally accepted human rights standards is required to ensure the highest quality of services to senior citizens with mental illness.
Balanced diet and regular exercise has also a positive impact on mental health of the elderly. To conclude we need to respect older people as a rich source of wisdom and experience, as an asset to family and society, not a burden.
Dr Zubair is a Senior Geriatric Consultant and Dr Showkat Rashid Wani is a Senior Coordinator Directorate of Distance Education, University of Kashmir
DISCLAIMER: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.