Internationally, populace is ageing speedily. According to WHO report, it is anticipated that the number of persons aged 60 or over is expected to more than triple by 2100. Neuropsychiatric disorders among the older adult are more prevalent. Statistical reports indicated that 15% of adults aged 60 and over experience mental ailment.
Older people who cross 60 years of age undergo numerous health problems. These adults are highly important for healthy society and contribute a lot as family members, volunteers and as active participants in the workforce. Though some elderly people maintain good health through exercise, nutritious diet but many older adults are at risk of developing mental disorders, neurological disorders or substance use problems as well as physical illness or disability. Major neuropsychiatric disorders in this age group are dementia and depression.
Reports indicated that anxiety disorders affect 3.8% of the elderly population, substance use problems affect almost 1% and around a quarter of deaths from self-harm are among those aged 60 or above. Substance abuse problems among the elderly are often ignored or misdiagnosed.
In global society, there are manifold social, psychological, and biological factors determine the level of mental health of a personas well as the typical life stressors common to all people.Manyelderly peopleunable to live independently because of restricted mobility, long-lasting pain, infirmity or other mental or physical problems, and they need long-term care from their family members. Additionally, older people sometimes experience feeling of bereavement, lower social status in society with retirement, or a disability. These factors leads to isolation, loss of independence, loneliness and psychological anguish in elderly people.
Psychologists stated that mental health has great impact on physical health and vice versa. It can be established in medical reports that elderly people who experienced physical health conditions such as heart disease may develop feeling of depression as compared to people who are healthy.On the other hand, depressive elderly people with heart disease can negatively affect the result of the physical disease.
It has been observed that elderly people are physically neglected and sometimes they are treated badly in family as well as in society. Elder maltreatment can lead to physical injuries, as well as serious long-lasting psychological problems such as depression and anxiety.
One of the continuing problem with diagnosis and treatment of mental illness in elderly people is that they are more likely to report physical symptoms than psychiatric complaints. Though, even the normal physical and emotional stresses that go along with agedpeople can be risk factors for mental illnesses such as anxiety and downheartedness. The Geriatric Mental Health Foundation observed numerous triggers for mental illness in the old people:
There are numerous warning signs, which could indicate a mental health concern in older people:
Dementia and depression among the elderly as public health issues.
Dementia is a type of disorder that affects person’s brain works. Dementia is a syndrome in which patient’s condition is deteriorated in terms of memory, thinking, behaviour and they have difficulty to perform everyday activities. It mainly affects older people, although it is not a normal part of ageing.It is predictablein reports that 35.6 million people worldwide are living with dementia.
The total number of people with dementia is projected to almost double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050, with majority of sufferers living in low and middle income nations.
Medical experts affirmed that Dementia is a common condition of the elderly people characterised by manifold cognitive deficits resulting in a decline from previous level of function. In the older person, multiple pathologies contribute, including changes dementia with Lewy bodies in addition to vascular changes. Comorbid factors, such as depression, delirium and polypharmacy can contribute to cognitive decline. The most common of effect of dementia is Alzheimer’s disease. Another is vascular dementia which can develop following a stroke or if there is blood vessel damage that disrupts the supply of blood to brain. Dementia is not a normal consequence of growing old.
There are important social and economic problems in terms of the direct costs of medical, social and informal care associated with dementia. Furthermore, physical, emotional and economic stresses can lead to great pressure to families. It is necessary that the health, social, financial and legal systems must support people with dementia and their caregivers.
Dementia has numerous causes. Many medical conditions can cause dementia symptoms, especially in older people. The causes of dementia include various diseases and infections, strokes, head injuries, drugs, and nutritional deficiencies.
All dementias reveal dysfunction in the cerebral cortex, the part of the brain that controls perception, memory, thoughts, language, and consciousness. Some disease processes harm the cortex directly while others disturb subcortical areas of the brain that normally regulate the function of the cortex.
When the fundamental process does not permanently damage the cortical tissue, the dementia may sometimes be stopped or retreated.
To classify dementias, medical specialists may either separate the causes into cortical or subcortical dementias or into reversible and irreversible dementias.
Untreated brain infections such as HIV, Lyme disease damage brain cells by forming lesions and trigger inflammatory responses that damage or kill brain cells.
Symptoms of dementia differ significantly by the individual and the original cause of the dementia. The first sign of dementia is usually loss of short-term memory.
The person repeats what he just said or forgets where he put an object just a few minutes ago. Other symptoms and signs are as follows:
When to visit doctor: Elderly people who are experiencing dementia may not be aware of problem. Most people with dementia are brought to medical attention by a caring relative. Patients must seek medical attention in following conditions.
In some elderly people, the signs and symptoms of dementia are easily recognized; in others, they can be very subtle. It is important to perform a careful and thorough evaluation to identify their real cause. Health care provider will conduct a detailed medical interview to develop a picture of the symptoms. A systematic physical examination will look for evidence of illness and dysfunction that might shed light on what is causing the symptoms. An assessment of dementia symptoms should include a mental status evaluation.
Many medical researchers have stated that the progressive changes that occur in later life, such as at the time of retirement, the death of partner, increased isolation, and other medical problems lead to depression. In elderly people, it is most common mental problem. Depression also impacts person’s energy, sleep, appetite, and physical health.
Depression can cause great sorrow and leads to decreased functioning in daily life. Medical reports have signified that unipolar depression occurs in 7% of the general elderly population and it accounts for 1.6% of total disability among over 60 year olds.
Symptoms of depression in older people are often ignored and not treated because they overlap with other late life problems. Depression in the elderly often increases their risk of cardiac diseases and increases their risk of death from disease. Depression also increases the risk of suicide, especially in elderly men.
The suicide rate in people ages 80 to 84 is doubled as compared to other age groups.
Depression in the elderly people can lead to following symptoms:
There is a responsibility of health care agencies to train health providers and societies to meet the specific requirements of older people such as:
There are several treatment procedures for depression. They include medicine, psychotherapy or counselling, or electroconvulsive therapy or other newer forms of brain stimulation (such as repetitive transcranial magnetic stimulation. Sometimes, a combination of these treatments may be used to treat depression of elderly people.
For severe depression, medical practitioners use antidepressant medication.
Antidepressant medication may take longer to work in older people.
Another therapy effective in older people associated depression is electroconvulsive therapy (ECT). It is a useful treatment in melancholic and psychoticdepression when individuals who do not respond to medication, or when thedepression is very severe.
In the non-melancholic depressions, the usual range of psychotherapies is applicable.
Thoughpsychotherapists need to take into account the limitations imposed by poor hearing,poor eyesight and physical discomfort.
Depression can be prevented in older age group through lifestyle changes. There is growing data that cerebrovascular disease may be linked to depression in old age, so controlling the recognized risk factors for vascular disease may also prevent depression.These include:
Mental health of elderly people can be enhanced through promoting active and healthy ageing. Mental health-specific health promotion for the older adults involves creating healthy living conditions that allow people to lead integrated lifestyles. Promoting mental health depends on policies which ensure the elderly have the necessary resources to meet their basic requirements, such as:
It is important to quickly recognize and treat mental, neurological and substance use disorders in older adults. Both psychosocial interventions and medicines are suggested.
There is no medication currently available to cure dementia but some steps must be taken to support and improve the lives of people with dementia and their caregivers such as:
In community, older people must be given importance. There is a need to support them to maintain good general health and social care in order to prevent disease and manage chronic illnesses. Training all health providers in working with issues and disorders related to ageing is important. Effective, community-level primary mental health care for older people is vital. It is significant to focus on the long-term care of older adults suffering from mental syndromes, as well as to provide caregivers with education, training and support.
Anxiety disorders are also common in old age and may burden the public health system even stronger than depressive disorders. Anxiety at old age is often silent or difficult to diagnose as older adults tend to somatise psychiatric problems, have multiple psychiatric, medical, and medication issues. When elderly people are diagnosed with anxiety disorders, there is a relatively high probability of comorbid conditions being present. Van Balkometal.found that major depression, benzodiazepine use, and chronic somatic diseases were significantly more predominant in old people with anxiety disorder. Women do have a higher occurrence of anxiety disorders than men but this difference diminishes with growing age.
For treatment of anxiety disorder, effective psychotherapies such as cognitive behavioural therapy (CBT) are applied to the older adult population, and the combination of CBT and medication is more successful.
Medical specialists stated that many cases of delirium can be prevented by addressing modifiable risk factors and integrating environmental and clinical practice strategies in the care of older people. It is significant to involve family members and carers in the process of diagnosing delirium. Older people who affected by delirium are at greater risk of falls, functional decline and cognitive decline. Delirium is also related with higher mortality and morbidity, increased length of hospital stay and admission to residential care.
To treat delirium, Non-pharmacological strategies are used for all patients. The nonpharmaco logical approaches available include reorientation and behavioural intervention. Caregivers should use clear instructions and make frequent eye contact with patients. Sensory impairments, such as vision and hearing loss, should be lessened by use of equipment such as spectacles or hearing aids. Physical restraints should be evaded because they lead to reduced mobility, increased agitation, greater risk of injury, and prolongation of delirium. Other environmental interventions include limiting room and staff changes and providing a quiet patient-care setting, with low-level lighting at night.
It is well established in reports that mental disorders in elderly population are recurrent and they are frequently underdiagnosed. Most mental disorders are treatable once detected. Untreated mental disorders intensely impair life of patients andcare-givers, cost money, promote further ill health and burden for thepublic health system of nation.