The Grey Matter

CHENNAI: There’s no more ‘growing old’ when you hit 60. You’re already there, and with it, comes a host of health problems that can leave the most health-conscious feeling vulnerable and miserable.

The problem is compounded when senior citizens become mentally ill with issues like loneliness-induced depression, anxiety, psychosis, dementia and Alzheimer’s, etc.

Dementia, depression

Though technological advancements have helped in improving the quality of life of senior citizens, when you’re 60 years and above, health issues are a given. Therefore, the need to take care of one’s health, in the holistic sense, gains significance.

“One of the most common mental health issues among the elderly are depression and dementia. Dementia mainly occurs due to the change in the cognitive functioning of people at an advanced age,” said Vandana, consultant psychologist at V-Cope.

“Depression can lead to forgetfulness and preoccupation; so when we meet a senior citizen with such symptoms, we try to rule out depression first.”

She added that co-morbidities such as diabetes, hypertension and other chronic issues can also impact the mental health of senior citizens as it affects their moods. It is important to monitor their health as it can lead to anxiety.

“Loneliness is common among the elderly. That’s why it’s important they get emotional support in the form of love, care and concern. The family needs to take note of their resilience and coping mechanism in times of a crisis or hardship.

These factors help to determine psychological state, and if there was a lapse, how fast they would recover,” she added.

Burden to families

It’s also common for senior citizens to become dependent on others for basic everyday tasks. When they’re diagnosed with an illness, it adds to their insecurity of becoming a burden to the family.

“Old people often complain about their inability to find a job or even keep one because of the limitations of age and the competition they face with a workforce that’s largely younger than them.

This is a huge stress factor,” says a psychotherapist at the Institute of Mental Health. “After a diagnosis of a health problem, or a stroke or paralysis, senior citizens get stressed over their dependency on their family and loved ones.”

Dementia is also common. Forgetting their loved ones, becoming suspicious of everyone they used to hold dear, and seeing danger when there’s none – all this adds to their challenges.

Psychotherapists in the city stated that there were many old parents of adult-children with physical and/or mental disability. “They worry that their adult-children would not have anyone to take care of them, as they could not find a spouse who would be their caregiver.

So the uncertainty of ‘Who will take care of my child after I’m gone?’, a classic caregiver burden, leads to anxiety, depression and even psychosis,” added a psychotherapist.

Trivialised, ignored

Mental health professionals also get patients who have been unaware of their sexual orientation all their lives and realise it in their old age.

“We’ve seen people from the LGBTQIA+ community who began understanding their sexuality at an advanced age. They want to live their lives with their true identity but they don’t know how.

They have no idea how to approach people or how to explore their life,” added the psychotherapist.

Mental health concerns of the elderly are often ignored, trivialised and dismissed as ‘age-related issues’. However, it’s also a challenge to diagnose and manage them among the elderly, due to social stigma, limitations of physical illnesses, generation gap and difference of opinion and stigma.

“There’s a lot of undiagnosed depression among the elderly. Sometimes, symptoms would present in the form of memory issues while in actuality, what they have is underlying depression,” opined Vaishnavi, psychologist, IMH

For instance, it’s common to mistake cognitive problems as part of the normal aging process, or perceive complaints of pain as attempts to get attention from family. That’s why screening and early diagnosis are essential to prevent any untoward event.

“Senior citizens often feel invisible and useless. They believe they don’t belong anywhere. Hence, it is important to make them feel seen and productive,” she added.

Treatment approach

Psychologists at the IMH opined that to understand the mental health issues of the elderly, it was important to first understand their feelings.

“Having an empathetic approach helps. We have to give them a listening ear to understand what’s bothering them. Sometimes, we have to treat them like children.

If they’re educated, it’s easier to make them understand about their condition and treat them accordingly. Yes, a medical intervention has to be done to determine other illnesses,” says a psychologist at the IMH.

Treatment for mental health issues and therapy for the elderly are similar to the strategy adopted for youngsters. With the existing stigma and challenges such as lack of awareness about mental health, it’s difficult to explain their mental health concern to the elderly themselves.

“Most elderly patients come to us with complaints of sleeplessness and loneliness. They’re unaware of their mental health issues. They take a long time to understand it.

Very rarely have I met elderly patients who know what’s wrong with them,” said Dr Poorna Chandrika, former director, IMH. “Some live far away from their kids and there is a lack of monitoring.

If they’re in conflict with their kids, we have to spend more time to earn their trust so that they open up about their concerns. Some become very attached to us and expect reassurance and support from their therapists.”

Often, a mental health condition among the elderly is very different from the psychiatric problem that psychiatrists face. It could just be an electrolyte imbalance or a change in their routine that they are unable to cope with.

“In that case, treatment includes psychotherapy and cognitive re-framing. Elderly are more prone to falls and there are a lot of comorbid conditions or side effects, so medications are also given based on a slow approach. If there is a disruption in their routine, they tend to get upset,” pointed out Dr Poorna.

WHO’s world projections

Between 2015 and 2050, the proportion of the world’s population over 60 years will nearly double from 12% to 22% (from 900 million to 2 billion).

Depression is both under-diagnosed and undertreated in primary care settings. Symptoms are often overlooked and untreated because they co-occur with other problems encountered by older adults