Journal of Research, Extension and Development October 2013, Vo. 1, No.7, pp.

9 -12

ISSN: 2319-1899

Gerontological Mental Health in India

P. Udhayakumar1 and P. Ilango2 Abstract Aging is a universal phenomenon associated with deteriorating socio-psycho-physiological changes. This article explores the gerontological mental health problems among the Indian older adults. Secondary source of data was administered by using Situation Analysis of the Elderly in India (2011), NSSO Survey on Disability (2002) and Indian Population Census (2001) to assess the prevalence of mental health problems among Indian elders. The article continues with a discussion of gerontological mental health problems and concludes by addressing the role of gerontological social work in promoting gerontological mental health. Ph.D Research Scholar, Department of Social Work, Bharathidasan University, Tiruchirappalli. 2 Professor & Head, Department of Social Work, Bharathidasan University, Tiruchirappalli.
1

Introduction The ageing of the worlds population is a global phenomenon with extensive economic and social consequences. The ratio of the elderly population (60 years and older) is now 1 in 10. By 2050, those with age group of 80 will represent 27% of older population (Tan, 1999). The emergence of the specialty of psychiatry of the elderly has helped to raise the status of this vulnerable group and has also fostered research which offers hope for better treatment and outlook and provides the opportunity for training students in all health and social care related disciplines (WHO, 1996). Elderly people are regarded as one of the vulnerable populations in the field of nursing. Vulnerable populations are defined as being at risk of poor physical, psychological, and social health (Aday, 2000) and thereby require special care and attention. Older adults with mental illness frequently have substantial functional limitations, medical comorbidities, and cognitive impairments that together require a complex array of services. Comprehensive services for elders with mental illness have not traditionally been available in the community (Bartels, Levine, & Shea, 1999). Mental health disorders are an enormous social and economic burden to society by themselves, but are also associated with increases in the risk of physical illness (World Health Organization, 2001). Depression and anxiety are the most common mental health problems for older adults and have received the most research attention. Further they also have a major impact on the lives of older adults and their families. The surgeon generals 1999 report on mental health devoted a whole chapter to older adults and mental health, addressing a wide range of issues including serious mental illness, minor depression, Alzheimers disease, and substance abuse. The report concluded that mental illness among older adults will become a major public health problem in the near future because of demographic changes (U.S. Department of Health and Human Services, 1999). 1

Mental Health Problems among Elders Approximately 20% of older adults have a mental illness today, yet only half of older adults who acknowledge such problems receive treatment and only a fraction of those receive specialized mental health services (Dupree et.al., 2005; U.S. Department of Health and Human Services, 1999). Mental disorders among older adults may substantially impair physical functioning and result in unnecessary hospitalization or nursing home placement and increased rates of mortality. At the same time, individuals with physical health problems are more vulnerable to mental illness (Speer & Schneider, 2003; U.S. Department of Health and Human Services, 1999). Common psychiatric problems which prevail among elders are depression, Anxiety, dementia and suicide. Depression is the most common mental health problem of later life, affecting 1020 per cent of older people (NIMHE, 2005) and up to 40 per cent of care home residents, yet in older people depression is often underdiagnosed and under-treated. Studies suggest that among the elderly, anxiety disorders are more common than are depressive disorders, with prevalence rates of generalized anxiety disorder ranging from about four to twelve percent. As with depression, research suggests that the rate of sub-clinical anxiety symptoms is much higher than more severe, diagnosable disorder. The prevalence of sub-clinical anxiety is estimated at 17 to 21 percent (Himmelfarb & Murrell, 1984). Acute confusional states, nowadays synonymously called delirium, are frequent and dangerous events in elderly hospitalized patients. Elderly people have a higher risk of completed suicide than any other age group worldwide (WHO, 2002). Despite this, suicide in elderly people receives relatively little attention, with public health measures, medical research, and media attention focusing on younger age groups (Uncapher et al., 2000). Methodology The aim of this research study is to understand the mental health problems of Indian elders. The objectives of the study are: 1. To study the prevalence of gernotological mental health problem among the Indian elders. 2. To suggest suitable measure to improve the mental health status of the elderly. Secondary source of data was administered for this study by using Situation Analysis of the Elderly in India (2011), NSSO Survey on Disability (2002) and Indian Population Census (2001) to assess the prevalence of mental health problems among Indian elders.

Table 1 Percent Distribution of Population by Broad Age Group, India since 1951 Age Years 0-14 15-59 60+ Total 1951 38.4 56.1 5.5 100.0 1961 41.1 53.3 5.6 100.0 1971 42.0 52.0 6.0 100.0 1981 39.7 53.9 6.4 100.0 1991 37.6 55.7 6.7 100.0 2001 35.3 56.9 7.4 100.0 2011* 29.0 62.7 8.2 100.0 2021* 25.1 64.0 10.7 100.0 Source: Population Census data for the period 1951-2001 *Projected figure

The continuing population growth in India during the past 50 years has been accompanied by a marked increase in the number of the aged (persons aged 60 and above). As per the population census data during the period (1951-2001), table-1 indicates that there is an increase in percentage of aged population in each decade. According to 1951 census the total Indian old age population was 5.5 percent compared with other age groups. After 5 decades this proportion has raised to 8.2 percent and it was projected that the old age population will increase up to 10.7 percent during 2021 (Prakash, 1999). The Indian aged population is currently the second largest in the world. It has been estimated that number of old age population in India will increase from 76 million in 2001 to 137 million by 2021. Since India has witnessed the raise in old age population for past few decades, the time has come now to health care professionals and policy makers to give serious consideration to this demographic transition and deal with the issues relating to older persons. Table 2 Total Number of Disabled Elderly Persons in Different Age-Groups and their Percentage Distribution by Type of Disability Age group 60-69 70-79 80-89 90+ No. of PWD % distribution of disabled persons by type of (in thousands) disability in each age-group seeing speech hearing movement Mental 1919 52 4 11 28 6 1233 52 3 14 27 4 476 51 2 16 27 3 147 49 2 16 28 4

Source: Population Census (2001) Incidence of mental illnesses increases with increasing age. In India the onset of these disorders follows closely the occurrence of some traumatic events. All these events can be classified as various kinds of losses such as bereavement, moving 3

away of children, loss of status, retirement from job, threatened loss through physical illness and illness of the spouse (Rao, 1984). According to population census (2001), table-2 depicts the percentage of old age disability among various groups. Compared with other disabilities like visual, speech, hearing and movement, mental health problems are found to be less among the Indian elders. It was found that 6 percent of the elders with age group of 60-69 have mental health problems. Further, it was evident that 4 percent of elders with the age group of 70-79 and 90+ have mental health related problems and this proportion is less with age group of 80-89 years.
Table 3 Number of Disabled per 100,000 Elderly persons for different Types of Disability
Place of Residency Mental Retardation Mental Illness Blindness Type of Disability Low Hearing Speech Vision Hearing & Speech 132 137 Locomotor At least on disability 6401 5511

Rural Urban

11 7

180 167

1733 1087

747 459

1551 1385

190 223

2796 2888

Source: NSSO Survey on Disability (2002)

Approximately 20% of older adults have a mental illness today, yet only half of older adults who acknowledge such problems receive treatment and only a fraction of those receive specialized mental health services (Dupree et.al., 2005; U.S. Department of Health and Human Services, 1999). As age advances, due to deteriorating physiological conditions, the body becomes more prone to illness. Table 3 presents the distribution of types of disability among elderly persons residing in rural and urban area. NSSO survey on disability (2002) reported that mental illness was found among 180 elders residing in the rural areas and 167 residing in urban areas for every 100,000 elders. Further, prevalence of mental illness was found to be high among the rural elders. Due to lack of education and awareness about the mental illness, the rate of mental health problems are found to be high among the rural elders compared to the elders residing in urban area. Treatment for Mentally Ill Elderly There is clear evidence that older adults have high needs for mental health services related to mental disorders such as depression, anxiety, substance abuse, and cognitive impairment. The treatment for mental illness among elderly includes restoration of health; improving quality of life, minimising disability, preserving autonomy and addressing supporters' needs are equally valid. Early detection and intervention may improve prognosis, and education is required to counteract the therapeutic pessimism of both professionals and elder patients. Older people with mental illnesses may take longer to respond to treatment than their younger counterparts. Functional psychiatric illnesses in late life have a high rate of relapse; close follow-up and continued treatment may reduce this (WHO, 1996). Older people are particularly vulnerable to side effects of psychotropic drugs. Consideration must also be given to age-related changes in drug handling. Interactions between psychotropic drugs and older patients' co-morbid physical illnesses (and their treatment) are also common. Coexistent physical problems in 4

older people with mental illness must be treated; this may facilitate treatment of the mental illness. All psychotherapeutic techniques (e.g. supportive, psychodynamic and cognitive/behavioural) may be used with older people. Adaptations may be necessary to take into account any sensory or cognitive deficits (WHO, 1996). Social worker Interventions in Gerontological Mental Health Gerontological social work is particularly concerned with ameliorating those physical, psychosocial, familial, cultural, ethnic and racial, organizational, and societal factors which serve as barriers to physical and emotional well-being in later life. Interventions that enhance older adults' coping and problem-solving capabilities are perhaps the most basic and crucial aspect of gerontological social work. Gerontological social workers give special attention to the psychosocial meanings of change and loss, as well as to underlying biological, psychological, cognitive and social factors experienced by the older adult and family (Dobrof, 1998). Gerontological social worker play a vital role in promote wellness, prevention, early intervention, and outreach services in health, behavioural health, and social service programs for all older adults and their caregivers (IOM, 2008). Conclusion Mental health issues in later life can have devastating effects on older people and those close to them. Older adults fear growing older, and assume that old age is depressing and distressing, characterised by loss and disability, offering little to look forward to. Attitudes towards mental health services by older adults have also been suspected as major barriers to seeking treatment. Reasons why older adults have been thought to reject mental health care include lack of education regarding mental health and generational negative attitudes or stigma surrounding mental illness. Most mental disorders are treatable once detected. Untreated mental disorders strongly impair life quality of patients and care-givers, cost money, promote further disability and burden for the public health system. Mental health is of tremendous importance for functional independence and quality of life among older adults. Since it is impossible not to have any somatic diseases in old age, it is essential to develop strategies to cope with these impairments, which in turn strongly depend on mental, that is on both emotional, and cognitive health. Reference Aday, L.A. (2000). At risk in America: The health and health care needs of vulnerable populations in the United States (2nd ed.).San Francisco: Jossey-Bass. Bartels, S., Levine, K., and Shea, D. (1999). Community-based long-term care for older persons with severe and persistent mental illness in an era of managed care. Psychiatric Services, 50(9), 11891197. Dupree, L. W., Watson, M. A., and Schneider, M.G. (2005). Preference for mental health care: A comparison of older African Americans and older Caucasians. Journal of Applied Gerontology, 24(3), 196210.

Himmelfarb, S., and Murrell, S. (1984). The prevalence and correlates of anxiety symptoms in older adults. Journal of Psychology: Interdisciplinary and Applied, 116(2), 159-167. Institute of Medicine (2008). Retooling for an aging America: Building the health care workforce. Washington, DC: National Academies Press. Indira Jai Prakash (1999). Aging In India WHO Report. Bangalore University, India National Institute for Mental Health in England (2005). Facts for champions, London: Department of Health, p 11. Rose Dobrof (1998). Journal Gerontological Social Work Journal of Gerontological Social Work, Vol. 30 (3/4). Speer, D. C., and Schneider, M. G. (2003). Mental health needs of older adults and primary care: Opportunity for interdisciplinary geriatric team practice. Clinical Psychology: Science and Practice, 10(1), 85101. Tan SK (1999). Speech by the Minister of Community Development and Consumer Affairs at The Proclamation of the World Health Mental Day with the Theme Mental Health and Ageing, Malaysia. Uncapher H., and Arean PA (2000). Physicians are less willing to treat suicidal ideation in older patients. J Am Geriatr Soc 2000;48:188-92. U.S. Department of Health and Human Services (1999). Mental Health: A Report of the Surgeon GeneralExecutive Summary. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health. World Health Organization (2001). Strengthening Mental Health Promotion. Geneva, Switzerland. World Health Organisation (1996). Psychiatry of the Elderly- A Consensus Statement, Geneva