“We can all make a difference in the lives of others in need because it is the most simple of gestures that make the most significant of differences” – Miya Yamanouchi
The importance of mental health is highly underrated globally, and India is not far behind. The first director-general of the World Health Organization (WHO), Dr. Brock Chisholm, in 1954, had rightly declared that “without mental health, there can be no true physical health.”
Currently, elders comprise more than 10% of our population today and it is increasing rapidly. Mental health concerns in the elderly are often a large contributor to disability as well as morbidity. With advancements in healthcare leading to increased longevity, it is now painfully becoming evident that we need to be much more prepared to support elders in this country. Economic and social conditions like poverty, the breakup of the family support system, chronic illnesses, lack of awareness and services for elderly as well as loneliness all play a key role in rising mental health concerns for seniors.
Depression, which is a major mental health problem, is yet to be recognised as a public health challenge. The prevalence of geriatric depression or depression in the elderly is steadily increasing. Many elders experience depression as a result of loneliness. Loneliness is a feeling of being alone, and some elders feel lonely even without being physically isolated. Most cultures normalise loneliness as a natural part or byproduct of ageing. Family members don’t raise concerns when elders stop interacting as before. Reduced appetite, changes in sleep patterns, crying spells or poor hygiene are clear red flags. Add to this, the fact that there is little awareness of the difference between sadness and clinical depression. Due to this societal normalisation, geriatric depression often goes undiagnosed and untreated, therefore leading to serious health-related consequences. The right medication combined with psychotherapy can help elders cope with the illness early on. Apart from depression, there is also an increase in reported cases of dementia. Dementia is a chronic and debilitating neurodegenerative disease. In India alone, there are more than five million reported cases. It is characterised by a decline in multiple cognitive abilities that significantly interferes with an individual’s functioning; both physical and mental, making dementia a very misunderstood disease. While dementia is more common as people grow older, it is not a normal part of ageing.
Though by definition, dementia is a neurological condition it is perceived by many as a ‘mental illness’ because of the accompanying behavioural and psychiatric symptoms (BPSD). In addition to cognitive impairment, changes in mood, agitated behaviour, presence of hallucinations and suspiciousness, lack of social skills and disinhibition can all be commonly seen as part of dementia.
Dealing with difficult behaviours in dementia especially agitation, mood swings and sundowning can be distressing for both the caregiver and the elder. Using nonpharmacological strategies (identifying triggers, not arguing with them, distraction or validation) should be our general approach and one must invest time to learn what works or not for long term solutions. Besides, depression and anxiety in caregivers of dementia leading to caregiver burnout is also commonly seen and must be addressed immediately. Polypharmacy, as well as electrolyte imbalances (in sodium, potassium), can also make elders delirious, confused or lead to changes in mood. These are addressable issues and can be handled aptly if raised on time with healthcare professionals.
The need for de-stigmatising mental health challenges and creating a robust ecosystem to address it is critical. We need more trained professionals, access to better global resources, funding for better research and insurance coverage for chronic mental health conditions. The society at large needs to come out in the open on mental health and dementia, share experiences with strong messaging to drive community change.
The writer is a dementia specialist and CEO and cofounder of Epoch Elder Care.