The Ageing Mind

Dr Srikala Bharath is a Professor at Department of Psychiatry, NIMHANS (Bangalore) and Consultant – Adult and Old Age Psychiatric Services, NIMHANS. She is also a Consultant in Life Skills Education, having developed a model of School Mental Health Program to improve psycho social competence in adolescents by training teachers or school counselors. Silver Talkies met her to find out more about the psychological issues facing the elderly.

What are the most common psychological ailments among the elderly that you come across the most?

SB: Depression and dementia; other conditions are old age onset major illness like psychosis and mania. Medical conditions like diabetes or cancer and social events like bereavement are associated with depression and other psychological problems, etc.

Depression and loneliness are said to be two of the main psychological factors affecting the elderly today. What are your views on this?

SB: Yes depression is the most common psychological condition among adults and especially the old. Loneliness is one of the important social factors associated with depressive symptoms. Disability is the other physical factor that is associated with depressive symptoms. Disability can be described as anything that restricts one’s ability to function at full potential.

What are the other factors that usually lead to depression?

 SB: There are many other socio-econiomic, medical and biological conditions that can lead to depression. Depression is of different type – it could be mild or severe, long lasting or brief. Factors like economic constraints or loans, death of a spouse, friends, retirement; medical conditions like diabetes, stroke, hypothyroidism, Parkinson’s disease, isolation and restriction of activities due to disability like hearing/visual impairment, osteoarthritis; past history of depression and many family members (siblings and parents) suffering from depression are all associated with it. In short, there could be genetic or medical or social risk factors for depression. A person’s coping strategies, if poor, could also lead to depression. It needs to be remembered that depressive symptoms are more common than Depressive Disorder.

Very often depression goes un-diagnosed as family members are not aware of the signs or do not wish to acknowledge it. What are the typical signs they should be on the lookout for?

SB: To be called Depressive Disorder, a group of symptoms need to be more or less continuously present for more than 15 days to one month and affect the functioning of the person. Loss of sleep, loss of appetite, weight loss, feeling sad continuously despite efforts to change it, negative thoughts, hopeless, death wishes that are predominant over the days would be some. Crying spells, significant slowing of activities and speech, disinterest in daily activities will also be present. Depression is diagnosed by a combination of symptoms and signs and not by the presence of a symptom that lasts for a day or two.

Loneliness is often unavoidable in old age as children move away on jobs and the elderly person may lose his/her spouse. What would your advice be to elders to combat loneliness?

SB: Prepare for children leaving home. Widen social network. Be part of local social activities. Exercise on a regular basis with others. Have active hobbies like learning a new language, games, skill like singing, etc. Be involved in volunteering work. Being part of support groups help too. These could be local senior citizen forums, bhajan groups, walking groups, laughter clubs, etc.

What is a good way to keep the brain active and engaged for the elderly?

SB: Reading, puzzles, learning a new skill like a new language or computer skills. Learning to draw or paint.

Dementia also affects the elderly often. What are the signs the family needs to watch out for?

SB: Forgetting is the most common sign. Poor memory to recent events when compared to old memories is the cardinal sign. Important aspect of forgetting in dementia is that many of them are not even aware that they are forgetting. Some are aware. Forgetting should also interfere in their daily activities to ring alarm bells. This is common in Alzheimer’s Type of dementia. There are other types of dementia too.

Is dementia avoidable by taking certain steps or at least can the process be slowed down?

SB: What is good for your heart is also good for the brain. Have medical checkups on an annual basis. Keep diabetes and hypertension under control. Exercise. Reduce weight if obese. Stop smoking. Eat a healthy high fibre diet. Take care of the lipids/triglycerides, not just cholesterol. Take supplements like vitamins as many elderly vegetarians have Vitamin B12 and Folic Acid deficiency. Keep yourself intellectually active. Learn new skills. Be socially connected. Plan for old age. Volunteer.

In India many people are still wary of visiting a psychiatrist or mental health clinic. Does that become a hindrance in the way of help?

SB: Yes response to a treatment is better when a condition is treated early. Most of the cases of dementia in our clinic come to us in the severe stage when the drugs used for slowing down the process are not that effective. In such cases, working with the patients is not of much help. We can provide emotional support and guidance to the carers predominantly. If the patients are brought in earlier then medication can be started for slowing down the deterioration, prevent behavioral problems, etc.

When it comes to aged parents, are there certain things even very busy children must keep in mind?

SB: Very often children become the advisory panel. They don’t have the time but are ready to advice. I’d suggest that you look at your inventory of time spent with your parents. Are you just doling out medicine, money and driver? Or are also spending time with them, talking, walking, etc.

Tell us a little about the services for the elderly offered by NIMHANS?

SB: The Dept. of Psychiatry runs a Geriatric Clinic every Saturday from 2 pm onwards. This is a clinic meant for the elderly above the age of 55 or 60 years. The issues dealt with include dementia, depression, psychosis, chronic pain, etc. Elderly are advised to contact us on Saturdays after 2 pm at the Psychiatric Outpatient Services for any psychological issue. Depending on the need, after a screening, they are sent for a detailed evaluation or registration. We have about 250-300 registrations a year.

Dr Srikala Bharath spoke to Reshmi Chakraborty

All pics: Wikimedia Commons