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10 102013

Greater Kashmir


Our elderly are lonely; do we realise!!!
as family members, volunteers and ropsychiatric disorders are the com- feeling related to the person’s own purpose and hope that the distinction years, to nearly 70 million in 2030 .The
as active participants in the work- monest.20 percent of elderly do have experience of deficient social rela- between two gets blurred. I also see total number of new cases of demen-
force. The wisdom they have gained some neuropsychiatric illness severe tions. That subjective experience role of our spiritual being, which is tia each year worldwide is nearly 7.7
through life experience makes them enough to cause disability.Depres- usually come from deficient external innate to our culture and hence our million, implying one new case every
a vital social resource.But with this sion and dementia are the commonest factors like social networking, social very being helping us mourn and four seconds. Ask the families who
DR ARSHAD HUSSAIN demographic shift come the challeng- but good proportion of elderly have support etc or psychological and per- grieve without getting depressed. have patient with dementia ,it is over-
es and most of this challenges are to anxiety disorders .Multiple social, sonality factors leading to aloofness. Elderly maltreatment is increas- whelming for patients but it is no less health care. It is important to prepare psychological, and biological factors Loneliness besides being important ingly being recognised as an impor- burden on families. Dementia effects
health providers and societies to meet determine the level of mental health of cause for depression substantially tant mental health issue of aging. families physically socially ,economi-
“The day 10th October is the 21st the specific needs of older popula- a person at any point of time. As well increases risk of suicide and suicide There is very scarce data about this cally and psychologically as well.
anniversary of mental health day. tions.With age we lose ability to live as the typical life stressors common attempts in elderly. Loneliness also problem from under developed and The problems are plenty but do
Twenty years back Richard Hunter independently because of restricted to all people, many older adults lose contributes significantly to deaths developing world ,but is increasingly we have solutions. The focus of our
thought of telling the world that mobility,loss of vigour and declining their ability to live independently because of other physical causes. being recognised in developed world health care system is still communi-
there is no health without mental cognitive functioning. because of limited mobility, Loneliness of elderly is also in more than 7percent of aged popu- cable diseases, below 5, maternal and
health and he proclaimed 10th Octo- Along with these global demo- chronic pain, frailty or of concern to our culture. lation. WHO defines Elder maltreat- child health, the focus has to remain
ber as mental health day to focus the graphic trends are enormous social other mental or physi- The conflict created ment as a single or repeated act, or as we still have lot to do in these prior-
world attention on improved care for upheavals with globalisation, cal problems, and empty nests wherein lack of appropriate action, occurring ity areas , but we cannot be oblivious
mental health issues. The world woke urbanisation , declining of family as require some form parents pushed their within any relationship where there is to the changing realities of health .
up to the reality of mental health and unit.which will mean fewer people of long-term care. kids out of Kash- an expectation of trust which causes Aging society and its mental health
10th October has become the regu- to care for aging population within In addition, older mir for safety con- harm or distress to an older person. consequences are a reality and we need
lar affair world over to recognize the families. people are more cerns. These kids when we look at our changed urban- to refocus our health agendas to fit in
and register the epidemic of mental The definition of ‘health’ with likely to experi- were brought up in ised breaking culture and this defini- needs of changing society. From less-
health problems. The theme of World regard to old age is a subject of debate. ence events such as alien cultures, there tion maltreatment seems to be plenty ening loneliness to preventing elderly
Mental Health Day in 2013 is “Mental There is a consensus that health in old bereavement, a drop chances of coming without mechanisms of redressal. abuse to early detection and diagnosis
health and older adults”. age cannot meaningfully be defined in socioeconomic back decreased with Elie Wiesel said that without of depression and dementia the tasks
To age is to grow, and decline at as the absence of disease because the status with retirement, every passing day memory there is no culture. Without are many. All stake holders need to be
the same time; aging is a biological prevalence of diagnosable disorders or a disability. All of these because of employabil- memory there is no civilisation, no involved and a public health approach
reality with its own processes most in elderly populations is high. Instead, factors can result in isolation, ity and adjustability in own society, no future. And one of the con- is the only way forward to improve
of them still not in our control. With health is considered to be multifac- loss of independence, loneliness and culture,the net is majestic mansions sequences of changing demograph- care and quality of elderly population.
improving global health aged popula- eted: The diagnosis of disease should psychological distress in older people. with lonely elderly.....Empty Nest. ics is lot of elderly population with The complete dissociation between
tion is increasing steadily. The world be complemented by assessment of Mental health then impacts the physi- Loss and grief are integral part of fading memories -dementia as it is need and planning is reflected in the
will soon have a unique demographic discomfort associated with symptoms cal health and vice versa and this aging, from loss of mobility to inde- called is not part of normal aging it fact that we still do not have geriatric
spectacle; those aged 65 and more will (e.g., pain), life threat, treatment con- vicious circle usually has devastating pendence and to loss of loved ones, is a clinical syndrome that effects health facility even at tertiary care
outnumber those aged less than 5. The sequences (e.g., side effects of medica- effects on elderly. elderly do experience these losses at memory, behaviour and thinking centres of state. The policy makers
world population of 60yrs and above tion), functional capacity and subjec- Depression is a common affliction higher frequency than young popula- and hence the routines. Dementia is need to wake up to the new realities
is estimated to reach 2 billion by 2050 tive health evaluations (Borchelt et of of old age and in contrast to the fac- tion. Thus do contribute to depres- a global epidemic projections indi- and priorities and act now. By all what
and has already doubled since 1980. al., 1999). Furthermore, Rowe & Khan tors responsible in younger age like sive morbidity, in-spite of what DSM cate that the number of people with we have done in health till now has
This is undoubtedly a cause to rejoice (1987) suggested that the health of sub- genetic and psychological predisposi- tells us I strongly feel that grief and dementia will continue to grow, devel- achieved the goal of adding years to life
for GLobal health initiatives but these groups of older adults be defined in tion, negative life events depression mourning are part of our normal oping countries will experience the expectancy,but what we need to do now
celebrations may be premature if we terms of their status relative to age of old age is usually linked to physi- being and not diseases and only when greatest growth. The total number of is to add life to these years.
do not brace up to these new shifts in and cohort .Non communicable dis- cal ailments disability and frailty. they result in complete loss of joy and people with dementia worldwide is
the demographics. Older people make eases are the commonest afflictions of The other important factors is loneli- pleasure and result into sense of per- estimated at more than 35million and
important contributions to society elderly population,among them neu- ness which is a subjective, negative vasive despair rather than sense of is projected to nearly double every 20 Dr Arshad Hussain is assistant professor department of psychiatry,
Govt Medical College Srinagar

The policy makers need to wake up to the new realities and priorities and act now.

When the mind gives up.... Palatial Houses or Empty Nests

…..Humans can even kill themselves!!! Lonely parents living in grand houses mourning the absence of children

of drugs like phenothiazines Loss of Self-esteem toms like apathy, fatigue may
(anti-schizophrenic), barbitu- Agitation and restlessness dominate the clinical picture. In
rates and oral contraceptives west highest suicide rate is among
make one more prone to suicide. Planning and preparations elderly males, with alcoholism. As
d. Psychological Mechanisms: Verbal expression of suicidal intent stress and deaths of friends are so
Freud believed that suicide Suicide notes and warnings common among the elderly, adjust-
DR. MOHAMMAD MAQBOOL DAR was aggression turned inward Precautions against discovery and DR. ARIF MAGHRIBI ment disorder, depression and
against a loved person with failure of suicidal attempt adjustment disorder are common.

whom the individual had iden- Methods adopted- violent methods Adjustment Disorders: These
revalence. Transient suicidal ideation tified. indicate greater risk are common in old age and are due
is seen in most of the normal people. e. Situational: The escape from Preparation for the final exit: exe- Mental health of our elders is a to the numerous stresses – loss,
According to survey by World Health unbearable situation is a domi- cution of will, settlement of pending matter of grave concern now. Few physical illness, retirement or
Organization (W H O) in 1983, around nant theme in children’s suicide affairs. decades back it wasn’t so. But living outside. Symptoms include
2,400 persons commit suicide every day. and suicidal attempts. Procurement and possession of with rapid urbanization, high anxiety, depression, agitation.
Most recent figures from 21 countries lethal agents. rate of unemployment, growing Grief is common and may mimic a
show annual average suicide rate vary- Durkheim described 3 different trend of nuclear family, things major depression but often has an
ing from 7.1 to 33.9 per lac population social categories of suicide: 3) Management: Once suicide is have changed radically. Many obvious precipitant, is short lived
above 15 years of age. Hungary, Sweden, i. Egoistic: Due to loss of integra- committed, it is obviously no longer from our state - doctors, engi- with therapy. Alcohol, nicotine is
Denmark, Austria and Germany are the tion leads to a sense of isolation treatable. The management of sui- neers, MBAs, and others - have also a common response to stress
leading countries as so far of suicide is and morbid individualism, cide, therefore, lies in preventing left for other countries as they in the elderly and is frequently
concerned the lowest number of suicide ii. Altruistic: As seen in war, Army the act at suicide prevention cen- could not find a job; after initial unrecognized.
being in Chile and Ireland. men dying for the country, ters, crisis intervention centers (both reluctance they left for abroad How can we HELP: Be sup-
In India, 150 to 200 people commit iii. Anomic: When there is dis- of them are not available as yet on leaving their old parents alone. I portive, respectful, sympathetic
suicide every day. The average preva- turbance in the balance of the a large scale in India), Psychiatric see huge houses, but wearing dis- and a good listener. Let them
lence of suicide is about 10 per lac of individual’s aspiration on the emergency services, medical emer- tressed silence and gloom. Most express, listen to them with
population. The ratio of attempted sui-
cide to suicide is 8-10: 1 .
hand and the values of society
on the other.
gency services, social welfare centers
or even at home of the patient.
Let them of them suffer from what was
found in the West; empty nest
patience and attention. While
talking hold their hand, kiss it
Suicide rates increase with age, express, listen syndrome. Although our society and become a human placebo.
and on average are 50 times greater
in males than in females but the rate
to them with is in a denial mode but it’s very
much common now. Following
Encourage patients to express
themselves - about guilt, loneli-
of attempted suicide are maximum in i. Take all the suicidal threats, patience and are the common ailments that ness - and unburden themselves.
adult females. Suicide is the second
most common cause of death among
History of previous suicide attempts.
Gestures and /or attempts seri-
ously and notify a psychiatrist
attention. flourish in such a state of affairs.
Dementia: It often presents
Encourage self-esteem. Helping
patients review their life can be
adolescents and youth. Family history of affective illness, or a mental health professional. While talking first with agitation, anxiety, highly beneficial. Reminiscence
suicide and alcohol dependence. ii. Psychiatrist (or a mental health depression. Dementia also is adaptive coping behavior and
THE MAIN CAUSES OF SUICIDE Personal factors such as bereave- professional) should quantify
hold their presents with symptoms like helps promote self esteem. Encour-
CAN BE CLASSIFIED AS: ments or other losses. the seriousness of the situation hand, kiss it forgetfulness ,impaired cogni- age continued interests, friend-
Advanced age, particularly in males. - a proper risk assessment - and tive activities and aggression. ships, socialization, activities and
a. Genetic: There is an increased Marital status: widowed, divorced take remedial precautionary and become There is no magical cure or self support. Be a presence. Be
incidence of suicide in relatives or separated. measures. Inspect physical sur- a human complete cure for dementia, as available----frequent, regular and
of those who have committed it Living alone, poor social ties. roundings and remove all means it’s progressive and nonrevers- always reachable by phone.
and the concordance for suicide Unemployment, retired. of committing suicide, such as placebo. ible. Never the less consulting Biggest Donts: Never ask for a
in monozygotic twins may be as sharp objects,ropes,drugs,fire a psychiatrist or a qualified sleep inducing medicine to keep old
high as 18 %.The role of genetic Associated Illnesses and Conditions arms,etc. Also, search the counselor can make life of a people sedated and hence shrug off
factors is also proved by the asso- Chronic, painfull, physical illnesses. patient thoroughly; surveil- person with dementia lot more your responsibility, it has always
ciation of suicide with increased Psychiatric illnesses, particularly lance, depending on the sever- comfortable. Always check that proven to be harmful not only to
familial incidence of psychiatric depression. ity of risk. the patient of dementia does his your parents, but in most of cases
illness (Depression, Schizophre- Personality Disorders-antisocial, iii. Acute psychiatric emergency hearing and eye test on regular your children steal that medicine
nia, Alcoholism, etc.). Drug dependence interview. basis. Those lucky children who and get addicted to it.
b. Mental Illness: Depression, Alco- Insomnia, Anorexia and sexual iv. Counseling and guidance. To remain with patient of dementia Lastly we all must remember
holism, Schizophrenia, Person- impairment. deal with the desire to attempt must make sure he meets his old how our old parents and relatives
ality Disorder, Drug abuse, etc., Sudden Unaccountable well being in suicide, and to deal with on- friends, visits places familiar to cared for us when we were kids,
are the leading causes of suicide. a depressed patient. going life stressors, and teach- him often. Reiki therapy has a did they ever complain? How won-
c. Physical Illness: There is an Social Stresses. ing coping skills and interper- soothing effect on patients with derful if someone living in a nucle-
increased prevalence of suicidal sonal skills. dementia. ar family visits his parents today,
ideation in patients suffering Mental Status v. Treatment of the psychiatric Depression. Major depression spends time with them, gifts them
from viral fevour, hepatitis, Suicidal ruminations disorder(s) with medication, can develop in old age for the first something…….
kidney failure, multilating inju- Guilt feelings Psychotherapy and /or ECT. time or be a recurrence of a major
ries, cancer, etc.In epileptics; the Feelings of worthlessness and hope- affective disorder. Along with
risk is 4 times more. The intake lessness Author is Associate Prof. Psychiatry.Govt.Medical College,Sgr. depressed mood, physical symp- Author is trained in mental health ailments.