The challenges of old age in India : GERON 2010

The recently concluded GERON 2010 held in Mumbai brought forth a lot of challenges that the elderly in our country face. Not only were stereotypes challenged during the process of this 2-day long 6th annual conference of the Indian Association for Geriatric Mental Health (IAMGH), the statistics shared by experts from all over the country revealed the plight of the elderly that they face on a day to day basis.

The theme of the conference, ‘Healthy Ageing: From Concept to Reality’, aimed to provide hope for the elder and experts spoke on various psychological, social and spiritual strategies to combat the disorders of ageing like depression and anxiety, and how to enhance wellness so as to ensure healthy ageing. Legal and policy measures were discussed to ensure this and the role of NGOs and media in the advocacy of this was highlighted with the conference ending on a positive note that health and ageing was indeed possible and is something that the elderly could look forward to in the future.


Facts of the day

The brewing crisis will eventually become hard to ignore. Today, one in every 10 persons is 60 years or older. By 2050, the United Nations projects that one in every five persons will be 60 years and older. In India, there were 76 million elderly individuals in 2001 and that number is expected to swell to 327 million by 2010. Also, 4/5ths of the elderly live in rural India.


The challenges of old age

Mind
Old age introduces people to a lot of changes to their lives, beginning with retirement, loss of a social network, and changes in familial roles. With nuclear families, quite often, elderly couples of individuals end up living alone. The other factor that plays on the elderly person’s mind is the closeness to death. As they get older, they have to face the death of friends, siblings and at times, the death of a spouse. This leads to loneliness.

These conditions make them vulnerable to developing mental illnesses, of which depression is the most common. There is a high risk of suicide associated with depression in the elderly and anxiety disorders, sleep disorders and addictions are also seen. About 20 per cent of medically ill patients show some psychiatric illness of which an escalating problem is dementia. About 6 per cent in the age group of 60-65 develop dementia, which goes up to 20 per cent by 80 years of age.

Body
Problems like joint pain can severely inhibit movement and that can take a toll on the over all fitness of an elderly person. This in turn triggers a cycle, where the drop in fitness makes movement more difficult. Another problem highlighted is that of malnutrition in the elderly, as explained by Prof Khursheed Mistry. According to her, water should form the base of the food pyramid for the elderly. Also, the elderly need to be careful of their protein intake. The other challenge faced is electrolyte balance, which can be difficult to maintain in case the person is on a low salt diet.

Society
While tales from our country depict the elderly as wise people, studies today show that it’s not the case. The elderly are often looked down upon and are not even considered in the family decision-making process as highlighted by Prof S Siva Raju, chairperson, Centre for Development Studies, Tata Institute of Social Sciences. Many times, the elderly are left to fend for themselves as their children migrate away. In the case of rural India, children move to the cities, and in the case of urban India, children move abroad.

How is dementia identified?

Whenever one talks of dementia, the most common symptom that people know about is forgetfulness. At what point does a person stop thinking of forgetfulness as a part of ageing and start considering it to be dementia? Dr Charles Pinto, President, IAGMH and Prof Emeritus, dept of Psychiatry, Nair Hospital explains, “Most people are not aware of the symptoms of dementia and quite often, people come with other complains that in turn points to the underlying cause, dementia. For example, people might overlook memory loss, but when behavioural changes occur in the elderly, people bring them to a psychiatrist.”

“Quite often, dementia goes unnoticed in the early years due to the brain’s ability to compensate. Abroad, it is mostly identified and diagnosed right after a holiday wherein when an elderly person gets disoriented in an unknown surrounding, something that will not happen if they are at home. The other situation is the death of the spouse, where in the spouse was compensating for the loss of function in the partner. It may also be identified when a person visits a doctor or a hospital for another medical problem,” elaborates Dr Norman Relkin, Director, Cornell Memory Disorders Centre and Director, Presbyterian Hospital / Weill Cornell Medical Centre.

Is dementia a recent phenomenon or has it always been there?

“Over the years, not only has the average life span of a person gone up, it’s also the quality of life that has improved. As people have begun living longer than before, age-related diseases like dementia are being identified in people. As the number of ageing people increases, so will the incidence and this might attain crisis proportions if we do not prepare for it,” cautions Dr Relkin.

Sailesh Mishra, Founder President, Silver Inning Foundation and Founder, ARDSI, Greater Mumbai Chapter adds, “There is an urgent need for caregivers in the country. In most cases, the task of care giving to the elderly falls on the family and at times, even on one person in the family. Constant care giving can lead to caregiver burnout. For this purpose, we train ‘replacement or relief’ caregivers who allow the regular caregiver to take some time out for himself or herself. The other urgent need is day care centres, of which there is a serious shortage. While we provide special training and classes for caregivers, there is still an shortage of people who can take up the task and this will only get worse with time as the aging population increases.”

By Elton Pinto

Courtesy: The challenges of old age, News,Times Wellness Online