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PSYCHOLOGY AND PSYCHIATRIC DISORDERS

Ageing brings with it, attendant changes, in the psychological, family and social life of the individual.

Family life undergoes a sea change. The elderly person with his position as the protector being altered to a dependant status, the sense of mastery no longer persists. As a result a lowered self-esteem ensues.

Life long companions within the home are lost. Daughters marry and leave the homes. Sons in the pursuit of occupation too leave. The homes of the elderly are rendered lonely by the death of their spouse. This loneliness, added to the lowered esteem, causes intense grief/despair. Studies have found, the recently bereaved elderly are more prone to psychiatric and medical illness especially infarction and cancer.

A constricted sphere of activity in the absence of work, leisure activities, sensory handicap and musculo-skeletal disability results in reduced psychological resilience. The outlets that provided relief at an younger age are no longer available. This results in depression.

To tackle these psychological proble1ns the PHC doctor has to recognise the major contributory factors. Encouragement to be more active, cultivation of leisure time activity (such as visiting temples, panchayat meetings-sharing the wisdom of age with younger companions) are beneficial. To listen compassionately to the grief of the aged assists the process of mourning. The treatment of patient's sensory handicap and musculo-skeletal disability can by itself widen the patient's horizon of activity by removing barriers.

Fear of dying may be present, to a disabling extent in some eldery subjects. Probing into the life led by such person and helping him to see it as a life usefully led will help to an extent. If somatic accompaniments of anxiety are associated, anxiolytic drug therapy is of assistance.

The process of ageing, with neuronal death, causes memory deficits to appear. The elderly patient may become fastidious and excessively orderly in an attempt to cope with memory lapses by rigidity of habits or may become paranoidal accusing others of medding with, or theft of misplaced articles, a strong suspicion of organic dementia must be aroused.

The social life of the elderly is also affected by lowering of economic status, loss of companions of the age and changing social order in our country. The economic hardship can be alleviated by seeing that the economic benefits granted to the elderly accrue to them. The PHC doctor can help to this end by working jointly with revenue officials.

Social isolation and lack of social integration can only be managed by increasing the social activity. Medical assistance to treat handicaps that restrict activity is essential.

Even in the absence of 'family support' a good social support network can prevent psychiatric morbidity.

The role of Multi Purpose Health Workers is crucial in 'identifying such people in the community. These people can be managed both in their homes and at the PHC by a comprehensive approach.

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