PSYCHOLOGY AND PSYCHIATRIC
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
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.