Mental health is a state of mental wellbeing.
The elderly is afflicted by the process of ageing, which causes
a decrease in the functioning of all organ systems in the
body. In addition there is a change in their personal and
social life. They are unable to persue their occupation, loose
their productivity and earn ing capacity. Family life is traumatic
with exit of their children and from home and loss of spouse
and relatives and friends owing to death.
The major psychiatric illnesses in the elderly
are affective disorders, organic brain syndromes and paraphrenia.
The commonest psychiatric illness in the
elderly is depression. In a community survey it was estimated
to be prevalent at 59/ 100. The other affective disorder is
Depressive illness in the elderly is characterised
by depressed mood, sleep difficulties, worrying, slowness
in thinking and activity.
The patient complains of sadness, multiple
body complaints and does not pursue his occupation without
clear reason. On enquiry the patient reveals sleep difficulties,
poor appetite, constipation, sadness, tends to weep, shows
constriction in activity and is generally slow or sometimes
agitated. Often during home visits it may be revealed that
the patient lies in bed most of the time, does not work, does
not like to meet others, worries excessively and talks of
suicide. Very often a physical examination does not reveal
pathology that could cause so much functional disability.
A patient hearing of the individual's complaint
and encouragement to discuss his personal problems helps.
Recent stressful life events such as loss of loved ones or
property or status may be forthcoming. An assessment of the
suicidal ideation should always be undertaken by gentle emphathetic
direct questioning. A depressive with suicidal intent should
be referred for active inpatient management at the hospital.
A detailed evaluation of the patient's memory
and orientation is necessary to exclude organic dementia.
He can be managed with antidepressant drugs. Drug treatment
may cause retention of urine, constipation, arrhythmias and
blurring of vision. The patient is advised not to change his
postures suddenly so as to prevent giddiness and falls. Risk
of over dosage should always be borne in mind. As far as possible
the patient should be allowed to talk freely and the doctor
can assist in sorting out any problems in the family. Encouragement
and reasssurance form essential part of treatment. ECT is
safe in the elderly and is preferred in some cases.
It is a relatively less common mental illness.
Often the patient is brought to the hospital owing to the
sudden and dramatic nature of the illness. The patient is
usually excited, appears unduly happy, is over-talkative and
may harbour grandiose ideas. History often reveals over activity,
excessive spending and lack of judgement in social and personal
matters. Testing ..for memory defects and examination
for any cause of toxicity is undertaken. When these are not
present the patient may be sedated and referred to the referral
centre for further inpatient management.