An old man with grey hair and wrinkles on his face entered the room with his unsteady gait. The conversation with Mr. butt lasted for nearly an hour. He answered questions about his childhood, work, family, and retirement. His answers conveyed suffering; he conveyed life had not been good since he stopped working and lost his wife. While describing he appeared sad, jittery and irritated. His sons were planning to shift him to an old age home as they and their wives were working and couldn’t take care of him.
“I am not ready for this change. I need my family around”, he said but found it hard to tell that his family, “In my house, I can move around, go to the park, meet my friends, spend time with my grandchildren, help my daughters-in-law with few household chores”, he continued. “I don’t want to live alone at this stage of my life, I need my family. But I understand it’s difficult for them to take care of an “’ageing father’”.
We need to understand the needs and despair of people who are growing old. This is the period of transition when one has to deal not only with physical ageing and ageing of the brain but also with the challenges affecting mental and social well-being. Till a decade ago ageing was considered a natural process and hence it was not taken seriously. Today, ageing is viewed differently by society and individuals. Healthy ageing, active ageing, and happy ageing are today’s concepts of ageing. Now, ageing is a shared feeling of family, peer groups and society.
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Traditional Indian View of Aging
In Indian literature, the aged is generally termed “वृध्द “. Ageing was considered a stage of giving up all worldly pleasures and preparing themselves for the next world. It helped individuals accept ageing as part of their growth. The Upanishads advised people to respect and honour parents or ‘पितृ’ as god. It is considered the duty of a son to respect and care for his parents. Living with the eldest son and his family is the most common living arrangement even today.
Earlier families, irrespective of their financial status, considered it their responsibility to care for their elderly members. But now with the modernisation of our society, the apparent weakening of joint family systems and declining of social values, the care of older people is neglected. The traditional sense of duty and obligation of the younger generation towards their older generation is eroding.
Read More: What happens to the human brain as we get older?
Indian elderly generation is caught between the breakdown of traditional values on the one hand and the absence of adequate social and financial support, on the other hand. With ongoing economic development, children are moving to urban areas, sometimes leaving their parents alone at home. Even if the parents move with their children, they are sometimes unable to adjust to the new environment.
Today’s family is becoming a self-centred nuclear family wherein the old people’s services are used whenever it is required. It is a common scene in Indian families that the old people are used to looking after the children when both husband and wife go to work. Once the children become independent the elderly become an unwanted or extra figure in the family. With the change in the family structure, the elderly are losing their significance in their own house leading to increased feelings of loneliness.
Ageing and Mental Health
With the increase in fertility and medical facilities, we are going through a phase of rapid demographic ageing. Urban living, limited mobility, health problems like diabetes, hypertension, lack of exercise, dependency in daily living, lack of family support, loneliness, isolation and financial dependency are important contributing factors to mental illnesses. With globalisation and westernization, ageing is now having more implications for the individual and the society. Studies from hospitals, clinics as well as old age homes are alarming. They found depression as the most common psychiatric disorder in the geriatric population followed by anxiety disorders. Dementia seems to be the next silent epidemic in India.
Most of the time symptoms of depression are regarded as a part of the “normal aging process”. Even if it is acknowledged as a problem, some choose to self-medicate, resort to religious healing or leave it untreated. Those reaching out to mental health care workers have a stigma attached to them. Untreated depression in old age is often associated with poor quality of life and poor adherence to medical care and rehabilitation. As advancing age is often accompanied by loss of social support, retirement or relocation of residence and slowing down, family and physicians may miss the signs of depression making it difficult to reach out for help. Studies also document that older women are two to three times more likely to suffer from depression due to biological changes, life circumstances and cultural stressors.
Older people with anxiety disorders often go untreated for several reasons. One of the main reasons is that older people are more likely to emphasize their physical complaints and downplay emotional problems. The stresses and changes that go along with aging as poor health, memory problems and losses can cause anxiety. Common fears about aging like afraid of falling, being unable to afford living expenses and medication, being dependent on others, being left alone and death can equally contribute. Older people often do not recognize or acknowledge their symptoms. When they do, they may be reluctant to discuss their feelings with their family. Some people may not seek treatment because they have suffered symptoms of anxiety for most of their lives and believe the feelings are normal.
In older people, anxiety symptoms often overlap with medical conditions such as hyperthyroidism which may hide the symptoms or make them worse. Both family and physicians may miss symptoms of anxiety because of other medical conditions and side effects of prescribed medication for them. Older people also tend to express anxiety symptoms as physical problems such as pain rather than as psychological distress. As a result, they often seek treatment for depressive or anxiety symptoms from their primary care physician rather than a psychiatrist.
Anxiety symptoms also reduce their ability to perform activities of daily living. They are less independent and less compliant with medical treatment, which could worsen chronic medical conditions. They have decreased life satisfaction, memory impairment, poor self-perception and increased loneliness. But when anxiety becomes overwhelming and affects daily tasks, social life, and relationships, it needs treatment.
For older people, depression often goes along with anxiety, and both can be debilitating, reducing overall health and quality of life. Untreated anxiety can also lead to cognitive impairment, disability, poor physical health and a poor quality of life.
Along with the body, the brain also changes with ageing. There are some normal age-related changes in memory and thinking but when it starts interfering with daily living it’s a cause of concern. Dementia affects memory, thinking, language, judgment, behaviour and the ability to perform everyday activities. It has a physical, psychological, social, and economic impact, not only on people with dementia but also on their caregivers, families and society at large.
Role of family and loved ones
Caregivers play an important role in promoting positive mental health. In India, financial constraints are a big hurdle for seeking treatment. The challenge is to develop culturally sensitive services, affordable to low-income populations and spread more community awareness.
Caregivers can encourage the elderly to take up a hobby such as knitting or gardening or a social pastime activity such as volunteer work for a local charity. This will help them promote a sense of purpose in them. Various studies suggest that an active social life improves physical, mental and emotional health. So, encouraging them for social interaction like visits to friends and extended family will help. As with advancing age, sleep gets altered, and caregivers can ensure a regular sleep schedule and daytime naps. Teaching them about sleep hygiene is as important as counselling them about lowering their expectations about sleep duration.
Gentle exercises and healthy eating can help deal with ageing. Structured daily activities are one of the mainstays of elder care. It provides stimulation and interaction with the environment and gives a sense of control. Regular physical exercise even for just a few minutes daily, a simple walk in the garden or outdoors, yoga, and breathing exercises can be encouraged. If wheelchair-bound, then the upper body can be exercised with simple stretches, the use of a ball and hand exercises.
Monitoring through a simple nutrition chart can help maintain basic parameters and at times is the only intervention required to manage problems related to mental health. Caregivers can entrust them with meaningful responsibilities like taking care of plants, babysitting, and pets in the house. Social networks and social engagement like meeting in a senior citizen’s group, laughter clubs, book clubs, ‘सतूसंग` etc. reduce the risk of cognitive impairment.
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As much as the body needs physical exercises, the mind too needs to exercise itself. Cognitive training by brain-stimulating activities like reading, sorting, sequence, sudoku, cross-words etc. can help in postponing cognitive decline. Seeking professional help at the right time can improve overall health and quality of life ultimately leading to “happy aging”.
