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Recognising signs of mental illness in older adults

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Dr Jayashree Dasgupta, Co-Founder and Project Director, Samvedna Senior Care talks about mental illness in elderly

One of the 17 Sustainable Development Goals set out by the United Nations is Good Health and Well-being to “ensure healthy lives and promote well-being for all at all ages”. Although mental health and well-being are an essential aspect of life at all ages, mental health and wellbeing amongst the elderly is not given the importance it should receive. According to the WHO, approximately 15% of adults over 60 years have a mental disorder across the world. In India, the Longitudinal Ageing Study of India (LASI) 2021, mentions one in five elderly persons in India has mental health issues. This is a national survey of older adults and also found that over one in 10 people above 60 have “probable major depression” in the states of Madhya Pradesh, Uttar Pradesh, Delhi, Bihar and Goa which is also worrying and an indication that many older adults are not living satisfied happy lives. Considering that the elderly population above 60 years in India is estimated to grow by 41% over the next decade to reach 194 million, it is important to focus on mental health of older adults.

As one ages, there is an obvious deterioration in physical health but this can also impact mental health and vice versa. However, the emphasis on physical health problems in the elderly is much more than mental health difficulties which many older adults feel uncomfortable to talk about. To give an example, depression is much more common amongst the elderly than we like to acknowledge. A recent study that analysed data from 51 research studies across 16 states of India estimated the prevalence of depression among Indian elderly population to be as high as 34.4%. However, very few older adults spontaneously talk about ‘being depressed’ and this is often missed. They also often worry about becoming a burden on other family members, and most elderly are reluctant to talk about their emotional health due to stigma.

For many older adults, depression or anxiety may be a long standing problem. They often blame themselves for not feeling happier, or believe that they should be able to deal with whatever comes their way, by virtue of their age and being experienced in dealing with life’s ups and downs. For other older adults, anxiety or depression may be brought on by life events like loss of a spouse or friends, or outliving younger family members. Changes in living conditions and physical health problems can also lead to mental health problems.

In comparison to talking about emotional health, older adults are more comfortable discussing their physical health problems which are accepted to be part of aging and socially appropriate to talk about. Older adults are often comfortable meeting a physician for physical health problems which is also challenging as many physicians are not trained to recognize signs of mental illness in the elderly. Further, mental illness may co-exist alongside physical illness but may get missed. For example, a person with chronic illness like COPD or heart disease, may be depressed, but this may get missed as the focus is on treatment and management of the physical illness and the older adult feels that it is not important to talk about their emotions with the physician. It is important for physicians to recognize this and look for signs of mental illness in older adults. The Diagnostic and Statistical Manual 5 (DSM 5) has a Pocket Guide for Elder Mental Health which is designed to help physicians diagnose mental health issues in the elderly and provides guidance on how to approach talking about emotional health and wellbeing.

Mental health problems may also manifest differently in older adults as compared to younger adults. For example, older adults may experience more psychosomatic or physical symptoms, e.g., body pain, breathing difficulties, gastrointestinal problems or have sleep difficulties, rather than the classical symptoms of ‘feeling sad’. They may also attribute the feelings of sadness to their physical problems making it difficult for family members to realise that there may be an underlying mental health issue or one in addition to a physical health issue. Mental health and wellbeing is important for everyone so it is important to watch out for signs that may indicate a mental health issue in an older adult.

Here are five signs for family members to watch out for that may indicate an underlying mental health issue:

  1. Changes in appetite or weight
  2. Physical problems which can’t be explained by any medical reasons
  3. Loss of interest in things that were previously enjoyable or withdrawing from social activities
  4. Unexplained fatigue, energy loss, or sleep changes
  5. Changes in mood, Feelings of worthlessness, inappropriate guilt, helplessness; thoughts of suicide
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