The sad old days

Dr M Udaya Kumar Maiya

The world is ageing rapidly. People aged 60 and older make up 12.3 per cent of the global population. By 2050 this number will rise to almost 22 per cent. 

And despite having a young demographic dividend, India is also greying rapidly. A 2014 report by HelpAge India shows that while India will be the youngest country in the world by 2020 but by 2026 the number of elderly will be 173 million. This number is expected to reach 325 million by 2050 or 20 per cent of the population. While the overall population of India will have grown by about 40 per cent between 2006 and 2050, the elderly population will have grown by 270 per cent, making us a country with the world's second largest elderly population. 

With such a large percentage of the elderly, the number of accompanying problems of old age are bound to rise. Statistics show that approximately 15 per cent of the elderly population suffers from some mental disorder — most common being dementia and depression. Despite this, the latter has failed to receive the attention it deserves. The red flags are all there, but are masked as usual symptoms of old age. 

Depression among elderly can cause  severe emotional and physiological problems that can be detrimental and suffocating. The feeling of worthlessness and hopelessness starts taking over them resulting in neglect of personal care. Apart from skipping meals, they start caring less about their hygiene, and even medication. They may start socialising less and less and become increasingly isolated to the point that may result in suicidal thoughts. 

Symptoms

Memory problems, weight loss, slow movement, slow or slurring speech are among the other symptoms that can affect the elderly. Most of the time they may not share these problems with their loved ones, especially where they're made to feel like a burden in their household. They may feel that sharing their problems would only worsen their relationship with the family. 

A weak immune system, brittle or weak bones, other illnesses and disability can cause chronic or severe pains and lead to cognitive decline. This may alter their body image and shatter self-confidence. 

Demise of loved ones, including partners, family members, friends and pets further takes its toll. Many either end up relocating or living in isolation. Their social circle starts dwindling causing a lack of mobility. Loneliness may further deteriorate their medical problems.  

There is also the fear of death and anxiety over financial and health-related problems. All this causes feelings of hopelessness, despair, etc. Coupled with their poor physical and mental limitations, depression may set in. 

There are other factors and medical conditions such as Parkinson's, stroke, heart disease, diabetes, cancer, dementia and Alzheimer's that can trigger depression either directly or as psychological reactions. Painful, disabling and life-threatening nature of some chronic medical conditions can further fuel symptoms. 

Treatment

Medicine, electroconvulsive therapy (ECT), psychotherapy, counselling or other newer forms of brain stimulation are among the various treatment options available for depression. These optimal approaches depend on the type and severity of the symptoms, previous treatments and the medical conditions of an elderly person. After evaluation of their symptoms, they may even be provided with a combination of treatments. 

While anti-depressants may not be effective for younger patients, these drugs play a crucial role in aiding the aged. However, it is also imperative to consider their side effects. For instance, sedatives can cause confusion or even lead to a sudden drop in blood pressure when a patient stands up. This can cause falls and fractures. Also, antidepressants work slower for aged people than for the young. The length of treatment is comparatively prolonged as doctors prescribe lower doses initially since old are more sensitive to medication. 

Support and management

Family is the first support system for elderly with depression. The help and care from near ones, friends and support groups play a crucial role in tackling this problem. Socialisation can do wonders for their treatment. Supportive families have also realised the role of home care in their betterment. Due to despair when they can barely eat, sleep and bathe, elderly require sensitive handling to aid their well-being as depression drains a person of his/her energy and self-esteem.

Conclusion

Given the rise in elderly population and mounting evidence of depression among this age group, the problem should be tackled on a priority basis. India ranks 71 out of 96 countries in the elderly care index. Strict government initiatives are needed to address the issues faced by this population.  There is also an urgent need to sensitise and educate family members about the elderly people and their care at home.  

—The writer is medical director, Portea Medical, Bengaluru