World Mental Health Day 2021: Helping the elderly cope with mental health problems amid the pandemic
The pandemic increased the burden of mental health problems in older adults of the country. There is a greater need for a revamp of the geriatric mental health care services than ever before
Septuagenarian Sudhir Mathur had been battling mental health issues for decades, but the pandemic got the better of him. He had chosen to stay alone in Ghaziabad after his wife passed away in the late noughties, and the COVID-induced lockdown made it worse for him. His two children were abroad, and he had only one house help to his rescue, who too wasn't allowed to enter the society complex during the lockdown.
“My father's dishevelled look perturbed me when I first saw him over a video call in May last year. He hadn't eaten properly for days at a stretch. The house was in a mess. He was in a miserable shape, and that got us worried,” recalls his daughter Punam, who is based out of London. She quickly scouted for help, and thankfully her SOS call in a Facebook group got an overwhelming response from do-gooders in NCR.
“A COVID help group offered to provide meals at his doorstep, and someone else arranged for a virtual consultation with a mental health expert for my elderly father. The condition required medication, and he started showing signs of improvement with constant counselling and therapy,” says his son Rakshit.
A pandemic of another kind
According to the World Health Organisation, dementia and depression are the most prevalent mental and neurological conditions in the elderly. Dr PD Lakdawala, psychiatrist, Bhatia Hospital, Mumbai, says, “During the pandemic, senior citizens were mostly affected due to the constraint of going out of the house for fear of getting the infection. They were confined and not able to socialise, which has affected them physically and mentally. Many senior citizens came with panic and depression cases.”
Sailesh Mishra, founder, Silver Innings, whose foundation has been creating an elder-friendly world since 2008, recounts how he received many panic calls during the lockdown from children and relatives of the senior citizens who were staying alone in Mumbai. “Older people, I met and spoke to, were affected mainly by isolation, anxiety disorder, dementia, depression, mood disorder and behavioural changes. A recent epidemiological study has painted a grim picture of the situation. Around 20.5% of senior citizens in India suffer from mental health issues, but not all of them seek help, adding to the woes.”
Dr Lakdawala explains, “how a differing, but in many aspects, a similar picture emerged with regards to human resource and infrastructural requirements based on the two norms for the country to meet the challenges posed by psychiatrically ill older adults.”
Mishra, who was baffled by the rise in geriatric mental health cases during the pandemic, says, “Lockdown was announced suddenly. The fear of coronavirus and social distancing made it difficult for the elderly, especially those who stay alone. Confined within the four walls of the house with zilch interaction with the outside world, listening to sad news, and no positive social engagement took a toll on their mental health. They couldn't follow their daily rituals like a walk in the park or meeting their friends, which only added to their mental stress.”
Highlighting the impact of pandemic-induced lockdown on the vulnerable elderly population, Dr Lakdawala, adds, “In some patients with Alzheimer's, it was seen that the progression of the illness, which was supposed to be in the next four-five years, has worsened and speed up the illness in just a year.”
Also, the younger population moved from offline to online with ease, but it wasn't easy for the senior citizens. “From in-person to virtual consultation with the medical staff, the transition was easier said than done for them,” points out Mishra, who arranged for many such counselling sessions for senior citizens during the lockdown.
Don't be judgemental
But Mathur was not the only one to feel the heat of isolation, bear the pangs of anxiety and feel the blues during the lockdown. The pandemic saw the burden of mental health problems growing among the older adults of the country as pointed out by Mishra and Dr Lakdawala. While a few were quick to address these mental health issues and nip the problem in the bud, others, such as Mumbai-based sexagenarian Vinayak Balekar, have all along dismissed it saying, “there's just nothing to worry”. His daughter, Natasha, has been noticing a stark change in his behaviour post the lockdown. “No amount of cajoling has worked in persuading him to see a mental health expert so far,” she rues. “Every time I broach the topic, he rubbishes me. 'It is just another fad like the Westerners to see a shrink at the drop of a hat, and I am not a game for it,' he tells me. I don't know what to do with him!” says the young advertising professional.
Perhaps the notion of being judged is weighing him down and making him suffer in silence. Based on his experience of working with the elderly, Mishra says, “Accepting and admitting that one is struggling with emotional and behavioural issues, especially among the older population, is the key to early diagnosis and effective treatment.”
Natasha couldn't agree more. “There's a lot of awareness around mental health, and still there are many stigmas attached with the idea of seeing a psychiatrist or psychologist that defeat the purpose altogether,” she adds.
The National Mental Health Survey 2015-16 reported there are a mere 0.3 psychiatrists, 0.07 psychologists, and 0.07 social workers per 100,000 people in India. As of 2019, it was about 9,000 and counting, with 700 psychiatrists joining the league every year. “Going by these figures, India has 0.75 psychiatrists per 100,000 populations, while the desirable number is anything above three psychiatrists per 100,000," says Dr Lakdawala.
Mental health — psychological or psychiatric — conditions can manifest at any age, and it is no different for the elderly population. Lack of trained professionals, poor infrastructure, low awareness and insight among the geriatric population add to the mental health burden. Elucidating it, Chennai-based psychologist Dr Keerthi Pai, says, “India isn't well-equipped to deal with the mental health crisis among this population. Mental health is a big stigma among the elderly. They are unlikely to reach out for professional support. Also, there are very few specialized care and rehabilitation units; low accessibility of mental health care, especially those from rural areas, all adding to the burden of geriatric mental health care in the country.”
No doubt, the problem often lies in how mental health issues are perceived by society. Dr Lakdawala suggests that geriatric care should be implemented right at the community level, and further treatment must be provided at the primary health centres and community health centres. “Along with good infrastructure, staff should be adequately trained and equipped to handle geriatric mental health care. The number of trained staff should be increased adequately to meet the requirement gap of resources. Apart from this, prevention and regular screening for early diagnosis to prevent the advancement of the illness should be done.”
Dr Pai, on the other hand, suggests psycho-educating and empowering the caregivers, more community-based interventions, introducing geriatric mental health training programs for mental health professionals, developing diagnostic tools for the Indian population, incorporating spirituality and religion into mental health care, more research in this area, and of course, better legislature.
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