"Almost 10% of the Pakistani population are 60 years and over. As life expectancy continues to increase, this figure is also likely to increase in the years to come. Unfortunately this will also mean that psychological problems in the elderly will also continue to rise. For older, as with younger people, mental health conditions are an important cause of morbidity and premature mortality, informed Dr. Murad Moosa Khan, Professor and Chairman Department of Psychiatry at Aga Khan University Hospital. He was giving a presentation on "Psychological Problems in Elderly", at Signs, Symptoms and Care - a monthly health awareness programme, on March 6, 2004.
"The rapid pace of changes in the family structure, which has traditionally been the main support for the elderly, has proved upsetting for them. The break-up of the extended family, immigration, small family sizes, limited housing and economic constraints have very often created unhappy situations for men and women in the late years of their lives. Many are forced to live in isolation because the large families of previous years no longer exist and their children may have immigrated to distant lands in search of their own livelihood. Technological and economic changes also tend to exclude older people out of the work force. These factors as well as illnesses which come with old age add up to create stress which often prove overpowering for the elderly, making them prone to psychological illness like anxiety and depression", added Dr. Murad Khan.
Dr. Murad said, "Senior citizens cannot be equated with adults of a younger age as far as social and medical care is concerned. Their dietary, medical and emotional needs are of a different kind and fell into a category of their own. Similarly ageism is defined as prejudice against older people. It is quite widespread, in its various forms. Ageism implies that as soon as a person can be described as old they are automatically considered of little value, a burden on society, unable to look after themselves and slow, deaf or stupid."
"As far as neuropsychiatric conditions, are concerned dementia and major depression are the two leading illnesses in the elderly", informed Dr. Murad.
Dr. Murad further explained that "Depression in the elderly is an underdiagnosed and undertreated disorder. If all forms of depression are included, the prevalence is as high as 15% in people over 65 years of age. Because it has an atypical symptomatology and there is insufficient information about the disorder, patient and their relatives are not always aware that depression is present. The symptoms are instead regarded as part of normal ageing by family and doctors. While factors such as premorbid personality and life experience are related to vulnerability, it is loss events that seem to be particularly important in precipitating depression. These include loss of independence, loss of control, loss of mobility and loss of role. Recognition and management of these pervasive, persistent and severe depressive symptoms which are diagnostic of depression are important and can make a considerable contribution to improving the quality of individual's life."
"Today, treatment is available for depression in elderly people. This includes modern psychopharmacology, cognitive therapy and in extreme and severe cases, electro-convulsive therapy", informed Dr. Murad.
Similarly dementia, whose prevalence may range from 1.5% to 4% amongst the over 65s, is frequently seen as a normal part of ageing and is not perceived as requiring medical care.
Dr. Murad advised that to promote mental health and a sense of well-being in the senior citizens, it is essential that social networks be encouraged to provide them opportunities for leisure time activities, companionship with their peers and a sense of involvement in socially useful work. For this it is important to enable them to use their skills and capacities for the good of others so that they feel usefully engaged and not marginalized.
Dr. Murad concluded by saying that there is urgent need to raise awareness about mental disorders in late-life in the community and among health professionals and to improve access to appropriate health care for the elderly with mental illness.
Drs. Murad M Khan, Abul Faizi, Shifa Naeem and Ehsanullah Syed participated in the question and answer session at the end of the programme.
Aga Khan University Hospital provides high quality services to all segments of the population. Over 70% of the patients come from low to middle income areas.
Since the inception of the Hospital's Patient Welfare Programme in 1986, Rs. 0.9 billion has been spent benefiting over 175,000 needy patients. In addition, 'The Patients Behbud Society for AKUH' receives zakat contributions and disburses to the 'mustahaqeen'.