Academic journal article Indian Journal of Psychiatry

Psychiatric Morbidity in Geriatric People

Academic journal article Indian Journal of Psychiatry

Psychiatric Morbidity in Geriatric People

Article excerpt

Byline: Prashant. Tiple, S. Sharma, A. Srivastava

Background: The number of geropsychiatric patients is increasing but sufficient work has not been done in this area in many parts of India. Aim: This study explored the sociodemographic profile and clinical characteristics of patients aged 60 years and above, attending the psychiatric services of Institute of Medical Sciences and geropsychiatric patients of Mumukshu Bhavan (old age home) in Varanasi from September 1998 to September 1999. Methods: For the screening of psychiatric patients at Mumukshu Bhavan the Indian Psychiatric Survey Schedule was used. DSM-IV criteria were used for the diagnosis of patients and Chi-square test with Yate correction and Z-test were used for statistical analysis. Results: Depressive disorders were the most common psychiatric illnesses. Many patients had associated physical illnesses and among them hypertension was the most common. Family jointness was adequate for most of the patients. Objective social support was moderate for the majority of patients but perceived social support was poor. Patients of Mumukshu Bhavan perceived their social support to be either moderate or good. Conclusion: Depressive disorder was the most common psychiatric illness and among the physical illnesses hypertension was the commonest. People living in the old age home felt better than those who lived with their children's family.

Introduction

Of the total world population of 4.37 billion, about 250 million are over the age of 65 years.[1] The population of India increased from 685 million (geriatric group 6.4%) in 1981 to 846 million (geriatric group 7.5%) in 1991. The life expectancy of an average Indian has increased from 54 years in 1981 to 64.6 years in 2002.[2] According to Sharma the population of people aged 60 years or above is likely to increase to 18.4% of the total population by the year 2025.[3] Improved healthcare promises longevity but social and economic conditions such as poverty, break-up of joint families and poor services for the elderly pose a psychiatric threat to them.[4]

The modern era of geriatric psychiatry began in the early part of the nineteenth century with the differentiation of senile dementia, arteriosclerotic dementia and presenile psychosis. The need for research in geropsychiatry has increased because of the growth in size of the elderly population. The large geriatric population has an equally high psychiatric morbidity. Various studies have been carried out in India to estimate the prevalence rates, notable among which are Dubey (23.3/1000 population) and Nandi et al. 33%. [5],[6] Ramchandran et al. found that psychiatric disorders were present in 35% of the elderly population, out of which the rates of depression and schizophrenia were found to be 240 and 10 per 1000 population, respectively.[7]

Nielsen studied mental illness in old age in a Danish population and found that a low prevalence of psychiatric disorders was associated with those living with a spouse; a high rate was seen in those living with relatives or children, and the highest was for those living in an old age home.[8]

Community surveys of psychiatric morbidity by Dubey[5] and Verghese et al. [9] in India revealed a peak incidence of psychiatric disorders in middle age and a fall in old age.

Using DSM-IV diagnostic criteria Martha et al. found that 13.5% of newly admitted elderly home care patients suffered from major depression.[10] Ritchie et al. found a lifetime prevalence of 26.5% and 30% for major

depression and anxiety disorders in geropsychiatric patients, respectively.[11] Judith et al. found that instrumental social support provides marginal protection against worsening performance on instrumental activities of daily living, which were primarily a function of baseline depression severity.[12] McNulty et al. found that in older patients with schizophrenia co-morbid cognitive impairment and physical illness needed management by adequately resourced specialized old age psychiatric services. …

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