India has a rapidly ageing population. According to Census 2011, individuals older than 60 years constitute 8.6 per cent of the total population, which equals 104 million. The United Nations’ estimate is that this number will double by 2050. Apart from a host of other things, this demographic transition will mean a spike in mental health issues.
Ageing is a process. The body suddenly starts to struggle to keep up with the spirit. There are aches and pains, the organs do not function like they did in youth, memory lapses happen, multi-tasking suddenly seems like an uphill task, there is a change in appearance as well. All of this is bound to have an impact on the mind.
According to data from two long-term ageing studies — Health and Retirement Study (HRS) and English Longitudinal Study of Ageing — with age, a huge chunk of individuals with major depressive disorder or MDD tend to have increased frequency of symptoms.
Certain social factors affect the trajectory of MDD with ageing, namely retirement, loneliness, abuse, divorce or separation, loss of loved ones, unemployment, lack of financial independence and stigma.
Both depression and anxiety disorders change their characteristics with age. Problems with low mood (hallmark of depression) give way to other symptoms such as excessive preoccupation with health, long-term pain, sleeplessness, agitation and anxiety, memory deficits and social withdrawal.
Late-life depression or depression in older adults is extremely common and disabling.
The same holds true for anxiety disorders such as generalised anxiety disorder (GAD), phobias, social anxiety disorder, panic disorder and obsessive-compulsive disorder (OCD). While research suggests that social anxiety and panic disorder may get better with ageing, GAD and OCD have a fluctuating and at times a worse course. Phobias remain relatively stable with age and individuals usually learn to adjust or avoid phobic situations as well as contexts.
The Longitudinal Ageing Study in India is a “full-scale national survey of scientific investigation of the health, economic and social determinants and consequences of population ageing in India”. Its initial results show that six per cent of people in the age group 45-59 years are in the lowest percentile of cognitive (functions), and this tends to worsen in those who stay alone and are deprived of social stimulation.
The overall proportion of depressive symptoms among people aged 45 years and above is 28 per cent. Undiagnosed clinical depression forms a major bulk. Educational attainment is associated with a decline in depressive symptoms while post retirement, many may experience a worsening of a pre-existing low mood, anxiety and insomnia.
Ageing is inevitable, but ageing well is in your hands. How we spend our life through the 20s right up to the 40s, determine our mental and physical health in later years.
The keys to healthy ageing are hidden in lifestyle. For most elderly, retirement is a major life event that can trigger mental health problems. It can lead to loss of routine, reduced financial and individual freedom, more dependence, lesser mental and physical engagement and restricted mobility. All these factors are a risk for depression and anxiety disorders.
Ageing well becomes more important in those already having mental health conditions. The immediate family can help by identifying symptoms, supervising medicines/counselling, regular reviewing with the treating doctor, and ensuring proper diet, sleep and nutrition.
With age, problems such as diabetes, hypertension, osteoarthritis, prostate problems and postmenopausal health issues will arise — which have a direct bearing on mental health. Mental wellbeing is not possible without sound physical health, and vice versa.
Those with early signs of dementia need special attention. The brain needs to be active to fight dementia. Staying engaged in hobbies, learning new stuff, reading, connecting with people, having a routine, avoiding daytime naps and regular exercises are the ways to effectively train the brain.
Hearing and eyesight loss are common with ageing and need correction whenever possible. Research shows persistent hearing loss to be a risk factor for dementia.
The writer is a consultant psychiatrist based in Calcutta