M E N TA L H E A LT H P R O B L E M S

A M O N G E L D E R LY I N I N D I A :
A SOCIAL WORK STUDY AND ITS
INTERVENTION

B Y D R . C H A N D R A K A L A D I YA L I , P H D
A M I T Y U N I V E R S I T Y- I N D I A
ACTIVE AGING
Those who improve with age embrace the power of personal growth and personal
achievement and begin to replace youth with wisdom, innocence with
understanding, and lack of purpose with self-actualization.

Bo Bennett
MENTAL HEALTH
Mental health is concerned with the ‘mind’ of an individual that includes the person’s emotional,
psychological, and social well-being that has a direct bearing on, how we respond to every
events of life, think, feel and act and it also encompasses as how we handle stress, relate
ourselves to others, and make choices in every stage of life, from childhood and adolescence
through adulthood and until the golden period of our life i.e. old age.

The Mental Health has been the biggest issue or concern in the era of globalized/liberalized
/urbanized world irrespective of one’s stage of life; due to resultant side effects of women
empowerment (increasing female work force participation), disintegration of joint family
system and a shift from the community based society to individualized society. Therefore, the
badly hit population is the most vulnerable population who has not got their due attention till
a very recent time i.e. elderly population. Therefore, the present study wants to overview the
contemporary mental health problems the golden populations are silently suffering using the
content Analysis Methodology and would like to assess the Intervention techniques or
strategies, that have been in operation to help these very revered section of population and
suggest as how the Social Work professionals help in bringing up the quality of present
intervention and suggest for further effective sustainable methodologies to help aged to
overcome the mental health problem that has been diagnosed or underdiagnosed that are
symptomatic in their thinking, moods, and behavior .
DEMOGRAPHIC SCENARIO OF THE ELDERLY
Old age is a worldwide phenomenon, globally; the population is ageing rapidly. Between 2015 and 2050, the proportion of
the world’s population over 60 years will nearly double, from 12% to 22%.

As per the Ministry for Statistics and Programme implementation 2016 report, i.e. based on 2011 Census. India has 103.9
million elderly (i.e.about 8.5 per cent of the population). The elderly population has grown at about 3.5 percent per
year, double the rate for the population as a whole. A 2014 report by the non-profit ‘Help Age India’ shows that while
India will be the youngest country in the world by 2020, but by 2050 as many as 325 million people, or 20 per cent of
the population, will be 'elderly'. While the overall population of India will have grown by about 40 per cent between
2006 and 2050, the report adds, the elderly population will have grown by 270 per cent.

It is estimated that, in India, the economic loss, due to mental health conditions, from 2012 -2030, will be 1.03 trillions of
2010 dollars. Mental health workforce in India (per 100,000 populations) includes psychiatrists (0.3), nurses (0.12),
psychologists (0.07) and social workers (0.07).
CONCEPT OF OLD AGE AND MENTAL HEALTH:
Mental health is a very essential part of health and is not only the absence of mental illnesses. It refers to as
widespread range of activities directly or indirectly related to the different facets like:
The mental well-being of a person
Help Prevention of mental disorders of a person
Ensure Treatment and Rehabilitation of people affected by mental disorders.
Focus on Interventions, creating or raising awareness of mental health issues
Enhance the Mobilizing efforts in support of mental health are necessary for addressing the situation.
Old age is the phase of life that generally accompanies a number of problems that is evident with high rise in
morbidity, mortality, hospitalization and loss of functional capacity associated with or related to common
health problem and more of mental disorder in the elderly patients. The elderly are showing high risk of
developing mental disorders, neurological disorders or substance use problems and other health conditions
such as diabetes, hearing loss, and osteoarthritis. Furthermore, as people age, they are more likely to
experience several conditions at the same time. Mental health and well-being are as important in older age
as at any other time of life. Mental and neurological disorders among elderly account for 6.6% of the total
disability (DALYs: Disability adjusted life years) for this age group. Approximately 15% of elderly 60 and over
age group suffer from a mental disorder .
FACTORS CONTRIBUTE TO MENTAL
HEALTH PROBLEMS IRRESPECTIVE
OF AGE INCLUDING :
:




Biological factors such as genes or brain chemistry plays an important role in determining the mental set up.
Life experiences, such as trauma or abuses have a strong footing in determining the mental status.
Family history of mental health problems also has effect on the mental health of members.

Mental health problem that have been diagnosed or underdiagnosed are symptomatic in the person’s thinking, mood, behavior and responses to the
events of life has many early warnings or signs of e xperiencing one or more of the following feelings or behaviors:
Eating or sleeping too much or too little
Pulling away from people and usual activities
Having low or no energy
Feeling numb or like nothing matters
Having unexplained aches and pains
Feeling helpless or hopeless
Smoking, drinking, or using drugs more than usual
Feeling unusually confused, forgetful, on edge, angry, upset, worried, or scared
Yelling or fighting with family and friends
Experiencing severe mood swings that cause problems in relationships
Having persistent thoughts and memories you can't get out of your head
Hearing voices or believing things that are not true
Thinking of harming yourself or others
Inability to perform daily tasks like taking care of your kids or getting to work or school
MENTAL HEALTH PROBLEM SCENARIO OF INDIA

The mental disorders frequently encountered in the Indian elderly include dementia and
mood disorders, depression in particular. Other disorders include anxiety disorders,
drug and alcohol abuse, delirium and psychosis. The study on epidemiology of mental
health in older people in India is being carried out and morbidity data for our country is
gradually coming out. Most of these studies are part of general population studies or
hospital based or primary care geriatric patients' studies while few are community-
based. Female sex workers, low education, being a widow/widower/divorcee, medical
co-morbidities, poor socio-economic status and disability are all well-established
factors playing significant roles in psychiatric illnesses among the elderly.

The study of Shah et al. have reported that 34.5% elderly medical outpatients had
psychiatric co-morbidity and the most common diagnosis was depression (20%)
followed by substance-related disorders (4.9%), sleep related disorders (3.9%),
adjustment disorders (3.2%) and neurocognitive disorders (1.9%). Multiple social,
psychological, and biological factors determine the level of mental health of a person
at any point of time.
MENTAL HEALTH PROBLEM SCENARIO OF INDIA
There's an assumption that mental health problems are a 'normal' aspect of ageing but
most older people don't develop mental health problems and they can be helped if
they do
Over 20% of elderly suffer from a mental or neurological disorder (excluding headache
disorders)
6.6% of all disability (DALYs) among elderly is attributed to mental and neurological
disorders.These disorders account for 17.4% of Years Lived with Disability (YLDs).
The most common mental and neurological disorders in this age group are dementia and
depression, which affect significant number of people, approximately 5% and 7% of the
country’s older population, respectively.
Anxiety disorders affect 3.8% of the older population, substance use problems affect
almost 1% and around a quarter of deaths from self-harm. Substance abuse problems
among older people are often overlooked or misdiagnosed.
The average prevalence of mental health problems both in rural and urban communities
indicates that 20.5% of the older adults are suffering from one or the other problems
(Urban-17.3%, Rural-23.6%).
CAUSES OF MENTAL HEALTH PROBLEM
There are various causes for the mental health problems among elderly. There are common life
stressors to all people but some stressors could be more conspicuous during the golden
stage of life. These stressors can result in isolation, loneliness or psychological distress in
older people, for which they may require long-term care which becomes public health issues
among older people.
A substantial ongoing loss in Physical and psychological strength and capacities in an aged
population.
The gradual decline in functional ability that the elderly may experience reduced mobility,
Rise of prolonged pain due to gradual and steadier weakening of joints and muscles.
Increase the chances of infirmity or other health problems for which they require proper care and
some form of long-term care.
Elderly are potential population to experience events such as bereavement and separation.
Development of sense of drop in socio-economic status with retirement.
The Mental health has a direct impact on physical health and vice-versa. The elderly with poor
health conditions such as heart, kidney, lungs, and diabetes and hypertension problems have
higher rates of depression than those who are healthy. Moreover, if remains untreated or
under treated can negatively affect its result.
The grey populations are vulnerable to abuses that involve physical, verbal, psychological,
financial and sexual abuses, abandonment, neglect and serious losses of dignity and
respect. Elder abuse can lead not only to physical injuries, but also serious, sometimes long-
lasting psychological consequences, including depression and anxiety. Current evidence
suggests that 1 in 6 older persons experience elder abuse.
Retirement
CAUSES OF MENTAL HEALTH PROBLEM
Retirement: Getting older itself has lot of change in the lifestyle which
adds to it is the pain of being retired. Retirement can affect a
person in different waysDepression
Depression describes a range of moods; from feeling a bit low in mood to
feeling unable to cope with everyday life. It can affect anyone and of any
culture, age or background but the older population are more prone to
depression than any other age group. This is because older people are
much more vulnerable to factors that lead to depression, such as:
being widowed or divorced
being retired/unemployed
physical disability or illness
Loneliness and isolation.
Dementia
Dementia is a syndrome, usually of a chronic or progressive nature, in which there is
deterioration or decline in mental ability which affects memory, thinking, behavior,
problem-solving, concentration and perception and the ability to perform everyday
activities that occurs as a result of the death of brain cells or damage in parts of
the brain that deal with our thought processes
CAUSES OF MENTAL HEALTH PROBLEM
Alcohol abuse :There is a natural tendency, for the aged to lean on to the habit of drinking
to overcome many of their individual challenges in the age of dependency. But the
alcohol abuse habit goes unrecognized among older people.
Medication : Another very pecular problem in the old age is the risks associated with taking
multiple medications regularly and at the same time which can lead to many problems
like confusion and symptoms that are associated with mental illness in older people.
INTERVENTION OF SOCIAL WORK PROFESSIONALS
The professional Social workers with its theoretical knowledge base and practical skills, techniques and various methods inte rvene on elderly with various mental health
issues to achieve good mental health and wellbeing; that allows them to develop the Positive mental health in order to help t he grey population to:

Be aware and develop the sense of realization of their full potential by taking professional help if need be for their full f unctional (physical and psychological status).
To cope up with the various stresses of life by staying positive and connecting with people and near and dear ones.
To work productively by being physically active and even focusing on taking enough rest and sleep in a timely manner.
To make meaningful contributions to their communities by developing coping skills to be more resilient in the face of stress or problems and develop the leadership to help
others do the same
Looking at the seriousness of the mental health problems and needs of the golden age population of the country and the world together.Social work professionals can play
a very important role in the three dimensional areas:
PREVENTIVE MEASURE

PROMOTIVE MEASURE
PROTECTIVE/TREATMENT MEASURE
 INTERVENTION OF SOCIAL WORK PROFESSIONALS
Methods Objectives
 To help the elderly enjoy and
usher through the golden phase
of life healthy and in dignity.
 To identify the physio-
psychological, social changes
and the sign and symptoms of
morbidity in the old age.
Preventive measure  To help the elderly population
and their families/carer to
generate awareness about
different health issues and
medical co-morbidities,
To help focus on the special section of
population in the old age for example:
female sex workers, aged with low
education, being a
widow/widower/divorcee, medical co-
morbidities, poor socio-economic
status and disability that are also all
well-established factors playing
significant roles in psychiatric illnesses
among the elderly.
Strategies
 Treatment and care strategies to
address the problems of older
people
 It is important to prepare health
providers and societies to meet
the specific needs of older
populations,
 Preventing and managing age-
associated chronic diseases
including mental, neurological
and substance use disorders
 Designing sustainable policies on
long-term and palliative care;
 Developing age-friendly services
and settings.
 Training for health professionals
in providing care for older
people.
INTERVENTION OF SOCIAL WORK PROFESSIONALS
 To enable the elderly to have a
fulfilling phase of life.
 To help them understand that they are
the most important and sort –after
section of population.
 To uplift their self- esteem and help
them recognise their self- worth by
engaging them in productive work.
 To help them give the safe and
Promotive meaningful life to invest their energy
and life time learning to percolate
down as a lesson for the generations to
come.
 To enable them to mainstream their
enriching human resource in nation
building tasks.
 The mental health of older adults can be
improved through promoting active and
healthy ageing.
 Mental health-specific health promotion for
older adults involves creating living
conditions and environments that support
wellbeing and allow people to lead a healthy
life.
 Promoting mental health depends largely on
strategies to ensure that older people have
the necessary resources to meet their needs.
 Providing security and freedom;
 Adequate housing through supportive
housing policy;
 Social support for older people and their
caregivers;
 Health and social programs targeted at
vulnerable groups such as those who live
alone and rural populations or who suffer
from a chronic or relapsing mental or
physical illness
 Programs to prevent and deal with elder
abuse;
 Community development programs
  To help them to lead a healthy
and active life to make the life
and living of golden population
more celebrated.

To avoid worsening effect of
their deteroiorating health
Protective condition due to advancing old
measure age.
 To protect them from any
physiological and psychological
or mental distress caused by
family or society at large.
 To help the elderly to
completely cure or reduce the
repercussion of mental health
problems and other medical co-
morbidities associalted with it
like mental, neurological and
substance use disorders in older
adults.
 Prompt recognition and treatment of mental, neurological
and substance use disorders in older adults is essential.
Both psychosocial interventions and medicines are
recommended.
 There is no medication currently available to cure
dementia but much can be done to support and
improve the lives of people with dementia and their
caregivers and families.
 Early diagnosis, in order to promote early and optimal
management.
 Optimizing physical and mental health, functional
ability and well-being.
 Identifying and treating accompanying physical illness
 Detecting and managing challenging behavior;.
 Providing information and long-term support to
carers.
 Good general health and social care is important for
promoting older people's health,
 Preventing disease and managing chronic illnesses.
 Training all health providers in working with issues
and disorders related to ageing is therefore important.
 Effective, community-level primary mental health care
for older people is crucial.
 It is equally important to focus on the long-term care
of older adults suffering from mental disorders, as well
as to provide caregivers with education, training and
support.
 An appropriate and supportive legislative environment
based on internationally accepted human rights
standards is required to ensure the highest quality of
services to people with mental illness and their
caregivers.
CONCLUSION
The old age is the time meant for percolating down all the knowledge and enriched experience you have derived out of your life to the
new generation and even make important contributions to society as family members, volunteers or as an active participant in the
workforce. While most of elderly, do not have good mental health due to varied life stressors that could be due to physiological,
psychological, social, emotional or other factors. Hence the professional social workers has a great roles to play with profound
knowledge, skills, technique and standardized methodology to not only mainstream the grey population to become the enriched
human resource to contribute towards the future generation to become better but also help them to prevent, promote and protect
them against the onset or prevalence of poor mental health with better Investigation, diagnosis and treatment. For this purpose
the social work professionals have to work closely with family, community and the society at large Liasoning with all the stake
holders and most advanced availability of their health care and other