Mental health of elderly - a neglected social problem

The 80+ year old gentleman would come to the clinic with his grandson. He always dressed in clean white shirt and veshti (single piece of cloth draped around the lower part of the body). He walked with a mild stoop and with the help of a 5 foot stick, which he held in his left hand for support. A few years ago we had diagnosed him to have high blood pressure. I had started him on tablets. But he came only once in 3-6 months to visit us. He would come only when there was a dizzy spell, or a fall or some other disturbing symptom. Every time his blood pressure would be very high and we would sit and discuss the need to continue to his blood pressure tablets regularly. He would promise that he would take them regularly. But he never kept his promises. The main reason was because he was unable to visit the clinic independently and was always waiting for some younger member to bring him. The younger members were always busy and did not have the time for the old man.  

Yesterday our community health worker reported to me that he died of suicide last week. He had hanged himself from the ceiling fan of his home early one morning when everyone else was asleep. He had come to see us 3 weeks ago and had taken a refill of high blood pressure tablets. I had no clue that he was depressed or suicidal at that time. I was very disturbed all day yesterday in the clinic after hearing the news of his suicide. He had lived so long, what must have pushed him to take this decision all of a sudden? Was this the last independent act that he had done? Was he relieved of all his loneliness, neglect and misery? I had these questions haunting me all of yesterday. 

 

One of the greatest challenges faced by elderly in our society is social isolation and loneliness. Most of my clientele in the rural clinic are elderly men and women. Almost all of them complain of feeling lonely and isolated. Some of them feel isolated despite living with their sons and daughters in law. One of the greatest cause for conflict within the family is the generation gap and the unfulfilled expectations of the elderly and the young from one another. When this conflict is superimposed on poverty, and lack of any social support systems, it leads to severe depression, anxiety and stress. 

 

Mrs. M, an elderly woman with type 2 diabetes lives with her son and his family in the village. The son has a house constructed with bricks and cement and with a concrete roof. However, Mrs. K lives in a out-house, a small attachment at the back which has mud walls and a thatched roof. She cooks her own food. The son gives her a monthly allowance with which she manages her everyday life. One day Mrs. M had come to the clinic to visit us and got her medications. By the time she went home it was almost 1 PM. She was extremely hungry, but had to start cooking and it would take at least another hour or so to finish cooking and have food. When she entered the house, the son and his family were eating their lunch, but did not even invite her to join them for lunch. Mrs. M had to cook and have her food after 1 hour. When Mrs. M narrated this incident to me and cried, I felt helpless. This is the situation of so many elders in the villages. Most of them are economically non-productive. They are dependent on their sons and daughters for their livelihood. They are treated as a burden to the family. 

 

Mrs. T is another 75+ years old woman, living with her son and his family. She has early Parkinson’s disease and finds moving around very difficult. But she must go to the MGNREGA (Mahatma Gandhi National Rural Employment Guarantee Act) work in the village to earn at least 1000 – 2000 rupees a month. She says this gives her financial independence to at least take care of her medicines and toiletries. She has sustained several falls due to difficulties in balancing. I advised her to use a walker which we even arranged for her free of cost. But she refused saying, “If the MGNREGA manager sees me with the walker she will not allow me to work. Then I will not get even that little money that I need for my basic dignity”. 

 

Mr. G, who was a very active farmer during his heyday, is now more than 70 years of age and has handed over the reins to his sons and daughters. He offers to take care of the crop in the fields when his sons and daughters go away to work. He leaves his wife, who is also ailing with multiple medical problems, in his village and goes and stays in the farm house to take care of the crops. But his sons and daughters do not respect him or his opinions. They don’t even arrange for a comfortable stay in the farm house or regular meals for him. This has affected his diabetes control and the separation from his wife has also made him mentally unwell. When I suggested that he go back to living in his village, he said, “I also need some purpose in my life doctor. I cannot just keep eating and sleeping in my village. I have some ability in my body today and so I want to contribute”. I could relate to what he was saying. 

 

There is a need to promote health and wellbeing of elderly in the community. Interventions to create social supports and networks for the elderly through inter-generational interactions will help. Day care centres for elderly where they can come and spend the day, interact with one another and create healthy networks can be useful. There are various social welfare schemes like the elderly pension scheme and the disability pension scheme for which many of these elderly persons are eligible. But they are either unaware or do not have access to these schemes. There is a need to promote and popularize these schemes among the elderly. Part time livelihood and self employment opportunities within the space of the day care centres can be highly engaging and empowering to the elderly. Access to legal support and counsel to the elderly against neglect, abuse and financial exploitation can also be promoted. 

 

In the past three months I have heard of three suicides of elderly person in the local community where I work. This is hugely disturbing and potentially preventable. The public health problem of elderly mental health and elderly suicides is grossly neglected and needs immediate attention.