One study published in a renowned journal – ‘Lancet’, claims that the life expectancy in India has gained more than a decade – 59.6 years in 1990 to 70.8 years in 2019. However, the researchers also making a point of disappointment that healthy life expectancy has not been as dramatic as the growth of life expecting since people are living more years with illness – Physical as well mental.
Depression is a common mental illness characterized by persistent sadness and a loss of interest in activities that people normally enjoy accompanied by an inability to carry out daily activities. The pace of population ageing is much faster than the past. Old age is a period of transition when one has to deal not only with the physical aging but also with the challenges affecting the mental and social well-being. There is mounting evidence that depression takes a serious toll on physical health. Very often, they are undiagnosed and then left without seeking healthcare for the same.
Depression, along with other mental health disorders, has long been segregated and neglected. The elderly age group comprises a particularly vulnerable group as they often have multiple co-existing medical and psychological problems. Depression is under treated in this age group, and perhaps particularly so because it is not yet perceived as a priority public health problem in developing countries.
Societal modernization has brought in its wake a breakdown in family values and the framework of family support. With ongoing economic development, children are moving to urban areas, sometimes leaving their parents alone at home. If the parents move with their children, they are sometimes unable to adjust to the new environment. The change in the family structure along with economic insecurity results in the elderly losing their relevance and significance in their own house and increasing feelings of loneliness. This has a detrimental influence on the psychological health of the elderly.
All these factors make the elderly more prone to psychological problems. Even though depression is the commonest psychiatric disorder in the elderly, it is often misdiagnosed and under-treated. Perhaps due to the misconception that depression is part of ageing, rather than a treatable condition. In the absence of treatment, there will be significant clinical and social implications in the lives of the elderly, as depression has a tendency to be chronic or recurrent.
Depression decreases an individual’s quality of life and increases dependence on others. People with depression suffer from impairment of all major areas of functioning, for instance, personal care, family responsibilities, and social occupational capabilities. Elderly people tend to be less healthy physically and are more socially withdrawn. People with depression suffer overly from various medical disorders and die prematurely. Geriatric populations with depression are at a higher risk for chronic diseases like coronary heart disease (CHD), cancer, diabetes mellitus and hypertension.
There is an increasing number of older people with limited mobility and need of long-term care. These factors increase the elderly person’s dependency and make them vulnerable to maltreatment in various forms like deprivation of dignity and insufficient care etc. Elderly patients often need long-term institutional care, but such services are scant in India. Governments in developing countries such as India should attempt to change the negative perception the community holds towards mental disorders by giving priority to public education as many aspects of mental health care require active collaboration with the community. It is time to start the process of destigmatisation of mental health disorders.
In addition, supply of effective and affordable drugs in primary health facilities, recognizing and addressing the inequities in health, maximizing scarce public resources, regular training programmes for primary care providers, research on preventive and promotional aspects of mental health and sufficient fund allocation should be the priority areas for tackling depression in the elderly. Aggressive education and awareness campaigns to fight depression at individual, community and the national level and support to patients should be an essential component of future strategies. The burden of depression among the geriatric population of developing countries needs to be addressed as a priority, before it becomes a public health menace.