The greying population in India is fast growing with currently 80 million over the age of 60. Though the lives of the older population (referred to as the geriatric population in medical parlance) are efficiently medically managed and extended, the aged Indians are currently facing mental health problems like never before.
These are just not 'normal', 'everyday' worrying - but pathological worries and fears amounting to clinically significant but grossly under a recognised group of mental health problems called Anxiety Disorders.
Anxiety Disorder is characterised by an extremely unpleasant state of mind plagued by a relentless chain of fearful thoughts, a physical state of constant unease, racing heart, tremulousness and an inability to focus on day to day activities.When symptoms persist consistently for a period of 6 months or more a clinical diagnosis of Anxiety Disorder is made.
Chronic medical issues, financial problems and increasing need for dependency have long been known to contribute to anxiety among the elderly.But we are now seeing unique socio-cultural factors playing a major role in the emergence of intense geriatric anxiety.
Even as more and more young Indians are opting for foreign shores, we are witnessing a rapid emergence of a disturbing social phenomenon called PICA (Parents in India and Children Abroad). The breakdown of the extended family - a reverent feature of the Indian culture, elders having to move to residential centres to spend their last years have pushed the ageing Indians into unanticipated solitude, breeding anxiety.
Fear of dying alone and fears that the foreign bound son might not be able to perform the final sacred rites predominate the list of fears of the ageing population.
'Fear of Falling' referred to as FOF is also a common fear encountered in this population mainly attributable to isolation and the perceived absence of 'stronger 'caregivers in the immediate surrounding.
Recent changes in the economic arena leading to an inevitable need to depend on technology for transactions have left the elderly grapple with fears like never before. " I'm never going to be able to keep up the pace" " it's impossible for me to learn new stuff", " how am I going to be able to pay my bills now" are some of the most constant anxious preoccupations plaguing the minds of our elderly now.
If we examine their personality structure, it is more often than not, one of an exceedingly perfectionistic style, incapable of easy adaptability or flexibility.Though this is what would have helped them flourish in early life and to fulfil their responsibilities, it does not necessarily help them cope adaptively with later life challenges.
This style coupled with limited social networking during their active times (due to a responsibility driven attitude) also adds on to their inability to cope efficiently.
Unique socio-cultural challenges imposed upon a vulnerable age group would obviously lead to a high percentage of elders diagnosed with pathological anxiety. But anxiety disorder still evades recognition in this population in India.
This could be contributed in part to the culturally defined tendency of older adults especially Indian women to express their emotional distress as bodily aches and pains.Thus anxiety is often mistaken for physical ailments and the link is missed.
The stigma associated with psychiatry and the absence of grown-up children by their side to aid help seeking prevents the aged to seek appropriate help.
Anxiety disorders are urgent mental health issues that significantly impact the quality of life of the sufferer and contribute indirectly to the already existing disease burden. In spite of the various etiologies that anxiety might stem from, it requires being treated by a Mental Health Professional at the earliest.
The management would consist of medications (to settle the internal chemical disarray caused by stress) as well as other specialised non-pharmacological measures such as cognitive behaviour therapy and specific behavioural interventions.This would help the elderly to combat the feared and fearful disease of clinical anxiety.
But the most important aspect of management starts with the recognition of anxiety as a disorder by the family.It's time we stop dismissing excessive worrying as a normal ageing phenomenon.It's time we sit down, make time and address the seemingly irrational fears of those who painstakingly erased ours.
Reach Out!..Anxiety is a disorder...Anxiety is treatable!
Article by Dr. Yamini Kannappan, MBBS, DPM, DNB
Kauvery Hospital, Chennai