Dr. Mathew Varghese
Dr. Mathew Varghese

Eminent Geriatric Psychiatrist and Professor at NIMHANS, Bengaluru, Dr. Mathew Varghese had visited Kozhikode in the first week of February to deliver a speech at the inaugural event of the “MHAT Expert Lecture Series” at Nalanda auditorium.

On the sidelines of the event, Dr. Manoj Kumar of Mental Health Action Trust (MHAT) had a conversation with Dr. Mathew Varghese.

Q. Why should we focus on the mental health of the elderly?

There are many reasons. Older people suffer with multiple chronic medical problems, such as diabetes, hypertension, heart disease etc. 30-50% of such people with medical problems will also have mental health problems. Even people who do not suffer with medical illnesses have a higher rate of depression and anxiety (10- 20%). Besides these, there are other psychological issues and then of course is the huge problem of dementia.  

Q. Why focus on dementia?

Mainly because of the numbers. In India, there are about 10 crores of people above the age of 65 years. Of these 3-5% will develop dementia. Thus we have over 40 lakhs people with dementia in our country which makes us second only to China. And that is not all. In 20 years, there will be twice as many people who will struggle with dementia.

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Q. So what needs to be done?

For illnesses such as clinical depression and anxiety, early detection is the key. Nowadays, there are good medication options and increasingly, psychotherapy or counselling options are also being used.

Q. What about dementia?

Here also, it is imperative that we identify people with early memory problems. Memory problems in the elderly should not be seen as part of normal ageing. Once detected, there is the potential for treatment which will at least slow down the progression of the disease.

Q. Depression and dementia are major issues. What about other psychological problems?

People in the older age group are particularly vulnerable to problems such as bereavement and other major life happenings. These lead to severe losses and role changes. One particular problem is dependence on prescription drugs such as Loraepam and Clonazepam. Besides, the elderly are not immune to being dependent on alcohol and other drugs. Suicide among the elderly is also not unheard of.

Q. Why does the elderly become depressed?

As we grow older, we become increasingly socially isolated. There is a progressive reduction in our involvement with the family and society. Often, there are conflicts with children or other family members. Significant life events happen, such as the death of the spouse, deaths of contemporaries and retirement from life-long occupations. Besides, there is increasing frailty from physical diseases.

Q. How can we prevent dementia?

We have to start early, even in the third, fourth of fifth decades of life.  Lifestyle modification including changes in dietary and other habits and exercise will help. Besides, maintaining social networks is very important. The other important aspect is more difficult to achieve, which is being at peace with one self. Coping well with stress will definitely help. Keep your brain active through mental exercises such as learning a new skill or solving puzzles or doing Sudoku.

Q. You mentioned diet and life style earlier. Can you please elaborate?

In general, I would say that what is good for the heart is good for the brain. By this, what I mean is that things which have been proven to be effective in reducing the risk of heart disease are also found to be of benefit in protecting dementia. These include regular exercise, losing extra weight, reducing carbohydrates and a diet which is predominantly based on vegetable, fish, nuts and legumes. Controlling diabetes and hypertension, especially in the early years is very important.

Q. Despite the needs being so obvious, why are mental health services for the elderly lacking?

There is a prevailing tendency to minimize the health problems of the elderly and to see them as part of natural process of aging. Perhaps because of this, the need for a national response was felt by the government leading to the announcement of a National Program for the Health care of the Elderly recently. As per this, all medical colleges are expected to have separate geriatric departments and at the district level there should be geriatric clinics. The most important part of this will be to train health workers to provide care at home. The focus in India should be on providing care at home and not in nursing homes or in hospitals. This is exactly what all of you in MHAT are doing for younger people with mental illness.  The care can be informal or unpaid or it could be even paid care.

As you know, MHAT is planning such a service for the elderly in Kozhikode in the near future. We are also training geriatric care workers in association with TISS Mumbai. Yes, these are steps in the right direction.