Psychiatry of Old Age in India

Abstract

India has 42 million elderlies (60+) constituting 6% of population (1981 census). This is expected to cross 60 millions by the turn of the century and will more than double by AD 2025. Three-quarters of them are young-old and the rest old-old. Eighty percent of the country's population and 83% of the elderlies live in villages. India's scriptures fixed a life span of 100 years recommending incessant activity. Man's life is demarcated into four successive stages (Ashramas): of studentship, the householder, an ascetic and the forest dweller'. The last two favour ‘disengagement' and are prescribed for the old. In practice, they are rarely followed. The ‘joint-family' has fissured resulting in altered intrafamily roles and care of the elderly precarious. Location within the family does not assure one's integration; while living alone does not necessarily mean one's social isolation. The state of well being varies from 22.1% to 52.1% in the elderlies. The prevalence rate of mental morbidity is 89/1000 elderlies with geriatric depression accounting for 60/1000. Psychiatric disorder is seldom an isolated event and is associated with a high degree of physical comorbidity. First episode of mania is not uncommon. Suicides have been on the rise and the rate is 12/100,000; higher than the National rate: 7/100,000. Health care of the aged is to be a ‘total' one comprising physical, psychological, social, economical, nutritional, educational and rehabilitational aspects. In the management of the final challenge’, philosophical concepts should form part of the measures adopted.