| Source – harmony magazine sept 2004 |
| Helplines – Harmony Magazine Article- September 2004
You are not alone Depression among the elderly, though common, often goes un-addressed and unrecorded. Read the warning signs and reach out for help, says Nilanjana Sengupta 1. Introduction When A B Chopra, 64, retired as an officer from a bank two years ago, he was faced with a sudden vacuum in his life. With his only child, a daughter, married and settled outside Mumbai, and his wife busy with her social commitments, Chopra has gradually taken to alcohol. His friends worry. They have noticed him slipping into a state of depression, and fear he may become an alcoholic. As advised by a counselor, they are trying to convince him to seek help, but haven’t been successful yet. His wife didn’t notice any change him at first. Now, she acknowledges it may be a problem, but she still doesn’t think it’s serious enough to require medical intervention. Chopra’s friends, however, are not giving up-and with good reason. Depression among the elderly is a common and often chronic condition because it usually goes un-addressed and, therefore, unrecorded. “Depression appears as the single most common disorder [both mental and physical] in the higher age group,” says Dr. Indira Jayprakash, gerontologist and professor of psychology, Bangalore University. “And the prevalent rates of depression among the geriatric population quoted in some Indian studies may not even be accurate. Sometimes, depression may masquerade as physical illness or is mistaken for dementia. Often, it is even considered a ?normal’ part of old age.” 2. Watch out Mumbai-based consulting psychiatrist Dr. R N Jerajani, who has been observing seniors with psychiatric problems for over 20 years, says depression originates from anger growing within. Reaction to financial insecurities, an increasing apprehension about the future and fear related to illness and death can also give rise to the condition. The ?empty nest syndrome’-the feeling that everyone has gone away-is also on the rise in urban India, where grown-up children leave the house, either after marriage or to purse a career. The feeling of hopelessness is higher among women than men, reveals the research of S Siva Raju, professor at the Unit for Urban Studies, Tata Institute of Social Science (TISS), Mumbai. He attributes this to widowhood and, consequently, a higher sense of financial dependency on the family after the death of the husband. Himanshu Rath, convener of the Delhi-based NGO Agewell Foundation, feel abuse is also a major cause of depression among the elderly. Abuse, he says, can range from the emotional to the financial and physical, but largely remains hidden from public view in India. Most people suffering from depression talk less, show dwindling awareness of their surroundings, and lose interest in news and happenings. And they don’t always reach out for help on time. Experts say the elderly generally sense a helping hand as prying. “They prefer living a solitary existence than discussing their loneliness with anyone,” explains Professor Vidya Rao, head of the department of Social Welfare Administration, TISS, Mumbai. “They don’t want anyone to infringe upon their independence, however limited that may be.” 3. Reading the signs Depression, however, is not so difficult to detect. Even the family physician can pick up the signs. “Brooding and feeling worthless or hopeless should not be neglected or dismissed as a part of ageing because if it persists it may lead to passive suicidal thoughts,” says Dr. Nilesh Shah, professor of psychiatry at Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai. Earlier this year, 78-year-old Coreen Cherrian visited her family physician in Hyderabad, complaining of headaches, body aches and episodes of inexplicable weeping. Her husband and passed away four years ago, and her two daughters were settled abroad, visiting her once a year. When her younger daughter could not make it last year, she had started taking anti-depressants. The physician referred her to a psychiatrist. “What she needed was someone to speak to her, some one to actually listen to her,” analyses Dr. Jerajani. Cherrian sought help in time; others are not so fortunate. The US-based Alliance for Aging Research (AAR) confirms that depression among the elderly, if neglected, could even lead to suicide. An AAR study reveals that 18 per cent of suicide cases in 2000 were in the 65-and-over age group. The shocker: over the years, several American studies have revealed that up to 75 per cent of older adults who commit suicide visited a primary care physician just a month before. “In India, the incidence of seniors requiring help is eight times higher than the US,” says Shah. The social order also doesn’t allow many of them to reach out. Hence, the chances of coming to any statistical conclusions are rare. Dr. Shah points out here that the opportunity to get help is easier in countries like the US because the physician to patients ration is more favourable. After attending to the elderly for 15 years, he can’t say the same about India. One recourse, he says, is the help line. “Besides counseling, it facilitates a link between the caller and community-based care.” Dr. Jerajani agrees. “If the family has no time or is not around to take care of its elder members, one-button help line services can come in handy,” he says. 4. Dial for assistance In Chennai, 82-year-old Viji Hariharan remembers how loneliness drove her to dial the number of a senior citizens’ help line a few month ago. The counselor suggested she see a psychiatrist. She even attended a therapy session sometime ago. Though widowed and childless, she refuses to move in with her only nephew’s family abroad. Now, instead of lamenting that decision, she uses her time well. Hariharan teaches her domestic help’s children how to write Tamil, potters around her kitchen garden and goes for walk every morning and evening. She rarely finds the time to even sit down and have a cup of tea with her neighbours. One phone call make a world of difference. The Elders’ Helpline, set up recently in Chennai’s police headquarters, receives close to 150 calls every week. Problems range from abandonment of depression. Rehabilitation comprises accommodation of destitutes in old-age homes and referral of the depressed to psychologists. In Bangalore, Nightingales Home Health Services teamed up with the city police to launch a counseling line in 2002 for elders in Bangalore and Mangalore. Calls are received from neglected, abused and lonely senior citizens. The Aadhar helpline, operated by Agewell in Delhi. Receives about 150 calls everyday. At its Ahmedabad centre, 40 calls are received everyday. Karthika Anthony, a psychologist working with Mumbai-based Dignity Foundation, receives about 30 calls everyday; at least 15 are related to depression. “For those who seem to suffer from melancholia, we prescribe therapy session, or send volunteers to talk to them, depending on the severity of the problem,” she says. HelpAge India, an NGO working for senior citizens, also sends in volunteers. “We also suggest they join a senior citizens’ association in their locality,” says John Thattil, director, HelpAge India (western region). However, as Rath of Agewell points out, in many cases, volunteers are regarded as threats by the person’s immediate family, who are worried that a personal attachment would lead to a property claim. Professor Vidya Rao of TISS feels the answer rests with the community. “Communities have not done enough,” she says. “Housing societies and townships can play a supportive role to keep the elderly engaged. They must create recreational areas and provide space to the senior citizens living there to mingle with each other.” At home, the key may well lie in the hands of the younger members of the family. “They can help the elderly with love and by spending quality time with them,” says Dr. Rajeev Anand, a psychiatrist who runs the Rahat clinic in Andheri, Mumbai. Although the traditional Indian joint family has gradually fissured, 75 per cent of seniors still live with their families and “the totally isolated elderly person is still relatively rare”, writes Yogini V Meisheri, Seth GS Medical College, Mumbai, in the Journal of Postgraduate Medicine. That’s the silver lining. 5. Call for Help Name City No Featured in Harmony Magazine |