| Abstract|| |
Background: An exceptional increase in the number and proportion of older adults in the country, rapid increase in nuclear families, and contemporary changes in psychosocial matrix and values often compel this segment of society to live alone or in old age homes. As this group of people is more vulnerable to mental health problems, therefore a pilot study was carried out by the Department of Geriatric Mental Health, Lucknow with following aim.
Aim: To study mental health and associated morbidities among inhabitants of old age homes.
Materials and Methods: It was an exploratory study in which information about available old age homes at Lucknow were obtained and three of them were randomly selected. All the heads of these institutions were contacted and permission to carry out the study was obtained. Consent from the participants was obtained. Survey Psychiatric Assessment Schedule (SPAS), Mini Mental State Examination (MMSE), Mood Disorder Questionnaire (MDQ), and SCAN-based clinical interviews were applied for assessment by a trained research staff.
Results: Forty five elderly inhabitants who had given their consent to participate in the study were interviewed. Depression (37.7%) was found to be the most common mental health problem followed by anxiety disorders (13.3%) and dementia (11.1%).
Conclusions: A majority of the inhabitants (64.4%) were having psychiatric morbidity and no one was observed physically fit. Large sample studies are needed to substantiate the observations.
Keywords: Inhabitants, mental health problems, old age homes, older adults
|How to cite this article:|
Tiwari S C, Pandey NM, Singh I. Mental health problems among inhabitants of old age homes: A preliminary study. Indian J Psychiatry 2012;54:144-8
| Introduction|| |
The changing demographic scenario and population projections of India indicate that the growth rate of Indian older adults (aged 60 years and above) is comparatively faster than other regions of the World. Since recent past, due to marked increase in life expectancy, rise in number and proportion of older adults the population of older adults is increasing at a fast pace. In India at present, older adults constitute 7.6% of total population. Within three decades, the number of older adults has more than doubled i.e. from 43 million in 1981 to 92 million in 2011 and is expected to triple in the next four decades i.e., 316 million. , This clearly reveals that the growth rate of Indian older adults is comparatively faster than in other regions of the World. The life expectancy at birth has also increased from 62.5 years in 2000 to 66.8 years in 2011.  Rapid growth in percentage and proportion of older adults in the country is associated with major consequences and implications in all areas of day-to-day human life, and it will continue to be so. As a result, the aged are likely to suffer with problems related to health and health care, family composition, living arrangements, housing, and migration.
Traditionally, the family has been the primary source of care and material support for the older adults throughout Asia. And, the Indian family system is often held at high position for its qualities like support, strength, duty, love, and care of the elderly. The responsibility of the children for their parents' wellbeing is not only recognized morally and socially in the country, but it is a part of the legal code in many states in India. But urbanization, modernization, industrialization, and globalization have brought major transformations in the family in the form of structural and functional changes.  As a result of these socio-demographic changes, older adults at times are forced to shift from their own place to some institutions/old age homes. ,,
This segment of population is more vulnerable to health-related problems including mental health problems. Various prevalence studies have reported mental health problems among older adults to be very higher than other age groups. ,,, The available literature indicates that there are hardly any effort to understand the morbidity and the needs of such elderly people and specific studies related to the issue are hardly available. ,,, Viewing it, to assess mental health and other associated morbidities among inhabitants of old age homes, a study was planned and carried out by the Department of Geriatric Mental Health, Lucknow.
| Materials and Methods|| |
It was an exploratory study and was carried out in old age homes of Lucknow city. Prevalence of mental and physical health problems among inhabitants of old age homes was explored. Out of seven old age homes, three were randomly selected and heads of these institutions were contacted regarding permission to carry out the study. Three different types of old age homes were selected for the study. One of them was established by a religious organization-Gayatri Pariwar, in which the inhabitants had to pay a sum of Rs. 2500.00 as charges for their accommodation. The other two old age homes were free of cost.
Contact was made with older adults of these old age homes and their consent to participate in the study was taken. Survey Psychiatric Assessment Schedule (SPAS),  Mini Mental Status Examination (MMSE),  Mood Disorder Questionnaire (MDQ)  Schedule for Clinical Assessment in Neuropsychiatry (SCAN)  were used as screening and assessment tools. These tools were applied by a qualified and SCAN trained research staff. To find out the physical morbidity among these subjects, information was obtained from them by enquiring about their physical health and scanning the relevant documents (prescriptions of the doctors/ medications etc.). MMSE, MDQ and SPAS were used to screen the old age home inmates. The categorization into positive and negative cases was done on the basis of the available norms for the particular tool. Subjects who were found to be positive on these screening tools were further interviewed by SCAN-based clinical interview to arrive on to a diagnosis. The screening and SCAN-based clinical interview was done by qualified and trained mental health professionals. For assessing physical morbidities in the inhabitants, qualitative information like prescriptions and test reports as well as their own explanations (regarding physical symptoms/illness) were taken into account.
All the participants were categorized into three sub-groups-young-old: 60 to 69 years; old-old: 70 to 79 years; and oldest-old: 80 years and above , and data analysis was done by employing percentages and test of significance.
| Results|| |
The study was carried out in three of the old age homes, the details of inhabitants of these old age homes are given in [Table 1].
A total of 45 inhabitants (20 males and 25 females) of three old age homes had given their consent to participate in the study. Age wise and socio-demographic details of participant older adults are given in [Figure 1] and [Table 2], respectively. Further, data is analyzed in view of age and gender.
[Figure 1] reveals that a majority of the elderly were in old-old age subcategory (Male=50%; Female=64%) followed by young old (M=35%; Female=20%), and oldest old (Male=15%; Female=16%). Among these inhabitants, a majority were females (55.6%). As the inhabitants in different age categories were not found to be equally distributed or representative as per the proportions in the community, the socio-demographic details are done accounting the gender only.
A majority of inhabitants were illiterate (28.9%), followed by primary level education (20%) and graduate and above (17.8%). Only 6.7% of inhabitants had professional qualifications. Proportionately majority of females were either illiterate (32%) or having less education (primary = 28%; just literate = 12%). A majority of the inhabitants were widowed (females = 88%; males = 65%). Among males, 15% of habitants were married and similar proportion of males was unmarried; whereas in females only 12% were having married status. A majority of the females were financially dependent (84%), whereas a majority of the males (75%) were financially independent.
Pattern of mental health problems
[Table 3] reveals that a majority of inhabitants were suffering from depression (Males = 50.0%; Females = 28%). In males, the subsequent disorder was found to be dementia (20%) followed by anxiety (10%) and schizophrenia (5%). Anxiety disorders were found to be second leading disorders in females (16%). Dementia was found to be prevalent more in males (20%) than females (4%). Mental health problems were found to more common in the young-old group. In males, all elderly except one in each age group were suffering from one or other mental health problem. In the group of young-old females, everyone was suffering from one or the other mental disorders. Sixteen percent old-old females were found to have depression followed by dementia (8%) and anxiety (4%) disorders. Surprisingly, in the oldest-old group, none of the female was found to be mentally ill. However, Fishers' Exact P-value was found to be non-significant for various age categories of males and significant for females i.e., Fishers' Exact P-value=0.2379 (males) and 0.0212 (females).
Pattern of physical illnesses
[Figure 2] shows that all old age home inhabitants were having one or the other physical health problem. A majority of the subjects were having multiple physical morbidity in male and female both and females outnumbered males (Male=60%; Females=68%).
|Figure 2: Percentage of inhabitants of old age homes suffering with physical morbidity|
Click here to view
| Discussion|| |
A total of seven old age homes were found to be functional in Lucknow. Only 72.6% of inhabitant older adults had given consent to participate in the study. Majority of the older adults (56.45%) were residing in Dharmarth old age home (established by a trust), followed by Samarpan -a religious institute (35.5%) and government old age homes (8.1%). All of these old age homes were residential and having the provision to help and accomodate both male and female older adults.
A majority of the inhabitants of these old age homes were between the age group of 70 and 79 years followed by young old and oldest old (57.8%; 26.7%; and 15.5%, respectively). In old-old and oldest-old groups, females outnumbered males (Males = 50% and 15%; Females = 64% and 20%), but in the young-old group, males outnumbered females (Males = 35%; Females = 20%) signifying the current trend of feminization of the older adults.  Educationally females were maximally illiterate (32%) compared to males (25%) which is in accordance to Census of India, 2001 report.  Females (88%) outnumbered males (65%) in terms of their widowed/widower status supports findings of a recent epidemiological study.  A majority of females were dependent (88%), whereas a majority of males were independent (75%) in terms of their financial status.
The overall prevalence of mental health problems in inhabitants of old age homes provides a surprising finding that male suffers more than females (Male = 85% and Females = 48%) not in consonance with the latest epidemiological study.  Depression was found to be the most common mental disorders. Dementia, anxiety, and schizophrenia in males and anxiety and dementia in females supports earlier findings.  Others have also reported that the contribution of depressive disorders was highest in the community studies of elderly. , Cognitive impairment was found to be the second highest in the disorders however; the prevalence of dementia in India has been reported to be variable, from 1.4% to 9.1%. ,,, Surprisingly, all females of the old-old group were mentally fit, which is against the previous findings, report of an epidemiological study reveal that aged females are found to be more vulnerable to mental health problems than their counterpart males. 
All the inhabitants of old age homes were suffering from one or more (multiple) physical illness, no one reported herself as healthy. A majority of the inhabitants were having multiple morbidity (Male = 60%; Female = 68%) supporting the findings of previous studies where it is reported that mental health morbidity is seldom an isolated event in elderly and a minimum of two/three other clinical diagnoses is a rule. 
The prevalence of mental health problems as well as physical problems were found to be higher in inhabitants of old age homes in comparison to community. The reason could be significantly more psychological stressors, negligible family support, lack of medical (physical/mental) care and facilities, restricted environment of old age homes and financial constraints, etc.
Mental illnesses were found to be very common among old age home inhabitants. There is need to screen out various stressor and reasons responsible for developing psychiatric problems in inmates of old age homes. Further, similar studies are needed to evaluate the findings of this study.
| Conclusions|| |
- More than half of the inhabitants of old age homes were suffering from one or other mental health problems.
- Depression was the most common mental health problems.
- The inhabitants suffering from psychiatric illness had one or more associated physical morbidity(ies).
- All inhabitants of old age homes were having one or more physical morbidity(ies).
The study was carried out in a limited time period on a small sample of old age home thus may not be generalized on general population.
| References|| |
|1.||Appraisal of age data. In: Banthia JK, editor. Census of India. Series 1. New Delhi: Controller of publications; 2001;99. |
|2.||James KS, Sathyanarayana KM. Demographic change, age structure transition and ageing in India: Issues and challenges. Yojana- A development monthly 2011;55:28-31. |
|3.||CIA world fact book, https://www.cia.gov/library/publications/the-world-factbook. (accessed internet on September 5, 2011). |
|4.||Vijaykumar S. Challenges before the elderly: An Indian scenario. New Delhi: MD Publications; 1995. p. 53-77. |
|5.||Doty PJ. The oldest old and the use of institutional long-term care from an international perspective. In: Suzman RM, Willis DP, Manton KG, editors. The Oldest Old. New York: Oxford University Press; 1992. p. 251-67. |
|6.||McConnel CE. A note on the life time risk of nursing home residency. Gerontologist 1984;24:193-8. |
|7.||Murtaugh CM, Kemper P, Spillman BC. The risk of nursing home use in later life. Med Care 1990;28:952-62. |
|8.||Ramachandram V, Menon MS. Ramamurthy B. Psychiatric disorders in subjects aged over fifty, Indian J Psychiatry 1979;22:193-8. |
|9.||Reddy MV, Chandrashekhar CR. Prevalence of Mental and Behavioural Disorders in India: A meta- analysis. Indian J Psychiatry 1998;40:149-51. |
|10.||Tiwari SC. Geriatric Psychiatric Morbidity in Rural Northern India: Implications for the Future. Int Psychogeriatr 2000;12:35-48. |
|11.||Tiwari SC, Kar AM, Singh R, Kohli VK, Agarwal GG. An epidemiological study of prevalence of neuro-psychiatric disorders with special reference to cognitive disorders, amongst (rural) elderly- Lucknow study. New Delhi: ICMR Report; 2010. |
|12.||Nandi PS. A study of psychiatric morbidity of the elderly population of rural community in West Bengal. Indian J Psychiatry 1997;39:122-9. |
|13.||Branch LG. Relative risk rates of nonmedical predictors of institutional care among elderly persons. Compr Ther 1984;10:33-40. |
|14.||Greene VL, Ondrich JI. Risk factors for nursing home admissions and exits: A discrete-time hazard function approach. J Gerontol 1990;45:8250-8. |
|15.||Palmore E. Total chance of institutionalization among the aged. Gerontologist 1976;16:504-7. |
|16.||Bond J, Brooks P, Carstairs V, Giles L. The reliability of a Survey Psychiatric Assessment Schedule for the elderly. Br J Psychiatry 1980;137:148-62. |
|17.||Folstein MF, Folstein SE, McHugh PR. "Mini-Mental/state". a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-98. |
|18.||Hirschfeld RM, Williams JB, Spitzer RL, Calabrese JR, Flynn L, Keck PE, et al. Development and validation of a screening instrument for bipolar spectrum disorder: The mood disorder questionnaire. Am J Psychiatry 2000;157:1873-5. |
|19.||WHO. Schedules for Clinical Assessment in Neuropsychiatry (SCAN) Version 2.1. Geneva: World Health Organization; 1998. |
|20.||Venkoba Rao A. Psychiatry of Old Age in India. Int Rev Psychiatry 1993;5:165-70. |
|21.||Rajan SI. Demography of ageing. In: Dey AB, editor. Ageing in India: Situation analysis and planning for the future. Ministry of Health and Family Welfare-Government of India. Geneva: World Health organization; 2003. p. 3-11. |
|22.||UN. The woman ageing situations. New York: Centre for Social Development and Humanitarian Affairs, United Nations, 1991. |
|23.||Ramachandran V, Sarada Menon M, Ramamurthy B. Family structure and mental illness in old age. Indian J Psychiatry 1981;23:21-6. |
|24.||Vas CJ, Rajkumar S, Tanyakitpisal R, Chandra V. Alzheimer's Disease: The Brain Killer. New Delhi: WHO; 2001. p. 50. |
|25.||Shaji KS, Arun Kishore NR, Lal KP, Pinto C, Trivedi JK. Better Mental Health Care for Older People in India. Indian J Psychiatry 2004;46:367- 72. |
Nisha M Pandey
Department of Geriatric Mental Health, Chhatrapati Sahuji Maharaj Medical University, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]