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Globally the old age population has been increasing and Sri Lanka is no exception. According to the Ministry of Health, Highways and Social Services statistical manual, in 1995 the population above 65 years was 6.2% and the predicted figure for the year 2010 is 8.6% and the year 2020 is 12.1% 1. The mid-year population for 1998 was about 18.8 million 2. One has to consider the rising population above 75 years and 85 years also, as health care and life expectancy are improving. Another interesting observation is that our extended family system is gradually disappearing, particularly in the urban sector and one has to seriously consider this issue when planning psychiatric services. Not only physical illnesses but psychiatric ailments too tend to increase parallely as the ageing process begins.
Even though research with regard to old age psychiatry in Sri Lanka is scanty, the available data suggest a great need for this discipline. A survey done in the North Colombo General Hospital regarding admissions to the psychiatry unit showed that 7% were above 65 years old and the commonest morbidity was dementia (26%). The other important illnesses identified were depressive illness (25%) and schizophrenia (24%). Other patients had delusional disorders (10%), mania (7%), brief psychotic episodes (3.5%) and delirium (3.5%) 3. However, this was a hospital-based study and the figures may not represent the community. |
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In developed countries,
for instance in the United Kingdom, numerous studies have been done
since the original surveys of psychogeriatrics. Some of the classical
surveys of old age psychiatry were done at Newcastle Upon Tyne 4. A
more recent study regarding prevalence rates showed that among the population
65 years or more 4.6% had cognitive impairment, 13.5% were depressed,
10% had phobic disorders and 3.7% had generalized anxiety disorder 5.
Social factors as well as physical factors can precipitate psychiatric disorders of old age. For example, life events, lack of social support, lack of social stimulation, economic factors, and a variety of physical illnesses can contribute to psychogeriatric problems. According to Murphy6 there is an association between the onset of depressive illness in old age and severe life events, major social difficulties and poor physical health. Depressive illness is a major problem in the elderly and symptoms can manifest in various ways. Somatic symptoms of depression are a common presentation particularly in developing countries. In addition to that, clinicians often see anxiety, neurotic symptoms, agitation, restlessness, poor concentration and attention span leading to “memory problems” (depressive pseudodementia) and paranoid symptoms in the depressed elderly. Some of these patients resort to alcohol to obtain relief. Alcohol misuse can be |
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POINT OF VIEW
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Correspondence: Dr. K.A.L.A. Kuruppuarachchi, Dept. of Psychiatry, Faculty of Medicine, University of Kelaniya.