co-morbid with other psychiatric disorders such as depressive illness, phobic and anxiety disorders.
Even though depressive illness is a common clinical problem in the elderly, it is often undetected and inadequately dealt with particularly in non-psychiatric settings. A study done with regard to use of antidepressants by non-psychiatrists for the management of medically ill, depressed, hospitalized, elderly patients showed either inadequate treatment, improper treatment, or non-treatment 7.
Depression is associated with many physical ailments. It is common in neurological disorders, even though the exact causative factors and prevalence rates are still debatable 8. Also, inter-relationships between depression and diabetes mellitus/cardiac disease is better understood 9. Many of these physical illnesses tend to rise with increasing age and it is important to identify them early to reduce morbidity. A study done with regard to mortality of elderly patients with psychiatric disorders showed that late life psychiatric disorders to have an excess mortality10. Another study done with regard to age related factors on depression showed that physical illnesses and associated disability are risk factors; whereas normally functioning healthy elders are not at greater risk than young people, in developing depressive illness 11.
Anxiety disorders and other stress disorders are common in the old age population. Bereavement reactions are also encountered as they experience many losses during this age: retirement, marriage of children who then leave home, losing the spouse etc. Delusional disorders or paranoid states of late onset are seen in the elderly and the suffering may be immense due to these delusional systems. Dementias, mainly Alzheimers or multi-infarct, mixed or other
uncommon forms also contribute to significant morbidity and mortality.
At present in our country relatives of elderly patients play a major role in the caring process. However in time to come, services for the elderly mentally ill may have to be more organized and strengthened. Services should include health care as well as social services. It is important to train the medical profession (starting from undergraduates) to identify these problems early and to provide remedies whenever possible. In western countries this issue has been addressed to a considerable extent. Another important area that needs to be highlighted is allowing the elderly people to have social stimulation and recreational facilities. . Caring for carers is another important issue, as carers need emotional support and counselling constantly, particularly when dealing with illnesses like dementia. A study done with regard to reducing the burden of care in carers of Alzheimers disease sufferers demonstrated that the family intervention helped to reduce distress and depression significantly in the carers, simultaneously there was a significant reduction of behavioural disturbances among the patients12. A variety of facilities including residential homes, elderly mentally infirm (E. M. I.) homes, private homes, day centres and nursing homes (in addition to acute beds and long stay beds in the hospitals) are available in developed countries. Old age psychiatry has been identified as a sub speciality in psychiatry and many trainees take up Psychogeriatrics as their career.
Multidisciplinary teams including psychologists, community psychiatric nurses, occupational therapists, physiotherapists and social workers attend to a variety of problems encountered in these populations. In Sri Lanka too, time has come to give due consideration to provide comprehensive care for the elderly using a multimodal approach.