Alka Mansik Pramarsh Foundation Clinical Psychologists-Family therapists Indore 0731-4263087,9179383554

As Families go distant and international what happens to the elderly needs a special look.

Mr Subhash an octogenarian and his wife Sita a graceful old lady of 76 years have been roughing it out all alone for past twenty years or so. Their two sons moved out of the country in their career pursuits and have since settled abroad. A once in three years trip from either of their sons hardly provide the old couple a feeling of being part of the larger family. Yet they carry on taking care of each other. Mr Subhash suffers from sleep disorders , recurrent depression and anxiety. Sita fights her own battle with her old age issues yet bravely accompanying her husband to his sessions with the psychologist.

Similarly Mr Naweja a businessman finds it tough to carry on further as his son and daughter have moved out of home to metro cities to carve out their own career paths. Mr Naweja in his mid seventies suffers from and fights with many physical and mental ailments as he keeps his dates with doctors and the psychologist. He had lost his wife five years ago .A few months in the metropolis where his son works , were spent sitting alone at home but he eventually decided to come back and join business at his old place.

Mrs Khedekar lost her husband about twenty years ago when she was in her early forties .She didn’t give up then as her two sons were quite young and needed to finish their education.Her elder son moved abroad to meet his own career dreams and the younger one to another city for his pursuit of happiness.Years of loneliness has resulted into her developing psychosis ,schizophrenia and a host of other diseases.Though under the professional care of a trained nurse life is still very lonely for her resulting into periodic reversals of her treatment.

In recent times many of the older adults are leading their life all alone without the love and support of their near and dear ones as their wards necessarily have moved out on account of their careers to metropolitans , or abroad . In such a situation it is obvious that besides the emotional stress elders also have to take the stress of taking care of their mental and physical health and also to ensure a little bit of social health so that they don’t get loners and restricted to within .

In many cases it has been observed that the new couples prefer a life away from their parents in order to understand and know each other better and develop intimacy . Such a step is always good provided the periodic and regular touch with elders is maintained .

Let’s browse a few facts :

• Globally, the population is ageing rapidly. Between 2015 and 2050, the proportion of the world’s population over 60 years will nearly double, from 12% to 22%.In India there are currently 138 millions elderly persons comprising of 67 million elderly males and 71 million elderly females .
• Mental and neurological disorders among older adults account for 6.6% of the total disability (DALYs) for this age group.
• Approximately 15% of adults aged 60 and over suffer from a mental disorder.
• Maintenance of brain health is as important as the physical health of the elders .
• While most have good physical health, many older adults are at risk of developing psychological ,mental disorders, neurological disorders and brain health problems.
• They in their loneliness may develop substance use problems as well as other health conditions such as diabetes, hearing loss, and osteoarthritis.
• As people age, they are more likely to experience several co morbid physical,mental and neurological conditions at the same time causing much distress to the elderly.

Risk factors for mental health problems among older adults

There may be multiple risk factors for mental health problems at any point in life. Older people may experience life stressors common to all people, but also stressors that are more common in later life, like a significant ongoing loss in capacities and a decline in functional ability. For example, older adults may experience reduced mobility, chronic pain, frailty or other health problems, for which they require some form of long-term care. In addition, older people are more likely to experience events such as bereavement, or a drop in socioeconomic status with retirement. All of these stressors coupled with the prospects of staying alone without the company of their near and dear ones can result in isolation, loneliness or psychological distress in older people, for which they may require long-term care.

Mental health has an impact on physical health and vice versa. For example, older adults with physical health conditions such as heart disease have higher rates of depression than those who are healthy. Additionally, untreated depression in an older person with heart disease can negatively affect its outcome.

Older adults are also vulnerable to elder abuse – including physical, verbal, psychological, financial and social abuse ; abandonment; neglect; and serious losses of dignity and respect. Current evidence suggests that 1 in 6 older people experience elder abuse. Elder abuse can lead not only to physical injuries, but also to serious, sometimes long-lasting psychological consequences, including depression and anxiety.

What is the way out for us? Is a question often asked by the family members ,when they bring their parents and other elders for a counselling session or for a family therapy interaction with the author .

Tanvi (name changed ) had come to the clinic along with her mother in law . Her mother in law stays alone in the city just refuses to leave her familiar home and move with her son abroad.The septuagenarian suffers from depression,anxiety , sleep issues .Tanvi had to eventually tell this psychologist,”I am leaving her to your care .You act as a local guardian for her and keep us informed of her welfare”.

Though Tanvi could say that but several others of such elderly and their wards are left at their wits end ,not knowing whether to abandon their dream careers and come back ,force the elderly to accompany them or to leave their senior members of their family at the hands of domestic workers and professional agencies .

The struggle continues .

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Joseph a twelve years old adolescent didn’t quite understand what was happening to him .Every time he would want to say something to his parents or even to the teacher in the school it would be taken as an upfront defiance .His father would rebuke him and mother would end up in tears resting the blame on Joseph .Joseph had been identified as the trouble maker in school too .

Jatin a 13 years old lad had been singled out by his class teacher for creating trouble for others in class and he had been set up a bench to sit away from others in the class room ,causing so much embarrassment to him.

He would be rebuked each time others would make a noise in the class .The teacher would simply name him out first and would not even make amends when she found it was some other student who led the riot .

Swara’s family didn’t quite understand why she had started shouting back at her parents and teachers of late .They looked at it as her sulking behaviour and brought her to the clinic for counseling.

Apparently all these and many more of such Children and adolescents are singled out by the parents and their teachers as defiant kids and they are brought to us so resolve their behaviours issues and treat them for oppositional and defiant disorder . Such children are often referred to psychologists or even psychiatrists for behaviour correction because of their regular bad behaviours ,emotional adjustment problems – aggressive outbursts ,disrespect of others ,not following the norms set up by schools or families.the other issues often referred to are truancy , skipping exams ,acts or threats of self-harm, suicide attempts , running away from home .None of the parents would understand that the problem is not the outward expressive behaviour but the underlying stresses ,trauma and unhealthy family relationships ,environment or dynamics could be the cause of the unacceptable behaviour and problematic adjustment in society.

Teachers would simply complain to the parents about the non cooperative manners of child and when parents fail to correct the child by way of punishment or admonishment ,they walk into the clinic with only one expectation of “just fix my kid.”

In all such cases it has been observed that come what may the parents will simply look at the Counselor for help and magic cure without realising that the parental active participation and the school teachers pro positive approach will be more helpful along with the therapy sessions at the psychologist’

Just one way efforts by the therapist do not work with adolescents with ADHD /Dissocial behaviour / Adjustment disorder .They regress sooner to the same behaviour as soon as they return to the familiar negative environment The relapse will occur as soon as the affected adolescent returns to the same unhealthy patterns in the family /school environment.

A few changes at Joseph’s school with support from an understanding teacher helped us bring about a very positive result .The same child now has become a favourite student of all teachers . As a result of active participation by Swara’s parents Swara has become more tolerant of her parents expectations and a very healthy environment prevails at the family.

Similarly we found out that a comprehensive holistic treatment with the entire family of other children mentioned above has been very productive and effective way of treating Oppositional Defiance disorder /ADD/ADHD /Dissocial disorder without taking resort to medications.

Our experience at the Family Therapy India and Alka Mansik Pramarsh Foundation has been to go for the top down approach by involving school teachers and parents to help kids with above problems and bring about a positive changes to the defiance and anxiety of the kids .

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