Objective: The problems of elderly differ from that of the young. Isolation from society, feeling of loneliness, helplessness, and increased introspection are agonizing problem of elderly. The relationship between somatic and psychiatric disorders are strong in the elderly. To evaluate the magnitude of psychiatric problems in elderly, there relationship with socio-demographic profile and stressful life events.
Design: Out of total patients attending geriatric clinic, ten were selected for study randomly by blind procedure, study was conducted for 52 weeks period. One thousand elderly patients aged 60 or above form the sample as 40 patients declined from the study.
Materials and Methods: After written consent , patients were subjected to detailed evaluation by especially designed proforma to find out socio-demographic data, details of present illness, past illness and other relevant findings. All these patients were clinically assessed and diagnosed was made according to ICD-10 guidelines. Mini-Mental Status Examinations scale score of less than 24 was the basis to diagnose cognitive disorder. Hamilton’s anxiety rating scales and Yesavage’s Geriatric depression scales was used to assess severity of anxiety and depression. Presumptive stressful life event scale suited to Indian Culture and patient was used to check the life events that occurred within one year prior to onset of illness.
Results: 290 patients could be given ICD-10 diagnostic categories on detailed clinical interview. Of these 180 patients suffering from depressive disorders (62.07%) were assigned diagnosis – depression 80(27.59%), dysthymia 60 (20.69%) and recurrent depression 40 (13.79%). Other diagnosis were – 50 patients with cognitive impairment (17.24%), 40 of anxiety disorders (13.79%) and 10 patients of alcohol dependence and non-organic insomnia each (3.4%). More patient above 70 years (53.57%) suffered as compared to patients below 79 years (X2 = 11.403, df = 1, p< 0.001). patients of lower education suffered diagnosable psychiatric disorders- (83.33%) of patients of dysthymia, 80% of cognitive impairment and all patient of recurrent depressive disorder then patient of higher education. (X2= 7.9113, df=1, p<0.01). Patients with positive past history of psychiatric illness- recurrent depressive disorder (100%) and dythymia disorder (66.67%) suffered from diagnosable psychiatric illnesses (X2= 23.65, df=1, p<0.001). Cognitive impairment on MMSE significantly distinguished patients of cognitive impairment (n=50) from other ICD diagnosed subjects (n=290), (t=10.447, df=27, p <0.001). psychiatric diagnosed patient ( n=290) score significantly higher on HARS scale as compared to non-diagnosable patients (n=710) (t=3.996%, df=98, p < 00.05). dysthymia ( n=60 and anxiety disorders (n=40 diagnosed patients scored significantly high on HARS scale as compared to the rest of ICD-10 diagnosed subjects (n=190)(t=22.701. df=27, p<0.001).
Conclusion: A large number of the elderly people have high rate of psychiatric problems complicated by associated physical illness. 75% of the patients diagnosed as depression were below 70 years while all patients of cognitive impairment were above 70 years. With increasing geriatric population, special efforts should focus on providing psychiatric services to elderly.
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