Geriatric Psychiatry—an Upcoming Challenge

The advancing age of man brings its own specific problems to be dealt with. There is a gradually progressive decline in muscular strength, coordination , energy reserves, stress-tolerance, resistance to illness and ability to recover from illness. Joints get fibrosed, bones develop osteoporosis, muscles atrophy, skin becomes wrinkled and loses its elasticity and hair become thinner and grey. Increasing cholestrol deposit in blood vessels narrows vascular lumen with decreased blood supply to the brain resulting in cerebral atrophy and apoplexy. This is reflected in physiological changes viz., reduced memory, inabilitv to learn, lowered ability to integrate new information with old«nd to organize appropriate responses, a decreased flexibility and creativity in problem solving, a somewhat lowered capacity to cope with psychological stress and an increase in time required for various psychomotor tasks. Retirement from work, demise of spouse, reduced income, considerable increase in leisure, changing attitude of younger generation (generation gap) add to the stresses and pose new demands for adjustment for the individual. All this tends to produce anxiety, despair, feelings of uselessness and depression. Although dementia forms the major group of menial illnesses in old age (80%), functional psychoses are no less common. Associated cognitive impairment make.* differentiation between psuedo-dementia of depression and organic dementia more difficult. Physical ailments of old age like myocardial infarction, diabetes mellitus, hypertension and neoplasms are associated with their own specific psychiatric problems. It becomes a duty for the psychiatrist to motivate elderly patients to accept modern treatments for their illnesses and to develop a will to live in these desperate patients. This requires special psychothera-peutic skills and techniques. Changing physiology, metabolism and pharmacokinetics with ageing requires greater skill and close monitoring of physiological functions in drug treatment for geropsychiatric problems. Elderly patients thus pose a definite, discrete and different challenge for psychiatrist and require special skills to deal with. Increase in the medical and health facilities, prevention of young deaths due to infection and trauma, new advances in physical modes of treatment for illnesses of young age, increased means of comfort that reduce physical stresses of life and improved quality of nutrition—all together have resulted in an increased life expectancy of Indian population. The proportion of those aged 65 and above in the total population has increased from 3.1% (in 1951) to 3.35% (in 1971). In other words there has been a 63% increase in population aged 65 years and above as compared …