Mental Health

Mental Disorder in Old Age

Posted in Mental Disorder in Old Age by admin on September 14th, 2008

The problems of old age have loomed increasingly large on the social and medical scenes in the more advanced countries during the past half century and they are now assuming growing importance in the less developed countries. As living standards and the quality of medical care improve, mortality in infancy and in adult life decrease, and there is usually an associated decline in the birth rate. The ageing of the population is, therefore, an unavoidable concomitant of increasing affluence. It has been estimated that if present trends should continue, in twenty years’ time those aged 60 years and over will account for about 10% of the world’s population.

The mental diseases to which old people are liable constitute one of the most urgent medical problems confronting contemporary society. Whereas physical illnesses such as cardiac or respiratory disease impose some restraints or limitations on the manner in which old people live, it is the progressive forms of mental decline that threaten their autonomy and often cause them to become helplessly dependent upon others. Many surveys have demonstrated that, given some measure of support, physical handicaps, even when serious, will not prevent old people continuing to live at home or within the community. It is when intelligence and personality begin to decline and disintegrate that independence comes under threat. And with the increasing trend for women to find employment outside the home, the number available to provide care and support for aged relatives becomes even more restricted.
The frequency with which some forms of mental decline occur in later life has probably generated some of the pessimism with which senescence has been regarded down the ages. At a conservative estimate, approximately 21% of those in the community aged 65 and over will be found to be suffering from a recognisable mental disorder and the proportion affected rises steeply with increasing age.1 In fact, in all countries from which factual information is available, the prevalence of mental disorder reaches a peak in late life.

This must have been noted many centuries ago, and it probably explains the gloom, pessimism and foreboding with which old age has been regarded by most societies that have left a written historical record. Eulogies of old age such as that in Cicero’s De Senectute have been exceptional. Most of the accounts resemble those of Menander in ancient Greece:

‘The man who stays too long dies disgusted; his old age is painful and tedious; he is poor and in need. Whichever way he turns he sees enemies; people conspire against him. He did not go when he should have gone; he has not died a good death.’

The famous medical scientist of the 18th century Albrecht Von Halle complained of the bitterness of old age, its solitude, despair and its end in death. The assumption behind all those accounts was that every kind of mental disorder in old age causes the individual to decline without hope of relief into a mere ghost of his original self.

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