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January 09, 2020 Thursday 04:11:33 PM IST

The Aging Challenge


The term senescence refers to the aging process, including biological, emotional, intellectual, social, and spiritual changes. Reverence for the elderly is still a part of some cultures but it has changed in many places because of social factors. In many modern nations, however, industrialization contributed to the diminished social standing of the elderly. Today wealth, power, and prestige are also held by those in younger age groups. In India, the elderly account for 7% of the total population, of which two-thirds live in villages and nearly half of them in poor conditions. Urbanization, nuclearisation of family, migration, and dual career families are making care of the elderly more and more of a personal and social problem in India. In any attempt to study the process of aging, we must include its different aspects such as biological, emotional, financial, social, spiritual components.There is no particular age at which we can say that people cross the threshold into “old age.” People age at different rates; hence, for any given age, there will be great variation in all proposed bio markers of aging or phenotype of healthy aging. Let’s have a quick look at the common challenges the seniors face with special attention to mental health issues.  What are some of the challenges the older adults encounter during the ageing process?

Challenges of Aging 

Extensive research and studies have categorized eight set of challenges the seniors have to face. Each category reflects a significant need and opportunity, or an area where there is ample opportunity to “do good and do well”:

1. Engagement and Purpose: Ageism and outdated social norms have resulted in isolated and marginalized lives for older adults, in both rural and urban communities. Helping older adults get and stay meaningfully engaged is critical for their health and the health of our communities. New and creative ways are needed to not only tap into their wisdom but also to provide opportunities for lifelong learning and meaningful engagement across the lifespan.

2. Financial Wellness: People are living longer and traditional models of work and retirement have not kept pace. Financing longevity will require new models, new tools and new norms. New opportunities for later life employment, new models for planning and financing care and better ways to prevent scams and fraud are needed.

3. Mobility and Movement: Everyday objects, homes and communities not originally designed with longevity in mind often become obstacles to movement, safety, independence and socializing. Remaining safe and mobile are top priorities for older adults. There is a need for products, programs, and services that enable people to maximize their safety, strength, balance, fitness, independence and mobility as they age.

4. Daily Living and Lifestyle: The majority of seniors state a preference to “age in place,” yet one third of people over 65 need assistance with at least one activity of daily living (e.g. eating, bathing, dressing, etc.). Products and services are needed to help support not only older adults’ basic daily activities but also to foster and support their ability to thrive, pursue their passions and engage with their chosen lifestyles.

5. Care-giving: Care for seniors is provided by informal (unpaid) and formal (paid) caregivers. Both groups are increasingly caring for people with higher levels of acuity and complex conditions. Family caregivers who are often juggling other family and work responsibilities and living remote from the care recipient, need better support, training, resources and tools to help them take care of their loved ones and themselves. On the professional side, staff shortages and quality concerns loom large, so new solutions are needed to help attract, train, develop and leverage scarce human capital.

6. Health Care Coordination: The health care journey can be particularly complex and fragmented for seniors, two-thirds of whom have at least two chronic conditions.With the overwhelming majority of health care money spent managing chronic conditions, families and health insurance providers are aligned in their desire to care for people in the least restrictive, most cost effective setting. Families and providers need new tools and care models to support care transitions, clinical collaboration, medication management, population health management and remote care delivery.

7. Brain Health: Incidence of Alzheimer’s disease is 33% among people over 85 years old, the fastest growing segment of the population. While there remains no cure for Alzheimer’s disease, better tools and services are needed to increase awareness, develop tools for early prediction and diagnosis, optimize cognitive fitness, slow cognitive decline and support caregivers.

8. End of Life: Death is inevitable, but that doesn’t seem to make it any easier to talk about or prepare for. As a result, 25% of the Medicare budget is spent on the last year of life and many people still do not die where or how they want. Families and providers need help navigating end of life options, having the difficult conversations and ensuring that end of life wishes are met.

 For more information:

Aging and Mental Health Issues

Over 20% of adults aged 60 and over suffer from a mental or neurological disorder. Mental health problems are under-identified by health-care professionals. 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, seniors 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 can result in isolation, loneliness or psychological distress in older people, for which they may require long-term care.

Dementia, Depression and Anxiety

 The most common mental and neurological disorders in this age group (60+) are dementia and depression, which affect approximately 5% and 7% of the world’s older population, respectively. Anxiety disorders affect 3.8% of the older population.

 Dementia is a syndrome, usually of a chronic or progressive nature, in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities. It mainly affects older people, although it is not a normal part of ageing. It is estimated that 50 million people worldwide are living with dementia with nearly 60% living in low- and middle-income countries. The total number of people with dementia is projected to increase to 82 million in 2030 and 152 million in 2050.

 There are significant social and economic issues in terms of the direct costs of medical, social and informal care associated with dementia. Moreover, physical, emotional and economic pressures can cause great stress to families and carer-givers. Support is needed from the health, social, financial and legal systems for both people with dementia and their care--givers. We must pay special attention to the unpleasant fact that the care-giver is really the second patient.


 Depression has a powerful negative impact on ability to function, resulting in high rates of disability. The World Health Organization projects that by the year 2020, depression will remain a leading cause of disability, second only to cardiovascular disease. Depressed older adults also experience higher rates of insomnia and memory loss. They also have longer than normal reaction times, increasing the hazards associated with cooking, driving, self-medication and other tasks that require full attention. An older adult may also sense a loss of control over his or her life due to failing eyesight, hearing loss and other physical changes, as well as external pressures such as limited financial resources. These and other issues often give rise to negative emotions such as sadness, anxiety, loneliness and lowered self-esteem which in turn lead to social withdrawal and apathy. But it is important for caregivers to understand that while we may be able to identify factors that can promote depression, the condition itself is NOT a normal condition of aging. It is a treatable condition in over 90% of those affected.

An anxiety disorder causes feelings of fear, worry, apprehension or dread that are excessive or disproportionate to the current problem or situation. Anxiety disorders affect 3.8% of the older population. Identifying anxiety in older adults is important because it is often linked to depression, worsening memory, and other physical and mental health conditions. Untreated anxiety disorders can lead to cognitive impairment, disability, poor physical health, and a poor quality of life.

An integrated and inter-disciplinary policy, planning, execution and supervision is a must for geriatric care and welfare. The situation in India is far from ideal. Key actions include orienting health systems around intrinsic capacity and functional ability, developing and ensuring affordable access to quality older person-centred and integrated clinical care, and ensuring a sustainable and appropriately trained, deployed, and managed health workforce. Educating our seniors to the challenges of ageing is truly a need of the times.

Dr. Jose Cletus Plackal

Licensed clinical psychologist, BET-MRT, Jeevas Centre, Aluva, Kerala.

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