Psychological Problems in Geriatric-Age Group in Rural Area

Background: The study focuses on the factors that affect psychological health, medical ailments, nutrition, family support to the elderly of the rural area in the Wardha district of Maharashtra and also the solutions of the same. Aim: To assess psychological problems in the geriatric age group in rural area. Objectives: To find out the occurrence of health problems, common psychological and physical stressors faced, and the percentage of old age people residing with family who feel neglected in rural areas. Methodology: Cross sectional study with simple random sampling of 200 elderly above 60yrs of age residing in rural area of Wardha district from February 1, 2020 to March 1, 2020 with a preformed questionnaire. Results: amongst the study sample, it was found that tobacco chewing (50%), anaemia (40%) and hypertension (46%) were found to be major physical stressors. While poor concentration (40%), sleep disturbances (50%) and family neglect (71%), increased health expenditure (82%), limitation in physical activity (48%), decrease in social life (68%) were common psychological stressors affecting the life of geriatric population. Original Research Article Borode et al.; JPRI, 33(60B): 3883-3893, 2021; Article no.JPRI.71150 3884 Conclusion: Based on the results of the above study, there is an crucial need for the government to make action plans regarding old age pensions, proper nutrition and essential health facilities and sustaining the moral values which can make the younger generations feel more responsible towards the geriatric age group.


INTRODUCTION
Each and every living being taking birth in the world has an end; may it be animals, plants, or the most evolved animals on the earth: human beings. Starting from a simpletwo2 celled zygote in the womb to a complex structured form, human life undergoes various phases in life-from taking birth, infancy, childhood, teenage, adulthood, old age to terminate into death finally. Aging is an inevitable event for all human beings irrespective of gender, caste, creed, race, or habitat [1].
India is a democratic country with significantly rich cultural & social values. Being in its developing stage, it has a large no. of geriatric population. According to the estimations stated by UNESCO, 12.3% of the world's total geriatric population would be in India itself, around the year 2025. The number of the female geriatric population exceeds the male geriatric population [2].
This transposition in the demographic configurations in developing countries like India has made the senior population discernible [3].
Looking at the rapid growth of psychological problems in elderly, it is estimated to rise fourfold by the year 2030 compared to last three decades [4]. Correspondingly, moderate and extreme impairments are repeatedly observed in the black and institutionalized elders with minimal education [5]. These numbers show that government needs to set new goals regarding the challenges and issues that old age population in India faces and to build more better and healthy society.
The generation gap, increasing nuclear family structure, not so good attitude towards the aged, rapidly changing thought processes, profound influence of the western culture has made the geriatric population socially, mentally and physically unhealthy somewhere.
It leads to decline in the quality of life, which commonly includes loss of pleasure in life, loss of interest in oneself and others, low self-esteem, ideas of hopelessness and worthlessness, self-blame, feelings of excessive or inappropriate guilt.
Studies on well-being advancing in old age revolve around the concept of healthy ageing [6,7] His concept was formerly based on factual indicators like lack of physical disabilities, cognitive impairment, and social curtailment [8]; lately it was widened to inculcate positive psychological indicators like, a complicated construct incorporating emotional balance, rational decision-making, wisdom based on life knowledge, benevolence [9,10]. Despite the enormous socio-physical changes taking place with senescence, the subjective outlook towards these transformations have a crucial part in anticipating physical health, well-being in old age [11][12][13][14].
Psychological disturbances in elderly population differ from those at younger ages. The presenting symptoms initiate with increase in somatic complaints like joint pain, indigestion, backache etc. and are more similar seen to the phrase "smiling depression" which means no as such signs of sadness or depression seen on the face. The ingenious ability to mask the sadness, aloofness and anxiety in the older population is quite disturbing and dangerous as well as it may left undiagnosed and untreated. This difference is seen due to dissimilarities in the etiology of the both types. The depressive behaviour found in the elderly population is biological meaning to the individual genetic makeup, brain structure and neuronal functioning efficacy and its methodology of processing in majority but psychosocial factors also play an equal crucial role; the most important reason still being the deficiency of the neurotransmitters at the synapses. Dementia related diseases like Alzheimer disease and Parkinson disease can cause depression due to this cause. Heredity and aging further enhance the risk.
There is also remarkable relationship between metabolic syndromes like Diabetes, Hypertension, Stroke, Paralysis and the psychological problems which can be called as vascular depression and acts as a complicating factor for old age depression. Moreover, there can also be the symptomatic overlap of depression, psychosis, dementia, movement disorders and medical conditions and the drugs.
The type of personality according to the psychiatric classification also decides the thought process and ability to tackle the stress related issues and the type of coping mechanism used for it. There is also a great variation in the way of treatment in old age patients from the relatively younger ones. The diagnosis is done based on the DSM-5 criteria and treatment and always started slow and at the lower doses (gradual increasing) but trying to come to the standard therapeutic dose according to the patient's ability to absorb, breakdown and excrete the medication.
At least one in five persons above the age of 65 suffers from a mental illness [15] The generation gap, increasing nuclear family structure, not so good attitude towards the aged people, rapidly changing thought processes, deep influence of the western culture has made the geriatric population socially, mentally and physically unhealthy somewhere. It leads to decline in quality of life, loss of pleasure in life, disinterested behaviour towards oneself and the others, lack of self-esteem, feeling of misery and negligibility, self-accusation, feelings of excessive or unseemly guilt.
The study focuses on the factors that affect psychological health, medical ailments, nutrition, family support to the elderly of the rural area in the Wardha district of Maharashtra and also the solutions of the same. So, it has become extremely important to study the psychological problems, understand them, find the ways out for them and apply them so that the population over 60 years of age can spend more healthy, happy and carefree lives as depression in late life is common; but not inevitable.

Aim:
to assess psychological problems in geriatric age group in rural area.

Objectives
 To find out demographic distribution of old age person living with family in rural area.  To find occurrence of health problems in old age person living with family in rural area.  To find out the common stressor faced by senior citizens living with family.
 To identify various items of physical stressors of old age people residing with family.  To identify various items of psychosocial stressors of old age people residing with family.  To find out the percentage of old age people residing with family who feel neglected.

Study Setting
Old age people residing in rural area of Wardha district.

Study Participants
Old age people above 60 years of age living in rural area of Wardha District.

Sample Size Selection
Sample size studied was 200 subjects from rural areas of Wardha districts

Study Design
Old age people living with family of rural area of Wardha district by Simple Random Sampling.

Study Variables
Sex, age, marital status, religion, education, occupation income, health problems, physical stressors, psychosocial stressors and general questions.

Data Collection (Methodology)
This cross-sectional study of old age person living with family conducted at rural area of Wardha district. Old age people residing in rural area were included in the study. Verbal consent was obtained and those who were not willing to participate were excluded. A pretested questionnaire was used. Over a period of one month all consecutive old age people living with family in rural area were interviewed until the sample size of 200 was reached.  (22) Highest percentage(54%) of the senior citizens living with family were in the age group of 60-65 years and only 4% belongs to >80 years of age. 65% of the samples were male and only 35% were female. Highest percentage (80%) of the senior citizens living with family were married and only 20% were unmarried. Highest percentage (64%) of the senior citizens living with family were Hindus and only 4% were Muslim. Highest percentage (40%) of the senior citizens living with family were from educated up to higher secondary and only 12% were educated up to graduation.

Distribution of Samples
With regards to dietary pattern shows that majority (54%) were vegetarian and only 8% were non vegetarian. Majority (96%) were nonsmokers and only 4% were smokers. 98% of senior citizen living with family were nonalcoholic. Majority 50% of senior citizen living with family need not chew tobacco. 40% of senior citizens living with their family have pallor. 78% of senior citizens living with family need not have history of diabetes mellitus. 54% of senior citizens living with family need not have history of hypertension. 80% of senior citizen living with family need not have the history of major surgeries. 98% of senior citizen living with family need not have the history of fracture of limb. 98% of senior citizen living with family need not have the history of coronary artery diseases. 80% of senior citizen living with family need not have the history of counselling.
Physical stressors are experienced some of the times, certain time and most of the times 36(18%), psychosocial stressors are experienced some of the time 36(18%) and most of the times 64(32%) by senior citizen living with family.
Majority 72(36%) of senior citizen living with family most of the time had poor concentration, 80(40%) had poor concentration certain times, 84(42%) rarely had difficulty in chewing, 164(82%) rarely had difficulty in breathing, 56(28%) most of the times had history of joint pains.
Majority 100(50%) of senior citizen living with family most of the times had sleep disturbance, 96(48%) most of the times had limitation of physical activity, 136(68%) most of the times had decrease in social life, 76(38%) rarely had financial dependency on family members, 120(60%) of them get respect from children and grand-children and 170(85%) rarely have family members dependent on them.
Mean physical stressor score for poor concentration was 2.92±1. 10    Lack of support from family 78 39% 5 Liability of children 40 20% Aware of government scheme for old age 50 25% 5 Using government schemes 40 20% 6 Happy with their family 80 40% 7 Taking food regularly 160 80% 82% of elderly person living with family increased medical expenditure, at this stage followed by lack of freedom on spending 71%, reduced personal income 61%, lack of support from family 39% and liability of children 20%.
Distribution of old age people according to general assessment shows that 60% of the old age people's spouse were alive, 71% were feeling neglected, 22% take time for entertainment, 25% of them aware of Government scheme for old age, 20% were using Government schemes, 40% were happy with their family and 80% of them were taking food regularly.
An apprehensive thing that found during the studies is how an unhealthy shift in the mind-set of the elderly people occurs as the age progresses. It was found that due to the feeling of neglect and left out from the family members, the elderly people had developed more of an attention seeking behaviour. An example observed in few of the families can be quoted asthis elderly female was always appreciated by her in laws during her young age. Now she has an extended family of 2 sons with their wives and kids respectively who apparently take their own decisions and doesn't involve the old lady in the discussion. This attitude from her family has made her a kind of attention seeker through various acts. Some of them included-she has a tendency to fake the medical conditions and exaggerate the ill condition and incapacities for gaining medical attention. These people attend the nearby clinics almost every single day. Such elderly persons have increased danger of drug toxicity or side effects due easily available over the counter drugs especially NSAIDS owing to increased risk of even fatality for example renal failure and hepatic failure . It is an extremely difficult and challenging task for the medical professionals to differentiate such patients form the other ones. Placebo technique to some extent is considerably helpful in management for these patients. But the main issue of building healthy relations with their respective families is exigent as well as difficult at the same time.

DISCUSSION
In a study which was undertaken in Dharwad amongst the urban slum, the geriatric psychological problems were notably linked to the socioeconomic status, literacy status and the civil status.
In our study highest percentage(54%) of the senior citizens living with family were in the age group of 60-65 years and only 4% belongs to >80 years of age, 65% of the samples were male and only 35% were female, highest percentage(80%) of the senior citizens living with family were married and only 20% were unmarried, 64% of the senior citizens living with family were Hindus and only 4% were Muslims, 40% of the senior citizens living with family were from educated up to higher secondary and only 12% were educated up to graduation.
In our study 54% were vegetarian and only 8% were non vegetarian, 96% were non-smokers and only 4% were smokers, 98% of senior citizen living with family were non-alcoholic, 50% of senior citizen living with family need not chew tobacco, 40% of senior citizens living with their family have pallor, 78% of senior citizens living with family need not have history of diabetes mellitus, 54% of senior citizens living with family need not have history of hypertension, 80% of senior citizen living with family need not have the history of major surgeries, 98% of senior citizen living with family need not have the history of fracture of limb, 98% of senior citizen living with family need not have the history of coronary artery diseases, 80% of senior citizen living with family need not have the history of counselling.
Our study also supports the present finding which revealed that in relation to physical problems 72(36%) of senior citizen living with family most of the time had poor concentration, 80(40%) had poor concentration certain times, 84(42%) rarely had difficulty in chewing, 164(82%) rarely had difficulty in breathing, 56(28%) most of the times had history of joint pains. In relation to psychosocial problems 100(50%) of senior citizen living with family most of the times had sleep disturbance. despite certain physiological changes that affect sleep quality are held as normal with an increment in age, cognitive behavioral therapy (CBT) is used as a standard first-line treatment to minimize the sleep related issues in the elderly [16,17]. Mental disorder in elderly is associated with significant age related degenerative issues, but rates of specialized psychiatric consultation is low, even for those with comorbidities [18]. 96(48%) most of the times had limitation of physical activity, 136(68%) most of the times had decrease in social life, 76(38%) rarely had financial dependency on family members, 120(60%) of them get respect from children and grandchildren and 170(85%) rarely have family members dependent on them. Study by Ransing et. al. reflect on psychosis and depression in this region [19]. Few of the key studies on Geriatric issues were reviewed [20][21][22][23]. Articles on psychiatric problems and mental health issues in Maharashtra were reviewed [24][25][26].
Distribution of old age people according to general assessment shows that 60% of the old age people's spouse were alive, 71% were feeling neglected, 22% take time for entertainment, 25% of them aware of Government scheme for old age, 20% were using Government schemes, 40% were happy with their family and 80% of them were taking food regularly [27][28][29][30].

SUMMARY
 54% of the senior citizens living with family were in the age group of 60-65 years.  65% of the samples were male.  80% of the senior citizens living with family were married.  64% of the senior citizens living with family were Hindus and only 4% were Muslim.  40% of the senior citizens living with family were from educated up to higher secondary.  54% were vegetarian and only 8% were non vegetarian.  96% were non-smokers and only 4% were smokers.  98% of senior citizen living with family were non-alcoholic. Aging is physiological process of nature which can be slowed down but cannot be avoided. A healthy mind and body plays crucial role in this. . There are certain cognitive alterations happening with the increasing in age like decline and difficulty in holding a piece of information in mind, spatial disorientation, slowing down the pace of reasoning and problem solving ability. These issues can be better tackled by keeping oneself indulged in creative activities, using all the senses, following healthy lifestyle like daily exercise, yoga, pranayama and a good diet. 10. The concept of positive ageing in the "second innings" of life as described sportily by the people can bring a drastic bliss in the lives of the aged people. It is basically built on the foundation of adapting an optimistic attitude in life and the mind-set of self-love and embracing oneself is of utmost importance.

CONSENT
As per international standard or university standard, patients' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
It is not applicable.