Jaraiatrics

Jariatric (Geriatric)
Psychological Trauma
Psychological Trauma
Management Through
A d
Ayurveda
Ayurmitra, Nadi Bhishak Prof KSR Prasad
20‐02‐2021
@ SHRI HINGULAMBIKA AYURVEDIC MEDICAL COLLEGE AND HOSPITAL
KALABURGI, KANATAKA
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/

Introduction
Jariatric Psycho‐Trauma Management in Ayurveda
Introduction
• Jara is the old age or ageing process of the body tissue
sustenance and maintenance based upon the cell repair
p p
and cell division
– 90% of cell division takes place in the womb to make the
tissues and body shaping
– 9% of the cell division completes by 18 years of age or by the
time body is fully developed with functioning organs as Adult
time body is fully developed with functioning organs as Adult
– Only 1% remained maintains the body throughout the life till
death
• The rapid cell division makes one to be AGED early and
as much as the cell division is delayed we get the
RASAYANA effect

Sequential Loss of Biological Qualities in Aging
Decades Years Losses (Vagbhata) Losses (Sharangdhara)
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Sequential Loss of Biological Qualities in Aging
( g ) ( g )
First 0-10 Balya (Boyishness) Balya (Childhood)
Second 11-20 Vrddhi (Growth) Vriddhi (Developmant)
Third 21-30 Prabha (Luster) Chhabi (Beauty)
Fourth 31-40 Medha (Intellect) Medha
Fifth 41-50 Twaca (Skin) Twaca
Fifth 41 50 Twaca (Skin) Twaca
Sixth 51-60 Sukra (Sexual Ability) Drsti (Vision)
Seven 61-70 Drsti (Vision) Sukra (Sexual Ability)
Eighth 71-80 Srotrendriya (Audition) Vikram (Strength)
Ninth 81-90 Mana (Psyche) Buddhi (Wisdom)
Tenth 91-100 Sparshanendriya Karmendriya (Locomotor
3
(Psychomotor function) Activity)

Shate / saptame /Ashtame Hraset
Shate / saptame /Ashtame Hraset
• The Sharngdhara considered 10 year interval
for the loss of tissue ability and functions even
though Ayurveda said 120 years of life span
– Today with the circumstances and industrialization
probably we need to reclassify the time duration
of 3 categories – Avara – Madhyama – Pravara Ayu
or living with 6 7 8 years of span of intervals to
or living with 6‐7‐8 years of span of intervals to
count instead of 10 years said by Sharngdhara

Focus
Focus
• As Sharngdhara evolved two psyche factors –
– The first is loss of Intellect ‐ Medha in between 30‐40
years
– Second is loss of Wisdom – Buddhi / Psyche ‐ Mana in
Second is loss of Wisdom Buddhi / Psyche Mana in
between 80‐90 years
• Today context refer the growth stoppage as early
as Avara 12 years and till 16 years as Pravara
as Avara 12 years and till 16 years as Pravara
– To get the intellectual and psychological depreciation
we need not wait till 70 years of ageing
• We are loosing our intellect at 24 – 32 and Mano
dushti – psychological debility between 48 – 64
under present day circumstances
under present day circumstances
5

10 visible signs of Ageing
1. Hair loss
2. Eyes (Visual disturbances)
3. Ears (Hearing loss)
( g )
4. Lost Teeth
5. Wrinkled Facial skin
6 Dropped Breasts
6. Dropped Breasts
7. Dry loose Body skin
8. Thin Buttocks
i d i
9. Raised Veins
10. Weak Muscles and
bones
6

Prominent Seven Signs of Ageing
Prominent Seven Signs of Ageing
1. Lines and wrinkles
2 U ki t t
2. Uneven skin texture
3. Uneven skin tone
4 Appearance of pores
4. Appearance of pores
5. Blotches and age spots
6 Dry skin
6. Dry skin
7. Dullness
Most of the times all these are happening
pp g
because of malnutrition or the pollution
surrounded by us
7

Gender Differences of Ageing
Gender Differences of Ageing
doctorksrprasad@gmail.com /
09290566566
8

R l S P iti Si f b
Real Seven Positive Signs of observance
1. Emotional maturity appears
2 Wi d lf fid lf d l
2. Wisdom, self‐confidence, self‐esteem develops
3. Owning your own house fulfills
4 S f ti lif i li
4. Sense of perspective on life inclines
5. Sexual confidence deprives
6 Career develops
6. Career develops
7. Financial security obtains
This is one side of coin – the other side is dark and
This is one side of coin – the other side is dark and
terrible with blowing psyche and depressed
mind
9

The Realit of A ein
The Reality of Ageing
• In humans, ageing represents the accumulation of
h h b d
changes in a human being over time and can
encompass –
Physical
– Physical,
– Psychological, and
– Social changes.
Social changes.
• Ageing or aging is the process of becoming older.
– Reaction time, for example, may slow with age, while
, p , y g ,
knowledge of world events and wisdom may expand.
• Other wise, Ageing is a continuous process of
transformation and depreciation of Body and Mind
10

Facts of A ein
Facts of Ageing
• Between 2015 and 2050, the proportion of the
Between 2015 and 2050, the proportion of the
world's population over 60 years will nearly
double from 12% to 22%.
• By 2050, 80% of older people will be living in
low‐ and middle‐income countries and groups.
low and middle income countries and groups.
– The pace of population ageing is much faster than in
the past.
• All countries face major challenges to face this
demographic shift.
11

Aged condition in India
Aged condition in India
• Most common psychiatric illnesses in the Indian
elderly population are –
elderly population are
– Depression,
– Dementia and
– Anxiety disorders.
• 43% of elderly Indians are facing psychological issues
R il bl t t t th d f ld l i
• Resources available to cater to the needs of elderly in
the country are –
– Government and private psychiatric hospitals,
p p y p ,
– Non‐governmental organizations and
– The family as caregivers.
12
https://www.livemint.com/Politics/g1bVF6quRKldSxL6HljnzI/43‐of‐elderly‐Indians‐are‐facing‐psychological‐issues‐stud.html

M ths related to a in in India
Myths related to aging in India
• Age is an illness
Age is an illness
• Most elderly are depressed, demented, or
dependent
dependent
• Loss of social ties leaves the older adult alone
d i l d
and isolated
• In a chronic illness, social factors are less
important in late life
• The older the patient, the greater the cost.
p , g
13

The 4 t pes of a eism
The 4 types of ageism
1. Personal ageism is an individual’s attitudes, ideas,
practices, and beliefs that are biased against older
persons
2. Institutional ageism involves rules, missions, and
2. Institutional ageism involves rules, missions, and
practices that discriminate against older individuals or
groups based on age
3 Intentional ageism is attitudes rules or practices that
3. Intentional ageism is attitudes, rules, or practices that
are implemented knowing they are biased against
older people
4 U i i l i i id i d l
4. Unintentional ageism is ideas, attitudes, rules, or
practices carried out without the perpetrator knowing
these are biased against older persons.
14
Cavanaugh J, Blanchard‐Fields F. Adult Development and Aging. UK: Nelson Education; 2014. 96. Cruikshank M. Learning

Health Unhealth A ein
Healthy – Unhealthy Ageing
• Healthy ageing includes – Comfortable
Healthy ageing includes Comfortable
environment includes Home, Financial
security caring relatives & friends Social
security, caring relatives & friends, Social
relations, name and fame, etc.
• Unhealthy ageing is noted with neglected by
• Unhealthy ageing is noted with – neglected by
family & friends or pending over burdened
responsibilities of family social humiliation
responsibilities of family, social humiliation,
financial issues, depression, etc.
15

Ps cholo ical tra ma
Psychological trauma
• Longer life gives opportunities to the family and
Longer life gives opportunities to the family and
society but brings much psychological problems
to the elderly
y
• Instead of using elderly experiences they are
being neglected and being thrown out as waste
being neglected and being thrown out as waste
• Beyond biological ageing, retirement and
relocation adoptions and psycho‐social situations
relocation adoptions and psycho social situations
related to financial commitments brings more
vulnerable psychological trauma
p y g
16

What to do?
What to do?
1. Strengthen the physical ability through regular
g p y y g g
agreeable workouts
2. Following universal health care measures
according to Agni and Dosha influences
according to Agni and Dosha influences
3. Create Age‐friendly environments to be active
physically and mentally
physically and mentally
4. Keep yourself friendly every where but offer
advise only when asked
5. Following Yoga, Panchakarma, Ayurveda Diet
schedule along with Diava Vyapashraya Chikitsa
+ Satwavajaya Chikitsa
+ Satwavajaya Chikitsa
17

Understanding Mental Health Issue
Understanding Mental Health Issue
• Anxiety Disorders (5% of the
household population)
p p )
• Depression and Bipolar
Disorder (11.3% prevalence
of depression and 2.6% for
of depression and 2.6% for
bipolar disorder)
• Eating Disorders
• Obsessive Compulsive
• Obsessive Compulsive
Disorder (OCD)
• Phobias and Panic Disorders
P t T ti St
• Post‐Traumatic Stress
Disorder (PTSD)
• Schizophrenia (affects 1% of
h l i )
the population)
18

P t ti l t i f t l ill i ld l
Potential triggers for mental illness in elderly
• Physical disability or loss of mobility
y y y
• Dementia‐causing illness (e.g., Alzheimerʼs
disease)
• Loss of a loved one
• Long‐term illness (e.g., cancer or heart disease)
M di ti i t ti
• Medication interactions
• Chronic pain
• Alcohol or substance abuse
• Alcohol or substance abuse
• Emotional or memories and thoughts
• Poor diet or malnutrition
Poor diet or malnutrition
19

Warnin si ns of Mental Health
Warning signs of Mental Health
1. Changes in appearance or dress,
2. Confusion & Disorientation,
3. Depressed mood lasting longer than two weeks.
4. Problems with concentration or decision‐making
5. Memory loss, especially short‐term memory loss (STML)
y , p y y ( )
6. Feelings of worthlessness,
7. Inappropriate guilt & Helplessness;
7. Inappropriate guilt & Helplessness;
8. Social withdrawal
9. Thoughts of suicide
9. Thoughts of suicide
20

10. Physical problems that can't otherwise be explained:
aches constipation etc
aches, constipation, etc.
11. Problems in maintaining the home or yard.
12 T bl h dli fi
12. Trouble handling finances
13. Trouble working with numbers
f i i hi h d b j bl
14. Loss of interest in things that used to be enjoyable.
15. Decrease or increase in appetite; changes in weight.
16. Unexplained fatigue
17. Energy loss
18. Sleep changes
21

Assess to determine Assistance
Assess to determine Assistance
• Life tasks and self‐care ‐ activities such as
dressing, preparing meals, or using the phone
• Safety ‐ including financial safety and driving
• Physical health ‐ include pain or uncomfortable
symptoms, hospitalizations, or loss of appetite
• Mood and brain health such as feelings of
• Mood and brain health ‐ such as feelings of
hopelessness, loss of interest in activities they
used to enjoy, or isolation
• Medication safety ‐ including skipping
medications, and worrisome side effects or
symptoms related to medications
symptoms related to medications
22

Most common Dementia
Most common – Dementia
• The most common mental health issue among
e ost co o e ta ea t ssue a o g
the elderly is severe cognitive impairment or
dementia.
• About 5 million adults 65 and older have
Alzheimerʼs disease — about 10% of seniors
• Depression and mood disorders affect up to 5%
of seniors 65 and older living in the community
O l 13 5% f ld d lt i i h
• Only 13.5% of older adults are receiving home
healthcare or are hospitalized / sent to old age
homes with care
homes with care
23

Depression
Depression
• Almost all people feel at times during their
li h i d di i t t
lives unhappiness, sadness or disappointment.
– The incidence of depression is higher in the
elderly
elderly.
• Factors associated with the occurrence of
depression are of two types:
depression are of two types:
– those related to elderly living environment that
causes pressure and stress, and
p ,
– those related with the elderly and more
specifically with its biological functions.
24

Depression
Depression
• The effect of an unhappy event in an elderly
person with lack of these neurotransmitters
can cause depression.
– Suicide is the leading risk for depressive patients.
• Maintenance of a depressed elderly in a
p y
desired operating level depends on the
politeness, the kindness and the sympathy
p , y p y
cultivated between the elderly and the nurse
25

Social e cl sion
Social exclusion
• Elderly people with age discrimination, who
de y peop e t age d sc at o , o
reduce or eliminate entirely and encounter major
obstacles in achieving their plans.
• Withdrawal of the elderly from the society is
common.
• Elders avoid social contacts because of the
reduction of functions, Prolonged bed rest,
sedation and unavoidable immobilization etc
sedation and unavoidable immobilization, etc.
• A psycho intellectual dimension helps elderly to
achieve the greatest goals
achieve the greatest goals
26

An iet and phobias
Anxiety and phobias
• Stress is the dominant symptom of neurotic
St ess s t e do a t sy pto o eu ot c
disorders and shows both psychological and
physical signs and symptoms.
• Anxiety in the elderly are the agony for
apparently insignificant events and the agonizing
ti i ti i d l l ll ith
anticipation in everyday level as well as with
loneliness and self‐care inability.
• Physical and social changes are many and as a
• Physical and social changes are many and as a
result the fears of the elderly do require
psychological support
p y g pp
27

Loneliness
Loneliness
• Loneliness is a sad feeling of isolation from other
people, usually accompanied by mental fatigue,
people, usually accompanied by mental fatigue,
bitterness, or even despair.
• Inability to daily life adjustment in new conditions most
often leads to melancholia
often leads to melancholia
• Other conditions includes – remembrance of lost loved
ones ‐ Children, parents, etc. or weakened relationships,
ki l di
working at long distances, etc.
• Antidote to loneliness is –
– 1) the cultivation of self‐esteem,
1) the cultivation of self esteem,
– 2) elimination of negative thoughts and traumatic
experiences of the past.
– 3) Create and strengthen relationship with people
– 3) Create and strengthen relationship with people
28

Psycho‐social problems
Psycho social problems
• The close bond inside the family can help and
support people by showing them that they are
ll f il
really a family
• Family can give elderly an appropriate stimuli to
adjust himself in order to remain independent and
adjust himself in order to remain independent and
active
• Family can keep the elderly occupied with things
that make them pleasure such as guarding and
caring for their grandchildren, etc.
• Even a simple phone call can offer to these people
• Even a simple phone call can offer to these people
maximum joy and gives them consolation that
someone cares for them
29
Kourkouta L.1*, Iliadis Ch.2, Monios A.3 , Prog Health Sci 2015, Vol 5, No1 Psychosocial issues in elderly

GENERAL CHALLENGES FOR
GENERAL CHALLENGES FOR
GERIATRIC MENTAL HEALTH IN INDIA
The demography of aging in India
• India has a total population of 1.31 billion and the
h f i di id l d 60 d
growth rate of individuals aged 60 years and
older is three times that of the population as a
whole may reach 20% of the total population by
whole may reach 20% of the total population, by
2050
– Women in old age are more prone to social insecurity,
g p y,
health problems, and greater emotional/financial
insecurities
30
Lodha P, De Sousa A. Geriatric mental health: The challenges for India. J Geriatr Ment Health 2018;5:16‐29.

The heterogeneity of clinical
The heterogeneity of clinical
presentations in geriatric mental health
– There are incomplete clinical pictures where
diagnostic criteria are not satisfied, but the
diagnostic criteria are not satisfied, but the
problems are severe enough to warrant
treatment.
– The patient being on multiple medications and
multiple doctors treating the patient need to work
in synergy for best results
31

The challenge for dementia care in India
The challenge for dementia care in India
– In 2010, there are 3.7 million Indians with
dementia and the total societal costs is about
14,700 crores.
– Research indicates that up to 90% of the time,
challenging/psychiatric behaviors (agitation,
irritability restlessness sleep disturbance and/or
irritability, restlessness, sleep disturbance, and/or
emotional distress) that occur in persons with
dementia may be caused by either factors in the
dementia may be caused by either factors in the
environment or by a caregiver approach.[
32

Social factors that play a role in
Social factors that play a role in
geriatric mental health problems
• Along with the typical life stressors common to all people,
many older adults lose their ability to live independently
because of limited mobility, chronic pain, frailty, or other
mental or physical problems.
– A majority (80%) of them are in the rural areas
– Feminization of the elderly population (51% of the elderly
population are women)[
– Increase in the number of the older‐old (persons above 80
years)
A l t (30%) f th ld l i b l th t li
– A large percentage (30%) of the elderly is below the poverty line
1) Retirement: 2) Housing issues: 3) Financial issues:
4) Lack of transport: 5) Parents in India and Children Abroad:
33

A r eda Care
Ayurveda Care
• Ayurveda offers treatments of Rasayana &
Ayurveda offers treatments of Rasayana &
Vajikarana as the standard modes of
protecting physical Ageing
• The psychological ageing effects are well
addressed through Satwavajaya Chikitsa and
Daiva Vyapashraya Chikitsa
• The most important modality to neutralize the
adverse effects of ageing is Yoga and
Panchakarma
34

Sat a aja a Chikitsa
Satwavajaya Chikitsa
• Ardhebhyo – Ahitebhyo ‐ Mano Nigraha ‐
Ardhebhyo Ahitebhyo Mano Nigraha
Controlling mind generating –
– Jnana – self Knowledge experience
– Jnana – self Knowledge experience
– Vijnana – affirmative knowledge understanding
Dhairya courage to face
– Dhairya – courage to face
– Smrithi – recollection of goods
S dhi ithd l f
– Samadhi – withdrawal of senses
35

Dai a V apashra a Chikitsa
Daiva Vyapashraya Chikitsa
• Daiva Vyapashraya Chikitsa is
d d f
mentioned in Ayurveda for
regulating and strengthneing
Psyche
Psyche
• Out of –
– Mantra – recitation of Mantra
– Swastayana – chanting auspicious
hymns
– Niyamana – observance of spiritual
Niyamana observance of spiritual
rules
– Pranitapata – observance of Godly
places
places
36

Yo a Chikitsa
Yoga Chikitsa
• Out of Ashtanga Yoga –
g g
– Asana – Physical
Musculoskeletal toning
g
– Pranayama – Neuro
respiratory exercise
– Dhyana – Meditation ‐
Psycho concentration
37

Panchakarma Chikitsa
Panchakarma Chikitsa
• Ayurveda Panchakarma role in
elderly psychosocial & physical
elderly psychosocial & physical
management is most important as it
can regulate and alter the situation
• Associated Rasayana management
with Panchakarma is a better
modality when an elderly is properly
modality when an elderly is properly
counseled and cared
• The role of Family or Care takers is
foremost valued and undoubtedly
extrodernary
38

Panchakarma Sched le for elderl
Panchakarma Schedule for elderly
– Abhyanga & Sarvanaga sweda – once in 7 days
y g g y
– Virechana – once in 15 days
– Yoga Vasti – once in 40 days for 8 days
– Shirodhara – once in 3 months for 7 days
– Sansarjana Krama
• Ayurveda Dosha Based diet that suits the diseases already
• Ayurveda Dosha Based diet that suits the diseases already
existing
– Advised to follow Satsanga or Goshti with like minded
and friends
– Adaptation of visiting Temples and Public places is
also required
also required
39

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40

Concl sion
Conclusion
• Jara or Ageing is not a sin or crime and it is a
Jara or Ageing is not a sin or crime and it is a
natural process in life
• Looking at the present day situations one has
Looking at the present day situations one has
to make a proper arrangements for his future
life with – financial and comfort living
• Following the Ayurveda Dinacharya –
Ratricharya –Ritu charya – Ahara Vihara along
with suitable Panchakarma makes the
individual Happy – Healthy – Ageing
41

01 Thank You
01 Thank You
Ayurmitra‐ Nadi Bhishak KSRPrasad (Technoayurveda)
9290566566 /9503227966
42

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