Elderly individuals face numerous psychosocial challenges including depression, social isolation, elder abuse, changes in societal roles, and losses. As people age, they experience role changes such as retirement, widowhood, and becoming grandparents which impact their identity and independence. They also face multiple losses including health, social contacts, finances, independence, and respect. Depression is common but often underrecognized and untreated. Social isolation can exacerbate mental health issues. Elder abuse includes physical, emotional, sexual, and financial abuse as well as neglect. Ageism also negatively impacts the elderly through discrimination and negative stereotypes. Maintaining life satisfaction, social support, health, finances, and personal control are factors that can promote successful aging.

1. PSYCHOSOCIAL ASPECTS OF
ELDERLY
Dr. Divyamol K Sasidharan

3. HEALTH
"a state of complete physical, mental, and
social well-being and not merely the absence
of disease or infirmity.“
World Health Organization. (2006). Constitution of the World Health Organization – Basic Documents, Forty-fifth edition,
Supplement, October 2006

5. PSYCHOSOCIAL PROBLEMS
• Depression
• Social isolation
• Elder abuse
• Change in societal roles
• Multiple losses
• Financial Constraints
• Agism

6. Change in societal roles
• Retirement
– often the first major transition faced by the
elderly.
– reduced income and altered social role and
entitlements.
– Concerned by the dependence

7. Change in societal roles
• Pre-retirement counseling
• Involving in social activities and other areas of
interest also improves the quality of life
• Elderly have a lot of experience and wisdom
which can be employed for the better of the
country.

8. Change in societal roles
• Widowhood
• Men are at a higher risk of dying, themselves soon after the
death of a spouse.
– Some researchers believe that a man’s wife is often his only close
friend and confidant.
– There is evidence that older men are less likely to be able to carry out
routine activities such as shopping and financial responsibilities.
• Women are usually less financially secure when widowed and
are more likely to enter poverty status.
• Widowers are 5 times more likely to remarry than widows.

9. • Transition from a parent to grand parent
• Transition from a bread winner to a
dependant
• Loss of identity in society
Change in societal roles

10. • Ensure good retirement plans
• Old age pension schemes for the elderly
• Retirees volunteer and find ways to provide
service to others.
• Volunteering supports a personal sense of
purpose
Change in societal roles

11. MULTIPLE LOSSES

12. • Loss of physical health
• Loss of social contacts – friends/ family
• Loss of financial security - retirement
• Loss of independence and power
• Loss of mental stability
• Loss of respect
MULTIPLE LOSSES

14. Multiple Losses
• Breaking bad news
– Consider social support (who to ask to be present)
– Consider setting (where to meet)
– Try to establish a relationship of mutual respect and trust
– Discover what the patient or the family knows or think they know
already
– Invite questions
– Give information at a speed and in a language that will be understood
– Monitor what has been understood
– Recognise that it takes time to hear and understand bad news
– Give the patient or the family time to react emotionally
– Give verbal and non-verbal reassurance of the normality of their
reaction
– Stay with the patient or the family until they are ready to leave
– Offer further opportunities for clarification, information, or support

15. MULTIPLE LOSSES
• Complications:
– Physical
• Impairment of immune response
• Psychosomatic disorders
• Increased risk of heart disease
– Psychiatric
• Depression
• Anxiety/panic disorders
– Specific
• Post traumatic stress disorder
• Chronic grief

16. • What can be done?
– Know the patients emotional status
– Give emotional support to the elderly
experiencing loss
– Group counseling with people experiencing loss
will also be beneficial
– Monitor for chronic grief
– Offer treatment when necessary
– Do not hesitate in giving assistive devices to
improve the function
Multiple Losses

17. Depression
• Often unrecognized
• Primary care physicians accurately
recognize less than one half of patients with
depression
• Ernakulam District : 2015
– 37% depression according to the geriatrics
depression scale.
– Of these, 10.6% had severe depression.
• Multifactorial
• Treatable
• Sadovsky, R., “Prevalence and recognition of depression in elderly patients,” American Academy of Family
Physicians, 57;5 (1998):1096.

18. Depression
• Presenting Symptoms:
– Memory difficulties or personality changes
– Physical aches or pain
– Fatigue, loss of appetite, sleep problems or loss of
interest in sex — not caused by a medical
condition or medication
– Often wanting to stay at home, rather than going
out to socialize or doing new things
– Suicidal thinking or feelings

19. Depression
• Complications of depression include:
– Weight gain/ obesity - heart disease and diabetes
– Pain or physical illness
– Alcohol or drug misuse
– Anxiety, panic disorder or social phobia
– Family conflicts, relationship difficulties, and work or
school problems
– Social isolation
– Suicidal feelings, suicide attempts or suicide
– Premature death from medical conditions

22. Depression
• Treatment options:
– Antidepressants
– Psychotherapy or counselling
– Electroconvulsive therapy
– Other newer forms of brain stimulation (such as
repetitive transcranial magnetic stimulation
(rTMS))

23. SOCIAL ISOLATION

24. Social Isolation
• A state in which the individual lacks a sense of
belonging socially, lacks engagement with
others, has a minimal number of social
contacts and they are deficient in fulfilling and
quality relationships"
• Social isolation in older adults: an evolutionary concept analysis. Nicholson NR Jr. J Adv Nurs. 2009
Jun;65(6):1342-52. doi: 10.1111/j.1365-2648.2008.04959.x. Epub 2009 Mar 9.

25. Social Isolation
• Age well Foundation in New Delhi - 87% of the
70-80 age group complain of isolation.
• It can exacerbate a person's feelings of
– low self-worth
– shame
– loneliness
– depression
• Thus, social isolation can be both a cause and
symptom of other mental health issues.

26. Social Isolation
• Three questions that are often used in research
to assess loneliness may be useful:
1) How often do you feel that you lack
companionship?
2) How often do you feel left out?
3) How often do you feel isolated from others?
• Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT. A Short Scale for Measuring Loneliness in Large Surveys: Results
From Two Population-Based Studies. Res Aging 2004; 26(6): 655–672

27. Social Isolation
• Increase awareness
• Address depression
• Increase opprtunities for the elderly to
contribute their wisdom to the society
• Geriatric clubs
• Promote living with family

28. ELDER ABUSE

29. Elder Abuse
• Elder abuse is a single or repeated act, or lack
of appropriate action, occurring within any
relationship where there is an expectation of
trust, which causes harm or distress to an
older person.

32. Elder Abuse

33. • Prevalence and risk factors of abuse among community dwelling elderly of Guwahati City, Assam
Ashok Jyoti Deka1, Arupjyoti Kakati2, Neelakshi Mahanta3, Ajaya Mahanta4, Anku Moni Saikia5
ELDER ABUSE

35. Elder Abuse
• only 1 in 24 cases of elder abuse is reported
• Part of the problem is almost all the elderly,
nearly 98 percent, chose not to file legal
complaints.

36. Elder Abuse
• SCREENING QUESTIONS:
– Has anyone at home ever hurt you?
– Has anyone ever touched you without your consent?
– Has anyone ever made you to do things you didn’t want to do?
– Has anyone ever taken anything of yours without asking?
– Has anyone ever scolded or threatened you?
– Have you ever signed any document that you didn’t
understand?
– Are you aftraid of anyone at home?
– Are you alone a lot?
– Has anyone ever failed to help you take care of yopur self when
you needed help?
*AMA Diagnostic and treatment guidelines in Elder Abuse and Neglect, 1992

37. Elder Abuse
• History Taking:
– Observe the patient behaviour( anxiety,
depression, withdrawal, low self esteem,
confusion)
– Observe patient – caregiver interactions
– Talk to the patient ALONE
– Talk to the caregiver ALONE
– Assess the social Support system
– Look for “red flags”

38. Elder Abuse
• Warning signs of physical abuse:
– Unexplained signs of injury, such as bruises, welts, or
scars, especially if they appear symmetrically on two
sides of the body
– Broken bones, sprains, or dislocations
– Report of drug overdose or apparent failure to take
medication regularly (a prescription has more
remaining than it should)
– Broken eyeglasses or frames
– Signs of being restrained, such as rope marks on wrists
– Caregiver's refusal to allow you to see the elder alone

39. Elder Abuse
• Warning signs of Emotional abuse:
– Threatening, belittling, or controlling caregiver
behavior that you witness
– Behavior from the elder that mimics dementia,
such as rocking, sucking, or mumbling to oneself
• Warning signs of Sexual abuse
– Bruises around breasts or genitals
– Unexplained vaginal or anal bleeding
– Torn, stained, or bloody underclothing

40. Elder Abuse
• Elder neglect by caregivers or self-neglect
warning signs:
– Unusual weight loss, malnutrition, dehydration
– Untreated physical problems, such as bed sores
– Unsanitary living conditions: dirt, bugs, soiled bedding
and clothes
– Being left dirty or unbathed
– Unsuitable clothing or covering for the weather
– Unsafe living conditions (no heat or running water;
faulty electrical wiring, other fire hazards)
– Desertion of the elder at a public place

41. Elder Abuse
• Financial exploitation warning signs
– Significant withdrawals from the elder's accounts
– Sudden changes in the elder's financial condition
– Items or cash missing from the senior's household
– Suspicious changes in wills, power of attorney, titles, and
policies
– Addition of names to the senior's signature card
– Unpaid bills or lack of medical care, although the elder has
enough money to pay for them
– Financial activity the senior couldn't have done, such as an
ATM withdrawal when the account holder is bedridden
– Unnecessary services, goods, or subscriptions

42. Elder Abuse
Among caregivers, significant risk factors for
elder abuse are:
– Inability to cope with stress (lack of resilience)
– Depression, which is common among caregivers
– Lack of support from other potential caregivers
– The caregiver’s perception that taking care of the
elder is burdensome and without psychological
reward
– Substance abuse

43. Elder Abuse
Risk factors in the elderly for abuse:
– The intensity of an elderly person’s illness or
dementia
– Social isolation; i.e., the elder and caregiver are
alone together almost all the time
– The elder’s role, at an earlier time, as an abusive
parent or spouse
– A history of domestic violence in the home
– The elder’s own tendency toward verbal or
physical aggression

44. Elder Abuse
• How to intervene:
– Provide care giver support
– Have a someone(nurse/social worker/member of
religious community) visit the home on a regular
basis
– On- going monitoring of the situation
– Education on aging, the available social security
schemes and legal Acts by the government, and
counselling on how to tackle issues in life

45. Elder Abuse
• LAWS FOR ELDERLY:
– Section 125 of the Cr PC: A magistrate can order a
child to maintain his/ her old parents
– Hindu Adoptions and Maintenance act(HAMA) – An
aged parent can demand maintenance from the child
the same way a wife can demand from her husband
– Domestic Violence Act(DVA): Lodge a complaint with
the local police
– Maintenance of welfare of parents and senior citizens
act 2007 – No advocate needed, Maximum
10000/month and fine of 5000/3 months jail
• NGO – Help Age India

46. AGISM

47. Agism
• Discrimination based on age
• Pervasive through society
• Rooted in language, attitudes, beliefs,
behaviors, and politics
• Aging profoundly influences physiology. Our
challenge is to accommodate but not
discriminate

48. Agism
• Expected to 'accept' the 'facts of aging.‘
• Miss a word or fail to hear a sentence and
they are charged with 'getting old,' not with a
hearing difficulty.
• Called 'cranky' when they are expressing a
legitimate distaste with life as so many young
do.

49. Agism
• Negative aging stereotypes
– “ inevitability of decline”
– nothing to do to avoid decline in health and
function
• The older individual internalizes, starts to
believe, and live out the messages heard
throughout a life time

50. Agism
• Study of 429 community dwelling, 65-100 yo
– >50% felt it was an expected part of aging:
• to become depressed
• to become more dependent
• to have more aches and pains
• to have less ability to have sex
• to have less energy
– Those with low expectations were less likely to
seek health care for age-associated conditions
“Do older adults expect to age successfully?” Catherine Sarkisian, et al. JAGS November 2002, 1837-1843

51. Agism
• Modifiable conditions
– Depression
– Memory impairment
– Urinary incontinence
• Lower expectations (redefining health) may be a
compensatory mechanism to maintain life satisfaction
• Conclusions: Modifiable conditions remain underdiagnosed
and undertreated
“Do older adults expect to age successfully?” Catherine Sarkisian, et al. JAGS November 2002, 1837-1843

52. • What can be done?
– Do not discriminate based on age
– See the person as a whole.
– Many of the problems considered as part of aging
can be modified to a great extend
– Be open minded

53. FIVE FCTORS OF SUCCESSFUL AGING
• LIFE SATISFACTION: rewarding, few regrets,
positive attitude about past and future
• SOCIAL SUPPORT SYSTEM: network of family
and friends
• GOOD PHYSICAL AND MENTAL HEALTH
• FINANCIAL SECURITY
• PERSONAL CONTROL OVER ONE’S LIFE:
independence, dignity, and self-worth