A Study on Prevalence of Selected Mental Disorders (Anxiety, Depression, Dementia) Among Residents of Old Age Home in Jabalpur City, Madhya Pradesh, India

Introduction: Ageing is a normal phenomenon and an inescapable process. According to WHO. World-wide over 20% of adults aged 60 and over suffer from a mental or neurological disorder and according to the National Mental Health Survey of India (2015-16) the prevalence of mental disorders in geriatric population in our country is 10.90%. Thus, this study aims to assess anxiety, depression and cognitive disorders among persons living in OAH and to explore the various factors associated with it. Methodology: A descriptive cross-sectional study was conducted in OAH Jabalpur. All residents of OAH were included in the study so no need for sampling. The sample size was 73. A Predesigned semi-structured Questionnaire was used which comprised of the socio-demographic profile with using GAD-7, GDS-15 & MMSE-30 for screening of psychiatric morbidity. Data analysis was done by using IBM SPSS-23. Results: The result shows the mean age of the study subject was 72.14 ±7.48. The prevalence of Anxiety was 19.2%, prevalence of depression was 41.1% and prevalence of cognitive impairment was 23.3%. Conclusion: In this study it was found out that substantial proportion of older adults were suffering from anxiety, depression and cognitive impairment, most of older adults were widowed and there is a need to provide psychological support, a positive environment and proper care to improve mental health.


INTRODUCTION
Ageing is a normal phenomenon and an inescapable process. Aging refers to the multidimensional process of physical, psychological and social changes. Recent advances in health-related knowledge, health sciences and improvement in social conditions have led to an increase in life expectancy in most countries of the world. However, increased life expectancy around the world also brought new public health challenges, such as increasing incidence and prevalence of chronic, age-related disorders 1 . The geriatric population is defined as population aged 60 years and above 2 . People aged 60 years and over are ex-pected constitute to 10.2% of the total world population by 2025 2 . The life expectancy of an average Indian has been increased from 36.7 in1951 to over 67.14 in 2012. In addition, the population of older adults aged ≥60 years in India increased to 102 million in 2011. The proportion of elderly persons in India rose from 5.3% in 1961 to 7.5% in 2001, and was currently 8.4% in 2011 3 . There is no health without mental health. Mental health is a very essential & integral component of health. Mental health is influenced by a complex interaction between biological, social, environmental, cultural & economic factors; the imbalance of these determinants may lead to mental disorders, which affect everyone irrespective of age, gender, residence & living standards. According to W.H.O. Worldwide over 20% of adults aged 60 and over suffer from a mental or neurological disorder (excluding headache disorders) and 6.6% of all disability (disability adjusted life years-DALYs) among person age more than 60 years is attributed to mental and neurological disorders 3 . The most common mental and neurological disorders in this age group are depression, dementia and anxiety disorders which affect approximately 7% and 5% and 3.8% of the world's older population, respectively .3 . According to National Mental Health Survey of India (2015-16) the prevalence of mental disorders in geriatric population in the country is 10.90%. 4 . The persons living in OAHs often various problems due to living with unknown person, not a personal room or a separate area, highly institutionalized, depersonalized, and bureaucratic atmosphere in OAHs. Elderly living in such homes face problems due to tight and rigid schedules, separation from the family members, isolation from the social life, anxiety over adopting oneself to a new environment. A recent study was reported that misbehaviour of children (29.8%) and lack of financial support (29.3%) were the most common reasons for living in OAHs 5 .Whereas study conducted by Akbar s et al, depression was the most prevalent disorder (53.7%), as compare to dementia (21.6%) in older adults residing in OAH 6 . Therefore, with this background, the present study is carried out to estimate prevalence and pattern of selected mental disorders (dementia, depression, anxiety) and associated socio-demographic factors among residents of old age home in Jabalpur district, Madhya Pradesh, India

MATERIALS & METHODS
A cross sectional study was conducted among geriatric people who were living in the red cross old age home (OAH) in Jabalpur city Madhya Pradesh from December 8 th , 2021 to January 31 st , 2022.
The inclusion criteria: All older adults aged 60 years and above residing in old age home for 1 month or more, able to understand and reply to all questions, and giving written informed consent were included in the study.
Exclusion criteria: Residents diagnosed with any severe mental /physical health problem which can impede the interview were excluded from the study.
Before initiating the study written permission was obtained for the present study from the administrative authority of Old Age Home. Then interview of study participants was conducted. A total 73 eligible participants were included in the study. The purpose of the study was explained to every study participant and their written informed consent was obtained. Data collection was done using following study tools.
(i) A semi-structured interview proforma, (ii) Generalized anxiety disorders-7 (GAD-7) 7 for anxiety, (iii) Geriatric Depression scale (GDS-15) for depression 8 ,and (iv)Mini Mental Status Examination (MMSE) 9 for cognitive impairment of study participants. The statistical data analysis was done by using IBM SPSS statistics for window, version 23. Chi square test was applied as a test of significance while P value less than 0.05 was considered significant. Further clinical evaluation of those persons who detected with mental disorder was conducted in the NSCB Medical college hospital.      6 shows the prevalence of dementia was 21.6% in old age homes northern India which was similar to present study. The reason for dementia and depression, as the most common mental health problems in the present study, could be attributed to multidimensional risk factors such as financial constraints, lack of spouse/partner, poor infrastructure of the OAHs, no association between family members, and problem in physical health. In fact, as the female participants were more in this study and most of them were widows. There were many studies emphasizing on widowhood which could be strongly associated with depression.
In present study we found that dementia was statistically significantly associated with stay duration in old age homes (P<0.05). In addition, physical ailments and impairments, which were not the focus of our study, could have affected the anxiety and depression related problems, as found by a study reporting the OAH inhabitants suffering from psychiatric illnesses, had one or more associated physical morbidity. 10

CONCLUSION
In the present study prevalence of mental disorders was substantially high among study participants. From the study we can conclude that as age advancing the prevalence of mental disorders specially dementia increases, imposing a greater demand on health care. Stay duration (>10years) at old age home was found a significant risk factor for dementia. Person who never talks to any family members or relatives showed higher prevalence of mental morbidity. These findings suggest the need for integrated mental health services aiming at psychological, psychiatric, and cognitive betterment of the institutionalized elderly and for reducing loneliness old age People should be engaged in recreation activities. Regular health check-ups, counselling and psychological services should be provided in old age homes to address the co-morbidities and screening of mental disorders.