Interface of Law and Psychiatric Problems in the Elderly.

ABSTRACTAnxiety and insomnia are correlated in older adults and their caregivers, yet the moderating role of mental health literacy (MHL) is unclear. This study aimed to explore dyadic effects of anxiety on insomnia among Chinese chronically ill older adults and family caregivers across age groups and whether MHL moderates these effects. Data came from 1033 dyads of older adults and their family caregivers in China through the Guangdong Mental Health Survey. Anxiety was assessed with the Generalized Anxiety Disorder‐7, insomnia with the Insomnia Severity Index, and MHL with the Chinese National Mental Health Literacy Scale (consisting of mental health knowledge, attitudes, and capacity). The Actor‐Partner Interdependence Moderation Model was applied for analysis. Young caregivers' mental health attitudes, β = −0.558, p = 0.002, mitigated the effect of their anxiety on their insomnia, while older adults' mental health knowledge, β = 0.428, p = 0.019, enhanced this relationship. Older adults' mental health attitudes, β = −0.731, p = 0.004, reduced the impact of middle‐aged caregivers' anxiety on the latter's insomnia. Middle‐aged caregivers' mental health capacity, β = −0.367, p = 0.004, attenuated the effect of older adults' anxiety on caregivers' insomnia. No significant moderating effects were observed in the dyad group of older adults and older caregivers. Within caregiving dyads, enhancing MHL can potentially reduce the impact of anxiety on insomnia. Interventions aimed at improving the mental health attitudes of older adults and caregivers are more likely to alleviate anxiety and insomnia than mental health knowledge and capacity.

Population ageing is occurring rapidly in India with the proportion of older adults (aged 60 years and above) estimated to reach 20% by the year 2050 from the existing 10%. The prevalence of mental health problems in older adults is also expected to increase significantly due to population ageing. Nearly 20% of older adults have at least one mental health condition including the subsyndromal conditions. The data from National Mental Health Survey (NMHS), Longitudinal Ageing Study of India (LASI) and the recent LASI-Diagnostic Assessment of Dementia have estimated the national prevalence of Psychiatric disorders like depression and dementia. 30.2% of older adults have significant depressive symptoms and 8.3% have major depressive disorder. The prevalence of dementia is estimated as 7.4% with an estimate of 8.8 million persons with dementia in 2016 and projected increase to 16.8 million in 2036.More than 90% of older adults with mental health problems in India remain undiagnosed and untreated. Access to non-pharmacological interventions for older adults with mental health conditions as well as their caregivers are very limited. Mental health problems in older adults are often considered as normal for ageing by older adults, family caregivers as well as health care professionals. Dedicated and specialized clinical services for geriatric mental health care is not available in most of the mental health care institutions.This symposium will present a critical review of the progress in geriatric mental health care services across India by summarizing the initiatives to promote geriatric mental health care and training. The need for comprehensive psychosocial care and psychiatric rehabilitation along with the acute geriatric mental health care will be addressed by experts involved in geriatric mental health care and training.The symposium will have the following presentations. 1.Geriatric mental health care in India- scope, challenges and innovative initiatives: Prof. Sivakumar Palanimuthu Thangaraju, Professor of Psychiatry & Head, Geriatric Psychiatry Unit, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India2.A review of the initiatives for the training to promote the workforce for geriatric mental health care in India: Prof. Krishna Prasad Muliyala, Professor of Psychiatry & Head, Psychiatric Rehabilitation Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India3.Psychosocial interventions for geriatric mental health care- Scope and challenges: Prof. Thirumoorthy A, Professor & Former Head, Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India

ObjectivesThis study examines the association between elder abuse and psychological distress among older adults in India and explores whether this association varies by the level of psychosocial and material resources.DesignThe...

The study aimed to estimate the associations between elder abuse and poor physical health, poor mental health, and health risk behaviors in older adults in a national community-based survey in India. The study sample included 31,477 older adults (≥60 years) from a cross-sectional national community dwelling survey in India in 2017–2018. Results indicate that the prevalence of elder abuse in the past 12 months was 5.2%. In the adjusted logistic regression analysis, elder abuse was significantly positively associated with poor mental health and poor well-being (low life satisfaction, not happy, insomnia symptoms, depressive symptoms, loneliness, neurological or psychiatric problems, and lower self-rated health status), poor physical health (bone or joint disease, physical pain, gastrointestinal problems, incontinence, functional disability, underweight, and persistent headaches), fall and health care utilization. In addition, in unadjusted analysis, elder abuse was associated with poorer cognitive functioning, current tobacco use, and dizziness. Elder abuse among older adults in India is associated with poor physical health, poor mental health, and health care utilization, emphasizing the need to consider elder abuse in various physical and mental health contexts.

Treatment gap and care characteristics for mental disorders among older adults in India: Evidence from National Mental Health Survey 2015-16.

IntroductionDiarrhoeal diseases are common among children and older adults. Yet, majority of the scientific studies deal with children, neglecting the other vulnerable and growing proportion of the population–the older adults. Therefore, the present study aims to find rural-urban differentials in the prevalence of diarrhoea among older adults in India and its states. Additionally, the study aims to find the correlates of diarrhoea among older adults in India. The study hypothesizes that there are no differences in the prevalence of diarrhoea in rural and urban areas.MethodsData for this study was utilized from the recent Longitudinal Ageing Study in India (2017–18). The present study included eligible respondents aged 60 years and above (N = 31,464). Descriptive statistics along with bivariate analysis was presented to reveal the preliminary results. In addition, binary logistic regression analysis was used to fulfil the study objectives.ResultsAbout 15% of older adults reported that they suffered from diarrhoea in the last two years. The prevalence of diarrhoea among older adults was found to be highest in Mizoram (33.5 per cent), followed by Chhattisgarh (30.7 per cent) and Bihar (30.2 per cent). There were significant rural-urban differences in the prevalence of diarrhoea among older adults in India (difference: 7.7 per cent). The highest rural-urban differences in the prevalence of diarrhoea were observed among older adults who were 80+ years old (difference: 13.6 per cent), used unimproved toilet facilities (difference: 12.7 per cent), lived in the kutcha house (difference: 10.2 per cent), and those who used unclean source of cooking fuel (difference: 9 per cent). Multivariate results show that the likelihood of diarrhoea was 17 per cent more among older adults who were 80+ years compared to those who belonged to 60–69 years’ age group [AOR: 1.17; CI: 1.04–1.32]. Similarly, the older female had higher odds of diarrhoea than their male counterparts [AOR: 1.19; CI: 1.09–1.30]. The risk of diarrhoea had declined with the increase in the educational level of older adults. The likelihood of diarrhoea was significantly 32 per cent more among older adults who used unimproved toilet facilities than those who used improved toilet facilities [AOR: 1.32; CI: 1.21–1.45]. Similarly, older adults who used unimproved drinking water sources had higher odds of diarrhoea than their counterparts [AOR: 1.45; CI: 1.25–1.69]. Moreover, older adults who belonged to urban areas were 22 per cent less likely to suffer from diarrhoea compared to those who belonged to rural areas [AOR: 0.88; CI: 0.80–0.96].ConclusionThe findings of this study reveal that diarrhoea is a major health problem among older adults in India. There is an immediate need to address this public health concern by raising awareness about poor sanitation and unhygienic practices. With the support of the findings of the present study, policy makers can design interventions for reducing the massive burden of diarrhoea among older adults in rural India.

Diarrhoeal diseases are common among children and older adults. Yet, majority of the scientific studies deal with children, neglecting the other vulnerable and growing proportion of the population-the older adults. Therefore, the present study aims to find rural-urban differentials in the prevalence of diarrhoea among older adults in India and its states. Additionally, the study aims to find the correlates of diarrhoea among older adults in India. The study hypothesizes that there are no differences in the prevalence of diarrhoea in rural and urban areas. Data for this study was utilized from the recent Longitudinal Ageing Study in India (2017-18). The present study included eligible respondents aged 60 years and above (N = 31,464). Descriptive statistics along with bivariate analysis was presented to reveal the preliminary results. In addition, binary logistic regression analysis was used to fulfil the study objectives. About 15% of older adults reported that they suffered from diarrhoea in the last two years. The prevalence of diarrhoea among older adults was found to be highest in Mizoram (33.5 per cent), followed by Chhattisgarh (30.7 per cent) and Bihar (30.2 per cent). There were significant rural-urban differences in the prevalence of diarrhoea among older adults in India (difference: 7.7 per cent). The highest rural-urban differences in the prevalence of diarrhoea were observed among older adults who were 80+ years old (difference: 13.6 per cent), used unimproved toilet facilities (difference: 12.7 per cent), lived in the kutcha house (difference: 10.2 per cent), and those who used unclean source of cooking fuel (difference: 9 per cent). Multivariate results show that the likelihood of diarrhoea was 17 per cent more among older adults who were 80+ years compared to those who belonged to 60-69 years' age group [AOR: 1.17; CI: 1.04-1.32]. Similarly, the older female had higher odds of diarrhoea than their male counterparts [AOR: 1.19; CI: 1.09-1.30]. The risk of diarrhoea had declined with the increase in the educational level of older adults. The likelihood of diarrhoea was significantly 32 per cent more among older adults who used unimproved toilet facilities than those who used improved toilet facilities [AOR: 1.32; CI: 1.21-1.45]. Similarly, older adults who used unimproved drinking water sources had higher odds of diarrhoea than their counterparts [AOR: 1.45; CI: 1.25-1.69]. Moreover, older adults who belonged to urban areas were 22 per cent less likely to suffer from diarrhoea compared to those who belonged to rural areas [AOR: 0.88; CI: 0.80-0.96]. The findings of this study reveal that diarrhoea is a major health problem among older adults in India. There is an immediate need to address this public health concern by raising awareness about poor sanitation and unhygienic practices. With the support of the findings of the present study, policy makers can design interventions for reducing the massive burden of diarrhoea among older adults in rural India.

The aging Chinese population is growing fast, and the proportion of the population aged 60 years old is projected to reach 28% by 2040, estimated 402 million. With increased life expectancy, the aging population tends to suffer from health risks and diseases, which create a burden on public health policy. Hence, it is essential to promote healthy and active aging, which includes improving older adults' physical and mental capacities and advocating for the achievement of a healthy life expectancy. Despite the rapidly growing aging population in China, there have been no reviews investigating the effect of physical activity on physical and mental health among older Chinese adults. Therefore, the current study aimed to review studies from the past 15 years that illustrate the effect of physical activity on physical and mental health among Chinese older adults. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR), this review addresses the associations between physical activity, physical health and mental health among older Chinese adults. A total of 371 studies were included in the scoping review, which covered the relationships between physical activity, physical health and mental health variables. The scoping review also revealed the impact of various kinds of physical activity affecting older adults' physical health, such as functional fitness, body composition, fall risk and balance, and mental health issues, such as depression, anxiety, cognitive function and quality of life. Moreover, studies have identified innovative forms of physical activity as emerging trends in physical activity interventions for older adults. To conclude, this scoping review captured the common effects between physical activity and overall wellbeing, including physical, mental, and cognitive health. Additionally, diverse forms of physical activity intervention, such as group-based and supervised individual interventions, should be supported, and cross-cultural exercise comparisons should be made in future explorations.

Due to different nature of social engagements of older adults in South Asian countries specially attributed to the traditional family-based care and support, beneficial effects of religiosity and religious involvement on mental health and cognitive function in older age might be different than those in the Western world. Yet, there is a paucity of research in these countries on the role of religion in moderating the relationship between late life depression and cognition. This study explored the association of depressive symptoms with cognitive impairment and the moderating effects of religiosity and religious participation in those associations among older Indian adults. A cross-sectional study was conducted on data that were drawn from the Longitudinal Ageing Study in India wave-1, collected during 2017–2018. The sample size comprised of 31,464 older adults aged 60 years and above. Shortened 10-item Centre for Epidemiologic Studies Depression Scale was used to measure depressive symptoms. Items from the Mini-Mental State Examination and the cognitive module of the China Health and Retirement Longitudinal Study and the Mexican Health and Aging Study were adapted for measuring cognitive impairment. Moderated multiple linear regression models were used to test the research hypotheses of the study. The proportion of older adults who reported religion as less important to them was 21.24%, whereas, only 19.31% of the respondents participated in religious activities. The mean score of cognitive impairment (on a scale of 0–43) in the current sample was 19.43 [confidence interval (CI): 19.32–19.53] among men and 23.55 [CI: 23.44–23.66] among women. Older adults with depressive symptoms had significantly higher likelihood of cognitive impairment [aCoef: 0.18, CI: 0.16–0.20] in comparison to older adults with no depressive symptoms. Older individuals who were religious were significantly less likely to have cognitive impairment [aCoef: − 0.43, CI: − 0.61 to − 0.25] than their non-religious counterparts. Compared to older adults who did not participate in religious activities, those who participated in religious activities were less likely [aCoef: − 0.52, CI: − 0.69 to − 0.34] to have cognitive impairment. Further, significant moderating effects of religiosity and religious participation in the relationship between depressive symptoms and cognitive impairment were observed. The current study contributes to advancing knowledge about the mental health benefits of religiosity and religious participation by focusing on older adults in India who culturally have limited chances to participate in social activities. The findings suggest that older adults with depressive symptoms may participate in religious activities which may reduce their chances of cognitive impairment. This protective effect of religiosity and religious participation on late life cognitive health has important implications for promoting alternative social support mechanisms for older adults in terms of enhancing their mental wellbeing and contributing to active aging.

BackgroundThis study investigates the association between elder abuse, pain with depression among older adults in India, with a focus on the interacting effect of gender. Elder abuse is a growing public health concern globally, and understanding its connection with pain and depression is crucial for prevention and intervention strategies, particularly in vulnerable demographic groups.MethodsData were drawn from the nationally representative Longitudinal Ageing Study in India (LASI) survey conducted in 2017-18 with the total sample size of 73,396. Study sample based on individuals aged 60 years and above, consisted 31,902 older adults. This study combines two binary variables pain and depression symptoms into a composite binary variable Pain with depression (Yes/No). Pain was assessed by asking question to the participants whether they are often troubled with pain. Depression was evaluated using the Centre for Epidemiological Studies depression Scale known as (CES-D-10), using four categories of scale options. A range from 0 to 10 of composite score is obtained and individual who score more than 4 were taken as depressed. Logistic regression models and Chi-square test of significance were used to analyse the relationship between elder abuse and pain with depression, while controlling for socio-demographic, functional and behavioural factors. Interaction effects of gender were examined to assess differential abuse risk between older male and female.ResultsThe analysis revealed that 5.2% of older adults reported experiencing abuse, with a higher prevalence among female. Older adults with pain and depression were significantly more likely to face abuse, with female showing consistently higher odds of abuse compared to male. Specific groups, such as those aged 75 and above, unmarried, uneducated and living in rural areas were at greater risk.ConclusionThe study highlights the strong association between elder abuse, pain with depression, especially among older female. These findings underscore the need for targeted public health interventions among vulnerable groups such as older female, and future research to explore cross- national dynamics and underlying risk factors.

Suicide rates in older adults are much higher than those in younger age groups. Given the rapid increase in the proportion of older adults in Korea and the high suicide rate of this age group, it is worth investigating the mechanism of suicidal ideation for older adults. Generally, adverse childhood experiences are positively associated with suicidal ideation; however, it is not fully understood what mediating relationships are linked to the association between these experiences and current suicidal ideation. The data from 685 older Korean adults were analyzed utilizing logistic regression, path analyses, and structural equation modeling. Based on our theoretical background and the empirical findings of previous research, we examined three separate models with mental health, physical health, and social relationship mediators. After that, we tested a combined model including all mediators. We also tested another combined model with mediation via mental health moderated by physical health and social relationships. The univariate logistic regression results indicated that childhood adversity was positively associated with suicidal ideation in older adults. However, multivariate logistic regression results demonstrated that the direct effect of childhood adversity became nonsignificant after accounting all variables. Three path models presented significant mediation by depression and social support in the association between childhood adversity and suicidal ideation. However, combined structural equation models demonstrated that only mediation by a latent variable of mental health problems was statistically significant. Social relationships moderated the path from mental health problems to suicidal ideation. Despite several limitations, this study has clinical implications for the development of effective strategies to mitigate suicidal ideation. In particular, effectively screening the exposure to adverse childhood experiences, early identification and treatment of depressive symptoms can play a crucial role in weakening the association between childhood adversity and suicidal ideation in older adults.

BackgroundGender and health are two factors that shape the quality of life in old age. Previous available literature established an associaton between various demographic and socio-economic factors with the health and well-being of older adults in India; however, the influence of childless aged is neglected. Therefore, the study examined the gender differential in psychological health and subjective well-being among older adults, focusing on childless older adults.MethodologyThis study utilized data from Building a Knowledge Base on Population Aging in India (BKPAI). Psychological health and subjective well-being were examined for 9541 older adults aged 60 years & above. Descriptive statistics and bivariate analysis were used to find the preliminary results. Further, multivariate analysis has been done to fulfill the objective of the study.ResultsAround one-fifth (21.2%) of the men reported low psychological health, whereas around one-fourth (25.5%) of the women reported low psychological health. Further, around 24 per cent of men and 29 per cent of women reported low subjective well-being. Results found that low psychological well-being (OR = 1.87, C.I. = 1.16–3.01), as well as low subjective well-being (OR = 1.78, C.I. = 1.15–2.76), was higher in childless older women than in childless older men. Higher education, community involvement, good self-rated health, richest wealth quintile, and residing in urban areas significantly decrease the odds of low subjective well-being and low psychological well-being among older adults.ConclusionThere is a need to improve older adults’ psychological health and subjective well-being through expanded welfare provisions, especially for childless older adults. Moreover, there is an immediate requirement to cater to the needs of poor and uneducated older adults.

BackgroundHealth at older ages is a key public health challenge especially among the developing countries. Older adults are at greater risk of vulnerability due to their physical and functional health risks. With rapidly rising ageing population and increasing burden of non-communicable diseases older adults in India are at a greater risk for multimorbidities. Therefore, to understand this multimorbidity transition and its determinants we used a sample of older Indian adults to examine multimorbidity and its associated risk factors among the Indian older-adults aged 45 and above.MethodsUsing the sample of 72,250 older adults, this study employed the multiple regression analysis to study the risk factors of multimorbidity. Multimorbidity was computed based on the assumption of older-adults having one or more than one disease risks.ResultsOur results confirm the emerging diseases burden among the older adults in India. One of the significant findings of the study was the contrasting prevalence of multimorbidity among the wealthiest groups (AOR = 1.932; 95% CI = 1.824- 2.032). Similarly women were more likely to have a multimorbidity (AOR = 1.34; 95% CI = 1.282—1.401) as compared to men among the older adults in India.ConclusionOur results confirm an immediate need for proper policy measures and health system strengthening to ensure the better health of older adults in India.

Physical activity, health and well-being among a nationally representative population-based sample of middle-aged and older adults in India, 2017–2018

Introduction: Dizziness may be associated with negative health outcomes. This study aimed to determine the associations between dizziness and mental and physical health outcomes in middle-aged and older community-dwelling adults in India. Methods: Cross-sectional data from 72,262 individuals (≥ 45 years) of the Longitudinal Ageing Study in India (LASI) Wave 1 in 2017-2018 were analyzed. Dizziness was assessed with the question of having persistent or troublesome dizziness or light headedness in the past two years. Results: More than one in seven participants (13.7%) reported past 2-years dizziness. In adjusted logistic, linear and Poisson regression analyses, dizziness was associated with worse self-rated health status, lower life satisfaction, major depressive disorder, insomnia symptoms and severe fatigue. Regarding physical health, dizziness increased the odds of pain conditions, cardiovascular conditions, chronic lung disease, functional limitations, fall history, hearing loss, impaired vision and higher number of medications currently used. In addition, in the unadjusted analysis, dizziness was negatively associated with cognitive functioning. Conclusion: Dizziness was associated with six poor mental health and eight poor physical health outcomes. Findings support multidimensional management of dizziness in the general population.