Læknablaðið - 01.12.1973, Blaðsíða 66

264
LÆKNABLAÐIÐ
MENTAL HEALTH
In work with old people the importance
of the mental health of the individual can-
not be overstressed and recently a case was
referred to the department where a man
had become suddenly very depressed and
talked cf suicide. His wife reported this to
the doctor and he was referred for investiga-
tion. This man of 70 was a retired labourer
who kept saying “I cannot seem ever to
get into a happy frame of mind” and who
was found in fact to be deeply depressed.
On investigation, a recent silent myocardial
infarction was discovered and with bed rest
there was a dramatic improvement in his
mental state. There almost certainly was
underlying endogenous depression but this
was a minor symptom compared with his
mental state on admission. It is common to
find mental illness associated with physical
disease. Mental confusion in the elderly can
be compared with the “fit” or convulsion
of the infant and physical causes must be
sought.
REASSURANCE
The old, like the young, have a constant
need for reassurance and an urgent need
for a careful reappraisal of how the com-
munity regards the elderly individual. New-
man in New Zealand has felt for many
years that a proportion of elderly individ-
uals with urinary incontinence had this
symptom because they felt that they had
been completely abandoned and neclected
by society. They felt that no one cared
for them any more and that there was
no point in being continent, and they
abandoned all pretence of being ordinary
individuals. Certainly in looking at long-
stay wards in other parts of the world, in
the East for example, where different morai
and ethical codes prevail, incontinence does
not seem to be so common as it is in the
countries of the West.
Most of the illnesses which older people
take are remedial, but because of multiple
pathology the aged are at risk from taking
too many medicines. An order of priority in
therapy must be established and the doctor
must not attempt to treat all diseases diag-
nosed at one and the same time. Simple
medication ordered with clear instructions
is the rule, with a close watch for any toxic
drug effect essential. Many modern medi-
eines are hallucogenic, sometimes producing
the most odd effects, and where such hallu-
cinations are of recent onset, all drug
therapy should be stopped immediately. It
is important to remember that these older
individuals would not have reached old age
without having a certain soundness of
structure in body and mind and they will
have an amazing aptitude for recovery. As
long as we are faced with an increasing
incidence of senile dementia, particularly in
women over 75, the community cannot rest
content with the present measures taken,
particularly with regard to the mental
health of old people. Society in general has
to adapt to an ageing poplation and supply
their needs — work opportunity, interests,
a place for the skills and talents of old
people — all these must be provided. The
French describe the age cf retirement as
the “third age” and plans should be made
to make this a time of happiness and enjoy-
ment and not a phase of life to be dreaded
and abhorred.
REFERENCES
Loe, R. H. Postgrad. med. 45:179. 1969.
Pathy, M. S. Brit. Heart J. 29:190. 1967.
Rodstein, M. Archives of Int. Med. 98:84.
(1956).
Strang, S. L. Geront. clin. 5:171. (1963).