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   Table of Contents - Current issue
Coverpage
January-June 2022
Volume 9 | Issue 1
Page Nos. 1-62

Online since Wednesday, August 3, 2022

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EDITORIAL  

Catatonia in the elderly: Does it require attention! p. 1
Sandeep Grover
DOI:10.4103/jgmh.jgmh_33_22  
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ORIGINAL ARTICLES Top

Role of leisure activity in quality of life and meaning in life of male and female older adults p. 4
Pooja Mukherjee, Ankita Ghosh, Subrata Dasgupta
DOI:10.4103/jgmh.jgmh_44_21  
Context: India at present is experiencing a phenomenal increase in the number of older adults. Old age is marked by challenges across multiple domains of life. To overcome the challenges of old age, the focus should be on improving the quality of life (QOL) and meaning in life (MIL) of older adults. Aim: This study aimed to determine the effect of leisure activity on QOL and MIL of male and female older adults in old-age homes. Methodology: A cross-sectional study was conducted among 120 male and female retired older adults (65–80 years), living in old-age homes of Hooghly district, West Bengal, using the Older People's Quality of Life Questionnaire (OPQOL-35) by Bowling and Meaning in Life Questionnaire (MLQ) by Steger, Frazier, Oishi, & Kaler. Results: Older adults who engaged in active leisure activities had higher QOL and MIL than those engaged in passive leisure activities. Male older adults had higher QOL and MIL than female older adults. Conclusion: Opportunities to pursue active leisure activities should be promoted among older adults in old-age homes.
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Home-based care of persons with dementia during COVID-19 pandemic: Caregivers' experiences p. 9
Cicil R Vasanthra, Thirumoorthy Ammapattian, Sojan Antony, Girish N Rao, Krishna Muliyala Prasad, Kanjirakattu Madom NarayananUnni Anu, Thomas Gregor Issac, Sivakumar Palanimuthu Thangaraju
DOI:10.4103/jgmh.jgmh_10_22  
Background: Dementia is a neurocognitive disorder that contributes to a high caregiver burden. This article describes caregivers' experiences in providing care at home for persons with dementia during the COVID-19 pandemic. The pandemic had brought the world to a standstill that no one alive had experienced before. Methods: Cross-sectional focus group discussion with 17 caregivers of persons living with Alzheimer's disease was conducted using video conferencing software. Results: The significant issues reported by the caregivers were changing routine, an increase in demanding behavior, an increase in the tendency of wandering behavior, increased frustration among caregivers, intolerance, and overall burden. However, some caregivers were also able to adapt to emerging situations and design a new set of daily living activities. Conclusion: Understanding caregiving experiences and guiding caregivers to build their resilience would prevent caregivers' burnout.
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A study on socioeconomic correlates of family caregiver burden: Comparison between geriatric patients with dementia and with schizophrenia in a tertiary care center in Kolkata p. 13
Amrita Samanta, Santanu Ghosh
DOI:10.4103/jgmh.jgmh_7_22  
Background: The role of being a caregiver of elderly patients with chronic psychiatric illnesses can be challenging. The objective of the current study was to determine and compare the family caregiver (FCG) burden of dementia and schizophrenic elderly patients and their associated sociodemographic factors. Materials and Methods: This descriptive cross-sectional study was conducted among 122 randomly-selected FCGs of geriatric patients with dementia (84) and schizophrenia (38) in the psychiatry outpatient department of RG Kar Medical College and Hospital, Kolkata. The original 22 items Zarit Burden Interview tool was used to assess caregiver burden. Data were analyzed in SPSS Version 20.0. The Mann–Whitney U-tests and Chi-square test were performed for bivariate analyses. Value of P < 0.05 was considered statistically significant. Results: Median age (inter quartile range) of dementia and schizophrenia patients were 74 (13) years and 67 (6) years, respectively. All FCGs studied were burdened with caregiving. FCGs of the schizophrenic group were more burdened than those of the dementia group (median score: 66 vs. 45, P = 0.000016). The female gender of patients and caregivers, years of institutional education, years of illness of the patient, and dependence on the caregiver for activities of daily living were positively associated with burden in both the groups. For FCGs of dementia patients, patients being widowed or separated (P = 0.00128), belonging to Islam by religion (P = 0.0083) and joint families (P = 0.00672), lower monthly family income (P = 0.00021), no current income of patient (P = 0.0001), higher monthly expenditure on patients (P = 0.0000), and the presence of chronic ailments requiring regular treatment (P = 0.00078) were found to be significantly associated with more burden. Conclusion: Field-based strategies addressing the caregiver burden of geriatric psychiatric patients must be developed and integrated into the existing health-care system.
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Hopelessness and quality of life in elderly: A community-based cross-sectional study p. 21
Amithabh Sajeev, Anil Kakunje, Ravichandra Karkal
DOI:10.4103/jgmh.jgmh_12_22  
Introduction: Elderly population has a higher vulnerability to many physical and mental disturbances. These setbacks can lead to decreased quality of life (QOL) which may increase the feeling of hopelessness among the elderly. Aim: This study aims to assess the association between hopelessness and the QOL among the elderly in the community. Materials and Methods: This cross-sectional study involved 100 elderly people with 50 participants each from two different locations of South India. The study was conducted from February 2020 to December 2020 after obtaining the institutional ethics committee approval. Beck's Hopelessness Scale and the World Health Organization quality of life (WHOQOL)-BREF instrument were used to assess hopelessness and QOL. Results: The average age of the sample was 66.26 ± 5.29 years with a male predominance. The Beck's hopelessness score was greater in females, whereas the WHOQOL score was higher in males. We also found a significantly strong negative strength of association (Pearson's correlation score of − 0.954) between Beck's hopelessness score and WHOQOL scoring systems. Our study showed that hopelessness and QOL were significantly influenced by educational status, marital status, annual income, medical illness, psychiatric illness, and duration of hospital admissions. Conclusion: Elderly people with good financial stability are more secure with a higher QOL.
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Clinician's experience of telepsychiatry consultations with elderly patients p. 26
Chandrima Naskar, Sandeep Grover, Aseem Mehra, Swapnajeet Sahoo
DOI:10.4103/jgmh.jgmh_31_22  
Background: During the coronavirus disease-2019 pandemic, telepsychiatry became a norm as a primary method of health-care delivery across India. However, not much evidence is available regarding the experience of psychiatrists in providing a telepsychiatry consultation. Objective: This study aims to assess the experience and satisfaction of the clinician in providing teleconsultations to elderly patients/their caregivers. Methodology: Clinicians scored their experience, satisfaction, and their perception of therapeutic alliance in providing the teleconsultation to patients of age 60 years or more, in a detailed Google Forms-based questionnaire. Results: Ninety-eight teleconsultations were assessed by clinicians. The patients had a mean age of 69.5 years, with an equal number of males and females. In more than 80% of the teleconsultations, patients were accompanied by their relatives. In about one-fourth of the consultations, psychiatrists encountered connectivity issues from the patient side. Overall, for three-fourth (72%) of the teleconsultations, clinicians reported being satisfied to a large extent; for two-thirds (66%) of the consultations, the clinicians rated their teleconsultation experience as that of providing an in-person consultation; and for about 10% of consultations, the experience was rated as better than the in-person consultation. In terms of a therapeutic alliance, in almost 85%–90% of consultations, the clinicians noted that they could build a rapport, empathize with their patients, and build a relationship of trust with the patients and their caregivers. Conclusions: Teleconsultation with the elderly might not be as difficult as intuitively thought and clinicians are in general satisfied with the same and consider that they can establish a good therapeutic alliance with the patients and their caregivers.
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Changing social dynamics and older population: A qualitative analysis of the quality of life among older adults in Kerala p. 34
Julie Abraham, Sibasis Hense, Elezebeth Mathews
DOI:10.4103/jgmh.jgmh_19_22  
Background: The concomitant availability of services and care with the rise in the older population in India does not commensurate with their health care needs, thus affecting their well-being and quality of life (QoL). The Indian State of Kerala, epidemiologically and demographically advanced and often compared with developed countries, has the highest number of older persons. It also ranks top in the human development index in the country. This study seeks to explore the factors influencing QoL among older persons in Kerala, a state located within a low middle-income country. Materials and Methods: Qualitative methods using exploratory design were employed. Ten focus group discussions and ten face-to-face in-depth interviews were conducted in two districts of Kerala. The data were thematically analyzed using a framework approach. Results: The study explored a multitude of factors influencing QoL among older people in Kerala. The themes that emerged from the study were, “Financial securities and insecurities,” “psychological well-being,” “lifestyle,” “health-care utilization,” and “social engagement.” Conclusion: The current study findings have explored the changing importance or value of the factors attributed to older persons' QoL in an advanced population within a low middle-income country such as India.
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A comparison of post-COVID-19 psychiatric manifestations among adults and elderly p. 43
Mrugesh Vaishnav, Sandeep Grover, Parth Vaishnav, G Prasad Rao, Gautam Saha, Ajit Avasthi
DOI:10.4103/jgmh.jgmh_35_22  
Aim: This study aimed to estimate the prevalence of psychiatric morbidity in elderly patients recovered from coronavirus disease-2019 (COVID-19) infection, the present study aimed to compare the prevalence of psychiatric morbidity among elderly (aged ≥60 years) and adult patients (aged 18–59 years). Methodology: Two hundred and three elderly patients and 1714 adult participants had completed the Patient Health Questionnaire-9, generalized anxiety disorder-7 (GAD-7), Fear of COVID-19 Scale, Brief Resilient Coping Scale, The Brief Resilience Scale, and a self-designed questionnaire to assess the neuropsychiatric symptoms. Results: In the whole sample, the prevalence of depression was 34.4%, GAD was 32.6%, sleep disturbances were 58.3%, suicidal ideations were 23%, COVID-19-related fear was 32.1%, low resilience was 18.7%, and low resilient coping was 49.5%. Compared to adult participants, elderly participants had significantly higher prevalence and severity of depression, anxiety, COVID-19 fear score, low resilience, and low resilient coping. In the whole sample, the prevalence of posttraumatic stress disorder (PTSD) symptoms was 23.8%–25.3%, panic attacks were 17%, loneliness was 23.2%, forgetfulness was 21.8%, and cognitive slowing was 19%. Compared to the adult participants, significantly higher proportion of the elderly reported PTSD symptoms, cognitive slowing, and forgetfulness. Conclusions: Compared to adult subjects, elderly subjects who have recovered from COVID-19 infection have significantly higher prevalence of depression, anxiety, fear, post-traumatic symptoms, and cognitive symptoms. Hence, there is an urgent need to assess psychiatric morbidity among the elderly subject who have recovered from COVID-19 infection and institute interventions at the earliest to improve their mental health outcomes.
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Dropout rates and its correlates among the elderly patients attending a community health center p. 54
Aseem Mehra, Sandeep Grover, Ajit Avasthi
DOI:10.4103/jgmh.jgmh_34_22  
Aim: The current study aimed to evaluate the dropout rates and the reasons for dropouts among elderly patients presenting with mental health problems to a community health centre. Methodology: This naturalistic, longitudinal, follow-up study was carried out in the Outpatient Setting of a community health centre in North India. The study included 169 patients, aged ≥ 60 years diagnosed with mental health problems. They were assessed at the baseline and then followed for a period of 1 year. Those who dropped out from the outpatient clinic were contacted over the phone to evaluate the reasons for dropout from treatment. Results: The mean age of the participants was 67.6 years and the mean number of years of education was 2.9. Most of the patients were female, married, Hindu, unemployed, from lower socioeconomic status, and non-nuclear families. The most common diagnosis was that of depression (42.6%), and this was followed by somatoform disorder (11.2%). The mean age of onset of psychiatric disorder was 62.2 years, with a mean duration of illness being 30.3 months. Nearly half (53.3%) of the patients dropped out of treatment after their first visit and 90% dropped out by 1 year. Overall the most common reason of drop out was complete relief of symptoms, and this was followed by the presence of family problems, and farming-related work. Among the very early drop out (never returned to clinic after the first visit) the most common reason for dropout was complete relief in symptoms, followed by inability to follow up due to family problems, no relief in symptoms, and farming-related work. Among those who dropped out within 6 months, the most common reason was complete relief of symptoms followed by lack of time due to personal reasons. When the reason for “late” dropout (dropout between 6 to 12 months) was evaluated, the most common reason was complete relief of symptoms followed by an inability to follow up due to problems in the family. Conclusion: A significant number of elderly patients with mental health-related problems drop out of treatment prematurely. Psychoeducation about the illness, outcome, and course of illness should be done at each step, and prevailing psychosocial issues need to be evaluated to reduce the rate of dropout among elderly patients with mental health-related problems attending the community health centre.
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LETTER TO THE EDITOR Top

The pharmacological treatment of behavioral alterations in the course of dementia p. 60
Davide Cristina
DOI:10.4103/jgmh.jgmh_18_22  
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