Background: Late-onset depression, defined as the first major depressive episode at ≥60 years, is linked with distinct neurocognitive impairments. Despite strong international evidence, comprehensive control-matched comparative studies in the Indian population are scarce. Objective: The objective of this study was to evaluate and compare neurocognitive functions in patients with late-onset depression and healthy controls across multiple domains. Materials and Methods: This cross-sectional study included 50 late-onset depression patients and 50 age-matched healthy controls from a tertiary hospital in Rajasthan. Participants underwent assessments using the Hamilton Depression Rating Scale, Hindi Mental Status Examination, and a neuropsychological test that evaluated attention, working memory, processing speed, executive function, verbal learning and memory, and visuospatial skills. Statistical analyses included t-tests, correlations, andanalysis of variance. Results: Groups were demographically matched (mean age: 66.2 ± 5.06 vs. 66.5 ± 5.39 years). Late-onset depression patients showed significant deficits across all cognitive domains. Executive function (Trail Making Test B: 102.5 ± 4.0 vs. 74.5 ± 4.7 s, P < 0.001) and processing speed (Trail Making Test A: 47.3 ± 6.0 vs. 32.6 ± 3.7 s, P < 0.001) were most impaired. Working memory, attention, memory, and visuospatial skills were also significantly reduced (all P < 0.05). Cognitive performance did not differ significantly across depression severity categories, and clinical variables showed weak correlations with neurocognitive measures. Conclusions: Late-onset depression is associated with widespread neurocognitive impairment, particularly in executive function and processing speed, independent of symptom severity. These findings support the vascular depression hypothesis and highlight the need for comprehensive neuropsychological evaluation and integrated treatment approaches in elderly first-episode depression.
Background: Depression among older adults is often underrecognized and undertreated, leading to significant physical morbidities. Depression in older adults can have significant implications, such as cognitive decline, suicide risk, impairment in activities of daily living (ADL), and socialization. Objectives: This study aimed to estimate the burden of depression among residents of old age homes and examine its association with impaired ADL. Materials and Methods: A cross-sectional design was used, involving 60 participants from three old age homes in West Bengal. Participants were screened for self-reported multimorbidity, depression, and ADL impairment. Statistical analysis was performed using Jamovi software. Results: Twenty-one participants (46.6%) screened positive for depression, 19 (31.6%) had moderate ADL impairment, and 3 (5%) had severe impairment. Depression was significantly associated with multimorbidity (P = 0.006). Depression and ADL impairment have no statistically significant relationship. Conclusion: The findings highlight that depression is common among institutionalized older adults and is closely linked to multimorbidity. Addressing depression and optimizing care for multimorbidity should be prioritized by administrators and health officials.
Population ageing is emerging as a critical determinant of substance use patterns worldwide. Aging, in general, has imminent public health implications for countries (such as India) that are undergoing rapid demographic transit. The elderly population represents a growing but under-examined group within substance use research and clinical practice globally. Age-related physiological changes alter the risk profile of substance use in older adults, resulting in larger negative effects even in lesser amounts. Clinical presentations are frequently atypical, contributing to underrecognition and delayed diagnosis. In primary care, substance use-related harms in the elderly are frequently overlooked or misattributed to comorbid medical or cognitive conditions. In India, this invisibility is compounded by the limited availability of age-specific epidemiological data and health systems that remain largely oriented toward the working-age population. This narrative review synthesizes available Indian and international literature on substance use and related disorders among older adults. We have discussed the current epidemiology, clinical presentation, and diagnostic dilemmas. Particular attention is given to elderly women, in whom substance use is often linked to heightened stigma and poor help-seeking. Management strategies, including pharmacological and psychosocial interventions, rehabilitation, and the role of primary care integration, are discussed. Emerging areas, such as digital health interventions, brain stimulation, and integrative medicine, are discussed, alongside their limited evidence base. In the end, key research priorities and policy directions are debated. This review underscores the need for more systematic research, age-sensitive clinical frameworks, and greater visibility of the elderly within substance use discussions in India.
Background: Management of acute mania in older adults is challenging due to multiple medical comorbidities and age-related changes affecting drug safety and tolerability. Although lithium and sodium valproate are standard treatments, their use in later life is often limited by renal, metabolic, and bone-related concerns. Endoxifen has recently emerged as a potential antimanic agent with favorable tolerability in young adults, but evidence in older populations is scarce. Methodology: We conducted a clinical audit of case records of nine older adults with mania who received adjunctive endoxifen and had at least one follow-up visit. All patients underwent systematic clinical evaluation using standardized rating scales, including the Young Mania Rating Scale (YMRS). Anonymized demographic, clinical, and biochemical-radiological data, along with treatment response and adverse events, were extracted and recorded using a predesigned data collection sheet. Results: This audit included the case records of 9 older adults (8 males), with an age range of 61–92 years, who were on adjunctive endoxifen. On follow-up, the change in YMRS observed was from 30.76% to 92%; similar trends were observed in the subjective improvement of symptoms as well. All the cases had at least one or more medical morbidities. There were no significant adverse events observed that necessitated the cessation of the medication during treatment. Conclusion: Adjunctive endoxifen can be an effective and safe treatment option for older adults experiencing manic symptoms with coexisting multimorbidity and polypharmacy in complex clinical situations where conventional mood stabilizers pose tolerability or safety concerns.
Tiredness of life has been considered a valid criterion for granting euthanasia, particularly in older adults with multiple comorbidities. An 80- year-old divorced man living alone, Mr A, with no history of psychiatric disease, went by his own initiative to the emergency room where he expressed the wish to be euthanized, alleging the tired of life argument. Social determinants were identified as the cause of disappointment. He was admitted to a social facility and, almost a year later, has been doing well. Challenges related to specificities of psychiatric diseases and pathologizing context-dependent normal negative emotions may allow an easier assessment of suffering as intolerable. Furthermore, the acceptance of the tired of life argument for PAD, when no incurable and refractory disease is present, expands the inclusion criteria to virtually anyone who might be aided to die, exposing particularly vulnerable populations, such as older adults. Older adults with comorbidities may lead meaningful lives with appropriate investment and support. Autonomy should not exempt the State from its duty of multidimensional care and support
It is of the utmost importance to distinguish psychiatric illness from normal negative emotions. An 82-year-old man without a history of psychiatric disease was committed for a suicide attempt and medicated with an antidepressant. At reevaluation, no psychopathology was present. Medication was weaned off, and he was discharged home. The case report illustrates psychiatrization driven by top-down factors, such as the diagnostic vagueness of classification systems or the heterogeneity of psychiatric assessments. Diagnosing mental health involves much more than following a checklist and merely considering the patient’s words and responses to questioning.
Auditory hallucinations can occur in normal senior adults or indicate serious medical illness. No algorithm exists for approaching auditory hallucinations in the medical literature, which can confuse the practicing physician. We developed an algorithm to implement a systematic, step-by-step approach that may aid in diagnosing and managing emerging auditory hallucinations in geriatric patients by considering potential differential diagnoses and etiologies. Our work was prompted by a case of auditory hallucinations in an eighty-five-year-old white female with severe hearing impairment and frontotemporal dementia who was referred to the geriatric medicine outpatient clinic by treating primary care provider for management of auditory hallucinations. Prompt recognition and referral to a Geriatrician/Geriatric Psychiatrist, especially when clinical suspicion of certain dementias is high, could lead to better management of the disease course in scenarios where psychosocial factors play a significant role in alleviating the burden on the patient’s family. Refractory auditory hallucinations impose significant morbidity on both the patient and the family. A straightforward algorithmic approach could shed light on the potential etiology and facilitate timely management.
Introduction: Decline in functional abilities is commonly observed among elderly women in old-age homes, particularly impacting key intrinsic abilities such as physical ability, cognitive performance, and psychological resilience. Objective: This study assessed the effects of a structured 4-week yoga intervention on functional abilities among elderly women residing in an old-age home. Materials and Methods: A single-group pretest–posttest design was employed on 46 female residents (mean age: 70.37 ± 5.93 years) of Apnaghar Old-age Home, Agartala, Tripura, India. The progressive yoga intervention began with 30-min sessions 4 days a week during the 1st week and increased to 45 min daily by the 4th week. Participants were assessed using the Short Physical Performance Battery (SPPB), handgrip strength measurements (Camry EH101 Dynamometer), cognitive function evaluation (Mini-Cog™), and psychological well-being assessment (World Health Organization [WHO]-5 Well-being Index). Wilcoxon signed–rank test with significance set at P < 0.05 was used to assess pre–post intervention changes in functional abilities following yoga program among female residents. Results: The mean age of the participants was 70.37 ± 5.93 years. Following the intervention, all assessed parameters demonstrated statistically significant improvements. The SPPB scores increased from 7.80 ± 0.65 to 8.52 ± 1.15 (P < 0.001), handgrip strength rose from 12.35 ± 1.31 kg to 13.99 ± 1.89 kg (P < 0.001), Mini-Cog™ scores improved from 3.00 ± 0.87 to 3.80 ± 0.40 (P < 0.001), and the WHO-5 Well-being Index scores enhanced from 57.83 ± 4.60 to 77.39 ± 6.71 (P < 0.001). Conclusion: The structured 4-week yoga intervention significantly enhanced physical function, muscle strength, cognitive function, and psychological well-being in older women living in an old-age home. The results suggest that yoga is an effective therapy for enhancing functional ability and quality of life in this vulnerable population.
Objective: The objective of this study was to estimate the prevalence of polypharmacy and identify associated factors among the elderly population in Thrissur district, Kerala. Methods: A cross-sectional study was conducted in a selected ward in Thrissur district, Kerala, among a total of 104 elderly individuals aged ≥60 years. Data were collected using a pretested, structured questionnaire through face-to-face interviews. Polypharmacy was defined as the use of four or more medications. Associations between polypharmacy and various factors, such as age, duration of illness, doctor visits, mental health, and sleep patterns, were analyzed using Chi-square tests. Results: The prevalence of polypharmacy was 44%. Significant associations were found with advanced age (P = 0.004), longer duration of illness (P = 0.0001), monthly doctor visits (P = 0.0001), low mood experiences (P = 0.0001), and sleep duration of <6 h (P = 0.0001). Gender, education, socioeconomic status, and body mass index showed no significant associations. Conclusions: Polypharmacy is prevalent among the elderly in Thrissur. Perceived low mood experiences are reportedly high among those subjected to polypharmacy. It may be due to the moderating effect of polypharmacy on depression as both share common factors. These findings highlight the need for regular medication reviews, improved mental health support, and patient education to promote rational drug use and improve geriatric healthcare outcomes.
With an increasing global demographic shift towards an aged human population, there is now an urgent call for paradigm shifts from deficit-oriented aging models toward strength-based models focusing on positive aging outcomes. In this conceptual work, a multi-faceted construct surrounding serene, graceful, and positive aging is explored with a global perspective, integrating cross-cultural understandings and evidence-based frameworks. It proposes an integrative model that encompasses psychological well-being, social connectedness, spiritual fulfilment, and adaptive resilience, drawing on theories of successful aging, principles from positive psychology, and cultural gerontology. The cross-cultural analysis indicates vast differences in perceptions of aging while identifying cross-cultural factors contributing toward an ideal aging experience. Implications for mental health practitioners, policymakers, and researchers in the formation of culturally sensitive interventions and support systems are evaluated. This framework may become a springboard for the promotion of dignity, meaningfulness, and psychological well-being in the later years of life across multiple global settings.
Background: Positive aging is becoming a global concern as the geriatric population is increasing. There is a growing interest in identifying factors that influence the maintenance and preservation of cognitive functioning and well-being in the geriatric community. Among these, spiritual and gratitude practices have gained increasing interest due to their potential influence on cognitive as well as affective domains. Objectives: In this context, the aim of the present study was to compare cognitive functioning and subjective well-being (SWB) among elderly individuals with high and low engagement in spiritual and gratitude practices. Methods: The study employed a cross-sectional and comparative research design, using convenience sampling to recruit participants. From an initial pool of 100 individuals screened according to the inclusion and exclusion criteria, 42 participants (both genders) were selected. Based on their scores on measures of spiritual and gratitude practices, they were categorized into two groups: high and low engagement. Further, these participants were assessed for SWB, as well as various domains of cognitive functioning using standardized tools. Results: The outcome of the present study indicated that participants with higher engagement in spiritual and gratitude practices had significantly better performance on measures of working memory and verbal fluency and experienced enhanced SWB. Conclusion: The findings suggest that engagement in spiritual and gratitude practices can serve as protective factors to support cognitive health and well-being in the aging population.
Introduction: Old age was an inevitable stage in the human life cycle. The occurrence of age-associated disease, dementia, was increasing and causing disharmony in the ability to meet needs effectively and become long-term dependent on their caregivers for daily needs. Caregivers face many obstacles as they balance caregiving with other demands. This leads to chronic burden and stress on caregivers of patients with dementia. Aims: The study aimed to assess perceived stress and burden among the caregivers of patients with dementia. Materials and Methods: The study adopted a descriptive cross-sectional research design, conducted in the outpatient department of LGBRIMH, Tezpur. The purposive sampling technique was used to select 30 caregivers of patients with dementia. The unpaid family member, taken care of a patient with dementia for at least 1 year duration, was included in the study. A self-structured sociodemographic pro forma, Zarit Burden Interview Scale, and Perceived Stress Scale were used to collect the data after ethical clearance and written permission from the concerned authorities. Results: The study results showed majority of the participants have high perceived stress, and have moderate-to-severe burden. There was a significant association found between perceived stress with total hours of caregiving in a day, and level of burden with religion, domicile, and total hours of caregiving in a day by participants. There was also a significant positive correlation found between perceived stress and burden among the caregivers. Conclusion: The study contributed to the understanding of various sociodemographic variables, which were found to be associated with stress and burden of caregivers of patient with dementia. The findings suggest an urgent need for interventions that address caregiver stress, caregiving load, and provide culturally sensitive support, particularly for rural caregivers. Health professionals should routinely assess caregiver well-being and integrate support services into outpatient and community-based dementia care.
Background: Psychiatric service utilization is influenced by psychological distress, demographic, and contextual factors. This study examined trends in psychiatric presentations among community-dwelling older Albertans (65+) from pre-pandemic to postpandemic phases. Methods: A retrospective longitudinal cohort design analyzed psychiatric presentations using Alberta physician billing data from 2017 to 2022 using ICD-9/10 codes. Rates were compared across pandemic phases. Descriptive statistics, one-way analysis of variance, and general linear model (GLM) evaluated the effects of the pandemic, sex, geographic location, and healthcare setting. Results: There were over 1.68 million psychiatric presentations among older adults during the study period. Overall presentations increased by +24.82% during the pandemic, primarily due to a +26.66% rise in outpatient visits, which stabilized but did not return to pre-pandemic levels. Females comprised 62.82% of encounters, with a nonsignificant +27.75% increase during the pandemic that stabilized. Males showed a +39.95% increase during COVID-19, then a −9.86% decline postpandemic – both nonsignificant. GLM analysis identified geographic location and healthcare setting as significant predictors of psychiatric presentations among older adults; females and urban residents had higher outpatient use. In outpatient settings, urban residence predicted presentations, while rural status approached significance for emergency visits. No significant trends were found for inpatient care. Conclusion: Findings suggest the mental health impact of the pandemic persisted post-pandemic, exacerbating disparities in psychiatric service utilization, highlighting the need for targeted interventions such as telepsychiatry and expanded outpatient services. Future research should focus on interventions aimed at reducing geographic disparities in mental healthcare access.
Dementia is a progressive condition that dramatically affects cognitive abilities and daily functioning, often creating a considerable strain on caregivers. While there are medications available, they mainly provide symptomatic relief. This case series explores the clinical progression of three patients with different types of dementia, utilizing minimal medication alongside organized nonpharmacological strategies. Patients experiencing dementia received tailored care that included cognitive stimulation, environmental modifications, caregiver training, and psychosocial support. Medications were minimized and adjusted through ongoing assessments. All three patients experienced either stabilization in behavior or slight improvements in cognitive function. Caregivers reported a reduction in their own distress. Interventions such as music therapy, aids for spatial orientation, and routine daily schedules significantly contributed to these outcomes. Prioritizing emotional needs and adhering to structured routines, along with limited medication use, can improve comfort and functioning in advanced dementia while reducing caregiver burden.
Background: The geriatric population is increasingly vulnerable to psychiatric illnesses due to biological, psychological, and social changes associated with aging. However, mental health services for this group remain neglected. Methods: This cross-sectional study included 221 elderly patients attending a geriatric psychiatry clinic in Kashmir. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition criteria were used for diagnosis. Data were analyzed using SPSS 20 with Chi-square and logistic regression. Results: The most prevalent psychiatric disorders were major depressive disorder (29%), dementia (27.2%), and bipolar disorder (26.2%). Significant predictors of depression included female gender, illiteracy, and widowhood. Depression and neurocognitive disorders were more frequent in the 60–65-year age group. Conclusion: There is a substantial burden of psychiatric morbidity among the elderly in Kashmir. Regular screening and tailored interventions are needed, especially for vulnerable subgroups such as women, widows, and the illiterate.
ABSTRACT Background: Delirium is a common and serious complication in geriatric patients following femur fractures, yet risk stratification remains understudied. Identifying modifiable risk factors is critical for improving clinical outcomes. Methods: This prospective observational study enrolled 30 elderly patients (aged ≥65 years) with acute femur fractures at a single institution. Delirium risk was assessed using the Nottingham hip fracture score (NHFS), alongside variables including age, gender, cognitive status (evaluated through standardized tools, e.g., Confusion Assessment Method [CAM]), comorbidities, medication use, and hemoglobin (Hb) levels. For cognitively impaired patients, written informed consent was obtained from caregivers to ensure ethical inclusion. Results: Participants were stratified into two age groups: 66–84 years ( n = 18, 60%; mean age 70.22 ± 3.96) and ≥85 years ( n = 12, 40%; mean age 86 ± 1.6). A majority (86.67%, n = 26) demonstrated significant cognitive impairment (MMSE score <6; mean 3.23 ± 1.07). All participants were institutionalized, with 53.33% female, 60% having ≥1 comorbidity, and 40% presenting with Hb <10 g/dL. Multiple linear regression revealed that age negatively correlated with CAM scores (β = −0.31, P = 0.041), whereas higher NHFS scores predicted increased delirium risk (β =0.59, P < 0.001). The model explained 57.38% of the variance in delirium risk ( R ² =0.5738). Conclusion: Age, cognitive impairment, and elevated NHFS scores are significant predictors of delirium in geriatric femur fracture patients. These findings underscore the need for early, targeted interventions (e.g., optimizing Hb levels and managing comorbidities) to reduce delirium risk in this vulnerable population.
ABSTRACT The behavioral and psychological symptoms of dementia (BPSD) are neuropsychiatric symptoms that accompany the syndrome of dementia. Research indicates that increased protein kinase C (PKC) signaling is one of the earliest changes observed in the pathology of Alzheimer’s disease dementia. Endoxifen a potent inhibitor of the PKC signaling pathway has demonstrated benefits in controlling acute bipolar mania, impulsivity, and borderline personality disorder. Here, we present the case of a patient with BPSD and hypersexuality managed with endoxifen 8 mg in addition to other medications for BPSD. Adjuvant treatment with endoxifen was efficacious in controlling severe behavioral symptoms and hypersexual behavior, with no adverse effects.
