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   Table of Contents - Current issue
Coverpage
July-December 2020
Volume 7 | Issue 2
Page Nos. 67-117

Online since Thursday, January 21, 2021

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EDITORIAL  

Mental disorders and noncommunicable diseases: A likeness, an overlap or an affiliation? p. 67
Devakshi Dua, Sandeep Grover
DOI:10.4103/jgmh.jgmh_49_20  
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REVIEW ARTICLES Top

Smoking and tobacco use cessation in the elderly p. 70
Siddharth Sarkar, Nishtha Chawla, Prabhoo Dayal
DOI:10.4103/jgmh.jgmh_23_20  
Smoking and tobacco use are the most used psychoactive substances globally, with an estimated population of more than one billion users across the world. It is a significant public health problem and is associated with a multitude of adverse health consequences, particularly in the elderly population, such as various types of neoplasms, cardiovascular and respiratory illnesses, delayed wound healing, and cognitive deficits. It has been seen that the adverse consequences are reduced in past smokers/tobacco users who have eventually become abstinent as compared to active smokers/users. Effective treatment strategies are available to assist individuals in quitting smoking or tobacco use. It is especially important in the elderly as their mobility is reduced, and so is their motivation to quit, mainly due to the longer duration of tobacco use and insufficient knowledge about its adverse effects than the younger population. It is worthwhile to understand the impact and the measures of assessment and treatment to improve the health outcomes in the elderly. This review intends to present clinically relevant aspects of smoking and tobacco use in the elderly, including epidemiology, predictors and risk factors, adverse impact on physical health, and assessment and management of tobacco use and smoking.
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Caregivers' concerns for older persons during COVID-19 pandemic p. 78
Kuljeet Singh Anand, Himank Goyal, Abhishek Juneja, Rakesh Kumar Mahajan, Mina Chandra
DOI:10.4103/jgmh.jgmh_25_20  
The newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been isolated and identified from patients with unexplained pneumonia in Wuhan, China, in December 2019. SARS-CoV-2 mainly causes mild-to-severe respiratory tract symptoms. Elderly people, particularly those with underlying comorbidities, are likely to develop a more severe COVID-19 disease as compared to young people. Therefore, the Centers for Disease Control and Prevention has recommended that older people, living in community settings, should stay at home as much as possible. While all of this is challenging for older people living in the community and long-term facilities, it can also create enormous stress and challenges for their caregivers. It is challenging for caregivers to provide appropriate care while taking care of their own health and maintaining social distancing norms. This calls for the use of different types of caregiving support for elders living in community as well as long-term care centers including the use of novel approaches and technology. A formal approach needs to be framed, taking help from the social workers to attend to the concerns of caregiving during the crisis of COVID-19.
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ORIGINAL ARTICLES Top

Elderly population and the presumptive stressful life events scale: An empirical appraisal p. 82
Anindya Das, Apoorva Chaudhary, Lakshay Tyagi
DOI:10.4103/jgmh.jgmh_38_20  
Introduction: Presumptive stressful life events scale (PSLES) is used widely in Indian life-event research. The use of PSLES in the elderly has been rather mechanistic, without giving due emphasis on the unique experiences of the elderly, particularly within the context of contemporary social change of family values in India. This research aimed to critically appraise the relevance of PSLES in the elderly. Methodology: The research was part of a larger project on stress, coping, and religiosity in (faith bases) ashram-dwelling elderly. A single consenting ashram for the elderly (for aged > 60 years) consented to the study. Participants were included if they had stayed for more than 6 months and had no impairment that compromised understanding of the research. We used the PSLES (a checklist method) for evaluating life events. We supplemented our exploration with open-ended interviews to evaluate the relevance and salience attributed to these life-events. Results: Ninety-four elderly participated (response rate was 70.15') with a mean (standard deviation) age of 74.56 (7.39) years, equally represented by either gender, with a mean duration of ashram stay of 10.85 years. Most frequent events reported were death in the family, going on a trip/pilgrimage, personal illness, and changes in biological functions. Discussion: PSLES was developed for adult Indians, and its use in the elderly may need modification due to qualitatively and quantitatively varying life events, such as the importance of nonegocentric stress (loss of job of one's child) versus egocentric stress (own hospitalization) or change of salience of events (e.g., lack of son versus daughter). Conclusion: To improve the relevance of PSLES for life-event research and capture the unique experiences of the elderly, suggested modifications are necessary.
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Clinical profile of acute confusional state in elderly patients in a tertiary hospital in western Rajasthan p. 86
Dhruv Thakur, Khushboo Agarwal, Alok Gupta, Rajat Gupta
DOI:10.4103/jgmh.jgmh_36_20  
Context: Acute confusional state can be predisposed by preexisting chronic health conditions and drug/substance abuse or can be precipitated by acute insults such as infections and electrolyte imbalance. It is more common in the elderly population, and adverse outcomes include prolonged hospital stay and increased risk of complication or mortality. Aims: The aim of this study was to find out the clinical profile of confusional state in western Rajasthan. Settings and Design: This was a cross-sectional prospective design. Materials and Methods: The study was conducted on 180 elderly patients presenting with acute confusional state diagnosed according to the Confusion Assessment Method Instrument. After a thorough history, all patients went through a complete physical examination and were monitored systematically every 12 h until discharge or death. Routine blood tests were done in all the patients and imaging done as indicated. Statistical Analysis: SPSS was used for statistical analysis. Results: Predominantly affected group in both the genders was 60–70 years. One hundred and fifty-one patients had a history of comorbid illnesses, 47.78' of the patients had a significant history of substance abuse, and 137 had psychosomatic disorders. Around one-third of the study population was socially isolated. The most common acute insults were metabolic encephalopathy, infection, and dehydration. Hypoactive delirium was found to be most common (72.77'). Almost half of the patients presenting with confusion (49.5') expired. Vasopressor and ventilator support were required in more than half of the patients. Most of the patients had multiple causes for confusion with only 10.5' of the patients having a single cause. Conclusion: Timely diagnosis and appropriate interventions are necessary to reduce hospital stay and further complications associated with it.
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Exploring the quality of life of couples whose children are settled abroad p. 94
Anisha Juneja, Akanksha Juneja, Sarla Jawa
DOI:10.4103/jgmh.jgmh_13_20  
Objective: The present study was aimed at exploring the quality of life of parents whose children are settled abroad and the resultant changes in their quality of life. Methods: The research was designed primarily in the qualitative mode because the research caters to a subjective, personal, and experiential realm of parents. The total sample consisted of 30 couples (30 mothers and 30 fathers) working currently in Delhi. The tools used in the study were the General Health Questionnaire-12 (1992) and an Interview Schedule developed for the study. The results were analyzed using content analysis, frequency count, and narrative analysis. Results: The findings showed that few parents suffered from empty nest syndrome. All of them reported changes in their quality of life, but most of them seem to be satisfied with their lives. Conclusion: Understanding the life of such parents has counseling implications. There is a need to develop interventions to enable these parents to continue living their life with enthusiasm and contentment as well as challenge the popular negative connotations of the term empty nest.
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Mental health concerns related to COVID-19 outbreak in the middle-aged and elderly population: A web-based, cross-sectional survey from Haryana, North India p. 100
Jaison Joseph, Karobi Das, Suryakanti Dhal, Tamanna Sehrawat, Sweety Reshamia, Gazal Huria
DOI:10.4103/jgmh.jgmh_22_20  
Background: The coronavirus disease 2019 (COVID-19) pandemic is a global health emergency that could potentially have a serious impact on public health, including mental health. Elderly people are more vulnerable to the stress associated with the COVID-19 outbreak, and there is a dearth of epidemiological data on this issue. Aim: We conducted a web-based survey to evaluate the mental health concerns of middle-aged and elderly populations related to the COVID-19 outbreak from Haryana, India. Materials and Methods: An online survey was conducted from April 17 to May 01, 2020 using the principles of the snowball recruiting technique. The mental health concerns of the potential study participants were evaluated using the Hindi version of Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) scales. Results: There were a total of 1006 responses, out of which 266 were excluded from the analysis. The mean age of the participant was 58.68 (standard deviation [SD] = 8.05) years, and around 36' of respondents were the elderly with an age range of 60–79 years. The mean and SD of the GAD and PHQ were 2.51 (3.69) and 2.80 (4.86), respectively. The overall prevalence of anxiety and depressive symptoms was 19.7' and 21.5', respectively, (GAD-7 and PHQ-9 cutoff score of more than 05). We found a significant association between mental health outcomes with the presence of comorbid illness and physical activeness during the lockdown period. Conclusion: The present study represents a preliminary report on the psychological impact of the novel coronavirus outbreak in the Indian middle-aged and elderly community. The findings can be preliminary evidence for conducting a larger longitudinal study to guide policy-makers for subsequent research and clinical intervention strategy for mental health concerns related to COVID-19.
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CASE REPORTS Top

Peripheral edema associated with low dose of pregabalin in an older person p. 105
Shivanee Kumari, Aseem Mehra, Sandeep Grover
DOI:10.4103/jgmh.jgmh_31_20  
Peripheral edema has been reported as an adverse effect of various medications including antibiotics, nonsteroidal anti-inflammatory drugs, anti-hypertensive drugs, antipsychotics, etc., There are a limited number of cases reported the association of a high dose of Pregabalin association with peripheral edema, but none of them reported the low dose association with peripheral edema. We report a case of an older person presented with depressive disorder, had peripheral edema with 50 mg of pregabalin. It is suggested that a clinician should be aware of this association. Geriatrician should be careful when advising the pregabalin to an older person.
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Challenges in geriatric mental health delivery during the COVID-19 lockdown in India: Illustration using a case report p. 108
Migita M D’cruz
DOI:10.4103/jgmh.jgmh_28_20  
The COVID-19 pandemic and the global/local response to it have placed the mental health of older adults disproportionately at risk. We illustrate the challenges in geriatric mental health care during the COVID-19 lockdown in India using a case report. Mr. S, a 65-year-old man, developed very late-onset schizophrenia-like psychoses in January 2020. While his illness is not novel, the pandemic accentuated his distress and led to barriers in accessing elective mental health care. Social inequity including economic disparity and digital literacy amplified barriers in accessing care. In the meantime, he developed suicidal ideation and attempted self-harm, which was averted. Mr. S was finally able to access subsidized government mental health care in June 2020 and is recovering. However, we argue that the barriers to treatment and consequent delay in care in the context of the pandemic are worth addressing.
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Six decades of natural opiate use in a nonagenarian p. 111
Saumya Mishra, Siddharth Sarkar
DOI:10.4103/jgmh.jgmh_29_20  
Elderly natural opiate users are often forced to seek treatment when they cannot avail opioids. We present here a case of a 98-year-old male who came to us with six decades of natural opiate use in the form of raw opium and poppy husk. The patient was managed symptomatically with tramadol and diazepam for about 6 months. The case highlights the long duration of natural opiate use for nearly six decades, its impact and outcome in terms of psychosocial functioning, and the successful management of elderly patients with natural opiate use in outpatient settings.
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A rare co occurrence of Cervical Dystonia and Pathological Laughter in an elderly female p. 113
Vishnupriya Veeraraghavan, Krishnan Srinivasan, John Dinesh Alexander
DOI:10.4103/jgmh.jgmh_30_20  
Dystonia is a movement disorder whose main feature is a sustained or intermittent muscle contraction causing abnormal, often repetitive, movements. Cervical dystonia (CD) is a type of focal dystonia affecting cervical muscles leading to abnormal postures and movements of the head, neck, and shoulders. Pathological laughter and crying are a condition characterized by uncontrollable episodes of laughter and crying. It occurs without any apparent triggering stimulus or in response to a stimulus which had not resulted in cry or laughter before the onset of the condition. It is characterized as a disorder of emotional expression rather than a disorder of feelings. The purpose of presenting this case report is that this patient presented with pathological laughter and CD without any other neurological complications which are a very rare and unusual presentation.
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LETTERS TO EDITOR Top

Improving the mental health of older adults in the era of COVID-19 pandemic through home-based physical activity p. 116
Chidiebere Emmanuel Okechukwu
DOI:10.4103/jgmh.jgmh_45_20  
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