People live longer, but is treatment on par?

2018-07-19 06:01

The country’s elderly population may be increasing, but are medical facilities to treat the mental health conditions associated with ageing keeping up?

According to Prof. Felix Potocnik, member of the South African Society of Psychiatrists, health services are falling behind in providing services for the elderly living with conditions such as dementia and depression­.

According to a statement, Potocnik estimates that 30% of adults over 60 will at some stage require medication for mental disorders and the elderly population is growing rapidly “without adequate state mental health care”.

In August last year, Statistics South Africa’s mid-year population estimates indicate the proportion of elderly in South Africa is growing, reaching 4.6 million (8.1% of the total population) in 2017 compared to 2.8 million older people in 1996 (7.1%).

Potocnik stresses there is a difference between normal ageing and impaired mental health.

“Older adults who are suffering from depression experience symptoms that disrupt their daily lives, resulting in withdrawal from social activities, friends and family and all the things that used to bring them joy. It is important for family members to be vigilant and recognise any changes in behaviour and to seek help from medical and allied services.

“While some element of forgetfulness accompanies one’s later years, it is important to realise that it is not a disability if you can still make rational decisions and get on with your daily life. Although the key symptoms of dementia include forgetfulness, in the earlier stages it is about multiple cognitive deficits that herald a decline in one’s ability to think abstractly and logically, to use language properly and to make sensible decisions.”

The Western Cape has some 600 000 elderly of whom an estimated 40 000 (6.6%) are suffering with dementia, claims Potocnik.

But according to provincial health department spokesperson, Bianca Gilbert, there are limited statistics on the prevalence of dementia.

“Very few population prevalence studies have been done in South Africa as a whole, and we therefore do not have accurate estimates of the number of people who suffer from dementia,” she says.

According to resources available from Dementia SA, there “is a complex relationship between depression and dementia”.

“The symptoms of dementia and depression, including a withdrawal from social activities and a general apathy, may seem very similar. An elderly person with severe depression may occasionally be misdiagnosed as having dementia. The situation is further complicated by the fact that the person with dementia may also be depressed­.”

A study by Karl Peltzer and Nancy Phaswana-Mafuya published in Global Health Action in 2013, put “the overall prevalence of symptom-based depression” at 4%” in the elderly.

Disability, lack of quality of life, and chronic conditions were associated with the self-reported depression symptoms.

However, treating mental health conditions in the elderly can be challenging.

The WHO Global Health Observatory data estimates that there is less than one psychiatrist per 100 000 of the South African population.

These numbers are in reality even lower, says Gilbert.

“According to local studies the number of psychiatrists is much lower: 0.28 per 100 000 in South Africa. These studies estimate a number of 0.9 psychiatrists per 100 000 of the population in the Western Cape,” she says.

In addition, only one facility in the Western Cape is dedicated to psychogeriatrics (psychiatry for the elderly).

Potocnik says: “We used to have five dedicated psychogeriatric units at our South African universities, whereas now there is only one situated at Stikland Hospital in Bellville.”

Gilbert confirms: “There is one inpatient unit for elderly patients with mental disorders at Stikland Hospital and a Psychogeriatric Outpatient Clinic at Stikland and Groote Schuur hospitals. The majority of elderly patients are required to attend general psychiatric services, available at local clinics or general hospitals, for their mental health needs.

“The waiting period at the psychogeriatric unit at Stikland Hospital is approximately five weeks.”

Gilbert adds that the unit’s biggest challenge is the social support of patients. “The service is designed to be a medium-stay hospital, however patients and their family are often under the impression it is long-term; this assumption is incorrect. Patients often stay in the ward for an unnecessarily long time, because clinical teams are unable to find support for them in the community. This means that beds are often occupied unnecessarily.”

Potocnik says the greater reliance is placed on family, friends, social support groups, district clinics and regional hospitals to help with the task of providing services for the elderly. In addition, medication is costly, explains Potocnik, and is not always funded by medical aids.

Gilbert adds that family of elderly patients with mental disorders is often expected to look after them.

“In most cases, the family is willing and able to do so. However, often the family is not able to look after their elderly relatives. It is important to take cognisance of the fact that elderly individuals are vulnerable and legally protected by the ‘Old Persons Act’. They therefore cannot be discharged to a family who is not supportive and where they will have to fend for themselves,” she says.

The country’s elderly population may be increasing, but are medical facilities to treat the mental health conditions associated with ageing keeping up?

According to Prof. Felix Potocnik, member of the South African Society of Psychiatrists, health services are falling behind in providing services for the elderly living with conditions such as dementia and depression.

According to a statement, Potocnik estimates that 30% of adults over 60 will at some stage require medication for mental disorders and the elderly population is growing rapidly “without adequate state mental health care”.

In August last year, Statistics South Africa’s mid-year population estimates indicate the proportion of elderly in South Africa is growing, reaching 4.6 million (8.1% of the total population) in 2017 compared to 2.8 million older people in 1996 (7.1%).

Potocnik stresses there is a difference between normal ageing and impaired mental health.

“Older adults who are suffering from depression experience symptoms that disrupt their daily lives, resulting in withdrawal from social activities, friends and family and all the things that used to bring them joy. It is important for family members to be vigilant and recognise any changes in behaviour and to seek help from medical and allied services.

“While some element of forgetfulness accompanies one’s later years, it is important to realise that it is not a disability if you can still make rational decisions and get on with your daily life.”

The Western Cape has some 600 000 elderly of whom an estimated 40 000 (6.6%) are suffering with dementia, claims Potocnik.

But according to provincial health department spokesperson, Bianca Gilbert, there are limited statistics on the prevalence of dementia.

“Very few population prevalence studies have been done in South Africa as a whole, and we therefore do not have accurate estimates of the number of people who suffer from dementia,” she says.

According to resources available from Dementia SA, there “is a complex relationship between depression and dementia”.

“The symptoms of dementia and depression, including a withdrawal from social activities and a general apathy, may seem very similar. An elderly person with severe depression may occasionally be misdiagnosed as having dementia. The situation is further complicated by the fact that the person with dementia may also be depressed.”

A study by Karl Peltzer and Nancy Phaswana-Mafuya published in Global Health Action in 2013, put “the overall prevalence of symptom-based depression” at 4%” in the elderly. Disability, lack of quality of life, and chronic conditions were associated with the self-reported depression symptoms.

However, treating mental health conditions in the elderly can be challenging.

The WHO Global Health Observatory data estimates that there is less than one psychiatrist per 100 000 of the South African population.

These numbers are in reality even lower, says Gilbert.

“According to local studies the number of psychiatrists is much lower: 0.28 per 100 000 in South Africa. These studies estimate a number of 0.9 psychiatrists per 100 000 of the population in the Western Cape,” she says.

In addition, only one facility in the Western Cape is dedicated to psychogeriatrics (psychiatry for the elderly). Potocnik says: “We used to have five dedicated psychogeriatric units at our South African universities, whereas now there is only one situated at Stikland Hospital in Bellville.”

Gilbert adds that the unit’s biggest challenge is the social support of patients. “The service is designed to be a medium-stay hospital, however patients and their family are often under the impression it is long-term; this assumption is incorrect. Patients often stay in the ward for an unnecessarily long time, because clinical teams are unable to find support for them in the community. This means that beds are often occupied unnecessarily.”

Gilbert adds that family of elderly patients with mental disorders is often expected to look after them.

The country’s elderly population may be increasing, but are medical facilities to treat the mental health conditions associated with ageing keeping up?

According to Prof. Felix Potocnik, member of the South African Society of Psychiatrists, health services are falling behind in providing services for the elderly living with conditions such as dementia and depression­.

According to a statement, Potocnik estimates that 30% of adults over 60 will at some stage require medication for mental disorders and the elderly population is growing rapidly “without adequate state mental health care”.

In August last year, Statistics South Africa’s mid-year population estimates indicate the proportion of elderly in South Africa is growing, reaching 4.6 million (8.1% of the total population) in 2017 compared to 2.8 million older people in 1996 (7.1%).

Old age vs illness

Potocnik stresses there is a difference between normal ageing and impaired mental health.

“Older adults who are suffering from depression experience symptoms that disrupt their daily lives, resulting in withdrawal from social activities, friends and family and all the things that used to bring them joy. It is important for family members to be vigilant and recognise any changes in behaviour and to seek help from medical and allied services. While some element of forgetfulness accompanies one’s later years, it is important to realise that it is not a disability if you can still make rational decisions and get on with your daily life. Although the key symptoms of dementia include forgetfulness, in the earlier stages it is about multiple cognitive deficits that herald a decline in one’s ability to think abstractly and logically, to use language properly and to make sensible decisions.”

Need for professionals

The Western Cape has some 600 000 elderly of whom an estimated 40 000 (6.6%) are suffering with dementia, claims Potocnik.

But according to provincial health department spokesperson, Bianca Gilbert, there are limited statistics on the prevalence of dementia.

“Very few population prevalence studies have been done in South Africa as a whole, and we therefore do not have accurate estimates of the number of people who suffer from dementia,” she says.

According to resources available from Dementia SA, there “is a complex relationship between depression and dementia”.

“The symptoms of dementia and depression, including a withdrawal from social activities and a general apathy, may seem very similar. An elderly person with severe depression may occasionally be misdiagnosed as having dementia. The situation is further complicated by the fact that the person with dementia may also be depressed.”

A study by Karl Peltzer and Nancy Phaswana-Mafuya published in Global Health Action in 2013, put “the overall prevalence of symptom-based depression” at 4%” in the elderly.

Disability, lack of quality of life, and chronic conditions were associated with the self-reported depression symptoms.

Treatment challenges

However, treating mental health conditions in the elderly can be challenging.

The WHO Global Health Observatory data estimates that there is less than one psychiatrist per 100 000 of the South African population.

These numbers are in reality even lower, says Gilbert.

“According to local studies the number of psychiatrists is much lower: 0.28 per 100 000 in South Africa. These studies estimate a number of 0.9 psychiatrists per 100 000 of the population in the Western Cape,” she says.

In addition, only one facility in the Western Cape is dedicated to psychogeriatrics (psychiatry for the elderly).

Potocnik says: “We used to have five dedicated psychogeriatric units at our South African universities, whereas now there is only one situated at Stikland Hospital in Bellville­.”

Gilbert confirms: “There is one inpatient unit for elderly patients with mental disorders at Stikland Hospital and a Psychogeriatric Outpatient Clinic at Stikland and Groote Schuur hospitals. The majority of elderly patients are required to attend general psychiatric services, available at local clinics or general hospitals, for their mental health needs.

“The waiting period at the psychogeriatric unit at Stikland Hospital is approximately five weeks.”

Gilbert adds that the unit’s biggest challenge is the social support of patients. “The service is designed to be a medium-stay hospital, however patients and their family are often under the impression it is long-term; this assumption is incorrect. Patients often stay in the ward for an unnecessarily long time, because clinical teams are unable to find support for them in the community. This means that beds are often occupied unnecessarily.”

Potocnik says the greater reliance is placed on family, friends, social support groups, district clinics and regional hospitals to help with the task of providing services for the elderly. In addition, medication is costly, explains Potocnik, and is not always funded by medical aids.

Gilbert adds that family of elderly patients with mental disorders is often expected to look after them.

“In most cases, the family is willing and able to do so. However, often the family is not able to look after their elderly relatives. It is important to take cognisance of the fact that elderly individuals are vulnerable and legally protected by the ‘Old Persons Act’. They therefore cannot be discharged to a family who is not supportive and where they will have to fend for themselves,” she says.

The country’s elderly population may be increasing, but are medical facilities to treat the mental health conditions associated with ageing keeping up?

According to Prof. Felix Potocnik, member of the South African Society of Psychiatrists, health services are falling behind in providing services for the elderly living with conditions such as dementia and depression­.

According to a statement, Potocnik estimates that 30% of adults over 60 will at some stage require medication for mental disorders and the elderly population is growing rapidly “without adequate state mental health care”.

In August last year, Statistics South Africa’s mid-year population estimates indicate the proportion of elderly in South Africa is growing, reaching 4.6 million (8.1% of the total population) in 2017 compared to 2.8 million older people in 1996 (7.1%).

Old age vs illness

Potocnik stresses there is a difference between normal ageing and impaired mental health.

“Older adults who are suffering from depression experience symptoms that disrupt their daily lives, resulting in withdrawal from social activities, friends and family and all the things that used to bring them joy. It is important for family members to be vigilant and recognise any changes in behaviour and to seek help from medical and allied services.

“While some element of forgetfulness accompanies one’s later years, it is important to realise that it is not a disability if you can still make rational decisions and get on with your daily life. Although the key symptoms of dementia include forgetfulness, in the earlier stages it is about multiple cognitive deficits that herald a decline in one’s ability to think abstractly and logically, to use language properly and to make sensible decisions.”

Need for professionals

The Western Cape has some 600 000 elderly of whom an estimated 40 000 (6.6%) are suffering with dementia, claims Potocnik.

But according to provincial health department spokesperson, Bianca Gilbert, there are limited statistics on the prevalence of dementia.

“Very few population prevalence studies have been done in South Africa as a whole, and we therefore do not have accurate estimates of the number of people who suffer from dementia,” she says.

According to resources available from Dementia SA, there “is a complex relationship between depression and dementia”.

“The symptoms of dementia and depression, including a withdrawal from social activities and a general apathy, may seem very similar. An elderly person with severe depression may occasionally be misdiagnosed as having dementia. The situation is further complicated by the fact that the person with dementia may also be depressed­.”

A study by Karl Peltzer and Nancy Phaswana-Mafuya published in Global Health Action in 2013, put “the overall prevalence of symptom-based depression” at 4%” in the elderly.

Disability, lack of quality of life, and chronic conditions were associated with the self-reported depression symptoms.

Treatment challenges

However, treating mental health conditions in the elderly can be challenging.

The WHO Global Health Observatory data estimates that there is less than one psychiatrist per 100 000 of the South African population.

These numbers are in reality even lower, says Gilbert.

“According to local studies the number of psychiatrists is much lower: 0.28 per 100 000 in South Africa. These studies estimate a number of 0.9 psychiatrists per 100 000 of the population in the Western Cape,” she says.

In addition, only one facility in the Western Cape is dedicated to psychogeriatrics (psychiatry for the elderly).

Potocnik says: “We used to have five dedicated psychogeriatric units at our South African universities, whereas now there is only one situated at Stikland Hospital in Bellville.”

Gilbert confirms: “There is one inpatient unit for elderly patients with mental disorders at Stikland Hospital and a Psychogeriatric Outpatient Clinic at Stikland and Groote Schuur hospitals. The majority of elderly patients are required to attend general psychiatric services, available at local clinics or general hospitals, for their mental health needs.

“The waiting period at the psychogeriatric unit at Stikland Hospital is approximately five weeks.”

Gilbert adds that the unit’s biggest challenge is the social support of patients. “The service is designed to be a medium-stay hospital, however patients and their family are often under the impression it is long-term; this assumption is incorrect. Patients often stay in the ward for an unnecessarily long time, because clinical teams are unable to find support for them in the community. This means that beds are often occupied unnecessarily.”

Potocnik says the greater reliance is placed on family, friends, social support groups, district clinics and regional hospitals to help with the task of providing services for the elderly. In addition, medication is costly, explains Potocnik, and is not always funded by medical aids.

Gilbert adds that family of elderly patients with mental disorders is often expected to look after them.

“In most cases, the family is willing and able to do so. However, often the family is not able to look after their elderly relatives. It is important to take cognisance of the fact that elderly individuals are vulnerable and legally protected by the ‘Old Persons Act’. They therefore cannot be discharged to a family who is not supportive and where they will have to fend for themselves,” she says.

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