Social disengagement, geriatric depression the elderly.
- Dr Nitin Mehta. MSc. PhD, FICN, Dip in Lib Sc. & Hosp. Admn.

An elderly person’s primary social network is shrinking due to the circumstances – death of a spouse or a friend, and preoccupation with life among family wards. Such events affect health, affecting the daily activities even though older persons have adaptive capabilities. The nature of social contact and interaction changes with old age. Social network in older people remain stable, even as frequency of contact decreases and instrumental and emotional support increases. Modest associations between social ties and cognitive decline that persists after adjustment for covariates e.g., ill health, and activities – daily & instrumental, socio-economical status, sex life, etc. Social disengagement is a risk factor for cognitive impairment in the elderly persons. Cognitive decline is far from being specific indicator of an underlying disease process. Various studies have shown associations between several measures of social and functional impairment Sensory loss and depression are so dominant as to be impairment in old persons and is an underlying cause of apparent cognitive impairment, however, some studies show no decline in cognition in older persons .Associations between a socially engaged life style and higher scores on memory and intelligence tests, short term interventions to foster social and intellectual engagement and dementia [ form of insanity] have been observed  in a community dwelling and nursing homes for older persons.. The concept of social engagement is intuitively accessible; it can be difficult to measure this, as previously socioeconomic or occupational status as synonymous with social engagement in the old age

In a follow up of the study of the elderly –motivation of successful aging, [age group >65, middle& upper income group, education higher school& college], aspects of social engagement and its association with incident cognitive impairment were studied in 148M/20F in yr 2002 & followed up in 88M/4F in yr 2004.This was designed with the addition of a comprehensive assessment of social connections and their activities , social disengagement index, geriatric depression index, Mini mental state examination[MMSE], and Short portable mental status questionnaire [SPMQ].

Cognitive function measured during interviews with10 item SPMQ, as 0-2 intact, 3-4 mild, 5-7 moderate and 8-10 severe impairment .Social  engagement  -6 indicators – 5-6 social ties  1pt., to zero ties 4 pts. Symptoms of geriatric depression a score of <16/20   were considered.

Table 1: Social disengagement, geriatric depression, MMSE, and SPMSQ in the elderly subjects in yrs 2002 and 2004. [All values in %] 

The scores of geriatric depression scale, MMSE, SPMOQ  in  the two yrs of follow up  show a distinct pattern of social disengagement in the elderly—a sea change in the attitude of these subjects. 

In a country  like India, there being a nuclear family tradition, being alone in old age is not common, the likelihood of a person living alone after death of a spouse is less .But rapid urbanization is setting the trend of break up of nuclear family .The social network is shrinking , the adaptive abilities of older persons change with the nature of contact and interaction with non family members in their area Involvement in daily family activities  without  any firm obligations make person formally tilt towards organizations  putting a stop to social withdrawal. Social ties /engagement prevent cognitive decline and the people must maintain social skills, the ability to communicate and the ability to sort out interpersonal situations. Depression is common in old age and is an underlying cause of apparent cognitive impairment and may in part lead to or be caused by social isolation and poor health .

The congenital impairment can be prevented in vast number of elderly people by promoting  arranging programmes of social engagement .Decline of cognition is complex and multifactorial and medical treatment  of many complicated cases is best ameliorative.

 
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