Patel V, Prince M
Sangath Society, Goa, India.
Psychol Med. 2001 Jan;31(1):29-38. doi: 10.1017/s0033291799003098.
While there is a growing body of epidemiological evidence on the prevalence of mental illnesses in late-life in developing countries, there is limited data on cultural perceptions of mental illnesses and care arrangement for older people.
This qualitative study used focus group discussions with older people and key informants to investigate the status of older people and concepts of late-life mental health conditions, particularly dementia and depression, in Goa, India.
Vignettes of depression and dementia were widely recognized. However, neither condition was thought to constitute a health condition. Dementia was construed as a normal part of ageing and was not perceived as requiring medical care. Thus, primary health physicians rarely saw this condition in their clinical work, but community health workers frequently recognized individuals with dementia. Depression was a common presentation in primary care, but infrequently diagnosed. Both late-life mental disorders were attributed to abuse, neglect, or lack of love on the part of children towards a parent. There was evidence that the system of family care and support for older persons was less reliable than has been claimed. Care was often conditional upon the child's expectation of inheriting the parent's property. Care for those with dependency needs was almost entirely family-based with little or no formal services. Unsurprisingly, fear for the future, and in particular 'dependency anxiety' was commonplace among older Goans.
There is a need to raise awareness about mental disorders in late-life in the community and among health professionals, and to improve access to appropriate health care for the elderly with mental illness. The study suggests directions for the future development of locally appropriate support services, such as involving the comprehensive network of community health workers.
虽然发展中国家关于老年期精神疾病患病率的流行病学证据越来越多，但关于精神疾病的文化认知以及老年人护理安排的数据却很有限。
这项定性研究通过与老年人和关键信息提供者进行焦点小组讨论，调查了印度果阿邦老年人的状况以及老年期心理健康状况的概念，特别是痴呆症和抑郁症。
抑郁症和痴呆症的案例被广泛认可。然而，这两种情况都不被认为是健康问题。痴呆症被视为衰老的正常部分，不被认为需要医疗护理。因此，初级保健医生在临床工作中很少见到这种情况，但社区卫生工作者经常能识别出患有痴呆症的人。抑郁症是初级保健中常见的症状，但很少被诊断出来。这两种老年期精神障碍都被归因于子女对父母的虐待、忽视或缺乏关爱。有证据表明，家庭对老年人的护理和支持系统不如人们声称的那么可靠。护理往往取决于孩子对继承父母财产的期望。对有依赖需求者的护理几乎完全基于家庭，很少或没有正式服务。不出所料，对未来的恐惧，尤其是“依赖焦虑”在果阿邦的老年人中很常见。
有必要提高社区和卫生专业人员对老年期精神障碍的认识，并改善患有精神疾病的老年人获得适当医疗保健的机会。该研究为未来开发适合当地的支持服务提供了方向，比如让社区卫生工作者全面参与。
