Whom we grant him long life we reverse him in the creation, then they will notuse intellect.

By; Dr. Abdelrazak Mansour Ali

Whom we grant him long life we reverse him in the creation, then they will notuse intellect, (Quran. Sura. 36, Verse,68)

The above mentioned verse of the holy Quran stated that when we become older and enter the progressive Senility, our physical and mental health gradually and progressively deteriorating that we reverse to early Childhood life. Now we try in this article to discuss the concept of this verse in the light of scientific and medical facts,  

Most developed world countries have accepted the chronological age of 65 years as a definition of 'elderly' or older person, but like many westernized concepts, this does not adapt well to the situation in Africa. While this definition is somewhat arbitrary, it is many times associated with the age at which one can begin to receive pension benefits. At the moment, there is no United Nations standard numerical criterion, but the UN agreed cutoff is 60+ years to refer to the older population.

Globally, the population is ageing rapidly. Between 2015 and 2050, the proportion of the world’s population over 60 years will nearly double, from 12% to 22%. Mental health and emotional well-being are as important in older age as at any other time of life.

Neuropsychiatric disorders among the older adults account for 6.6% of the total disability (DALYs) for this age group. Approximately 15% of adults aged 60 and over suffer from a mental disorder.

An ageing population tends to have a higher prevalence of chronic diseases, physical disabilities, mental illnesses and other co-morbidities. The health needs and health related problems of elderly people cannot be viewed in isolation. A wide gamut of determinants such as social concerns (viz. children moving out of their parents’ home in search of occupation, leaving them isolated without any physical support in daily activities); maltreatment towards elderly; poor knowledge and awareness about the risk factors; food and nutritional requirements; psycho-emotional concerns (viz. isolation, mental stress, difficulty in keeping themselves occupied); financial constraints (viz. definite reduction in income upon retirement, to the extent that it may interfere with basic needs of life as adequate nutrition, clothing and shelter); health-care system factors (viz. most countries lack effective health insurance system for elderly coupled with accessibility concerns and inadequacies in the government health-care system); and physical correlates; determine the medical problems and thus cast a significant impact on the quality-of-life of the elderly.

The so-called geriatric giants are the major categories of impairment that appear in elderly people, especially as they begin to fail. These include immobility, instability, incontinence and impaired intellect/memory.

Impaired vision and hearing loss are common chronic problems among older people. Hearing problems can lead to social isolation, depression, and dependence as the person can no longer talk to other people, receive information over the telephone, or engage in simple transactions, such as talking to a person at a bank or store. Vision problems lead to falls from tripping over unseen objects, medicine being taken incorrectly because the written instructions could not be read, and finances being mismanaged.

Thanks to new medications and surgical techniques, people are living longer. However, the body we had at 55 will be very different from the body we have at 75. Many issues, both genetic and environmental, affect how we age.

The most widespread conditions affecting those 65 and older include arthritis, heart disease, stroke, cancer, pneumonia and the flu. Accidents, especially falls that result in hip fractures, are also unfortunately common in the elderly.

A lot of our elders are coping with at least one of the following conditions, and many are dealing with two or more of the following:

Heart conditions (hypertension, vascular disease, congestive heart failure, high blood pressure and coronary artery disease)

Dementia, Alzheimer's disease, Delirium, Depression

-Incontinence (urinary and bowel)

-Arthritis, Osteoporosis, Diabetes. Frequent falls, which can lead to fractures

-Parkinson's disease

-Sleep problems. Breathing problems

-Eye problems (cataracts, glaucoma, Macular Degeneration)

-Cancer and Weight loss

As the body changes, other things to be aware of are:

-A slowed reaction time, which is especially important when judging whether a person can safely drive.

-Thinner skin, which can lead to tears or wounds that heal very slowly.

-A weakened immune system, which can make fighting off viruses, bacteria and diseases difficult.

-A diminished sense of taste or smell, especially for smokers, which can lead to diminished appetite and dehydration.

Older adults, those aged 60 or above, make important contributions to society as family members, volunteers and as active participants in the workforce. While most have good mental health, many older adults are at risk of developing mental disorders, neurological disorders or substance use problems as well as other health conditions such as diabetes, hearing loss, and osteoarthritis. Furthermore, as people age, they are more likely to experience several conditions at the same time.

The problem

The world’s population is ageing rapidly. Between 2015 and 2050, the proportion of the world's older adults is estimated to almost double from about 12% to 22%. In absolute terms, this is an expected increase from 900 million to 2 billion people over the age of 60. Older people face special physical and mental health challenges which need to be recognized.

Over 20% of adults aged 60 and over suffer from a mental or neurological disorder (excluding headache disorders) and 6.6% of all disability (disability adjusted life years-DALYs) among over 60s is attributed to neurological and mental disorders. These disorders in the elderly population account for 17.4% of Years Lived with Disability (YLDs). The most common neuropsychiatric disorders in this age group are dementia and depression. Anxiety disorders affect 3.8% of the elderly population, substance use problems affect almost 1% and around a quarter of deaths from self-harm are among those aged 60 or above. Substance abuse problems among the elderly are often overlooked or misdiagnosed.

Mental health problems are under-identified by health-care professionals and older people themselves, and the stigma surrounding mental illness makes people reluctant to seek help.

Risk factors for mental health problems among older adults

Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time. As well as the typical life stressors common to all people, many older adults lose their ability to live independently because of limited mobility, chronic pain, frailty or other mental or physical problems, and require some form of long-term care. In addition, older people are more likely to experience events such as bereavement, a drop in socioeconomic status with retirement, or a disability. All of these factors can result in isolation, loss of independence, loneliness and psychological distress in older people.

Mental health has an impact on physical health and vice versa. For example, older adults with physical health conditions such as heart disease have higher rates of depression than those who are medically well. Conversely, untreated depression in an older person with heart disease can negatively affect the outcome of the physical disease.

Dementia and depression among the elderly as public health issues

Dementia

Dementia is a syndrome in which there is deterioration in memory, thinking, behavior and the ability to perform everyday activities. It mainly affects older people, although it is not a normal part of ageing.

It is estimated that 47.5 million people worldwide are living with dementia. The total number of people with dementia is projected to increase to 75.6 million in 2030 and 135.5 million in 2050, with majority of sufferers living in low- and middle-income countries.

There are significant social and economic issues in terms of the direct costs of medical, social and informal care associated with dementia. Moreover, physical, emotional and economic pressures can cause great stress to families. Support is needed from the health, social, financial and legal systems for both people with dementia and their caregivers.

Older adults are also vulnerable to elder abuse - including physical, sexual, psychological, emotional, financial and material abuse; abandonment; neglect; and serious losses of dignity and respect. Current evidence suggests that 1 in 10 older people experience elder abuse. Elder abuse can lead not only to physical injuries, but also to serious, sometimes long-lasting psychological consequences, including depression and anxiety.

activities. It mainly affects older people, although it is not a normal part of ageing.

It is estimated that 47.5 million people worldwide are living with dementia. The total number of people with dementia is projected to increase to 75.6 million in 2030 and 135.5 million in 2050, with majority of sufferers living in low- and middle-income countries.

Treatment and care strategies

It is important to prepare health providers and societies to meet the specific needs of older populations, including:

-training for health professionals in care for older persons;

-preventing and managing age-associated chronic diseases including mental, neurological and substance use disorders;

-designing sustainable policies on long-term and palliative care; and

-developing age-friendly services and settings.

Health promotion

The mental health of older adults can be improved through promoting Active and Healthy Ageing. Mental health-specific health promotion for older adults involves creating living conditions and environments that support wellbeing and allow people to lead healthy and integrated lifestyles. Promoting mental health depends largely on strategies which ensure the elderly have the necessary resources to meet their basic needs, such as:

-providing security and freedom;

-adequate housing through supportive housing policy;

-social support for older populations and their caregivers;

-health and social programs targeted at vulnerable groups such as those who live alone and rural populations or who suffer from a chronic or relapsing mental or physical illness;

-programs to prevent and deal with elder abuse; andcommunity programs.

Interventions,

-Prompt recognition and treatment of mental, neurological and substance use disorders in older adults is essential. Both psychosocial interventions and medicines are recommended-There is no medication currently available to cure dementia but much can be done to support and improve the lives of people with dementia and their caregivers and families, such as:early diagnosis, in order to promote early and optimal management;

References;

1-WHO organized the First Ministerial Conference on Global Action Against Dementia in March 2015,

2-Health-care of Elderly: Determinants, Needs and Services

Saurabh Ram Bihar Lal Shrivastava, Prateek. Saurabh Shrivastava, and Jegadeesh Ramasamy.et al. Int. J PrevPMC3843313. Med. 2013 Oct; 4(10): 1224–1225. PMCID: