Geriatric Psychiatry in Pakistan: Addressing Mental Health Challenges for the Elderly

As Pakistan’s elderly population rises, the demand for geriatric psychiatry has become more urgent. Geriatric psychiatry, also known as elderly psychiatry, focuses on mental health disorders in individuals aged 60 and above. In Pakistan, socio-economic factors significantly shape how mental health issues manifest in this age group, with unique challenges that differentiate elderly psychiatry from other specialties.

Common Psychiatric Disorders in Pakistan’s Elderly

In Pakistan, depression and anxiety are the most prevalent psychiatric conditions among the elderly. Depression affects approximately 35% of the world’s elderly, and in Pakistan, factors such as family structures, poverty, and cultural norms play a crucial role in its severity​.

Symptoms often include sadness, loss of interest, sleep disturbances, and somatic complaints like fatigue and body pain. In rural areas, these conditions often go undiagnosed due to the lack of mental health infrastructure.

Dementia is another growing concern, affecting cognitive functions like memory, reasoning, and problem-solving. However, due to limited resources and awareness, it often remains undiagnosed in the early stages​.

Impact of Socio-Economic Factors on Mental Health

Socio-economic disparities heavily influence the mental health of the elderly in Pakistan. Poverty, social isolation, and lack of access to healthcare are among the key contributors to psychiatric disorders.

In urban areas like Karachi, elderly individuals from low-income backgrounds are more prone to anxiety and depression due to financial stress and lack of family support.

Pakistan’s elderly population in rural areas faces even greater challenges. Due to limited healthcare facilities, many elderly people remain untreated or misdiagnosed. Mental health services are concentrated in urban areas, leaving rural communities without adequate psychiatric care.

Family structure plays a crucial role in the mental well-being of the elderly. Those living in nuclear families or alone are more vulnerable to depression compared to those in joint family systems, where they receive more social and emotional support. Women, particularly widows or those living alone, are 2.6 times more likely to suffer from depression than their male counterparts.

Mental Health Stigma and Cultural Influences

Cultural stigma around mental health in Pakistan further complicates treatment efforts. In many parts of the country, mental illnesses are either ignored or attributed to supernatural causes, preventing individuals from seeking professional help​.

Religious beliefs can both hinder and support mental health interventions, with some families relying on spiritual healers over medical professionals​.

Moreover, the concept of “saving face” means many families are reluctant to admit to having a mentally ill family member, fearing social ostracism. This cultural barrier keeps many elderly individuals isolated and untreated​.

Treatment and Accessibility in Pakistan

Access to psychiatric care is limited, especially in rural Pakistan. Mental health services are mostly available in larger cities like Karachi, Lahore, and Islamabad. In rural settings, traditional healers often serve as the first point of contact for mental health issues, though they rarely offer effective treatment.

In urban areas, however, awareness of psychiatric interventions is growing. Cognitive-behavioral therapy (CBT), pharmacotherapy, and psychosocial support programs are increasingly being offered to treat elderly patients​. Unfortunately, the cost of these treatments, coupled with the absence of insurance coverage for mental health services, makes them inaccessible to much of the population.

Pakistan’s elderly population is growing, yet mental health services for this group remain severely underdeveloped. Socio-economic challenges, combined with cultural stigmas, have made treating psychiatric disorders in the elderly a complicated task. To address these issues, there is a pressing need for government intervention, increased public awareness, and expanded access to mental health services, especially in rural areas.

City-Specific Geriatric Psychiatry Services

Access to geriatric psychiatry varies greatly between Pakistan’s major cities and rural areas. Large urban centers provide more specialized care, but even these services are limited.

Karachi: Leading hospitals like Aga Khan University Hospital offer dedicated psychiatric services for elderly patients. The facility provides comprehensive care including therapy and medication management for conditions such as depression, dementia, and anxiety​.

Lahore: The Punjab Institute of Mental Health stands as one of the few public sector institutions that offer geriatric psychiatry services. However, public facilities often lack the resources to provide the best quality care due to overwhelming demand and limited funding​.

Islamabad: Pakistan Institute of Medical Sciences (PIMS) provides psychiatric services, but similar to Lahore, it struggles with long wait times and underfunding. Private institutions offer better services but at a cost that remains prohibitive for most.

Despite these services in major cities, rural Pakistan suffers from a lack of mental health infrastructure, making care inaccessible for many elderly individuals. Telemedicine could help bridge this gap by providing access to psychiatric services remotely, something already gaining traction in urban centers​(BioMed Central).

Costs and Affordability of Psychiatric Care

The cost of psychiatric care for the elderly in Pakistan remains one of the biggest barriers to receiving proper treatment. While some services exist in major cities, the high cost of private care makes them out of reach for a large portion of the population.

Therapy Sessions: Private therapy can cost anywhere from PKR 2,000 to PKR 5,000 per session depending on the psychiatrist and location. For elderly patients requiring regular therapy for depression or anxiety, these costs quickly add up.

Medication: Medications for mental health conditions like dementia or depression can range between PKR 1,000 and PKR 10,000 per month. These medications, while effective, are often not covered by insurance, making them an added financial burden.

Government Support: Programs like Sehat Sahulat attempt to offer some support, but mental health coverage remains inadequate. More needs to be done in terms of public healthcare reforms to make psychiatric care accessible to the elderly​.

With the growing need for elderly psychiatric care, government initiatives need to include mental health as part of national healthcare policies. Additionally, NGOs could play a more significant role in offering subsidized care for low-income individuals.

Cultural and Social Stigma Hindering Mental Health Care

Cultural stigma around mental health in Pakistan is particularly harmful to the elderly population. Many elderly individuals and their families view mental illness as a sign of personal or familial failure. This cultural perception discourages people from seeking help until conditions worsen.

Reliance on Spiritual Healers: In rural areas, mental health conditions are often misunderstood, leading families to seek help from spiritual healers before turning to medical professionals. The belief that mental illness is caused by supernatural forces like black magic remains widespread​

These misconceptions delay treatment and exacerbate conditions like depression and anxiety.

Social Isolation and Shame: Many elderly individuals face social isolation due to their mental health struggles. Family members may be unwilling to acknowledge or discuss mental health issues because of the shame associated with it. This isolation worsens the psychological symptoms experienced by the elderly, leading to a vicious cycle of untreated mental illness​.

For effective mental health care, public education campaigns need to tackle these deeply ingrained cultural barriers. Local communities, religious leaders, and media outlets can play a crucial role in normalizing conversations around mental health, thus reducing stigma and encouraging treatment.

Prevalence of Mental Disorders Among Pakistan’s Elderly

Despite its importance, the prevalence of mental health disorders among the elderly in Pakistan is underreported. Studies indicate that 19.5% of elderly individuals suffer from depression, but the actual number could be higher due to underdiagnosis.

Depression:

Depression is common among elderly Pakistanis, especially those living in nuclear family systems or alone. Women, particularly widows, are more vulnerable, facing 2.6 times higher rates of depression compared to men​.

Dementia and Cognitive Decline:

Dementia, a growing concern in Pakistan, often goes undiagnosed due to a lack of awareness and specialized screening tools. This condition affects cognitive function, making it hard for the elderly to carry out daily tasks and maintain social connections​.

Addressing these conditions requires a multi-faceted approach. More resources need to be allocated toward geriatric screening programs to catch mental health disorders early. Further, training for medical staff on the unique psychiatric needs of the elderly would help improve diagnosis rates.

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