A qualitative study on the mental health needs of elderly in Kerala, South India

Background: The proportion of elderly population in India is increasing and is the highest in Kerala. In an effort to review and modify the existing Old Age Policy, the state government deliberated on the need for elderly centered research. Aims: The aims of this study were to identify the unmet mental health (MH) needs of elderly population with attention to special groups such as widows and tribal population and to understand the gaps in delivery of MH services. Materials and Methods: A cross-sectional, qualitative study was undertaken in five districts of Kerala, selected purposively, ensuring representativeness, using 166 in-depth interviews and nine focus group discussions with elderly people from community and institutions and various key stakeholders. The interviews were transcribed and translated to English. Free listing of responses, domain identification, coding, summarization, and cross-tabulation were done. Semi-quantitative approach was used in analysis and presentation of report. Results: Depression, anxiety, insomnia, somatization, and dementia were the commonly reported MH problems in elderly people, especially institutionalized ones. Loneliness, isolation, neglect, and elder abuse were the major psychosocial issues identified. Poor social activities and interactions and poor utilization of MH services were also observed. Caregiver burden was found to be high and the available family support services were reported to be inadequate. Conclusions: MH problems were common in elderly, but utilization of MH services was low. This study highlights the need to improve accessibility, availability, and quality of MH services and family-support services for elderly.