Psychiatric and physical morbidity in an urban geriatric population - Some issues.

Sir,

Seby et al.[1] attempt to explore mental and physical health of elderly population is commendable. The study is very important as geriatric population is gradually rising over past decades, and thus the need of being aware of issues related to geriatric population has become quite necessary for every mental health professional.[23]

The authors failed to establish the association of physical illness with the mental illness due to small sample size. However, some concerns regarding the study persist. The points that appear in the discussion section should be cautiously judged with respect to the results obtained. Some clinical findings and the results are extrapolated and cannot be generalized e.g. the discussion about visual impairment in alcoholic elderly based on a single alcohol dependent patient. Moreover, there is a felt need to provide details regarding method of exploring physical illness, especially rheumatic heart disease (RHD), and any physical investigations or physician's help taken for doing so. There are some typographic errors that appear in the article, for example, Table 5[1] suggested that RHD was more common in depressive patients (6) as compared to dementia patients (3).However, the authors reported in results that RHD was more common in the dementia patients.

The authors used valid instruments in this vulnerable population, such as 15-item version of geriatric depression scale (GDS-15) (http://www.stanford.edu/~yesavage/GDS.html) that is considered to be a suitable instrument to diagnose depression in the medical elderly population.[4] From the article, it seems difficult to understand the various components of GDS-15 like generalized anxiety scale, phobic scale, and panic scale (page 122, para 5 right) which seem to be separate tools altogether. In methodology, the authors missed to mention training and inter-rater reliability of social workers or assessors employed to recruit the study subjects.

Nevertheless, the authors tried well to evaluate the co-morbidities in urban geriatric population. Undoubtedly, there is a need of more well-designed studies in this neglected area.