Old Age and the 3 D’S

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Old Age and the 3 D’S

As we navigate the everyday chaotic life, it's all become so easy to ignore the quiet hardships of the aged people who walk beside us—our grandparents, parents, neighbours, and even strangers we pass by. We frequently neglect to pause and consider the specific obstacles that these senior folks confront, particularly when it comes to the quiet conflicts they may be fighting within their own minds.

An older person is defined by the United Nations to be over 60 years of age. India also sees  that the growth of older adults is faster in  rate than some other countries . This segment of the population is vulnerable to not only physical but psychological deficiencies and problems too which makes it equally important to be aware of the problems they face and provide them the right help.

In a study conducted by Pandey et al (2012) most of the people in their sample that constituted of individuals in old age homes suffered from mental problems like:  

  • Depression
  • Anxiety
  • Dementia and delirium

Mostly we see that the aged population suffer from the 3D’s, which are known as three D's of Geriatric Psychiatry and these 3 D’s stand for:  

  • Depression
  • Delirium
  • Dementia

Depression can be simply defined as a prolonged state of sadness , where an individual loses interest in things they loved before , as well as not being able to take care of themselves in terms of their hygiene, diets, etc. This state causes them extreme clinically significant interference form living a normal life.

Delirium refers to a change in one’s mental abilities which leads people affected to suffer from confusions, memory loss,and lack of awareness. It can be confused with Dementia but the two are different . The latter refers to a condition where the person experiences memory loss, problems in thinking and social skills.Dementia isn't one specific disease and Several diseases can cause dementia.

The diagnosis of Delirium is often difficult to arrive at and its treatment is sometimes controversial since it involves the use of antipsychotic medications, but it is common in a variety of patient care settings and remains a risk factor for morbidity and mortality in older adults. Common symptoms of delirium include: disturbances in consciousness or loss of awareness of one's surroundings

Dementia on the other hand may affect a significant number of older adults and is associated with delirium, depression, frailty, and failure to thrive. Treatment of dementia is challenging and while medication interventions are common, environmental and problem solving therapies may have some of the greatest benefits.

Incidence and risk of depression increases with age and is more likely to present along with somatic complaints or insomnia and is more likely to be reported by older adults. Depression carries an increased risk for suicide in older adults and proven therapies should be initiated immediately.

The elderly have an altered presentation of depression. In the elderly, the common presenting symptom maybe anxiety, rather than the usual identified symptom of “depressed mood” may not be as prominent.

Interventions for the Three D’s:  

There are multitudes of interventions recommended for treating the myriad symptoms of delirium, dementia and depression. Among some of the most commonly employed are these:  

  • Provide reality orientation measures
  • Maximize autonomy
  • Maintain and establish a consistent schedule and routine
  • Speak and communicate clearly and slowly and do not rush
  • Maintain a calm and quiet environment
  • Post clock, calendar and pictures in view
  • Allow time for responses
  • Limit choices
  • Promote relaxation
  • Correct misperceptions calmly
  • Administer medications as ordered
  • Monitor intake: food and fluids, both intake and output


These three syndromes have great overlap, can exist simultaneously in the same patient, and often confer increased risk for each other.Hence it is important that we are aware of such conditions among the aged so that we can be of help that ratio of the population that is very vulnerable. The understanding of the 3 D’s can help us be more empathetic and aware citizens.

Download the Solh Wellness app as our mental health professionals can help you assess your symptoms and rule out any underlying medical issues. If stress is to blame, our therapists or counselors will help you deal with stress more effectively. Download the Solh Wellness app now!