The theme for World Mental Health Day this year highlights the plight of the older adult.
OCT 10 was World Mental Health Day. The annual commemoration of this event is significant in drawing attention to issues concerning not only mental illness, but mental wellbeing as well.
This year’s theme is “Mental Health and Older People”. This theme invites a multisectoral approach in removing barriers to mental healthcare, with a focus on older citizens.
The world population is maturing very quickly, and soon we will have a higher number of older adults than children. Since women live longer than men, at any given time, there are more older women worldwide than older men. This difference further increases with advancing age.
Many people do live a long and happy life without any mental health problems. Therefore, despite the usual perception of elderly people being sad, slow and forgetful, mental disorders are not an inevitable consequence of ageing.
Nevertheless, it is important for all stakeholders, especially healthcare providers, policy planners and caregivers, to realise that older adults face special health challenges. Many of the very old lose their ability to live independently because of limited mobility, frailty, or other physical or mental health problems, and may require some form of long-term care.
Poverty, social isolation, loss of independence, loneliness and bereavement can affect the mental health of older adults. They may also be exposed to maltreatment at home and in care institutions. This maltreatment is often seen in shoddy and unmonitored old-age homes that have mushroomed in our country in recent years.
On the other hand, strong policies regarding healthcare for the elderly, social support, and active family interactions, can boost the dignity and self-worth of older adults.
Changes in the social role of the elderly can have an impact on their wellbeing. In many developed and developing countries, older adults are now in better health compared to a decade or two ago. The retirement age has been increased in many of these countries. Older people are able to make important contributions to society as active participants in the work force, or in a family unit.
Any responsible society should realise the importance of harnessing the wisdom and potential of its older citizens.
What are the specific mental health issues to be addressed in old age?
This involves deterioration in memory, thinking, behaviour and the ability to perform daily activities. This is not a normal phase of ageing, although as we progress into old age, it is not uncommon to experience more frequent episodes of forgetfulness.
Older adults report lapses in memory, such as forgetting the name of a movie they just watched. They might also be vulnerable to confusion when they try to recall complex experiences.
If such lapses in memory have a negative impact on daily activities or jeopardises interpersonal relationships, then the older adult may be suffering from Alzheimer’s disease, which is the most common form of dementia.
This decline of the brain will profoundly effect the quality of life of the sufferers, and their caregivers as well. Although no absolute cure is available, much can be done for people with dementia through pharmacological and non-pharmacological interventions.
Therefore, early detection is important. Many studies have demonstrated that people who engage in intellectually stimulating activities, such as social interactions, chess, crossword puzzles, and playing a musical instrument, can significantly lower their risk of developing Alzheimer’s disease and other forms of dementia.
Many people feel that symptoms of depression are normal features of ageing.
Sometimes, it is difficult to detect symptoms of depression among senior citizens. One of the earliest manifestations would be a loss of interest in pleasurable activities. This could be very ordinary activities like reading the newspaper first thing in the morning or watching the eight o’clock news.
Sudden disinterest in such routine activities should ring alarm bells.
Older people may not even complain of feeling sad. They may express depression through physical complaints like pain or body ache.
Social factors underlie depression in older people, especially with the loss of a spouse, social isolation, boredom, financial problems, or even retirement, which is perhaps one of the most significant of life events.
Retirement brings on a new role, which is often difficult to accept. Retirees are often treated lightly, and made to feel unwanted or worthless.
The misery of depression can cause impaired mental and social functioning, leading to hopelessness and suicide. The risk of suicide is especially high among older single men.
Older people also sometimes feel overtly anxious and become panicky easily. This overt fear or anxiety may also be the initial symptom of depression in the elderly. It may get so out of control that it interferes with their ability to execute even small chores.
The good news is that depression in the elderly can be easily treated through appropriate medications and psychotherapy, but family and social support are also crucial.
What should we do?
The promotion of healthy ageing is an important role for all societies. Early recognition, diagnosis and treatment of mental disorders that are common in old age are important to prevent avoidable suffering and disabilities.
Care for older adults with mental illness requires sensitivity and relational skills to help the older person achieve and maintain the highest possible level of function and wellbeing.
Participation in meaningful activities, strong personal relationships and good physical health are key factors.
Poverty, unemployment or under employment are risk factors for disturbed mental health in older adults, and these need to be taken into consideration.
It is the duty of a responsible society to prevent the maltreatment of the elderly. Primary health and community care and social service sectors need to be educated and supported to deal with elderly abuse.
In this regard, appropriate legislation and punitive action against those who abuse or neglect the elderly must be enforced.
The theme for World Mental Health Day highlights the plight of the older adult, but we should also take note of the needs of those who care for the elderly. Older adults with dementia and depression commonly receive support from spouses, other family members, or friends.
Caregivers are themselves challenged by the burden of caregiving. The psychological wellbeing of caregivers must be addressed as depression has been found to be common among them.
Policymakers must plan for the significant social and economic implications in terms of direct medical costs and social costs involving the care of older citizens. Synergistic efforts by civil society, non-governmental and non-profit organisations, and public-private partnerships could facilitate the realistic implementation of health promotion strategies for older adults.
> Assoc Prof Dr Andrew Mohanraj is the deputy president of Malaysian Mental Health Association (MMHA). He is also a member of the Health Ministry’s Mental Health Promotion Advisory Council.