KUALA LUMPUR, Nov 3 — The ‘golden years’ is often portrayed as an idyllic era, a time for peace and relaxation, with happy moments playing with grandchildren and leisurely travel.
While this may be true for some, others may find their happiness and appreciation for life unexpectedly waning, without understanding why.
There is limited data on depression among the elderly – the National Health and Morbidity Survey 2023 reported a prevalence of 3.1 per cent among those 60 years and above, yet experts suspect the statistics are likely to be much higher. One study indicates a prevalence of almost 28 per cent among the elderly.
This disparity can arise from a combination of factors. Elderly as well as family members may not recognise depressive symptoms, assume that symptoms are just a passing phase, or feel embarrassed for needing help.
Among this population, there is also low awareness that depression is a treatable condition, and they may be further hampered by lack of access.
“This life stage comes with many challenges such as poor health, frailty and loss of independence.” explained Dr Serena In, clinical psychologist at IMU University.
“Many older persons also face circumstances that can trigger depressive symptoms such as loneliness or isolation, personal loss such as losing their spouse or loved ones, sudden changes in their health such as a stroke or cancer, or having to uproot themselves from their home in order to live with their children or move into a retirement home.
“These are all common situations that older people face, and with the Malaysian population rapidly aging, it’s important for us to seriously look into what we can do to help our older loved ones who may be affected.”
Depression Hides In Plain Sight
Depression is often poorly understood or overlooked, by the elderly themselves as well as family members who may assume symptoms are simply part of ageing.
Dr Chin Hui Sian, counsellor and lecturer at IMU University, said: “It is natural to experience a range of emotions, including feeling sad or low at times. However, a persistent low mood, loss of interest or pleasure in activities, or other significant emotional or behavioural changes that affect daily functioning, should not be ignored.
“For example, a person may experience noticeable changes in their appetite or eating patterns, sleep much more or less than usual, or withdraw from social interactions, including activities and relationships they previously enjoyed.
“These changes may indicate emotional distress or a mental health concern, such as depression, although they can also arise for other reasons. If these changes persist or interfere with daily life, the person may need to seek professional support.”
Counsellors, clinical psychologists, and psychiatrists each play a role in identifying and addressing mental health concerns, depending on their professional training.
Counsellors may use screening tools and clinical assessment to understand a person’s concerns and determine whether a referral is needed.
Clinical psychologists and psychiatrists can conduct further assessments to evaluate symptoms and establish a diagnosis within their respective scopes of practice.
Where necessary, a person may also be referred to a medical doctor to investigate possible physical causes of their symptoms.
Depending on the assessment findings, support may include counselling, psychological treatment, medication, or a combination of approaches.
“Depressive symptoms are not the same as being clinically depressed – the former may benefit from talk therapy while the latter often requires a combination of therapy together with pharmacological treatment.
Ultimately, only a clinical psychologist or psychiatrist is qualified to make a diagnosis and prescribe an appropriate treatment,” said Dr In.
The Difficult Route To Diagnosis And Treatment
While depression can affect people of all ages, several challenges are more prevalent among older persons, who may lack the ability or willingness to verbalise their symptoms or explain how they feel.
“People from different generations may have different views of depression. Some older adults, particularly those who grew up when mental health was less openly discussed, may be reluctant to acknowledge emotional distress or seek help.
“This may stem from deep-seated beliefs that they should remain strong, fulfil their responsibilities, or manage their difficulties independently so they do not become a burden to their family.
“Some may also notice or describe physical symptoms, such as headaches, stomach discomfort or fatigue, or changes in mood, such as irritability, rather than explicitly expressing feelings of sadness or depression,” said Dr Chin.
Another challenge can be reluctance on their part to seek or accept therapy, and Dr In says this occurs more commonly when they feel they are being forced by family members who view therapy as a quick fix.
“In some instances, feelings of neglect or resentment may point towards problems within the family, which need to be addressed for therapy to work,” she added.
Taking The First Step
With these challenges in mind, adult children may feel it’s an impossible challenge to get their parents the help they need.
Dr Chin advises taking a gentle, caring approach. “Showing concern and approaching the conversation with empathy and respect can go a long way.
“Rather than talking down to older adults, criticising their behaviour or forcing them to seek help, share what you have noticed and ask how they have been feeling.
“We might gently suggest speaking to their regular doctor about these changes. A trusted health care professional can assess both physical and mental health concerns and recommend appropriate support, which may include counselling or other forms of treatment.
“Physical and psychological concerns can coexist, so support for emotional distress does not necessarily need to wait until all possible physical causes have been ruled out.”
Another suggestion is to connect with parents through their hobbies or interests, said Dr In. “You can watch a programme that includes a person with depression, or bring up something you saw on the news to start the conversation.
“Even their grandchildren can become advocates as the younger generation are more aware of depression and the need for treatment, and grandparents are often more amenable to their suggestions.”
“All of us are ageing and we need to think about how we want to be treated when we get older. Do we ignore and abandon our parents and grandparents, who have skills and lived experience to share, and who can still contribute to society, or do we support them in their old age, the way they supported us?
“There is so much we can do to help them age with dignity and good quality of life, and in doing so create a better future for all of us.”
