The challenges of addressing mental health in older Malaysians: Are they being taken care of in the country?

By D. KANYAKUMARI

He didn't always feel like this. However, since his wife passed away in 2021, 83-year-old Cheah confesses that he struggles to get out of bed each day, and twice even contemplated ending his own life.

"Every morning, I open my eyes and wonder why I'm still alive. My Lily was my everything until this horrible coronavirus took her away," he said.

The retired structural engineer, who lives with his daughter, said he and his wife used to look forward to spending time with their grandchildren, but they have since moved away. And with his situation having changed so much over the last few years, Cheah said he feels he has lost his sense of purpose.

"I'm alone a lot. My daughter and son-in-law take good care of me. But there is only so much they can do. And to make matters worse, I have a weak heart. It all feels too much," he said.

Cheah's story is distressing. But what is sadder still, is that his situation is not unique.

According to the World Health Organization (WHO), around 14 per cent of adults aged 60 and over live with a mental disorder, and this accounts for 10.6 per cent of the total disability among senior citizens.

Yet far worse is the finding that over a quarter of deaths from suicide worldwide involve older adults, and that numerous situations — including feelings of isolation, loss of loved ones, chronic health conditions and a decrease in physical abilities — can trigger feelings of hopelessness.

All things considered, then, and with Malaysia expected to transition from an ageing society to a "super-aged society" by 2056, the government's promised Ageing Nation Agenda (ANM) framework can't come quickly enough.

What can be done to help an ageing nation?

For the record, the ANM has been touted as a comprehensive plan for people's well-being. And together with the promised Elderly Health Services Action Plan 2023-2030, an upcoming Senior Citizens Bill and various other initiatives, it is expected to help Malaysia meet the needs of its fast-ageing population.

Even so, some believe that any plan for dealing with the welfare of older Malaysians must begin with equal treatment.

Malaysian Mental Health Association (MMHA) president Prof Dr Andrew Mohanraj opines that on top of facilitating their medical needs, the powers that be should also look at continuing opportunities for health, participation and security.

He explains that this is why the WHO has adopted the term "active ageing", and why Malaysia's ANM should consider certain influences or "determinants", among them, health and social services and employment.

"Active ageing policies also need to intersect with broader schemes to reduce poverty among the elderly. Many older people don't have reliable or sufficient incomes, which seriously affects their access to nutritious foods, adequate housing and health care.

"The most vulnerable are those who have no assets, little or no savings and no pensions," he said.

Dr Kejal Hasmukharay, of Malaysia Healthy Ageing Society (MHAS), a non-profit organisation focused on healthy ageing concurs and adds that policies supporting pensions, social security and affordable healthcare are also much needed.

"Additionally, legal frameworks and support systems are necessary to safeguard the rights and well-being of vulnerable older persons. This includes assisting those facing barriers in accessing healthcare, social services, and transportation," she said.

Ageism and neglect should be tackled equally

Importantly, everyone involved must also recognise that the stigma associated with mental illness remains prevalent and stands in the way of older adults either reaching out for assistance or getting the help they require.

Take the case of 72-year-old, Saras, for example. With over three decades of working experience in the medical field, the septuagenarian says she knew that her thoughts and feelings were not normal. Unfortunately, her family didn't take her concerns seriously.

"After my husband passed away from a stroke in the early 2000s, I was largely on my own. Then, when my son had his kids, I moved in with his family. But my arthritis doesn't allow me much mobility, and I believe that has also contributed to my declining mental health.

"Also, because of the pain, I'm confined to the house. (The problem is) when I tried to explain my condition to my family, they would tell me things like: 'You're just getting old, you're fine'. But I wasn't fine," she lamented.

Saras said she eventually convinced her son to take her to see a psychiatrist, upon which she was diagnosed with clinical depression and attention deficit hyperactivity disorder (ADHD). However, that came about after 10 years of pleas for help.

Of course, older individuals aren't all in the same boat, and some manage to get treated quickly. However, MMHA's Prof Dr Andrew confirmed that cases like Saras' are common mainly because in comparison to other groups, the mental health struggles of older adults are routinely neglected.

He said, "Depression is the main mental health challenge in the elderly. It can also co-occur with other conditions such as cardiovascular disease, diabetes, cancer and neurodegenerative disorders. However, the challenge is in recognising and diagnosing depression, as symptoms are dismissed as a natural part of ageing."

Dr Kejal of MHAS, who is also a physician and geriatrician at Universiti Malaya Medical Centre, agrees.

She said, "The underappreciated yet intricate interplay between physical and mental health in older individuals complicates the landscape. In addition, our healthcare system, traditionally designed to address physical health concerns, lacks the integration of mental health services.

"Furthermore, despite increased awareness and de-stigmatisation efforts in recent years, there remains the stigma surrounding mental health issues in general."

As such, perhaps one of the first things to do, before anything else, is to recognise that older persons deserve mental wellness, and like everyone else, they just want to be as healthy and happy as they possibly can.

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