The Invisible Mental Health Issues Of Older Malaysians

Malaysia had fewer than 10 geriatric psychiatrists as of 2018.

KUALA LUMPUR, Nov 18 — Malaysia, which is expected to become an ageing society by this year, faces a shortage of health care professionals to address mental illness among the elderly.

As of 2018, Malaysia has fewer than 10 geriatric psychiatrists, comprising less than 2.4 per cent of the total 410 registered psychiatrists in the country. There are only 39 geriatricians in Malaysia.

“Many primary care clinics run health services for the older persons, but may not be trained and equipped to manage the mental health problems adequately. As of 2018, there were 39 geriatricians in the country, and 410 registered psychiatrists, with geriatric psychiatrists numbering less than 10.

“This is grossly insufficient as recent projections suggest that between 2020 and 2046, the percentage of elderly Malaysians will have increased from seven to 14 per cent [of the population],” Professor Philip George, an academic at International Medical University and a committee member of Malaysian Healthy Ageing Society (MHAS), told CodeBlue in an interview.

Philip stated that elderly people above 60 years old have higher prevalence in mental health issues. The risk is higher with increasing age.

According to the World Health Organization (WHO), dementia and depression are the most common mental and neurological disorders among people aged 60 and older, which affect approximately five and seven per cent of the world’s older population respectively. Globally, about 3.8 per cent of elderly people are affected by anxiety disorders.

“The prevalence of dementia rises with the increasing age with moderate to severe dementia in about 5 per cent in the general population older than 60 years of age. It increases by 5 per cent every five years, and so it can affect a fourth of the population 80 and above,” Philip said.
“Most studies suggest that depressive disorders are present in 15 to 20 per cent of the elderly. In a study done in 2009 among elderly Malaysians, depression rates were reported to be 13.9 per cent, but as life span increases, the rates will surely rise too.”

He also highlighted that isolation and loneliness can trigger anxiety or early signs of depression. At the same time, changes in roles and responsibilities, lack of financial support, poor mobility and increased losses may cause anxiety or depression.

“The older person may lose more function or lose friends and family among their peers. The empty nest syndrome is a common trigger for depression and anxiety disorder when children leave home and migrate to other places to start their own family and work. Those in care homes or nursing homes seem to have a higher risk of depression and anxiety,” Philip said.

Trained Caretakers Needed To Manage Mental Health Issues Among Senior Citizens

Residents at an Agecare Sdn Bhd nursing home in Cheras, Selangor, for the elderly. Picture courtesy of Agecare.

Philip also emphasised the importance of giving training to all primary health care professionals, including nurses and doctors, to receive training in managing mental health issues among the older persons population.

“General psychiatrists and geriatricians will have to upskill their knowledge and understanding in managing these conditions so as to better support the primary care health professionals. Nursing home and day care staff must also be empowered to identify the elderly with mental health issues so that they are identified early and receive appropriate care at a timely fashion,” Philip added.

Untrained caretakers are unable to recognise early symptoms of depression or mental issues among the elderly, said MHAS adviser Professor Nathan Vytialingam.

“For example, housemaids may be able to provide food at the right time to the elderly, but they are not supposed to administer the medication of elderly people, because they are not trained professionals,” Nathan told CodeBlue in an interview.

“Caregiving is not about providing good beds to sleep. It involves physical and mental care.”

Professor Nathan Vytialingam, adviser of the Malaysian Healthy Ageing Society

He also stated that elderly people should be engaged socially to reduce the risk of being affected by mental health problems. Therefore, caregiving should include physical and mental activities to provide a balance between good health and healthy emotions.

Can The Community Help Seniors?

Gan Pooi Chan, country manager for Homage Malaysia. Picture courtesy of Gan Pooi Chan.

Gan Pooi Chan, country manager for Homage Malaysia, an aged care provider, highlighted the role of non-governmental organisations (NGOs) in assisting elderly people to get out of depression and to provide an environment for them to stay active.

According to Gan, the elderly plunge into depression by confining themselves to the four walls at home.

“This is something that we realise. The people whom we are taking care of are all 60 years and above. I think in terms of their memory loss, the cognitive ability is deteriorating,” Gan told CodeBlue.

“So we work very closely with NGOs. They have their community centres. With the consent of the child, we ask them if that is alright for us to bring out their parents to the community centres just to mix around with other people, just get them more active and to socialise.

“That way they remain active and know what is going around.”

Gan stated that elderly people’s emotional needs and rights should be protected without any discrimination, as she pointed out that many are unaware of the effects of mental issues like dementia.

“Domestic helpers can be good at certain things like housekeeping. But when it comes to seniors, what they really want is somebody to read newspapers with them or walk down to the park with them. Just pushing the wheelchair in the park is not a quality measure to protect mental health of the elderly people.”

Gan said that dementia is not just a normal aging issue and the family relationship will be severely affected if it is not diagnosed and treated in its early stages.

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