Introduction

Old age is a phase in someone’s life. In Malaysia, elderly is categorized as those aged 60 years or more. When someone reaches old age, there are various changes occurring related to old age namely physical, psychological and social changes. Physical changes in the elderly have been covered in other topics.

From the psychological point of view, there is stigma or negative perception by the general public towards the elderly. Those stigmatized opinion have led to view that elderly a burden to the society, dependent on others, has already passed their productive period and associated with contracting many diseases. The negative perception is being enforced by commercial marketing strategies which emphasized on the hype of antiageing products. This negative perception is called ‘ageism’ which may lead to not only improper treatment of the elderly by the general public but also psychiatric problems among the elderly.

According to Dr Erik Erikson’s Theory of Psychosocial Development, old age is the stage in which individuals assess the quality of their lives. In reflecting on their lives, people in this age group develop a feeling of integrity if deciding that their lives were successful or a feeling of despair if evaluation of one’s life indicates a failure to achieve goals i.e. ‘ego integrity versus despair’.

Another factor which leads to the psychological problems in the elderly is loneliness. Loneliness can be caused by retirement, shrinking social network, death of loved one or disability due to physical illness. These can lead to the emergence of psychiatric problems for instance psychosis, depression, anxiety and suicidal thoughts.

Manifestation of Psychological Problems in The Elderly

Psychological problems in the elderly may present as listed below i.e.:

• Low self-confidence,
• Ambivalence or indecisive thoughts
• Poor sleep at night
• Loss of appetite and significant loss of weight
• Loss of interest
• Poor concentration
• Irritability
• Isolating self
• Memory problems
• Suicidal thought
• Psychotic symptoms e.g. hallucination (false perception without any stimulations) and delusion (false fixed belief which is not concordance with person’s educational and cultural beliefs)
• Prominent personality changes
• Illicit substance or alcohol abuse

Complications of The Psychological Problems In The Elderly

Psychological problems which are not treated may lead to psychiatric disorders such as:

• Major depression
• Anxiety disorder
• Phobic disorder
• Dementia
• Illicit substance abuse and dependence
• Suicide

Treatment of Psychological Problems In The Elderly

Treatment of psychological problems in the elderly encompasses either in pharmacological or non-pharmacological approach. The non-pharmacological approach should be attempted first before considering pharmacological treatment. Pharmacological treatment is considered for those presented with significant psychiatric problems which affecting the individual’s interpersonal, social and occupational life.

For those having serious depressive disorder, medication such as antidepressants from Selective Serotonin Reuptake Inhibitor group (SSRI) is the most preferred choice according to the Clinical Practice Guidelines on Major Depressive Disorders by the Ministry of Health, Malaysia*. Examples of SSRI are escitalopram, sertraline and fluvoxamine. The newer antidepressants such as venlafaxine and duloxetine (both are under the Serotonin and Noradrenergic Reuptake Inhibitor or SNRI group) and mirtazepine (under Noradrenergic and Selective Serotonin Agonist or NaSSa group) are the choice if the first-line antidepressant doesn’t work on the individual.

The other medications are specific for certain symptoms such as the use of antipsychotic medication for psychotic symptoms, anti-anxiety to curb anxiety symptoms and mild hypnotics for sleep disorders.

The other psychological treatment such as Cognitive-Behaviour Therapy (CBT) and individual therapy for instance problem-solving, supportive counseling and grief therapy can be applied to the elderly by the qualified therapists. However the non-pharmacological approach should be emphasized as the main treatment approach.

Prevention of Psychological Problems In The Elderly

The concept of ‘successful ageing’ is emphasized when dealing with prevention of psychological problems in the elderly. The successful

Successful ageing consists of three components i.e.

Low probability of disease or disability:

The prevention of disease is either primary or secondary prevention. In the primary prevention, the prevention of disease is the main objective such as healthy eating, regular moderate exercise, quit smoking, prevention from falls, and compliance with medication and go for regular medical check-up.

Secondary prevention focused on the preventing complication of the existing diseases such as hypertension and diabetes mellitus. Good compliance with medication and getting regular medical follow-up are emphasised from time to time.

High cognitive and physical function capacity:

This prevention method includes stress management, managing emotional outburst/anger, acceptance and adjustment of chronic illness such as stroke, Parkinson’s disease etc. It may involve the individual, family members and the doctor or health care professionals.

Prevention from dementia can be done by engaging the individual with mind stimulating activities such as reading, practicing cross-word puzzles, talking with people about any interesting topics etc.

Active engagement with life

Prevention includes continuing activities which maintaining individual’s self esteem e.g. keeping up appearance by completing personal care independently, continuing doing individual’s hobby and skills retention, maintaining independence, prevention of boredom by participating in community activities.

Rehabilitation

Planning of rehabilitation activities for the elderly should take into consideration of their needs and capabilities. The programs should be tailored and be flexible to individual’s current physical, cognitive and emotional problems such as stroke and dementia. The program should be adjusted to present individual’s needs from time to time.

It is vital for them to continually engage in activities that they are familiar with to retain their basic skills. They are also encouraged to utilize basic instrument such kitchen utensils or even gardening tools which they are familiar with. Activities can also encompasses completing personal care independently, looking after a pet or engaging familiar tasks. This may help maintain their self-esteem.

Social activities involving the whole family such as family gathering can be done periodically to help them linked in the normal social activities at home. They are also encouraged to join in the religious activities in public places in order to provide spiritually stimulating environment to the elderly and at the same time to contribute actively in the community within their own limits.

Mind-stimulating activities such as reminiscence the past stories and old photos not only will lift their mood but also a good starting point for conversation.  Another avenue for responsibility may be for a person to assist with chores relating to animal such as pet. This may be satisfying for some elderly.

References:

1. Clinical Practice Guidelines for Dementia 2^nd edition (2010) by Ministry of Health, Malaysia
2. Clinical Practice Guidelines for Major Depressive Disorder (2007) by Ministry of Health, Malaysia
3. Gender, healthy, ageing report by World Health Organisation 2003
4. Living with dementia, Alzheimer’s Australia (2006)
5. Synopsis Textbook of Psychiatry, Kaplan & Kaplan (1997)
6. Wikipedia on ageing, 17.6.2014
7. Wikipedia on boredom, 17.6.2014
8. Wikipedia on loneliness, 17.6.2014
9. Wikipedia on successful ageing, 17.6.2014