Holidays are typically a season of joyous celebrations, when relatives return from abroad and families get together. However, they can also trigger intense feelings of loneliness in the elderly.
Many of us in Asia are gearing up for a slew of festivities in the coming months, with Christmas just past, the New Year almost upon us, and Chinese New Year fast approaching. Thanks to the religious and cultural diversity in countries such as Malaysia, holidays and festivals come around multiple times a year, and with them, many social gatherings.
However, not everyone experiences holidays and festivities in the same way.
In November 2023, the World Health Organisation (WHO) announced a new Commission on Social Connection to address loneliness as a pressing health threat, with research showing that about one in four older people experience social isolation. This is echoed by another study commissioned by the National Academies of Sciences, Engineering, and Medicine which found that about 25% of people over the age of 65 feel depressed on a regular basis, with these numbers increasing significantly around the holiday season. This study found that social isolation, defined as an objective lack of social contact with others, and loneliness, which is defined as the subjective feeling of being isolated, are significant public health risks often associated with poor physical and mental health outcomes, yet they are often underappreciated.
Other research has linked social isolation and loneliness to a decline in various physical and mental conditions including high blood pressure, heart disease, obesity, weakened immune system, anxiety, depression, cognitive decline, Alzheimer’s disease and even death.
Ageing is also associated with a decline in the size of social network, diversity of relationships, and interactions, as opportunities for social interactions tend to diminish as people age. In the National Health and Morbidity Survey (NHMS) 2018, it was estimated that 7.4% of elderly people in Malaysia lived alone, and a further 31.9% reported having low social support in terms of social interaction and perceived satisfaction from their subjective support.
With Malaysia poised to become an 'aged' country by 2040, with 14.5% of its population aged 65 years and older, it is necessary to shift the conversation on healthy ageing from physical health and longevity to psychological and sociological factors that have proven to significantly influence how well individuals age.
Loneliness can lead to poorer health
Dr Joel Low, Director & Clinical Psychologist from The Mind Psychological Services and Training, and the President of the Malaysian Society of Clinical Psychology, explains, "The frequency and magnitude of a person's thoughts can contribute to the onset of pyschological disorders. Persistent loneliness can give room for negative thoughts to develop and exacerbate in the elderly, which can potentially displace their ability to focus on their day-to-day tasks and contribute to their decline in mental health and physical wellbeing. This could worsen in individuals with mental illness or a history of mental illness."
One trend that has persisted through and after the COVID-19 pandemic is the increasing preference for a fully remote or hybrid work model among younger employees, and by extension the continued and consistent use of technology such as video calls to connect with others.
However, what younger people consider commonplace and convenient could be challenging for the elderly folk. He elaborates,"More people are spending their holidays abroad and choosing to connect with their elderly folk via video call, not realising technology could become an additional barrier for their elderly who have not been used to connecting with others online, and are less able to embrace or adapt to technology."
How can the elderly cope with the holiday blues?
The first step in addressing mental health issues, is acknowledging that mental health issues among senior citizens is a very real problem, says Dr Low.
“As psychologists, we would look out for significant changes to someone’s social functioning and/or occupational functioning, specifically around the holiday season. Social functioning is how a person usually socialises, and occupational functioning describes how a person goes about their day-to-day activities. These changes can either be negative, where the person displays a decrease in functioning, or even positive, where the person displays increased functioning. Positive changes may be less obvious but are a concern, as they could indicate the individual is compensating to cover up more sinister feelings or thoughts,” he explains.
Some tips to help the elderly navigate through loneliness and depression during the holidays include:
1. Staying connected
The elderly may be less willing to reach out to family members, or do not want to seem like a bother to others during the holidays. If an elderly person is fortunate enough to have friends and/or their family around, it is important for them to be in constant touch with them as much as possible. Being constantly engaged is a good way to stave off negative thoughts.
“Meanwhile, those who have elderly family members or friends living alone should reach out to them particularly during challenging periods like the holidays. Don’t second-guess yourself or assume they are fine; reach out to them and ask if they need help or simply pay them a visit to lift their spirits,” advises Dr Low.
“We prioritise different things in different phases of our lives. Teenagers or young adults tend to focus on growing their social circles. Older individuals, on the other hand, are more concerned with the consolidation of their relationships around their loved ones, so when they are left alone during the holidays, the sense of detachment can be quite profound, especially when they're not able to connect to family members with whom they don’t have much contact,” says Dr Low.
While gatherings with the elderly can help them feel connected, we could also help and support them in acknowledging it is okay to not feel celebratory or partake in the festivities when they do not feel up for it.
3. Keeping busy
For the elderly who are able but do not have family or friends living nearby, it is important to have activities lined up, such as those involving charity work or the neighbourhood community. "This does not only help the elderly connect with other like-minded people, but also helps them feel useful, and lifts their spirits," says Dr Low.
Day facilities for the elderly are also becoming increasingly popular options, with some hospitals and community centres offering activities and gatherings for the elderly to participate in. These create avenues for social interactions with their peers while actively engaging their minds and bodies.
4. Seeking help if it gets too much
Generally, adults who feel excessive sadness, helplessness, and lethargy, spanning two weeks or more could be having depression. However, such mental health conditions among older people are often underrecognized and undertreated, and the stigma surrounding these conditions can make it difficult for people to seek help.
“Family members and friends can help initiate conversations about mental health with their elderly. While you may not be able to convince the elderly person to consult with a clinical psychologist or therapist, continuous conversations can remove some of the stigma surrounding mental health and normalise talking about their struggles,” says Dr Low.
The following organisations offer emotional and psychological helplines for those experiencing mental distress:
+603 7931 8436
+603-27806803
+6017-6133039
KL: 03-79568145 (24 hours)
Ipoh: 05-5477933 (4pm-11pm)
Penang: 04-2815161 (3pm to midnight)