Loneliness creeps in when the elderly are cast aside due to changes in social dynamics, writes Kasmiah Mustapha
FLORENCE Lim’s (not her real name) husband died six years ago. Her only child is married and has moved to another town with her husband.
Since her retirement, Lim, 61, does not keep in touch with her former colleagues. She does not drive but relies on public transport and that makes it difficult for her to move around. She only interacts with her neighbours when there are events in her neighbourhood.
While Lim is not isolated from her family, she lives alone because she does not want to stay with her daughter. Being on her own has had an effect on Lim, who is hypertensive. There are times she becomes withdrawn, is easily irritated and forgetful.
While there is no data on elderly Malaysians living alone, it is reported that in Britain and the United States, one in three people older than 65 live alone. They suffer from loneliness due to a solitary lifestyle, lack of close family relationships, and age-related health conditions.
Loneliness among the elderly is identified as a major public health issue. It can increase the risk of high blood pressure, a weakened immune system, depression, heart attack, heart disease, stroke and dementia. Those who suffer from loneliness are also at risk of premature death.
KPJ Ampang Puteri Specialist Hospital senior consultant psychiatrist Dr Azhar Zain says as people age, their social situation changes and this is one of the reasons why they feel lonely. The situation intensifies especially after retirement and they feel they are getting old and are not needed.
He explains: “When they are no longer working, they will lose touch with their friends from the office. If they live alone, it can make the situation worse as they will feel lost, unless they do something to keep busy.
“The situation can make them angry and irritable. It is also likely that they will ignore or avoid family members and neighbours, which makes them lonelier.”
LACK OF COMMUNICATION
Although living alone is identified as the main cause of loneliness, researchers at the University Of California, San Francisco, found that two-thirds of the 1,600 elderly in their study, who said they were lonely, were married or living with a partner.
Dr Azhar says the changes in family dynamics may be one of the reasons. For instance, even though parents stay with their children in the same house, they may have limited communication. He says as children and grandchildren are busy, most of the time the old folk are at home with the maid.
“Years ago, children had more time as they would be home by 6pm. Now the world has changed and so have family dynamics. In a situation where a parent has to stay with the children after the spouse passes on, it is more difficult for him/her to adapt as he/she is no longer independent. Without someone to talk to, he/she can suffer from loneliness,” he says.
“Some elderly couples may communicate with each other through their children or grandchildren, so when they are alone, they don’t know how to talk to each other. This can lead to loneliness for both of them.”
Dr Azhar says the nature of their personality can also make some people more prone to loneliness. They isolate themselves despite the social support network. They may find it hard to face being old. They feel people don’t understand them or regret that there are things they can’t do anymore.
“People think a person is not lonely if he or she is never alone. But some people can feel lonely even when there are people around them. It is hard for the elderly to talk about their feelings, so it is important for those around them to notice any change in their behaviour,” he says, adding that loneliness is more common among women. This leads to a higher risk of depression, especially when they are going through menopause. In addition, women do not have social support, as most of the time they are either at work or at home.
“In our culture, women don’t go out to meet friends, unlike men. Their interaction with friends is at the office and once they are home, it is only with the children. As women go through the menopause stage, depression is one of the symptoms and it can get worse with loneliness.
“Due to depression, women may suffer from pseudo dementia and experience memory loss, become confused or are unable to focus. But it does not mean they have dementia or Alzheimer’s disease. When they complain that they can’t sleep, can’t eat, misplace and forget things, these may be linked to depression,” he says.
“Some patients do not want to say they are depressed. Doctors must know what to look for as there are tests that can be done to determine if the person is depressed or suffering from dementia.”
As a support system for the elderly is lacking in the country, Dr Azhar, who is an advisor to the Malaysian Healthy Ageing Society, says it is important that they take steps to overcome loneliness.
“We can treat the symptoms but it is more important for them to take steps to overcome their situation. The elderly need to modify their way of thinking. They have to find things to do, such as joining a group to meet people and make friends or getting a new hobby,” he advises.
“Keep in touch with family and friends. Ask children or grandchildren to teach them new technology so that they will not be left out.
“If they live in nursing homes, make sure they are engaged in activities every day. Don’t leave them on their own; family members must visit them often and regularly.”