Understanding mental health in older adults

Yong recalled how fit he was when he was young. His routine was the same every day for 50 years.

He would wake up at 5am, take his breakfast, and get himself ready for work, where he would go to the sea with the boat shared with other fishermen. He would return home after a few days, bringing massive baskets of fishes to be sold at the market.

Feeling the sea breeze and seeing his family’s excitement gave him a sense of calm and happiness. That was until he could not continue working anymore when he turned 65 last year.

He was diagnosed with colon cancer the same year, and he just could not believe it. Already struggling with diabetes, hypertension, and psychiatric illness, he felt the sky was falling.

He felt he was no longer in control of his life when all these unfortunate events occurred within the same year. He completed chemotherapy as per schedule, but he decided not to proceed with the operation. Knowing how stubborn he was, his son decided not to push him to change his mind.

Yong had suffered psychiatric illness for more than 30 years, yet it was still hard for his family members and himself, to make sure that he took his medication every day. He refused to take his medication when he thought he was well. There had been frequent hospitalisations at the psychiatric ward whenever he skipped his medications, and there were stressors with his income, or when he had conflicts with family members.

Due to his age, he was no longer living in his own house. His eldest son decided to bring him and his wife to live with him so that he could be cared for.

Yong took some time to get adjusted to the new environment and routine, but it got easier when he started to make friends with other elderly people in the same neighborhood.

A few months ago, there were multiple episodes where Yong had wandered around in the neighbourhood. Luckily, he was spotted by kind neighbours.

He also started talking about things that were trivial and irrelevant, and had also accused his daughter-in-law of trying to poison him.

There had been an abrupt drop in his weight. He refused to eat even after being told that the meals served were not home cooked.

Concerned by the deterioration in his mental health, his son consented to Yong being admitted, as he felt he could no longer manage his father.

“All my family members are dead. And this cancer is going to kill me eventually. I should probably be dead as well.”

For two weeks, this was the only thing that Yong would tell the attending doctors. He could not understand why the doctors didn’t believe him after hearing what he said.

It was challenging to manage him in the ward. He had developed side effects to psychiatric medications in the past. He could not tolerate higher doses like the younger adults could, in order to stabilise his condition.

After a trial of a few medications in the ward, and after a month of being admitted, Yong finally showed improvements. Doctors were able to challenge his belief regarding the death of his family members. He was allowed to meet his family members, as he showed signs of good recovery.

Subsequently, he was discharged and was given an appointment at the psychiatric clinic for his symptoms to be assessed at a later date.

What the doctors did not understand was the trigger factor that led him to have a relapse, which required an admission.

They tried to ask Yong about it a few times in the ward, but did not find the answer. Yong simply smiled every time they asked about it. They planned to enquire about it again during their clinic encounter later.

What they didn’t get from him at that point was that it was not easy for him to accept that he was no longer able to function, and did not enjoy optimal health, like before.

Yong’s wife and son were given a psychoeducational session prior to his discharge. They were counselled regarding the importance of adhering to medication and medical appointments. They were also taught about the early signs of relapse for his psychiatric illness, and the importance of family members providing social support to the patient.

For elders with similar life experiences as Yong, having absolute acceptance of their current wellbeing is like going on a journey that might take a lifetime to complete.

This is the personal opinion of the writer and does not necessarily represent the views of Twentytwo13.