Depression among older Malaysians can go unnoticed when changes in mood, behaviour and physical health are mistaken for normal ageing, according to mental health experts from IMU University.
While retirement is often associated with relaxation and spending time with loved ones, some older adults experience loneliness, declining health, bereavement and a loss of independence that may affect their mental well-being.
According to Malaysia's National Health and Morbidity Survey (NHMS) 2023, the prevalence of depression among individuals aged 60 and above was 3.1%. However, a separate study cited by IMU University reported a prevalence of almost 28% among older Malaysians.
The estimates come from different studies and should not be treated as directly comparable without considering their respective methodologies and populations. Nevertheless, the figures highlight the importance of recognising mental health concerns among older adults.
Dr Serena In, Clinical Psychologist and Head of Department at IMU University, and Dr Chin Hui Sian, Counsellor and Lecturer at IMU University, explain that limited awareness, stigma and difficulties accessing professional support may prevent older individuals from receiving help.
They emphasise that depression is not an inevitable part of ageing and that families can play an important role in recognising changes and encouraging appropriate care.
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| Depression among older adults may be overlooked when emotional and behavioural changes are attributed to ageing, according to mental health experts from IMU University. Photo: IMU University. |
Why Older Adults May Be More Vulnerable to Depression
Older adults may experience several major life changes within a relatively short period, including retirement, deteriorating health, reduced mobility and the loss of loved ones.
Some may also struggle with changes in their living arrangements, particularly when they need to move away from familiar surroundings to live with their children or enter residential care.
Dr Serena In explained that these circumstances can contribute to emotional distress, particularly when individuals experience multiple challenges simultaneously.
"This life stage comes with many challenges such as poor health, frailty and loss of independence. Many older persons also face circumstances that can trigger depressive symptoms such as loneliness or isolation, personal loss such as losing their spouse or loved ones, sudden changes in their health such as a stroke or cancer, or having to uproot themselves from their home in order to live with their children or move into a retirement home."
She added that Malaysia's ageing population makes it increasingly important to address mental health concerns among older adults and consider how families and communities can provide appropriate support.
Although sadness and grief can occur naturally in response to difficult experiences, persistent symptoms that interfere with daily functioning may require professional assessment.
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| Dr Serena In, Clinical Psychologist and Head of Department at IMU University, highlights how loneliness, health problems and changing family circumstances can affect older adults' mental well-being. Photo: IMU University. |
Warning Signs of Depression in Older Adults
One of the main challenges in recognising depression among older adults is that symptoms are sometimes dismissed as ordinary consequences of ageing.
Family members may assume that a parent or grandparent has become quieter, less sociable or more irritable simply because of advancing age.
Dr Chin Hui Sian cautioned that persistent emotional and behavioural changes should not be ignored, particularly when they begin affecting everyday activities.
"It is natural to experience a range of emotions, including feeling sad or low at times. However, a persistent low mood, loss of interest or pleasure in activities, or other significant emotional or behavioural changes that affect daily functioning, should not be ignored."
According to Dr Chin, possible warning signs include:
- Persistent low mood: Feeling sad, withdrawn or emotionally distressed over an extended period.
- Loss of interest: No longer enjoying hobbies, social activities or relationships that previously brought pleasure.
- Changes in appetite: Eating noticeably more or less than usual.
- Changes in sleep: Sleeping significantly more or less than usual.
- Social withdrawal: Avoiding family gatherings, friends or other forms of social interaction.
- Behavioural changes: Increased irritability or other noticeable changes that affect daily functioning.
These symptoms do not automatically indicate depression. Similar changes may also arise from physical illnesses, medication effects or other circumstances.
However, when symptoms persist or interfere with everyday life, a professional assessment can help determine whether further support is needed.
Depression May Present Through Physical Symptoms
Not every older adult experiencing emotional distress will describe feeling depressed or unhappy.
Some individuals may be more comfortable discussing physical discomfort than their emotional well-being, making depression harder for relatives to recognise.
Dr Chin explained that generational attitudes towards mental health can influence how older individuals understand and communicate their experiences.
"People from different generations may have different views of depression. Some older adults, particularly those who grew up when mental health was less openly discussed, may be reluctant to acknowledge emotional distress or seek help."
She noted that some older adults may report headaches, stomach discomfort, fatigue or irritability rather than directly expressing sadness.
These symptoms can have several possible causes, so families should avoid assuming that physical complaints are psychological without appropriate medical assessment.
A healthcare professional can evaluate physical and mental health concerns together and determine whether further investigation or support is appropriate.
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| Dr Chin Hui Sian, Counsellor and Lecturer at IMU University, advises families to look out for persistent changes in mood, appetite, sleep and social behaviour among older loved ones. Photo: IMU University. |
Why Older Malaysians May Be Reluctant to Seek Mental Health Support
Even when symptoms become noticeable, seeking professional help can be difficult for some older adults.
Dr Chin explained that individuals who grew up when mental health was rarely discussed openly may associate emotional difficulties with weakness or believe they should manage problems independently.
Some may also avoid telling family members about their concerns because they do not want to become a burden.
Dr Serena In added that reluctance can increase when older individuals feel pressured into attending therapy by family members who expect an immediate solution.
"In some instances, feelings of neglect or resentment may point towards problems within the family, which need to be addressed for therapy to work," she said.
These circumstances highlight why gaining an older person's trust and understanding their concerns can be important when discussing mental health support.
How Depression Is Assessed and Treated
IMU University's experts emphasise that professional assessment is important because depressive symptoms may arise for different reasons and do not always indicate a depressive disorder.
Counsellors, clinical psychologists, psychiatrists and medical doctors can each contribute to identifying concerns and determining appropriate support within their respective professional roles.
Counsellors may use screening and assessment methods to understand a person's difficulties and identify whether additional evaluation is required.
Clinical psychologists and psychiatrists can assess symptoms and evaluate whether a mental health diagnosis is appropriate. Medical doctors may also investigate physical conditions that could contribute to the symptoms.
Depending on an individual's needs, treatment may include counselling, psychological therapy, medication or a combination of approaches.
Medication, where appropriate, must be prescribed by a suitably qualified medical practitioner, while psychological treatment may be provided by qualified mental health professionals.
The appropriate approach depends on the person's symptoms, clinical assessment, preferences and overall health.
How Families Can Start a Conversation About Depression
For adult children who suspect that their parents may be experiencing depression, the first conversation can be particularly difficult.
Dr Chin recommends approaching the subject with empathy and respect rather than criticism or pressure.
"Showing concern and approaching the conversation with empathy and respect can go a long way. Rather than talking down to older adults, criticising their behaviour or forcing them to seek help, share what you have noticed and ask how they have been feeling."
She suggests gently encouraging older adults to speak with a doctor they already trust, particularly when emotional or behavioural changes are accompanied by physical complaints.
A familiar healthcare professional may be able to assess possible medical and psychological causes and recommend appropriate support.
Dr Serena In also encourages families to use everyday interests as opportunities to introduce conversations about mental health.
"You can watch a programme that includes a person with depression, or bring up something you saw on the news to start the conversation. Even their grandchildren can become advocates as the younger generation are more aware of depression and the need for treatment, and grandparents are often more amenable to their suggestions."
Rather than treating the discussion as a single attempt to persuade someone to seek therapy, families may need to allow time for trust and understanding to develop.
Practical assistance, including helping to arrange medical appointments or accompanying an older relative who wants support, may also make accessing care easier.
Supporting Mental Health and Dignity in Later Life
As Malaysia's population ages, Dr In believes greater attention should be given to how society supports older people who may be experiencing emotional distress.
She emphasised that older adults continue to possess valuable knowledge, skills and life experiences, and that their well-being should remain a priority for families and communities.
"All of us are aging and we need to think about how we want to be treated when we get older. Do we ignore and abandon our parents and grandparents, who have skills and lived experience to share, and who can still contribute to society, or do we support them in their old age, the way they supported us? There is so much we can do to help them age with dignity and good quality of life, and in doing so create a better future for all of us."
For families, recognising persistent changes in an older relative's emotional well-being and responding with patience can be an important first step towards accessing appropriate support.
