Elderly in the Gulf need effective mental health services

Depression and other psychological ailments are common among older people, and they are too reluctant to accept the help that is at hand.

The theme for this year's World Mental Health Day, on Thursday, will be "older adult mental health". The World Health Organisation intends to draw much-needed attention to the challenges facing elderly people with mental health problems. In the UAE and the Arabian Gulf, older adult mental health is of particular concern.

The rapid socio-economic changes in the Gulf have been felt more profoundly and perhaps more adversely by the elderly, particularly those old enough to recall the pre-oil era. Clive Holes, professor at the University of Oxford specialising in the Arab World, interviewed elderly Bahrainis as part of a study looking at national identity. He reported that one of the sentiments commonly expressed by the elders was: “zad il-kher u-qallat il-anasa” (life is materially better nowadays, but not so much fun).

The Gulf’s citizens over the age of 60 are a tiny minority among the relatively youthful population. UAE census data from 2005 suggest that older adults represent just three per cent of the population. Similar figures are reported for Saudi Arabia and several other Gulf nations.

This minority status is further compounded in countries where citizens are already a minority group, such as in the UAE, Qatar and Kuwait. Senior citizens have become a minority within a minority in a society virtually unrecognisable to the one in which they grew up. Regional research repeatedly suggests that this “demographic imbalance” may have a detrimental impact on the psychological well-being of the Gulf’s elderly.

There is also research suggesting that though the Gulf’s elderly experience significant levels of psychological distress, they tend to be under-represented among the users of mental healthcare services. This situation is partially because the Gulf’s elderly are reluctant to seek medical help for emotional difficulties. Another important factor is the ability of primary healthcare clinicians to actually identify psychological problems in elderly patients. Even when clinicians identify such problems, they are often reluctant to intervene.

This reluctance, too often, is rooted in ageist beliefs. One common assumption is that psychological problems such as depression are unavoidable in the elderly, an inescapable by-product of deteriorating health and approaching mortality. Such assumptions normalise debilitating psychological problems in the elderly, problems that might otherwise have been alleviated. Similarly, some clinicians view elderly patients as too frail to tolerate further interventions, or as not being sophisticated or “psychologically minded” enough to benefit from talk-based therapies. Given the well-documented effectiveness of such therapies, this is a huge opportunity missed.

Ageism is one factor contributing to the under-utilisation of mental health services by the Gulf’s elderly. But there are a host of other factors, such as a lack of specialist elderly services in the first place and a scarcity of therapists able to provide culturally-appropriate interventions. This situation is all the more problematic when we consider the rates of common psychological problems reported by the Gulf’s elderly in the various regional research studies. In one Saudi study, 7,960 older adults attending healthcare centres were interviewed; 30.1 per cent of the participants were reported as experiencing mild depressive symptoms, with a further 8.4 per cent described as experiencing “severe depressive illness”.

A similar study in the UAE, spanning three cities, reported a depressive illness prevalence of 20.2 per cent. This study looked at a sample of 610 elderly Emiratis resident in Dubai, Al Ain and Ras al Khaimah. Using a standardised geriatric screening interview, the study found significant differences between the rates of depression observed across the three cities. Dubai reported the highest rate of depression – 29.4 per cent – significantly higher than both RAK (12.7 per cent) and Al Ain (11.4 per cent). Could it be that Dubai's more dramatic transformation has had a greater impact on the mental health of its elderly population?

The Gulf’s older citizens have gained least and lost most in the rapid socio-economic transition. Initiatives aimed at promoting psychological well-being in the Gulf should not ignore the elderly. More importantly, such services should be culturally appropriate if they are to be accessed, accepted and effective.

Justin Thomas is associate professor of psychology at Zayed University and author of Psychological Well-Being in the Gulf States

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