Growing Strong: senior citizens & their mental health in the Philippines

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May 10, 2021

Writers: K Ballesteros& Jerwin Regala
Researchers: Angelica Jane Evangelista, Azie Marie Libanan &Gie Lenna Dela Peña 
Graphics: Krystle Mae Labio, Bee Fukumuto
Tweet Chat Moderators: Angelica Jane Evangelista, Ian Stephen Velez, Cerella Flores Kaguyutan & Christine Joy Salva Cruz
Documentation: Alvin Joseph Mapo & Ian Stephen Velez
Twitter Spaces Moderators: Alvin Joseph Mapoy, Azie Marie Libanan & Richardson Mojica 

Our mothers are both 63 and widows, and they both run small businesses from their home, by dint of necessity. While J’s mother relies heavily on activities, specifically church activities, and people outside their home for social engagement, K’s mom is a small business owner who has had to make tough decisions about the welfare of her employees. 

For about three years, J and their older siblings left their mother home alone because of their occupations: both Ates have their own families, their third-born was a seafarer, and J was a seminarian. Her routine changed: from being an all-rounder in-house mother to an outgoing socializer in the village and a consistent attendee in their local parish. But the pandemic, along with the mobility restrictions mandated by the government, further changed that routine. Home alone, they knew how lonesome her situation had become. Good thing, the seminary sent seminarians home after the lockdown announcement.

As businesses left and right began to lay off employees or to enact furlough schemes, K’s mom was adamant about retaining the entire staff. Aside from those who voluntarily left to pursue other opportunities, there were no terminations. Being home, however, made it harder to coordinate with her team members. Her experience of stress and loneliness were compounded significantly by the longest lockdown in the world, and the continuing uncertainty surrounding the future of her business. 

Maintaining routines that are rich in social connections, becoming more adept at more current technologies, and access to activities–or businesses–that continue to provide mental stimulation and a sense of purpose, are all vital to older Filipinos’ mental wellbeing, as well as their overall health.  

What We Know About Older Filipinos’ Mental Wellbeing 

The World Health Organization (WHO)’s recent Comprehensive Mental Health Action Plan had been in place since 2013 (WHO, 2017), and secured a commitment from its member states to “promote mental well-being” (WHO, 2017) by providing for the needs of the elderly and other vulnerable individuals at every stage of recovery. This global action plan has been echoed by the Philippine Department of Health (DOH)’s Health and Wellness Program for Senior Citizens (2018) which aims to “develop a unified patient-centered and supportive environment standard to ensure safety and accessibility of senior citizens to all health facilities and to promote healthy aging in order to prevent functional decline”. Unfortunately for older Filipinos, the “heavier weight of the responsibility of caring for the elderly is on the shoulders of Filipino families, not on the State” (De Leon, 2014). Therefore, the Philippines  follows the global trend where the mental wellbeing of individuals aged 60 and over are under-diagnosed and, therefore, under-served (WHO, 2017).  

Studies concerning the mental wellbeing of Filipinos over the age of 60 are few and far between (Cruz, Cruz, & Saito, 2019; De Leon, 2014; Carandang, Shibanuma, Asis, Chavez, Tuliao, & Jimba, 2020). In their report titled The Quality of Life of the Filipino Elderly in Selected Cities and Provinces, Dr. De Leon explains that research on elderly issues, including their health, social security, their financial security, and their relationships is very limited due to their status as a minority compared to the youth (De Leon, 2014). For mental health and allied disciplines, the studies are even fewer. According to Ageing and Health in the Philippines, a landmark study from the Economic Research Institute for ASEAN and East Asia, “mental health amongst the older population is a major public health concern that has not yet been fully studied in the country” (Cruz, Cruz, & Saito, 2019). This dearth of nuanced clinical and professional knowledge about specific communities and demographic intersections characterizes the state of mental health in the Philippines. 

According to the WHO, “older adults with physical health conditions such as heart disease have higher rates of depression than those who are healthy” (WHO, 2017). This issue is more complicated because, according to the National Association of Chronic Disease Directories, living with depressive disorders “adversely affects the course and complicates the treatment of other chronic diseases” (Centers for Disease Control and Prevention [CDC] & National Association of Chronic Disease Directors [NACDD], 2008). 

Another interesting and overlooked emerging insight is how, according to De Leon, more urban-based older adult Filipinos report “problematic relationships including interpersonal violence, among household members than their rural counterparts” (2014). Older men also report that they rarely or never “received the support they needed” when it comes to addressing their mental wellbeing (CDC & NACDD, 2008). Other invisible and underrepresented demographic intersections include elders in rural communities where social support systems might not be easily accessible despite the DOH’s program to “ensure access…to essential geriatric health services” (DOH, 2018), and elders who are part of poorer communities. It is important to bear in mind that the “determinants of subjective well-being among senior citizens include socioeconomic status, psychological resources, social capital, and social relationships” (Carandang et al., 2020). This dovetails clearly with De Leon’s findings, where she states that the “area of residence and educational attainment showed significant correlations to more quality of life concerns, specifically household relationships and financial security” (De Leon, 2014). Less access to socially-funded services may also result in poorer overall health, and poorer subjective well-being. 

Older adult Filipinos’ experience of mental health is compounded by the presence of unique factors, including “[physical] health problems, bereavement from the loss of loved ones, and retirement” (Cruz, Cruz, & Saito, 2019). Understanding the needs of older adults entails insisting on more specific information about their lives, and the challenges of their lived realities. Older men, for example, have reportedly “the highest suicide rate of any age group” (CDC & NACDD, 2008). In the Philippine context, older Filipino men who may be uneducated at a higher level may expose them to “considerable internal conflict regarding gender roles, which might harm their mental health” (Carandang et al., 2020). Finally, another underserved, overlooked, and under-represented sector includes older Filipinos who are exempt from the pension system and its benefits. According to De Leon, pensioners are those who had been employed in formal and regular work whereas the majority of the older adult population are from the “marginalized groups of agricultural workers, fishers, laborers, and informal workers,…rely on the care of their children, grandchildren or relatives for their well-being in old age” (De Leon, 2014).

The Roles Older Filipinos Play 

Extended Filipino families uphold the tradition of respecting older Filipinos, and appreciating their contributions to their specific households and to society. Older persons feel that many people rely on them for advice, and they are keen on teaching or imparting knowledge to other people (Cruz, Cruz, & Saito, 2019). The younger generations believe and trust their wealth of skills and competence because they have lived through many situations, tough and tender ones. 

The Expanded Senior Citizen Act of 2010 or Section 3 of RA 9994 recognizes the important roles that older persons can contribute towards nation-building (Official Gazette of the Philippines, 2010). This act recognizes an older Filipino’s valuable services to their community, which include: tutorial and consultancy services, teaching, specialized lectures to share their expertise, and skill transfer. Implicitly, the section acknowledges the capacity of the older Filipinos to join the labor force of the country. Despite some potential health threats they may acquire due to aging, they are undoubtedly still motivated, skilled and productive. Older Filipinos are also usually the first preachers/ catechists/ teachers of religion of their younger relatives, since the majority of  them are deeply religious (Esteban, 2015 as cited in Buenaventura, Ho, & Lapid, 2020).

Thanks to the social benefits older adults acquire, senior citizens provide subsidies through their senior discount card: “because food subsidies for senior citizens also benefit their households in general, many elderly consider this as their tangible contribution to their households” (De Leon, 2014). Their roles within their families are influenced by the “overwhelming belief that children are obligated to support and take responsibility for their ageing parents” (Cruz, Cruz, Saito, 2019), older persons maintaining connections among family members not just strengthens the relationship, but also provides stability and reassurance. 

How to Age Well 

Create a routine to maintain physical health. Aging well primarily involves maintaining the basics like having regular exercise, eating well, and maintaining good sleeping habits. Older people should take care to consider the needs of their bodies and to pace their exercise accordingly. During the COVID-19 pandemic, this routine is even more important given that “disruption of important day-to-day activities for older individuals can pose a negative impact on older adults’ cognitive impairment, leading to poorer mental health” (Buenaventura, Ho, & Lapid, 2020). 

Engage in local community activities. Despite the ongoing pandemic, remaining engaged in a local community is important to maintain general wellbeing, especially for older adults (WHO, 2017; Carandang et al., 2020). Not only does continued engagement guarantee a sense of purpose, this connection also combats feelings of loneliness. According to the WHO, “social care is important for promoting older people’s health, preventing disease and managing chronic illnesses” (WHO, 2017). Connecting with and speaking to neighbors while maintaining appropriate health protocols may help provide “community-level primary mental health care for older people” (WHO, 2017) who cannot travel outside of their barangays. A sense of local communities will also help older adults remain active and responsive to their needs, and others’. 

Continue learning about new technologies. Older Filipinos may have a greater need to feel more consistently connected with members of their community, given that they feel keenly how “people rely on them for advice…[and for] teaching or imparting knowledge to other people”.  One big thing that we can do as a family to our elders is to introduce them to digital platforms and teach them to stay connected with their friends and other relatives digitally. When J introduced their mother  to Facebook, this gave their mother a new routine that addressed her isolation. She eventually bought her own smartphone. One of J’s sisters built a sari-sari store for her. Now, their mother spends most of her time in her lovely store while playing and watching something on her smartphone. Engaging in more current technology can make emerging health services more accessible. For example, the development of “tele-health approaches can provide older adults and their family with better access to healthcare providers” (Wu, 2020). Private sector providers and non-government organizations offer “free telephone and online consultation and counselling services…older individuals with anxiety and depression can benefit from psychotherapeutic treatments” (Subramanyam et al. 2018 as cited in Buenaventura et al., 2020), which increases access to services if older adults are able to navigate technology more effectively.  

Strengthening their relationship with their faith and faith-based communities. Older adults relied more on meditative and faith-based activities like prayer as a way of managing their stress (De Leon, 2014). This strong sense of spirituality “serves as a strength and protective buffer to stress and suffering” (Esteban 2015 as cited in Buenaventura et al., 2020). Joining older relatives and community members in these activities, and actively speaking about faith and spirituality may help adults cope, and help transfer healthy stress-related coping techniques. Similar stories of living home alone from other church members, which J’s mom has encountered and talked to, have given J’s mother the comfort and resilience to go forward daily. 

Practice help-seeking behavior. Older adults value their contribution and their influence on the lives of others (Cruz, Cruz, & Saito, 2019). They also value their psychological resilience, or their capacity to cope with emotions, gain social support, and solve problems (Carandang et al., 2020). Empowering older adults by helping them shift their goals may help protect their sense of psychological resilience. Promoting help-seeking behavior, and actively combating the stigma attached to mental health will only help older adults experiencing distress to ask for appropriate interventions without shame. In practice, J’s mother listens to friends’ stress and their sources of anxiety, or provides a space to let them reminisce and talk. She loves hearing from someone she hasn’t heard from in a while.  For J’s mom, it was important to provide this safe space for her friends, who are likely older adults also, and are used to attending social gatherings. 

K’s mother still experiences anxieties and stress, but she’s learning to recognize her triggers, and to create a space for herself in the face of stressful situations. When she feels particularly stressed, she takes 15-minute power-walks around the living room as a form of exercise. They seem small, but initiating conversations with friends, maintaining a supportive faith-group, and making time to look at antique plates help her cope. 

J’s mother’s new routine starts by waking up as early as 4:00 in the morning. After stretching and doing her morning exercise, she drinks her coffee and opens her store at 5:30 AM, 30 minutes after the decreed curfew hours. While waiting for her early-bird customers, she would switch her phone on for the 6 AM Online Mass. She spends most of her day watching over her store while talking randomly with someone on Messenger or doing other chores. She even has her small bed in the back of her store so that she can rest during the dead hours in the afternoon. J’s mother is naturally social, so she is friendly to anyone who wants to buy something. At the same time, having a store also helped her cope with the stresses brought on by the pandemic.

In recognition of Mother’s Day, join us on our tweetchat this Monday, 10 May. Let’s talk about our elders, and how to better support their mental health! Tara, #UsapTayo!

Pre-Questions

  1. Who are the older Filipinos who are part of your household? Kumusta ang mga nakatatandang Pilipino sa buhay mo?
  2. What are your favorite activities with your mom during the ongoing lockdown?

Questions  

  1. Like the mothers in our article, how has your mom’s roles & responsibilities changed during the pandemic? 
  2. What does your mom consider highly important for her mental wellbeing & how can you help provide these needs for her?
  3. What does a supportive community for Filipino moms look like now?

Works Cited  

Centers for Disease Control and Prevention and National Association of Chronic Disease Directors. The State of Mental Health and Aging in America Issue Brief 1: What Do the Data Tell Us? Atlanta, GA: National Association of Chronic Disease Directors; 2008.

Mukku, S. S. R. and Sivakumar, P. T. T. (2020) ‘Mental Health Care of Older Adults during Coronavirus Disease (COVID-19) Pandemic: Challenges and Way ahead in India’, Indian Journal of Psychological Medicine, 42(5), pp. 495–496. doi: 10.1177/0253717620944824.

Cruz, G.T., C.J.P. Cruz and Y. Saito (eds.) (2019), Ageing and Health in the Philippines. Jakarta: Economic Research Institute for ASEAN and East Asia (ERIA).

Wu, B. Social isolation and loneliness among older adults in the context of COVID-19: a global challenge. glob health res policy 5, 27 (2020). https://doi.org/10.1186/s41256-020-00154-3

Republic of the Philippines. Congress of the Philippines. (2010). Republic Act No. 9994. Available at: https://www.officialgazette.gov.ph/2010/02/15/republic-act-no-9994/

World Health Organization [WHO]. (2017). Mental Health of Older Adults. Available at: https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults (Accessed on 04 May 2021).

Buenaventura, R. D., Ho, J. B., & Lapid, M. I. (2020). COVID-19 and mental health of older adults in the Philippines: a perspective from a developing country. International psychogeriatrics, 32(10), 1129–1133. https://doi.org/10.1017/S1041610220000757

Carandang, R.R., Shibanuma, A., Asis, E., Chavez, D.C., Tuliao, M.T., & Jimba, M. (2020). ‘“Are Filipinos Aging Well?”: Determinants of Subjective Well-Being Among Senior Citizens of the Community-Based ENGAGE Study’, International Journal of Environmental Research and Public Health, 17 (2020). doi:10.3390/ijerph17207636 (Accessed on 04 May 2021). 

Philippine Department of Health [DOH]. (2018). Health and Wellness Program for Senior Citizens. Available on: https://doh.gov.ph/Health-and-Wellness-Program-for-Senior-Citizen (Accessed: 04 May 2021). 

De Leon, A., (2014). The Quality of Life of the Filipino Elderly in Selected Cities and Provinces. Available at: https://tsaofoundation.org/doc/financial-security-older-women-jan-2015/Dr%20Aurora%20De%20Leon%27s%20Presentation_First%20Multipartite%20Regional%20Meeting%20on%20the%20Financial%20Security%20of%20Older%20Women%20in%20East%20&%20Southeast%20Asia_FINAL.pdf (Accessed: 04 May 2021). 

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