Fourteen per cent of Hong Kong's population is aged 65 or older, a figure that is expected to increase to 30 per cent by 2040. With urbanisation and modernisation changing the roles of older people, seniors face a new set of pressures.
Some older adults feel isolated by a greater focus on the individual. They feel they are cut off from younger members of the family who have different values, a greater affinity for global values compared to traditional values, and may not even share the same language or dialect as their elders.
The elderly face other life transitions too: losing friends or loved ones, a diminishing support system, moving into long-term care, coping with economic hardship, facing ill health and mortality, and the burden they feel they impose on loved ones.
These adjustments can challenge their mental health.
Counselling has always existed to help individuals cope with life transitions. It was once more informal, directed by religious practitioners, physicians and community elders.
It has now become much more formalised and professional. Gerontological counselling is an integral part of palliative care for the elderly in Hong Kong.
With its bio-psycho-spiritual approach, it has proven an effective intervention in helping the elderly address psychological and emotional issues, and to help them develop the skills necessary for better mental health.
In fact, researchers at the Chinese University of Hong Kong have shown that grief therapy can relieve emotional distress in elderly people facing terminal illnesses, enabling them to maintain a good quality of life.
While the literature documenting the effectiveness of counselling often concentrates on younger populations, there is a growing body of work examining gerontological counselling.
A report for the Singapore-based the Tsao Foundation, an aged-care research and lobby group, found "the elderly benefitted significantly from counselling through a combination of supportive care and interventions which allowed them to deal with deep-seated emotional pain, accept unchangeable situations, find new direction and gain new meanings and perspectives to their struggle."
Bob Knight, professor of gerontology and psychology at USC Davis School of Gerontology, says depression and other psychological problems in later life can have serious effects on health if they are not treated.
"In less psychologically minded people, emotional distress often presents as physical symptoms," he says.
"Depression, anxiety, and so forth can also interfere with medical treatment for existing physical health problems."
According to the Coroner's Court, the suicide rate among people older than 60 years was as high as 20.9 per 100,000 people, the highest among all age groups in Hong Kong.
It is assumed that the elderly, with greater levels of education and higher socioeconomic status, are more likely to seek counselling. But Dr Raymond Lo, from the Department of Medicine and Therapeutics, Chinese University of Hong Kong says more research is required.
"Age should not be a barrier per se. The oldest patient who received counselling from my experience is 107 years old. Education and literacy are not barriers either," he says.
"Problems do arise with cognitively impaired or dementia patients, however, where verbal comprehension is affected. In these circumstances, simple non-verbal interventions like soothing music can help relieve anxieties restlessness, sadness and fear.
"It needs to be emphasised that care and attention from caregivers is a great form of support. Simple skills and approaches can be practiced by caregivers, while difficult cases can be referred."
Lo's research on palliative care patients shows that older patients can be psychologically stronger than the young, but they often have a smaller social support network. Often the old are caring for the very old.
Educated adults may need more counselling, partly because they were previously more autonomous in their decision-making and find it difficult to accept a dependent role.
Counsellors face numerous challenges in getting the elderly to commit to counselling due to social norms, the cost, a poor understanding of the process, and, importantly, the relative lack of access to geriatric counselling support.
Societal pressure partly stems from the stigma of seeking psychological help.
More training for professionals, wider promotion in the media and public education are needed to correct the stigma directed at elders who need counselling.
Gerontological counselling takes many forms and should be tailor-made. Lo says counselling may need to include family or a form of family-wide therapy, not just to the patient.
Another approach involves validation of the client's life history and achievement to raise self-esteem. The details do not have to be spectacular, but can be anything with meaning and significance, such as a mother successfully raising a family.
Another example is helping the client to find meaning and a purpose in life. In one scenario, an elderly man rediscovered a zest for life after talking to a student. The student learnt from him and can now help other elderly people adjust.
From a public policy standpoint, good psychological services can reduce health care costs by improving adherence to medical treatment and by reducing overuse of medical treatment for emotional problems.
The elderly deserve a comfortable old age, where their emotional needs are better understood.