New study finds that living at home with family does not mean elderly people do not feel sad and lonely
Staying holed up at home in old age, even when living with family, could leave a person sad, lonely and even depressed. Close to one in five of 412 elderly people surveyed for a new study showed signs of depression. They were all aged 75 and above, and living at home. That result in the study by the National University Health System (NUHS) has raised the red flag on old-age depression, given that Singapore is ageing faster than most countries in the world. Nearly 21 per cent of those over 80 – and 16 per cent of those in their mid to late 70s – indicated that they were sad, lonely or in low spirits in the study by the research team from NUHS’ Department of Psychological Medicine. Significantly, nine in 10 did not live alone. Previous studies have shown that those who live alone tend to be more depressed than those who do not. “What our new study shows is that you might live with others, yet still be alone,” said Associate Professor Rathi Mahendran, who will present the findings at a conference on ageing here on Thursday. “We need to take heed, given that we’re likely to see a rapid rise in our 80-plus population pretty soon – and most will live with family at home.”
There are now 73,000 people aged 80 and above in Singapore. This is likely to rise to 108,000 by 2020 and to nearly 180,000 by 2030, according to projections by the Institute of Policy Studies. “Families sometimes take sadness and loneliness for granted in their elderly, saying these are a part of growing old,” said Prof Mahendran. “That should not be the case.” She added that more resources were needed to focus on studying the needs of the “old-old” – those aged 80 and above. Past studies have tended to look at those aged 65-plus. Her colleague, Associate Professor Kua Ee Heok, who has spent more than three decades studying depression and dementia in the elderly, agreed. “The big concern is that a rise in elderly depression could cause suicide rates to spike too,” he said.
While suicide rates among the very old here are not readily available, raw numbers indicate an upward trend. Forty-one people aged 75 and above killed themselves in 2010, the latest year for which data is available, compared to 34 in 2006. That same year, 14 men aged between 80 and 84 killed themselves, the highest figure for that age group in nearly 20 years. The figure for women in the same age group – eight – was the highest in 12 years. After reaching one of the highest suicide rates in the world for those aged 65 and above – at around 50 per 100,000 in 1995 – the rate dipped to about 24 in 2004, rose to 27.6 in 2007, and stabilised. In 2009, the elderly suicide rate per 100,000 for men was 28.7 and 19 for women. While this is lower than the peaks of the late 1980s and mid-1990s, it is much higher than in countries such as the United States, where suicide rates have hovered around 14 for those aged 65 and above.
Given the rapid increase in the elderly population, it is possible that Singapore’s suicide rates per 100,000 may well remain stable or come down. But that does not impress Prof Kua. “The point is that suicide is preventable,” he said. “And that’s what we need to focus on.” He agreed with Prof Mahendran that particular notice needs to be paid to depression in the very old, saying there were two key reasons to do so. First, unlike dementia, depression can be prevented and treated more effectively. The prevalence of depression is double that of dementia and it is associated with a host of physical health problems in old age, he said. “Families tend to notice signs of dementia and come forward for treatment,” he said. “Not so with depression – and this needs to change.” Prof Mahendran’s findings on depression are markedly higher than the 7 to 7.5 per cent of respondents in a similar age group who showed depressive symptoms in a larger study published in 2009. The key difference, she said, is that the earlier study surveyed elderly people in community settings, such as those who attend senior activity or day-care centres, whereas her study was conducted door to door in Jurong and Bukit Merah with people at home.
Studies here have shown that older adults who stay employed or retirees who volunteer have better mental health, Prof Kua pointed out. “The key is to talk to people – your family, friends, colleagues or churchmates – and remain engaged.” Volunteers working with the elderly agree. Ms Jane Lim, 48, has been running socialisation programmes at the void decks of one-room flats in Bukit Merah, Toa Payoh, Hougang and other places. Her “Happy Angel Seniors Programme” offers lonely elderly a chance to know their neighbours, make friends and remain alert and active. Encouraged by volunteers, they sing, dance, perform skits and discuss current affairs as part of the programme. There are 400 participants islandwide. “We try to reach them early, when they are in their 50s and 60s,” said Ms Lim. “If we wait till they’re 80, it might be too late.”
Older people now fitter than before
The 80s may well be the new 60s. A new study of 412 people aged 75 and above has shown that people are fitter than they used to be. Only one in four people aged over 80 needed help to do one or more things such as feeding, bathing or dressing themselves, or climbing stairs. This is sharply down from the proportion of nearly two-thirds found in a study 15 years ago. But there is a marked decline in physical and cognitive abilities when a person crosses 80. For instance, only one in 10 of those in their late 70s could not perform these essential “activities of daily living”, compared to one in four of those aged 80 and above. Similarly, about 44 per cent of those aged between 75 and 79 were unable to do one or more tasks such as cooking, shopping or making telephone calls. It was 62 per cent for those past 80 years old.
The latest study, done by researchers from the Psychological Medicine Department at the National University Health System (NUHS), also found that cognitive impairment climbed from 28 per cent in those in their late 70s to 44 per cent in those aged 80 and above. Respondents were asked questions like what time it was, where they were and how to spell words like “world” backwards, to gauge their cognition in accordance to an international tool to screen for cognitive disabilities. While people are living longer and are in relatively better physical shape, more heed should be paid to their mental health and their concerns, says eldercare expert Kalyani Mehta. “We need more studies that look at the social and economic well-being of older folk, not just health issues – and these concerns, often inter-linked in the minds of the elderly, should be studied together,” said the head of the Gerontology Programme at SIM University. There was also a need to make older folk “feel valued”, she said. “We should look at increasing opportunities for older folk to volunteer, help their frailer peers and feel valued at the same time,” she said.
Senior citizens like Mr Wee Char Lee, 85, are already leading the way. The retired father of three visits two activity centres for the elderly run by Presbyterian Community Services for three to four hours nearly every day to chat with residents. “We laugh and joke, we sing, we gossip,” he said. “Companionship makes us forget the worries of the world.” Mr Wee, who spent 40 years working for a global technology company, takes special care of those who have been touched by tragedy. A woman in her 60s in his group recently lost her husband to suicide. “She was very very depressed at first, and even had to seek medical help,” he said. “But these days, being with others her age is making her heal slowly.”