Old, But Not Gold?: Mental Health Issues Faced By Singaporean Elderly

What does mental health even mean?

Mental health can be defined as our emotional, psychological, and social well-being, which is very different from mental illness (1). Mental illness is generally defined as health conditions involving changes in emotion, thinking and/or behavior. While both terms may seem similar, a very easy distinction to make is that mental illness usually comes with a diagnosis, while mental health is usually less serious, requiring less intense methods to upkeep.

Why should we care about the mental health of the elderly?

As more realise the importance of mental health, the conversation rarely includes any discussion regarding the mental health of the elderly in Singapore. While it is important to acknowledge the mental health of teenagers and working adults due to the stress they inevitably would feel, it is also important to address the issues that the elderly may face, despite us not being able to relate to them.

Furthermore, as the silver tsunami is either upon us or going to be upon us, the number of elderly people will increase, as the younger generation shrinks. With the young having to work to support their elderly parents, their elderly parents are usually left alone, either to ponder the meaning of life, or to wonder when their expiry date will be.

It is not surprising that the elderly today would have more to worry about than the generations before them. Living longer means that they have a greater chance to develop diseases or health conditions such as dementia, cancer, etc. (2). The possibility of developing such diseases must do great damage to one’s mental health.

Living out of sync: Dementia

Perhaps the most commonly-associated mental health issue with elderly, dementia diagnoses in Singapore have been on the uptick in recent years, with more Singaporeans seeking mental healthcare screening due to their increased knowledge on the subject (3).

This is because Singapore has a staggering number of elderly with dementia: 1 in 10 Singaporeans aged 60 years and above has dementia, according to the Well-being of the Singapore Elderly(WiSE) nationwide study by the Agency for Integrated Care (AIC) (4).

Vascular dementia is a common type of dementia, which is an illness that affects the brain, leading to progressive memory loss, a decrease in intellectual ability and personality changes. It affects a person’s ability to think, learn and make decisions.

Vascular dementia is caused by reduced supply of blood to the brain due to damaged blood vessels, depriving brain cells of vital oxygen and nutrients. Those suffering from vascular dementia (or any type of dementia, for that matter), although they may not be conscious at all of their worries, still undergo many challenges in their day-to-day lives; They struggle to keep up with the simplest, regular activities for a day.

In this time, especially, when many of our regular routines have been disrupted, the impacts of these on elderly with dementia are even worse, where this departure from normalcy worsens their condition (3).

Longer lifespans also mean that they would have to worry about financial support for longer. As not many are fortunate enough to have financial support from their children or themselves, many have to work to support themselves even though their bodies may be too frail to handle it. Given that the retirement age is slowly inching up from 63 to 68 in 2022 (5), we can expect that there would be more elderly people working physically taxing jobs while worrying about their physical health.

With all that they have to worry about, it is not surprising that many elderly frequently feel depressed, and even anxious.

Hopelessness in life: Dementia

Without a doubt, one of the increasingly infamous mental diseases in the past few years and the very first thing that pops up when we talk about mental diseases would be depression. While much light has been shed on depression in youth and adults, not many realise that this too affects the elderly. Significantly, 3% to 6% of the elderly in Singapore suffer from depression (6).

Depression encompasses two types — persistent depressive disorder (PDD), also known as dysthymia, and major depressive disorder (MDD). PDD is a mild version of this disease of which symptoms include insomnia, low motivation and self-esteem, and feelings of hopelessness. MDD, on the other hand, could be much more serious — patients suffer from loss of interest in even daily routine activities (like eating), pain from nowhere and even delusions.

However, it is not to say that one should accord MDD all the attention — both kinds of depression can have a significant impact on life, and need to be seriously addressed. Moreover, PDD in depressives may develop into MDD.

Apart from therapy with help of experts and medication, help from others, such as family and friends, is also needed for successful treatment and recovery when dealing with depression (especially PDD).

Everyday trauma: Anxiety

For the elderly, depression often goes along with anxiety, and both can be debilitating, reducing overall health and quality of life. Anxiety can interfere with memory, and significant anxiety can contribute to amnesia or flashbacks of a traumatic event. Globally, studies have shown that anxiety disorder is more common in the elderly, affecting 7% of seniors, than depression, which affects about 3% (7). Likewise, about 10% of the population suffer from anxiety disorders, making it a very prevalent problem in Singapore (8).

Unfortunately, there are many factors that can easily contribute to anxiety in the elderly. Such would include stress or trauma, ingestion of alcohol, caffeine, medicine, and especially other mental illnesses or neurodegenerative disorders (like Alzheimer’s or other dementias).

Furthermore, stresses and changes that come with ageing—poor health, memory problems, etc—can contribute largely to anxiety disorders. Common fears that strike anxiety in the elderly include the fear of falling, the inability to afford living expenses and medication, loss of independence, isolation, and death.

This constant state of worry may seriously affect older people’s quality of life by causing them to limit their daily activities and experience trouble sleeping. Some behavioural symptoms include changes in appetite, lack of energy, loss of interest, feelings of worthlessness and guilt, difficulties with concentration, and even recurring thoughts of death and suicide. These would take a toll on their physical health as well, leaving impacts like aches and pains, restlessness, slow movements and constant fatigue (9).

If left untreated, anxiety disorders may cause or worsen depression too. Although it is normal for them to worry more about deteriorating health and financial concerns as they age, we should still aim to be more aware of anxiety disorders prevailing in the elderly, and perhaps, spend more time interacting with them.

Caring for elders in our midst

With the knowledge that we have gained above, what can we do with it?

As an aging society, elders are all around us and are a vital community in Singapore. Hence, even if the elders around you or in your family may not be afflicted with the same problems, there are still ways we can reach out to them, as individuals and loved ones.

However, should you notice your elderly family members or neighbours exhibiting such symptoms, or even if you meet them in passing, you can take the first step to reach out to them — be it with a video call, a (safely distanced) home visit, or even anything as simple as chatting with them whenever you see them.

Especially in this time of reduced social interaction, community support systems become even more important, and feelings of isolation and despair are magnified for not only elders but many of us. Reaching out to others can also help to alleviate this ache.

Mental health literacy and education is of increasing prominence among Singaporeans (3); however, what use is this without our capacity to act on this? The driving force behind any philanthropic act is surely empathy — something that cannot be taught. Only by empathising with our elders and the struggles they may face can we then desire to help them, which extends to anyone who may be going through issues with mental health.

As Singaporeans, it is on us to lend our support to our elderly in order for them to experience aging meaningfully and gracefully.

Where to get help:

Samaritans of Singapore Hotline: 1800 221 4444

Institute of Mental Health’s Helpline: 6389 2222

Singapore Association of Mental Health Helpline: 1800 283 7019

You can also find a list of international helplines here. If someone you know is at immediate risk, call 24-hour emergency medical services.

Written by: Leia Ong, Naydene Tan, Murugan Rakshita, Li Decong, Amanda Tan

Bibliography

1. Gov.sg. What is mental health? Retrieved from https://www.mentalhealth.gov/basics/what-is-mental-health

2. Brown, G.C. (20 Feb 2015) Living too long. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4328740/

3. Jalelah Abu Baker. (12 March 2021) Better Mental Health awareness among seniors, but more can be done, say experts. Retrieved from https://www.channelnewsasia.com/news/singapore/singapore-mental-health-awareness-elderly-seniors-dementia-14271078

4. Too, J., Loo, X.S., Lim, V. (22 May 2020) Mental Health of Elderly in Singapore: What can be done during times of uncertainty to improve the mental health of elderly in Singapore? Retrieved from https://sph.nus.edu.sg/wp-content/uploads/2020/08/PHTT-Interns-2020-Mental-Health-of-Elderly-in-Singapore.pdf

5. Ng, C. (6 Mar 2021) Budget debate: Raising of retirement, re-employment ages will go ahead as planned in 2022. Retrieved from https://www.straitstimes.com/singapore/politics/budget-debate-raising-of-retirement-re-employment-ages-will-go-ahead-as-planned

6. Ko, S.M. (n.d.) Depression and the elderly. Retrieved from https://mtalvernia.sg/education/depression-and-the-elderly/

7. Jaclyn Lim. (Retrieved 21 May 2021). Anxiety in Singapore: Stats, Types and Who's at Risk​. HealthXchange.sg. Retrieved from https://www.healthxchange.sg/wellness/mental-health/anxiety-singapore-stats-types-risk

8. Amal Chakraburtty. (1 March 2007). Anxiety Often Missed in Elderly. Webmd. Retrieved from https://www.webmd.com/anxiety-panic/news/20060522/anxiety-missed-elderly

9. Geriatric Mental Health Foundation. (Retrieved 21 May 2021). Anxiety and Older Adults: Overcoming Worry and Fear. Geriatric Mental Health Foundation. Retrieved from https://www.aagponline.org/index.php?src=gendocs&ref=anxiety