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SINGAPORE: When elderly people complain about their perennial aches and pains, do not brush them off — the aches could be a sign of something more serious, like depression.
According to the National University Hospital's (NUH's) senior consultant in psychological medicine Professor Kua Ee Heok, the elderly will not admit that they are depressed. Instead, they often complain about aches and pains to their neighbourhood general practitioners (GPs).
A 2003 study of some 68 elderly patients who were admitted for attempted suicide at NUH found that 30 to 40 per cent of the elderly had seen a doctor just a month before their suicide attempt.
"They will say they have chest pains, or pain in the liver," said Prof Kua, who is also head of Psychological Medicine at the National University of Singapore's Yong Loo Lin School of Medicine. Insomnia is another sign of disquietude.
Often, the elderly are misdiagnosed and treated symptomatically, instead of receiving appropriate counselling and medication. "They may be given painkillers, sleeping pills, or both; keep them at home, go to another doctor, get the same diagnosis and after a few doctors, take an overdose of the medication," said Prof Kua.
The elderly tend to be deliberate in their suicide attempts — planning them in advance and scheduling them on weekends when the family or caregiver is away. As such, they are more successful in their attempts.
Experience has shown that if their depression is diagnosed amid these aches and pains, then they can undergo counselling and get treated at the primary level.
The elderly suicide rate peaked in 1995, at 52 per 100,000 males and 33 per 100,000 females. This was the world's second highest rate after Hungary. But in recent times, with intervention and support from government and community, the rate has been steadily decreasing over the years to 27 per 100,000 males and 11 per 100,000 females in 2005.
The elderly concessionary rates for transport, setting-up of elderly day care centres and the Singapore Action Group of Elders (Sage) help-line have been instrumental in bringing elderly suicide figures down.
GPs have also been advised to find out whether elderly patients live alone, as this increases their suicide risk, especially if they are physically disabled.
While attempted suicides among the elderly have declined over the years, the proportion of young people attempting suicide seems to be on the rise, from 3.1 per cent in 1991 to 15.6 per cent in 2000. Peaks occur in May and October, which are often the exam months.
Unlike the elderly, the young are often more impulsive in their suicide attempts, and often seek attention before or after their attempt by calling their friends or family.
As with the elderly, Prof Kua stressed that the onus lies with the family for the young as well.
Parents should monitor their children for signs of withdrawal or have sleeping problems. The government has also been providing more full-time counsellors in schools.
Prof Kua has recently reprinted three books on mental health and wellness. Available in bookstores, proceeds will be donated toward the cyclone victims in Myanmar. - TODAY/ac
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