SINGAPORE: While it may be statistically likely that there will be an increase in the number of suicides among the elderly here given the rising number of old folk among Singapore's ageing population, more could be done to reach out to those who are vulnerable, said counsellors who are familiar with issues faced by this segment of the population.
Their suggestions include training more frontline staff in and beyond the healthcare sector to recognise the signs of depression and suicide risk, encouraging more employers to hire older workers and for families and the community not to make light of any talk of suicide by anyone.
The Samaritans of Singapore late last month flagged that the number of elderly aged 60 and above who took their own lives in 2017 was the highest since it started tracking suicides in 1991. Figures show the that 129 elderly people in Singapore committed suicide last year, six cases more than in 2016.
While the number has gone up, the suicide rate among this group has in fact fallen over the years, the Ministry of Health (MOH) said. Except for a slight increase compared to 2016, the suicide rate of 16.4 per 100,000 people aged 65 and above in 2017 was lower than the rates in the several years preceding that.
Singapore’s suicide rates were also lower than Hong Kong, where the suicide rate for people over 65 in the city stood at 24.2 per 100,000 people in 2016, and South Korea, where there were 78.1 deaths by suicide per 100,000 population aged over 80 years in 2016.
KEEP THE ELDERLY EMPLOYED
Still, experts said that one suicide is a suicide too many. Senior lecturer in the Master and PhD in Gerontology programmes at the Singapore University of Social Sciences Helen Ko said that older adults have typically had the highest suicide rates.
She pointed to physical illnesses and mental disorders, especially depression for this. Life stressors such as unemployment and the loss of loved ones are other contributory factors, she added.
She believes that keeping more elderly people employed could be a step in the right direction in improving the situation in Singapore. Dr Ko, who is also the executive director of Beyond Age, a consultancy that deals with ageing issues, said there are many benefits from employment.
“There’s the social aspect. And the elderly also feel a sense of usefulness, of contributing to the workplace and the society,” she said. While suicide is complex, employment is “certainly one way forward”, she said.
She added that the income they receive gives them a sense of independence. She acknowledged however that there are challenges, as employers are reluctant to hire older workers despite their wealth of experience.
Dr Ko, who has 30 years of experience as a counsellor in the sector, added that there are other preventive steps to be taken before the elderly reach a depressive state. She highlighted active ageing programmes initiated by the Government and volunteer welfare organisations as positive steps, as they keep the elderly engaged, and their minds healthy.
Such programmes give the elderly something to look forward to, she said. She gave an example of a Seniors Sports Day that was jointly organised by Singapore University of Social Sciences, St Luke’s ElderCare and SASCO Senior Citizens’ Home recently.
“I believe we need to have more such preventive programmes,” she said.
While she lauded the many day care centres that have sprouted up, she cautioned that there are costs involved that not all can afford.
MORE TRAINING TO SPOT THE SIGNS
Dr Ko also suggested training more professionals like nurses, doctors and the police to pick up warning signs of elderly at risk of suicide.
Assistant Director of Hua Mei Counselling and Coaching at Tsao Foundation Wang Jing echoed the same view that more people should be trained.
“Eldercare professionals like physicians, social workers and counsellors, especially, ought to make it a point to look out for signs of emotional wellness and distress and to screen and use standard assessment scales to identify risks so that action can be taken promptly,” she said.
She added that as the Government is actively promoting befriending of older persons as a volunteer service, the volunteers could be given training to recognise indications of depression and suicide ideation. They should also be provided with protocols and channels for them to flag out persons-at-risk to their professional caregivers or other trained service staff at Family Service Centres and similar agencies, she said.
Psychiatrist from Nobel Psychological Wellness Clinic Dr Seng Kok Han said that family physicians are a good starting point as most elderly with depression are seen by their family physicians.
“However, geriatric depression is often under-recognized and undertreated, in part because they frequently have multiple medical disorders presenting as possible causes of patients’ symptoms, health care providers are often more focused on medical problems,” he said.
Some of his patients who contemplated suicide include those whose children visited them only once a year, who suddenly found their lives without meaning after retirement, and who regretted neglecting their families previously and families now abandoning them.
MORE EDUCATION NEEDED ON DEPRESSION, SUICIDE SIGNS
He also said that that the elderly who talk about suicide should not be taken lightly. “Studies have shown that people who committed suicide tend to have mentioned suicide to someone before,” Dr Seng said.
Ms Wang said that one point to note within the family is that living under one roof is not enough - what makes the difference is making time to listen to and support one another.
"Signs of low mood, self-neglect, stray statements on wanting to end their life can all point to deeper distress and should not be just dismissed and brushed aside," she said.
There also needs to be more public education on depression, which is a major reason behind suicides, said Dr Seng, who was previously chief of the Department of Geriatric Psychiatry at the Institute of Mental Health.
“Depression is not a normal aspect of ageing,” he said.
Ms Wang shared the same sentiment about public education.
“Through awareness and acceptance, there will be less stigma around feelings of depression and suicidal thoughts and a better chance of dealing with them before it’s too late,” she said.
Ms Wang said that around 5 per cent of clients with Hua Mei Counselling and Coaching concern suicide ideation, a figure that has been fairly stable over the year. Interventions have been successful so far, she said.
WHAT HAS HELPED IN SOME CASES
Consultant in the Department of Geriatric Psychiatry at IMH Dr Richard Roshan Goveas gave examples of some early signs of elderly with suicidal thoughts.
These could include changes in behaviour such as becoming increasingly withdrawn and socially isolated, the direct or indirect expression of suicidal ideation or impulses including symptomatic acts such as giving away valued possessions, making a will and storing up medication, and feelings of hopelessness and helplessness in the family and social network.
Someone has to watch over an elderly person who is highly suicidal or attempted suicide, Dr Goveas said. This is usually done in a hospital setting, he added.
“The underlying mental illness like depression must be treated. When the mental state of the elderly patient improves, other agencies may need to be involved, depending on each case,” he said adding that the agencies may include family services centres, counselling service, day care or senior activity centres and befriending services.
Elderly patients with suicidal thoughts have been helped with medications such as antidepressants, he said. In patients with chronic pain, better pain management helped.
In patients who were socially isolated, attending day care or senior activity centres helped. In patients with poor family relationships, referral to counsellors helped, he said.
Ms Wang said that in one instance, a client with uncontrolled diabetes, who was scheduled for a leg amputation and warned he could go blind, feared his independence would be so compromised that he wanted to end his life.
However, the timely intervention of the Hua Mei Counselling and Coaching team, and the provision of practical aid in collaboration with other services helped to change his mind. He is coping well on his own with the help of a motorised mobility aid, she added.
Dr Seng encouraged family members to recognize and acknowledge any fear or anxiety experienced by elderly family members facing depression.
“Be sensitive. Do not make judgmental remarks or stressful demands such as expecting him or her ‘to simply snap out of it’,”he said.
Where to get help: Samaritans of Singapore operates a 24-hour hotline at 1800 221 4444, or you can email pat [at] sos.org.sg. You can also find a list of international helplines here. If someone you know is at immediate risk, call 24-hour emergency medical services.