SINGAPORE: When Mr Ng Kok Sing’s mother started showing signs of poor memory and became bad-tempered six years ago, the eldest of four sons noticed the changes.
His mother, Madam Lee Lye Kuen, ran a hawker stall and could remember her customers’ orders, but she was misplacing things, and forgetting to brush her teeth.
She had a group of friends at the local community centre, but her bad temper drove them away, he told CNA in a phone interview.
Mr Ng’s daughter took Madam Lee to the doctor, and the elderly woman was diagnosed with dementia at Singapore General Hospital (SGH).
“I didn’t know much about dementia. After getting the report from SGH, I just could not understand. I was a bit shocked,” Mr Ng said.
Mr Ng said his knowledge of dementia was initially minimal, but he made an effort to find out more so he would be equipped to take care of his mother. He did not understand why his mother had the condition as there was no history of it in his family, he said.
“After I found some articles and attended some talks, slowly I understood what dementia is. I had to face it,” he said.
On the other hand, Madam Lee is aware of what dementia is from media articles and talks at the Fei Yue Retirees Centre where she goes, Mr Ng said. But she does not know that she has the condition.
MORE MENTAL HEALTH AWARENESS AMONG SENIORS AND FAMILIES
A spokesperson for Fei Yue Community Services said that in recent years there has been more mental healthcare screening at polyclinics.
“We do see more diagnosed with dementia,” she said, noting that seniors are more aware of dementia and depression because of communications though various media channels.
“Their family members, friends, peers and neighbours who may be diagnosed with similar mental health conditions have also made them more aware,” she said. She added that the elderly are also more open to finding about mental health issues by attending talks and workshops on mental health.
The COVID-19 pandemic has also “surfaced many mental health cases within the community”, she said.
“There is now more prominence and light given to mental health wellness,” she said.
“Together with some of the Government initiatives, the community has become more aware and embraces (the fact) that mental health issues and mental well-being are important to one’s health. The younger generations like the baby boomers help to detect early symptoms and signs amongst the elderly, to seek intervention and treatment.”
The Samaritans of Singapore (SOS), which provides emotional support to those in crisis or are thinking about suicide or affected by suicide, also said that awareness of mental health has “generally increased in the past few years”.
The organisation has observed an increasing number of community initiatives to support the elderly and their caregivers as well as to increase awareness around mental health conditions, said its chief executive Gasper Tan.
“Specifically, we have seen a greater understanding of dementia,” he said.
SOS noted that agencies such as Lien Foundation, Khoo Teck Phuat Hospital and the Agency for Integrated Care (AIC) have been fronting educational campaigns.
“(They) had played a vital role in equipping and training more with the necessary knowledge and skills to identify symptoms of dementia as well as how to support affected people in the community,” he said.
Mental health among seniors came into the spotlight in Parliament last month, after MP Mohd Fahmi Aliman (PAP-Marine Parade) asked about the effectiveness of Government initiatives in reducing elderly suicide and the support mechanisms for old people who are socially isolated.
Senior Minister of State for Health Janil Puthucheary said that there were 400 reported cases of suicide in 2019. Of these, 122 cases, or 30.5 per cent, involved persons 60 years and above.
“The causes of suicide are complex and multi-faceted, often involving family, social and mental health issues,” he said.
“Therefore, the Government works closely with Ministry of Social and Family Development and community partners on multi-pronged approaches, comprising promoting mental health and well-being, raising awareness on suicide prevention, and providing professional support and crisis interventions to at-risk groups, including targeted support for older adults.”
MORE WORK NEEDED
While awareness among seniors is improving, more can still be done so they and their families are more familiar with mental health issues, eldercare groups said.
“In our counselling experience, a lot of times older people don’t feel comfortable sharing and talking about their mental health issues,” said Ms Wang Jing, assistant director of Hua Mei Counselling and Coaching at Tsao Foundation. Even when they do share openly, their families sometimes might not understand their challenges, she said.
People may come to the wrong conclusions that seniors who are depressed or anxious “think too much or simply forgetful or careless” and that their mental state is a normal aspect of ageing, she said.
“Mental health issues can be invisible and be misunderstood,” she said.
She added that the behaviour of older people that can hint at a sense of anxiety or distress can be seen by others as being unreasonable or insecure.
“More can be done to promote awareness and understanding that these are not necessarily part of ageing but a mental health issue which we can all solve together,” she said.
Fei Yue Community Services also said that there is still much work that can be done.
“The stigma and misconception, and lack of knowledge still exists. Many prefer to not talk about it or dismiss the idea if they should share with someone their emotional state of being,” a spokesperson said.
She added that family members and friends are “critical” to getting seniors to attend workshops or talks to get themselves more acquainted with managing their mental health.
Given that dementia and depression are common mental health issues among seniors, the AIC said that families should look out for signs of these conditions. A spokesperson said that signs of dementia include difficulty performing daily activities like cooking and dressing, changes in behaviour like becoming socially withdrawn and more easily upset, and issues with cognition such as difficulty remembering things and having problems with language and calculations.
For depression, signs include thoughts of suicide, a change in sleeping patterns, and irritability and outbursts of anger, she said.
Mr Tan said that among those who called the 24-hour SOS hotline and disclosed their age, about 20 per cent of calls between April 2019 and March last year were from people aged 60 and above.
While some call to reach out for a listening ear or vent their daily frustrations, “others may call SOS when they are in crisis, and in need of emotional support to cope with their negative thoughts and suicidal ideations”, said Mr Tan.
“In such calls, our priority is to ensure the safety of the caller. In general, we strive to give clients a safe space where they can share their thoughts and feelings openly as we may be their only resource for support, he said.
He said that suicide is an “inherently complex issue”, with no single cause.
“It is often due to culmination of a variety of factors. When one experience feelings of hopelessness for a prolonged period of time, one may contemplate and even attempt suicide,” he said.
Loneliness, physical illness, loss of independence and loss of loved ones can contribute to seniors’ sense of despair, he said.
“The process of growing old is inevitably accompanied with physical and social changes. It can be difficult to cope and adapt to these transitions, there may be fear and feelings of loss with their physical deterioration, and even concern that they are putting on burden to the people around them,” he said.
He added that guilt is another emotion that they may encounter.
“When one is in such a situation, especially with a weak social support and no one to turn to, feelings of loneliness and alienation may be amplified,” he said.
SOS views education as key for suicide prevention, he said.
“The community must take an proactive commitment to destigmatise suicide and create more open and constructive conversations on how we can empower the elderly, such that they can sustain meaning especially in their late age,” he said.
“Furthermore, we believe that the onus should not lie only on the elderly, but the community at large to empathize and support these individuals.”
HOW FAMILIES CAN HELP
AIC echoed the view that it is important for the community to continue to come together, be aware of the various mental health conditions as well as their signs and symptoms, in order to be supportive of those living with such challenges.
They suggested that families supporting elderly loved ones at-risk of, or living with, mental health conditions should be aware of signs and symptoms of mental health issues, and know who to turn to for information, treatment or support.
The families should also learn about the condition and what to expect of those living with it, treatment options and how to manage their medication, and take time out from caregiving to practise self-care.
“This is important for caregivers so as to manage their own mental wellness and prevent burnout,” a spokesperson for AIC said.
Fei Yue Community Services said that families can support their elderly by being more patient and showing empathy when they display symptoms.
“The family’s willingness to adjust their own living lifestyle to fit the elderly’s needs and not the other way round will help and goes a long way too,” its spokesperson said.
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.