Understanding Elderly Mental Health
As the global population ages, elderly mental health has become an increasingly important issue. In Singapore, where life expectancy is among the highest globally, addressing mental health in older adults is critical. Seniors face a range of emotional, psychological, and cognitive challenges that deeply affect their well-being. Unfortunately, in many Asian cultures, including Singapore, discussing mental health is often seen as taboo, and such problems may be dismissed as a normal part of aging.
Mental health issues in the elderly are also expensive to manage. Dementia, one of the costliest conditions, affects many Singaporean seniors. In 2016, dementia was estimated to cost Singapore about SGD 1.4 billion annually in medical expenses, long-term care, and lost productivity for caregivers (Dementia Research Centre, 2016). This cost is expected to rise, as one in four Singaporeans will be aged 65 or older by 2030. Furthermore, mental health conditions across all age groups cost Singapore around SGD 16 billion annually (Chong et al., 2013), and in older adults, these issues often occur alongside chronic illnesses like heart disease and diabetes, exacerbating healthcare costs.
Understanding Their Needs
Despite their unique life stage, older adults share many common needs as other younger individuals. Maslow’s Hierarchy of Needs is a well-known psychological theory often applied to the elderly to explain their emotional and mental health needs:
Physiological Needs: This includes managing chronic illnesses, mobility, and sensory impairments (e.g., hearing, sight).
Safety Needs: Elders need physical and financial security, including access to healthcare, and safe living conditions.
Love and Belonging: As social networks shrink, emotional support from family and friends becomes crucial. Loneliness can lead to depression and anxiety.
Esteem Needs: Elderly individuals need to feel valued, respected, and independent. Losing autonomy and sense of purpose/ identity can lead to feelings of inadequacy and distress.
Self-Actualization: Engaging in meaningful activities that promote personal growth and self-reflection contributes to mental well-being.
Specifically, cognitive health is a major concern for older adults. While some cognitive decline is normal with aging, severe conditions such as dementia can pose significant mental health challenges. The World Health Organization (WHO) estimates that nearly 50 million people globally live with dementia, many of whom also experience mental health issues. A study by the National University of Singapore (NUS) found that cognitive impairment often precedes the onset of depression in the elderly.
A 2021 meta-analysis further revealed that cognitive decline and depression often co-occur in older adults, creating a feedback loop that worsens both conditions. Older adults who engage in cognitive training and mentally stimulating activities have been found to experience lower rates of depression and anxiety, highlighting the importance of lifelong learning and cognitive engagement (Smith et al., 2021).
Signs of Elderly Mental Health Issues
Recognizing the signs of mental health issues in the elderly is crucial for early intervention. Common symptoms include:
Persistent sadness or depression: Loss of interest in activities once enjoyed, or frequent expressions of hopelessness.
Social withdrawal: Avoiding family gatherings or social activities.
Changes in appetite or sleep: Significant shifts in eating habits or sleep patterns.
Confusion or memory problems: Memory loss or disorientation may signal cognitive decline or early-stage dementia.
Increased irritability or mood swings: Sudden changes in mood or increased irritability may be warning signs of anxiety or other mental health disorders.
The Role of Family in Supporting Elderly Mental Health
Recent research underscores the harmful effects of loneliness and isolation on elderly mental health. A study in The Lancet Public Health (2023) found that loneliness significantly increased the risk of depression, anxiety, and cognitive decline in older adults. This research emphasized the importance of social engagement for mental well-being, particularly as many seniors live alone or face diminished social networks.
In Singapore, a 2020 study found that approximately 50% of elderly citizens experienced social isolation, which was associated with a 1.5-fold increase in the likelihood of developing depression (Ng, 2020).
Family members and close community members play a crucial role in supporting elderly mental health in several ways:
Maintaining communication: Creating a safe environment for older adults to express their emotions can help reduce feelings of isolation. Regular visits, phone calls, and quality time can also create a sense of safety and significance through meaningful connection.
Encouraging independence: While providing necessary support, family members should encourage seniors to remain independent and stay engaged in daily activities to maintain an optimal level of functioning. If they don't use it (skills, abilities), they will lose it.
Promoting an active and healthy lifestyle: Facilitating and enabling active and healthy lifestyle is vital to their wellbeing. This includes making healthy diets and physical exercise accessible and sustainable for them, especially when they are no longer able to independently meet these needs.
Monitoring early changes: Family members should be observant of changes in mood, behaviour, or physical health. These should be investigated rather than dismissed as normal signs of aging.
Seeking professional help: When some issues become difficult to manage, family members should encourage and support their loved ones to seek help from professionals experienced in geriatric care.
Conclusion
Elderly mental health is a complex issue, but with the right support and attention, older adults can maintain a good quality of life. Families and community members play a crucial role, and preventive measures such as physical activity, social engagement, and cognitive stimulation can help reduce the risk of mental health challenges. Proactive observation is also crucial in identifying early signs of changes/ decline to allow timely intervention and support to be given.
References
Chong, S. A., Abdin, E., Sherbourne, C., Vaingankar, J. A., Heng, D., Yap, M., Subramaniam, M. (2013). Treatment gap in mental health care in Singapore. *Singapore Medical Journal, 54*(4), 222–227. https://doi.org/10.11622/smedj.2013066
Dementia Research Centre. (2016). Dementia in Singapore: A cost analysis. National Neuroscience Institute.
Ng, T. P., Chiam, P. C., Kua, E. H., Koh, M. Y., & Ng, R. (2020). Social isolation in older adults in Singapore and its effects on mental health. *International Journal of Geriatric Psychiatry, 35*(5), 501-507. https://doi.org/10.1002/gps.5299
Smith, G. E., Petersen, R. C., Parisi, J. E., et al. (2021). Cognitive training in aging: Meta-analysis of interventions for mental health. *Journal of Aging Research, 33*(2), 121–135.
