Mental well-being is often overlooked when caring for elderly. In many instances, signs and symptoms of deteriorating mental well-being in elderly are dismissed as a normal part of aging , which may lead to the worsening of their mental health and development of depression, anxiety and other mental illnesses.

Mental health is just as important as an elderly's physical health. In fact, if certain mental illnesses such as depression is left untreated, it can negatively affect an elderly's recovery from serious health conditions such as heart disease.

How common is depression among elderly in Singapore?

In Singapore, 6% of the elderly population (65 years old and above) have depression. In 2019, 30.5% of suicide cases were elderly 60 years old and above.

The following risk factors can increase the risk of an elderly having depression:

• Physical illness (e.g. diabetes, heart disease, cancer)
  • Having depression can also increase the risk of physical illnesses
• Disability (e.g. amputation)
• Loneliness
• Lack of physical exercise

Certain medications treating other health conditions can also cause depression, especially in elderly more prone to depression. These include, but are not limited to:

• Drugs to treat Parkinson's Disease (e.g. levodopa)
• Hormone drugs
• Anticonvulsants which are medications used to treat seizures (e.g. topiramate)

How do I know if the elderly in my family have depression?

Symptoms of depression in elderly can be hard to notice since they are often similar to symptoms of other health conditions such as dementia. Hence, it is important for family members and friends to be alert so that early intervention and treatment can be possible.

Signs and symptoms:

• Lack of desire/ interest in activities that were previously enjoyable
• Repeated panic attacks
• More irritable and sudden anger outbursts
• Feeling constantly sad or moody
• Becoming more socially withdrawn (e.g. refusing to accompany family or friends)
• Sudden change in eating or sleeping habits (e.g. eating or sleeping too much or too little)/ Sudden weight loss
• Inability to concentrate
• Constantly feeling tired
• Having negative feelings (e.g. guilt, helplessness, worthlessness)
• Having thoughts of suicide
• Slower body movements, thinking and speech

If multiple symptoms persist for a 2-week period or are severe enough to disrupt relationships or day-to-day activities , he or she may have clinical depression (major depressive disorder) and may need to seek help.

If an elderly constantly displays some of these symptoms but mildly, please also pay more attention since it could develop into a mental health condition in the future if no action is taken.

What should I do if an elderly has depression?

Having support from one's family members is very important for one's road to recovery. Family members of the elderly should take time off to get to know about the mental health condition , such as the treatment options, symptoms and how to provide care for the elderly.

Persuading the elderly to attend workshops to get to know more about their health condition is also important.

The following are tips on what family members can do as the role of a caregiver:

1. Encourage the elderly to lead an active lifestyle

Arranging and attending activities with the elderly can prevent social isolation and engage in regular exercise , which can help to bring about positive feelings. Some activities can include yoga or Taichi.

2. Having a support system

Visiting and spending time with the elderly regularly can help to build a support system within the family. This can encourage the elderly to confide in the family members about their concerns and emotions without being judged, which can help the elderly to feel less lonely and more supported.

3. Helping the elderly to find a sense of purpose

Entrusting the elderly with a responsibility such as watering plants or doing simple chores can provide the elderly with a sense of purpose and avoid negative emotions such as worthlessness.

Helping the elderly to find a hobby and participating in it together can also provide the elderly with a way to occupy their time. Setting and working towards goals provides a sense of accomplishment. Social activities such as chess or dance classes for seniors can also encourage social interaction.

4. Encourage the elderly to seek professional help

While support from the family is important, seeking professional help for treatment is also important in the road to recovery. Having open discussions about the topic and gently helping the elderly come to terms with their health condition is the first step to encouraging them to seek treatment.

Social stigmas may cause the elderly to be reluctant to seek help, hence it is important that the caregivers are empathetic and patient.

5. Consider hiring professional caregivers

Being a caregiver has a lot of roles and responsibilities which the family members may not be able to take up. Professional caregivers are trained in helping the elderly in their daily activities and identifying what the elderly may need. Hence, they may be able to devote more attention and time to caring for the elderly.

What are some possible treatment options?

A holistic approach is recommended for treatment of depression.

Lifestyle change

Family members should help the elderly and encourage them to:

• Eat healthily (e.g. prepare healthy meals for them to heat up easily)
• Exercise regularly (e.g. schedule and participate in physical activities with them)

Elderly may not take the initiative to make changes in their lifestyle, due to loss of appetite and other symptoms of depression, hence it is important for the caregiver and the family to play an active role in helping them to recover.

Medication

Antidepressants are usually the first line of treatment. They are prescribed based on factors such as if there are any other pre-existing health conditions , if overdose on the medication is lethal etc.

The following are two of the most common types of drugs prescribed:

Common side effects of antidepressants in general:

• Dryness of the mouth
• Constipation
• Dizziness
• Drowsiness
• Nausea and discomfort of the stomach

Psychotherapy/ Counselling

This method of treatment, also known as talk therapy, involves talking to a professional. This form of treatment may be more beneficial to elderly who have recently lost a loved one or have excessive negative thoughts and emotions.

During these sessions, the professional will help the elderly to learn to think more positively and identify past issues and problems that may be causing or triggering their depression. Through the guidance, the elderly can learn how to cope and recover from their health condition.

Creative arts therapy

These can include art therapy, dance therapy and music therapy etc. Creative arts can provide the eldelry with an outlet to express themselves freely , helping them to discover a sense of self and reduce stress. Furthermore, it encourages physical activity in the case of dance therapy and provides opportunities for social interaction.

Pet therapy

This form of treatment, also known as animal-assisted therapy , helps the elderly through sessions where he or she can interact with a trained pet , usually a dog. The presence of an animal can reduce stress and encourage touch through petting , which can help the elderly cope with negative thoughts and emotions. There are several organisations in Singapore that provide pet therapy.

Helplines

Samaritans of Singapore (SOS)

T: 1800-221 4444

The Seniors Helpline by SAGE (Singapore Action Group of Elders)

T: 1800-555 5555

For more information or if you require a medical consultation, please contact My Healthcare Collective here.