They call it the golden years of one’s life but, for some seniors, these later years may be overshadowed by psychogeriatric conditions. Among these conditions, dementia and depression are oftenheard concerns that older adults struggle with. According to the Well-being of the Singapore Elderly (WiSE) nationwide study conducted in 2013, dementia strikes 1 in 10 Singaporeans aged 60 years and above while the prevalence rate for depression is 1 in 27.

A decade after the study, the silver lining on the horizon lies in the greater awareness of mental health issues among the public and their increased willingness to seek help. “The COVID-19 pandemic has raised overall mental health awareness across all age groups, and there were more community outreach programmes to reach out to the seniors,” said Clinical Assistant Professor Vanessa Mok, Senior Consultant, Department of Psychological Medicine, Changi General Hospital (CGH), and Project Director of Community Psychogeriatric Programme (CPGP).

Yet, ensuring that seniors can get the help they need continues to be challenging. According to the National Population Health Survey 2022, Singapore residents aged 60 to 74 were the least willing to seek help among the age groups affected by poor mental health.

An ecosystem of care

Clin Asst Prof Mok leads the community mental health team at CGH to provide tailored mental health care for senior residents in the Northeast and Southeast regions of Singapore. She focuses on those who are unable or unwilling to access outpatient services at healthcare institutions. This inability could be due to mobility issues, concerns related to the stigma of mental health treatment, or a refusal to see a doctor. It was observed that some of these residents have not visited a doctor in decades.

The CPGP, which started in 2007, includes psychiatrists, psychologists, medical social workers, occupational therapists, physiotherapists, and other support staff. The multidisciplinary team’s comprehensive synergies enable them to address the gamut of health issues senior residents may face, alongside their mental health struggles. Patients may also be referred to the appropriate specialists or medical services when necessary, strengthening the ecosystem of care provided.

To reach out to more residents, CPGP conducts clinical home visits and partners community social and eldercare agencies. Training is provided to these agencies so that they can offer mental health screenings and support to senior residents, thus aiding in early detection.

Read more: Want to lower your risk of getting dementia? Here are ten ways, click here. 

Going beneath the surface

Early-detection efforts are particularly crucial as it can be challenging to identify signs of a precarious mental state in seniors. After all, a condition like depression can present in various ways.

“The signs are not necessarily sadness, hopelessness, or not wanting to live. Sometimes it can come across as a physical ailment,” explained Clin Asst Prof Mok, citing examples such as giddiness, headaches, heightened irritability, or a marked change in temperament. “The changes can be very subtle, and it is important for someone close to them to identify these changes. As symptoms are different in seniors, it is important to seek help early,” she stressed.

One cautionary point that a caregiver can note and monitor is when significant changes occur in an older person’s life. “For example, loss — of independence, relationships, or health — could be a trigger. It could even be a recent surgery such as knee replacement or a cataract operation; it does not necessarily need to be a major one,” shared Clin Asst Prof Mok. “Any sort of change is a point where we need to pay more attention to how they are coping, whether they need more help, and if they need to connect with a healthcare provider for appropriate assessments.”

A misconception that she would like to dispel is the conventional ideas about growing older that have been inculcated in us over the years. “One of the biggest misconceptions is that these struggles happen to everybody as they grow older — that’s not true. It’s never too early or too much to ask if something is wrong. What is most important is to start asking, so that concerns are identified early and there can be effective and timely treatment,” she said.

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