Understanding Elderly Depression in Singapore: The Role of Frailty
Published on 29th May, 2019 by Muhammad Haikal Bin Jamil
Trends in Elderly Depression and Suicide
It is widely known that depression usually affects individuals aged between 18 to 29. Not many would think of depression affecting elderly in their supposed golden years. Unfortunately, this is increasingly a reality. A news article by Paulo (2018) highlighted that one in five elderly aged 75 and above in Singapore show signs of depression as a result of chronic illnesses or loneliness.
Although it is not typical for older adults to be diagnosed with depressive disorders, they are more likely than middle aged adults to experience clinically significant depressive symptoms. They are likely to experience a more chronic course of depression due to the presence of other medical conditions and concurrent use of multiple medications. While older adults are more likely to experience other depressive symptoms that do not meet strict diagnostic criteria, lower-severity depressive symptoms should not be underestimated.
According to Samaritans of Singapore (2018), the number of suicides by elderly aged 60 and above hit a record high in 2017 despite a dip in the number of suicide in recent years. This is alarming trend has led to increased attention on elderly depression and interventions to prevent them from falling through the cracks of society.
What is Frailty?
Frailty is a common clinical syndrome found in older adults that is associated with increased risk for poor health outcomes including falls, disability, hospitalization and mortality. Frailty is said to be one of the most problematic issues of an aging population like Singapore’s due to its high prevalence among elderly.
More importantly, frailty does not only affect physical health but also mental health. As a matter of fact, past research has found strong associations between frailty and depression. However, opponents contend that this could be attributed to overlaps between somatic symptoms of frailty and depression. For instance, unintentional weight loss can be associated with both frailty and depression.
The Current Study
This study aims to estimate the prevalence of frailty among elderly in the community and study the relationship between frailty and depression in the elderly.
A total of 721 Singaporean older adults aged 60 years and above took part in this study. An assessment for frailty was administered by a nurse and participants were grouped into four levels of frailty: F1, F2, F3 and F4. F1 is the lowest level of frailty. Older adults in this category are actively involved in recreational or physical activities and experience no chronic conditions. F2 is a low level of frailty, where some bothersome symptoms are experienced. F3 refers to mild frailty. Older adults in this category require little to no assistance in daily activities but may experience mild dementia. F4 ranges from moderate to severe frailty. Older adults who fall in this category require moderate to maximum assistance in daily activities. They may have limited mobility or have severe dementia. The participants also completed a self-report measuring the presence of depressive symptoms.
Findings from the study
This study based on elderly in Singapore replicated the findings of past research – frailty was significantly correlated to depressive symptoms. In fact, depressive symptom scores increased as the levels of frailty increased. The association with depression remained even after accounting for socio-demographic factors, smoking habits, other medical conditions and number of long-term medications taken. This stable association illustrates how frailty and depression are two separate matters despite the fact that they share some symptoms.
The authors suggested two possible mechanisms:
• Frailty could possibly be a risk factor for the development of depression in older adults.
• Functional dependency or disability contributes to the development of both frailty and depression, resulting in the observed relationship.
Another important finding was that frailer participants experienced higher levels of depression even though they were less likely to live alone. It is expected that the frail elderly are more likely to live with at least one family member as they are less capable of independent living. Although these participants were not socially isolated, they were still vulnerable to depression.
Currently, there are considerable efforts in Singapore to prevent elderly depression by targeting social factors. Most interventions aim to increase social connectedness, reduce loneliness and encourage active life participation. While those measures are necessary, this study highlights the need to target physical factors too. Past research suggests that frailty results in depression because of its potentially adverse impact on an elderly’s self-esteem and self-worth (Aggar, Ronaldson & Cameron, 2011). It is important to note that this relationship is moderated by the attitude of the caregiver.
On the individual level, it is important to keep in mind these vulnerabilities that elderly face. Apart from simply spending more time with elderly at home, it is also helpful to monitor their physical condition, preventing it from deteriorating and affecting their mental well-being. If you already have frail elderly at home, be a source of emotional support for them and remind them that their physical condition does not change your love for them. If they exhibit signs of depression, it is advisable to seek professional help.
Aggar, C., Ronaldson, S., & Cameron, I. D. (2011). Self-esteem in carers of frail older people: Resentment predicts anxiety and depression. Aging & Mental Health, 15(6), 671-678. doi:10.1080/13607863.2011.562176
Ge, L., Yap, C. W., & Heng, B. H. (2018). Prevalence of frailty and its association with depressive symptoms among older adults in Singapore. Aging & Mental Health, 23(3), 319-324. doi:10.1080/13607863.2017.1416332
Paulo, D. A. (2018, April 23). 'Like a knife poking my heart': Loss, loneliness and the killing pain of elderly depression. Retrieved from https://www.channelnewsasia.com/news/cnainsider/elderly-depression-lonely-dementia-chronic-illness-treatment-10159670
Samaritans of Singapore. (2018, July 31). Suicide rate lowest, but number of elderly suicide highest recorded. Retrieved from https://www.sos.org.sg/pressroom/suicide-rate-lowest-but-number-of-elderly-suicide-highest-recorded
Article written by Tay Shi Ying. Shi Ying is a psychology undergraduate at the Nanyang Technological University (NTU) undergoing internship with ImPossible Psychological Services.