A new study of the elderly in Singapore has tossed up good and bad news about growing old.
The good news is that people are not only living longer, but also living healthier. Physical problems associated with old age that used to hit people in their 60s now set in only for those in their 80s.
The bad news? Although they are physically all right, many elderly people are lonely, sad or depressed. And this is so even for those living at home with family members.
It gives cause for concern and action, as Singapore's elderly population is set to grow sharply in the coming years, say National University Health System experts behind the study.
'Families sometimes take sadness and loneliness for granted in their elderly, saying it's a part of growing old,' said Associate Professor Rathi Mahendran.
'That should not be the case.'
Raising another red flag, her colleague, Associate Professor Kua Ee Heok, said: 'The big concern is that a rise in elderly depression could cause suicide rates to spike too.'
Staying holed up at home in old age, even when living with family, could leave a person sad, lonely and even depressed.
Close to one in five of 412 elderly people surveyed for a new study showed signs of depression. They were all aged 75 and above, and living at home.
That result in the study by the National University Health System (NUHS) has raised the red flag on old-age depression, given that Singapore is ageing faster than most countries in the world.
ARE YOU AT RISK OF DEPRESSION?
Nearly 21 per cent of those over 80 - and 16 per cent of those in their mid to late 70s - indicated that they were sad, lonely or in low spirits in the study by the research team from NUHS' Department of Psychological Medicine.
Significantly, nine in 10 did not live alone.
Previous studies have shown that those who live alone tend to be more depressed than those who do not.
'What our new study shows is that you might live with others, yet still be alone,' said Associate Professor Rathi Mahendran, who will present the findings at a conference on ageing here on Thursday.
'We need to take heed, given that we're likely to see a rapid rise in our 80-plus population pretty soon - and most will live with family at home.'
There are now 73,000 people aged 80 and above in Singapore. This is likely to rise to 108,000 by 2020 and to nearly 180,000 by 2030, according to projections by the Institute of Policy Studies.
'Families sometimes take sadness and loneliness for granted in their elderly, saying these are a part of growing old,' said Prof Mahendran. 'That should not be the case.'
She added that more resources were needed to focus on studying the needs of the 'old-old' - those aged 80 and above. Past studies have tended to look at those aged 65-plus.
Her colleague, Associate Professor Kua Ee Heok, who has spent more than three decades studying depression and dementia in the elderly, agreed.
'The big concern is that a rise in elderly depression could cause suicide rates to spike too,' he said.
While suicide rates among the very old here are not readily available, raw numbers indicate an upward trend.
Forty-one people aged 75 and above killed themselves in 2010, the latest year for which data is available, compared to 34 in 2006.
That same year, 14 men aged between 80 and 84 killed themselves, the highest figure for that age group in nearly 20 years. The figure for women in the same age group - eight - was the highest in 12 years.
After reaching one of the highest suicide rates in the world for those aged 65 and above - at around 50 per 100,000 in 1995 - the rate dipped to about 24 in 2004, rose to 27.6 in 2007, and stabilised.
In 2009, the elderly suicide rate per 100,000 for men was 28.7 and 19 for women. While this is lower than the peaks of the late 1980s and mid-1990s, it is much higher than in countries such as the United States, where suicide rates have hovered around 14 for those aged 65 and above.
Given the rapid increase in the elderly population, it is possible that Singapore's suicide rates per 100,000 may well remain stable or come down.
But that does not impress Prof Kua. 'The point is that suicide is preventable,' he said. 'And that's what we need to focus on.'
He agreed with Prof Mahendran that particular notice needs to be paid to depression in the very old, saying there were two key reasons to do so.
First, unlike dementia, depression can be prevented and treated more effectively.
The prevalence of depression is double that of dementia and it is associated with a host of physical health problems in old age, he said. 'Families tend to notice signs of dementia and come forward for treatment,' he said. 'Not so with depression - and this needs to change.'
Prof Mahendran's findings on depression are markedly higher than the 7 to 7.5 per cent of respondents in a similar age group who showed depressive symptoms in a larger study published in 2009.
The key difference, she said, is that the earlier study surveyed elderly people in community settings, such as those who attend senior activity or day-care centres, whereas her study was conducted door to door in Jurong and Bukit Merah with people at home.
Studies here have shown that older adults who stay employed or retirees who volunteer have better mental health, Prof Kua pointed out. 'The key is to talk to people - your family, friends, colleagues or churchmates - and remain engaged.'
Volunteers working with the elderly agree.
Ms Jane Lim, 48, has been running socialisation programmes at the void decks of one-room flats in Bukit Merah, Toa Payoh, Hougang and other places.
Her 'Happy Angel Seniors Programme' offers lonely elderly a chance to know their neighbours, make friends and remain alert and active.
Encouraged by volunteers, they sing, dance, perform skits and discuss current affairs as part of the programme. There are 400 participants islandwide.
'We try to reach them early, when they are in their 50s and 60s,' said Ms Lim. 'If we wait till they're 80, it might be too late.'