The Situation in Singapore today

Since 1999 was designated the “International Year of Older Persons” by the United Nations, the UN set up a set of principles for older persons. They are: independence, participation, self-fulfillment, care and dignity. How apt then that these principles should come to the fore today, in the new decade of the 2000s and beyond.

Ageing Population

Now, more than ever in a world of globalisation, nations like Singapore and Japan, that are industrialising quickly and growing economically are all aware that they have an increasing 'ageing population'. With a growing elderly population, decision makers are confronted with the need to make choices that affect society as a whole. Health systems, social services and employment practices need to be reshaped in order to respond adequately to this. At the end of June 1996, the resident elderly population (>65yrs) was 209,700. In 2000, it was 234,500 and by 2030, the number would have risen to 798,600. Former US President John F Kennedy’s quote has often been sighted when presenting the challenge to meet the needs of the elderly: “It is not enough for a great nation merely to add new years to life, our objective must be to add new life to the years.”

Role of VWOs (Elderly Care)

However, for a Welfare Service provider like SWS, the question cannot possibly entail its gargantuan scope, and cannot be about demographics and rationalising reasons for an ageing population or the methodological solution to it. When it comes to providing welfare services, the core focus for a Welfare Organisation is on the provisions for the availability and quality of such services to match this ever increasing need in Singapore today. SWS joins a host of several nascent and established VWOs here in Singapore in providing such services in the hope of providing assistance.


Approach to the Elderly

In line with the sentiment of adding "new life to the years" instead of adding new years to life, the following approach to the care of the elderly should be seriously considered:

Give the Elderly a Place In The Community By:
• Prevention, early detection and effective treatment of all diseases especially those known to result in long term disability
• Engaging them in productive and stimulating physical and mental activity including suitable employment and social recreational activities
• Setting up a wide range of services to care for those that need various degrees of care, and encouraging them to continue to be engaged in the community and be with family and friends as much as they are able to.

Set Up Care Services Providing:
• Care management services
• Flexible and responsive services catering to the whole continuum of needs and services required by the frail elderly and their families
• A holistic approach that encourages involvement from service users in the decision-making process for care management.


Health and Needs

A survey of senior citizens done in 1995 showed that more elderly people aged 55 years and above (85.2%) reported to be in good health compared to 1983 (69.4%), and there are less folk reported for being hospitalized (7% vs. 8.2%) at these two time points.

However, more than one quarter reported having at least one chronic illness:
• High blood pressure 52.2%
• Diabetes mellitus 31.7%
• Heart conditions 16.7%
• Rheumatism/arthritis 10.9%
• Stroke 3.0%


It is likely that more chronic problems will appear in the future because of three factors:

1. Better medical technology
2. Longer life span
3. Changing lifestyle and diet

Chronic Problems Anticipated
• Alzheimer’s disease
• Arthritis
• Dementia
• Diabetes mellitus
• Disabilities resulting from stroke and heart disease


Statistics on the Elderly Sick


Mobility Status of the Elderly Sick (aged 55 and above)
1. Bed-ridden 0%
2. Require walking sticks >60%
3. Need supervision with walking aids >30%

What Are the Needs of the Elderly Sick?
1. Shopping, marketing 56.7%
2. Laundry 56.1%
3. House cleaning 55.4%
4. Bathing 27.0%
5. Feeding 20.3%
6. Toileting 18.9%



Profile of the Elderly Sick
1. Economically active 51% below 60 yrs old
2. Have children, domestic helper or spouse 82%
3. Currently married 69.7%
4. Have children 72.8%
5. Not working 55.9%
6. Living with elderly 96.7%
7. Long-term care givers of 5 years or more 57.8%





  What about the Care-givers?

Who Are the Care-givers Of the Elderly Sick

1. Spouse 22.9%
2. Children 34.5%
3. Relatives 13.8%
4. Maids 24.8%
5. Others 3.7%

Effects on Care-givers

1. Social life suffered 30.5%
2. Health suffered 22.5%
3. Felt resentment toward family members who do not help 19.9%
4. Felt depressed about the demands of the role 27.1%

Institutional Care

When Is Institutional Care Needed?
Institutional care should be the last option and should be necessary for certain periods only for the following situations
• Acute deterioration of physical condition
• Treatment regimes, for example cancer chemotherapy
• Rehabilitation
• Respite for caregivers is needed

Depression in the Elderly

What Causes Depression in the Elderly

- Decline in coping abilities, together with the biopsychosocial stressors and life events in later life, such as loss of spouse, retirement, social isolation, physical illness, surgery, economic deprivation, poor living conditions, reduced independence and limited mobility

- Age-related biological vulnerabilities include reduction of chemical messengers in the brain (neurotransmitters), degeneration of brain cells and disorders of the nervous system.

Epidemiology of Depression in the Aged:


  Majority of severe depressions occurring in old age are relapses rather than the new late-onset disorders.


  Depression is most the prevalent mental health problem in the elderly. Women have higher rates of depression most of their life spans, but by age 55, men are beginning to catch up and perhaps even surpass women by age 80.


  Prevalence of depression is between 10-20% of the population aged 60 and above.

Features of Depression in the Elderly:


  Depression in the elderly tends to be more severe and debilitating and can be more difficult to treat than in the younger age group


  Suicide risk is higher (25% compared to 13% in younger patients)


  Recurrence is common and more frequent.


  Co-morbidity with anxiety and physical disorders is often present.
Special Considerations in the Treatment of Depression in the Elderly

Elderly people are more prone to sensitivity and side effects of drugs. Increased risk of drug interactions is important in the elderly, who often take large numbers of different drugs.
Depression in the elderly may easily be missed because of the bizarre symptoms, frequently of a physical nature which an elderly can present. Very often too, depression may be misinterpreted by family members as part of inevitable impairment of functioning. If left untreated, depression leads to needless despair, psychosocial deterioration, economic loss, physical illness and institutionalization.