Relevant studies on ageing – related issues

Geriatric counselling
 

CHAN, M. F., NG, S. E., TIEN, A., MAN HO, R. C., & THAYALA, J. (2013). A RANDOMISED CONTROLLED STUDY TO EXPLORE THE EFFECT OF LIFE STORY REVIEW ON DEPRESSION IN OLDER CHINESE IN SINGAPORE. HEALTH & SOCIAL CARE IN THE COMMUNITY, 21(5), 545–553. http://doi.org/10.1111/hsc.12043 
There is little evidence to support the efficacy of the life storybook creation process, which incorporates the use of narratives, in mediating depression levels. The study aimed to examine the effects of the life storybook creation process on depressive symptoms among older community-dwelling Chinese adults in Singapore. A randomised controlled trial was conducted from January 2011 to March 2012. Twenty-six Chinese aged over 60 years, who were able to communicate in Chinese and/or English, and with mild to severe depression were randomly allocated to either the life storybook (intervention) group (n = 14) or the non-life storybook (control) group (n = 12). Subjects in the intervention group were interviewed on a one to one basis on five sessions over 8 weeks. Depressive symptoms were measured using the Geriatric Depression Scale. Generalised estimating equations were used to examine the effects of the intervention on the elderly peoples’ depression level. Significant reductions in depression scores were found in the intervention group from baseline (mean 7.9 [SD 3.0]) to week 8 (2.5 [1.7], χ2 = 15.25, P < 0.001). At week 8, the intervention group showed a lower level of depression than the control (χ2 = 4.33, P = 0.037). This study supports the life storybook creation process as an effective intervention for depressed older Chinese adults living in the community. The findings suggest that this intervention may enhance the quality of care provided by healthcare providers as the therapeutic relationship between provider and client is being established.

MATHEWS, M. (2016). THE EXPERIENCE OF COUNSELING AMONG A SINGAPOREAN ELDERLY POPULATION: A QUALITATIVE ACCOUNT OF WHAT CLIENTS REPORT AS BENEFICIAL. JOURNAL OF CROSS-CULTURAL GERONTOLOGY. http://doi.org/10.1007/s10823-016-9290-4 
Adjustments that accompany ageing pose a challenge to the mental health of the elderly. Psychologically based counseling has been documented in Western societies as an appropriate intervention for elderly persons with depressive episodes. There is however very little research documenting how Asian elderly populations experience and benefit from counseling. This study addresses this research gap through a qualitative study based on post-counseling interviews with a sample of 41 elderly persons who received counseling at a dedicated organisation catering to the elderly in Singapore. The qualitative data revealed that clients benefitted from counseling through better emotional management - they received emotional support, found emotional healing and learnt to deal with the emotions associated with grief and loss. Clients also reported that counseling assisted them in decision making processes - older persons were able to conceive of alternatives to their predicament, obtained insights to embark on change, were enabled to take the perspective of others and found validation for their decisions. While many elderly clients greatly appreciated and benefitted from this service, citing demonstrable changes, among the very old such changes were uncommon. Cultural explanations for these differential reports and possible directions for much needed future research are provided.

NG, C. W. L., TAN, W. S., GUNAPAL, P. P. G., WONG, L. Y., & HENG, B. H. (2014). ASSOCIATION OF SOCIOECONOMIC STATUS (SES) AND SOCIAL SUPPORT WITH DEPRESSIVE SYMPTOMS AMONG THE ELDERLY IN SINGAPORE. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE, 43(12), 576–587.
INTRODUCTION: Depression in the elderly is a major public health issue. Socioeconomic status (SES) and social support are strong risk factors for depression. This study aimed to investigate the influence of SES and social support in elderly depression, and the modifying effect of social support on the relationship between SES and depression. MATERIALS AND METHODS: A community-based survey was conducted on residents≥60 years old. Depressive symptoms were determined with scores≥5 using the 15-item Geriatric Depression Scale (GDS). Multivariable logistic regression was performed to determine the odds ratio (OR) of depressive symptoms with respect to SES and social support, and interaction terms between the two variables. RESULTS: Of 2447 responses analysed, 188 (7.8%) respondents had depressive symptoms. Living in 2-room housing, living alone/with a domestic helper, infrequent leisure time with children/grandchildren or being childless, and feeling socially isolated were independently associated with depressive symptoms. Relative to residents living with spouse and children in 4-/5-room housing, the highest ORs for depressive symptoms were those living with spouse and children in 2-room (OR: 3.06, P<0.05), followed by living with children only in 3-room (OR: 2.98, P<0.05), and living alone/with a domestic helper in 4-/5-room (OR: 2.73, P<0.05). Living with spouse only appears to buffer against depressive symptoms across socioeconomic classes, although the effect was not statistically significant. CONCLUSION: Low social support and low SES significantly increased the odds of depressive symptoms. The moderating effect of social support on depression was however not consistent across SES groups. Specific interventions need to target different SES groups to better help older adults at risk of developing depression.

NYUNT, M. S. Z., CHIAM, P. C., KUA, E. H., & NG, T. P. (2009). DETERMINANTS OF MENTAL HEALTH SERVICE USE IN THE NATIONAL MENTAL HEALTH SURVEY OF THE ELDERLY IN SINGAPORE. CLINICAL PRACTICE AND EPIDEMIOLOGY IN MENTAL HEALTH: CP & EMH, 5, 2. http://doi.org/10.1186/1745-0179-5-2
BACKGROUND: Despite high prevalence of mental health problems, only a minority of elderly people seek treatment. Although need-for-care factors are primary determinants of mental health service use, personal predisposing or enabling factors including health beliefs are important but are not well studied. METHOD: In the National Mental Health Survey of Elderly in Singapore, 2003, 1092 older adults aged 60 and above were interviewed for diagnosis of mental disorders (using Geriatric Mental State) and treatment, and their health beliefs about the curability of mental illness, embarrassment and stigma, easiness discussing mental problems, effectiveness and safety of treatment and trust in professionals. RESULTS: The prevalence of mental disorders was 13%, but only a third of mentally ill respondents had sought treatment. Increased likelihood of seeking treatment was significantly associated with the presence of a mental disorder (OR = 5.27), disability from mental illness (OR = 79.9), and poor or fair self-rated mental health (OR = 2.63), female gender (OR = 2.25), and formal education (OR = 2.40). The likelihood of treatment seeking was lower in those reporting financial limitations for medical care (OR = 0.38), but also higher household income (OR = 0.31). Negative beliefs showed no meaningful associations, but the positive belief that ‘to a great extent mental illness can be cured’ was associated with increased mental health service use (OR = 6.89). The availability of family caregiver showed a negative association (OR = 0.20). CONCLUSION: The determinants of mental health service use in the elderly included primary need factors, and female gender and socioeconomic factors. There was little evidence of influences by negative health beliefs, but a positive health belief that ‘mental illness can be cured’ is a strongly positive determinant The influence of family members and care-givers on senior’s use of mental health service should be further explored.

NYUNT, M. S. Z., KO, S. M., KUMAR, R., FONES, C. C. S., & NG, T. P. (2009). IMPROVING TREATMENT ACCESS AND PRIMARY CARE REFERRALS FOR DEPRESSION IN A NATIONAL COMMUNITY-BASED OUTREACH PROGRAMME FOR THE ELDERLY. INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, 24(11), 1267–1276. http://doi.org/10.1002/gps.2256 
BACKGROUND: Mental illness is highly prevalent and disabling, but is under-treated. Outreach services attempt to overcome system and personal barriers to care, but there are few reports of their effects in improving access and use of mental health services. In the Community-based Early Psychiatric Interventional Strategy (CEPIS) programme in Singapore, community nurses routinely screened seniors for depressive symptoms, and provided psychoeducation and referral for primary care treatment. We evaluated the impact of the outreach programme and the extent to which determinants of treatment-seeking were altered by removing socioeconomic, physical and cognitive barriers to care. METHODS: Participants were screened using the geriatric depression scale (GDS) and independently assessed using structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnosis. Treatment-seeking at 1 month post-outreach was compared retrospectively to pre-outreach spontaneous treatment-seeking in the previous 1 year. RESULTS: Among 4633 participants, 370 (8%) with depressive symptoms included 214 (57.8%) with diagnosed mental disorder(s). Pre-outreach treatment-seeking was 10.3%. The programme resulted in 73.8% being successfully referred to GP treatment. Pre-outreach treatment-seeking was significantly associated with a diagnosed mental disorder (OR = 2.22), fair or poor self-reported mental health (OR = 3.26), > or = 10 depressive symptoms (OR = 3.18), perceived need for professional help (OR = 3.58), > or = 3 medical comorbidities (OR = 2.67), younger age <70 (OR = 2.55), female gender (OR = 3.58) and at least primary education (OR = 3.06). All but a few of these predisposing and enabling variables were not associated with post-outreach treatment-seeking. CONCLUSION: By eliminating socioeconomic, physical and cognitive barriers, equitable care provided in an outreach programme vastly increased referrals for primary care treatment for depression.

SIN, G. L., & NG, L. L. (2011). THE COMMUNITY PSYCHOGERIATRIC PROGRAMME: A PILOT PROJECT IN THE EASTERN SECTOR OF SINGAPORE. SINGAPORE MEDICAL JOURNAL, 52(7), 463–465.
As the population in Singapore ages rapidly, there is a race against time to prepare for the growing psychiatric needs of this population. The Community Psychogeriatric Programme was set up in Changi General Hospital to provide community mental health services for early detection and treatment of psychogeriatric disorders in the eastern sector of Singapore. The model of care involves working closely with community partners to provide training on mental healthcare in the older person, case discussion and consultation as well as clinical home visits. Efforts to raise awareness of mental health issues faced by our greying population have been encouraging but challenging. We hope that by reducing stigma and raising awareness, early access to treatment in the community will help to keep our older persons in the community for as long as possible.

SUBRAMANIAM, M., ABDIN, E., SAMBASIVAM, R., VAINGANKAR, J. A., PICCO, L., PANG, S., … CHONG, S. A. (2016). PREVALENCE OF DEPRESSION AMONG OLDER ADULTS-RESULTS FROM THE WELL-BEING OF THE SINGAPORE ELDERLY STUDY. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE, 45(4), 123–133.
INTRODUCTION: Depression is a significant public health issue across all sociodemographic groups and is identified as a common and serious mental health problem particularly among the older adult population. The aims of the current study were to determine the prevalence of depression and subsyndromal depression among older adults in Singapore. MATERIALS AND METHODS: The Well-being of the Singapore Elderly (WiSE) study was a comprehensive single phase, cross-sectional survey. Stage 1 Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) depression syndrome was used for this analysis. Association of depression and subsyndromal depression with sociodemographic characteristics, social support as well as comorbidity with chronic physical illnesses and quality of life was assessed. RESULTS: The prevalence of GMS-AGECAT depression and subsyndromal depression was 3.7% and 13.4%, respectively. The odds of depression were significantly higher among those aged 75 to 84 (2.1) as compared to those aged 60 to 74 years and in those who had a history of depression diagnosis by a doctor (4.1). The odds of depression were higher among those of Indian and Malay ethnicities (5.2 and 3.2 times, respectively) as compared to those of Chinese ethnicity. Those with depression and subsyndromal depression were associated with more disability, poorer life satisfaction, and medical comorbidities. CONCLUSION: Our study suggests that the prevalence of depression seems to have decreased as compared to a decade ago wherein the prevalence of depression was estimated to be 5.5%. This positive trend can be ascribed to concerted efforts across various disciplines and sectors, which need to be continually strengthened, monitored and evaluated.

YANG, S.-Y., BOGOSIAN, A., MOSS-MORRIS, R., & MCCRACKEN, L. M. (2015). MIXED EXPERIENCES AND PERCEPTIONS OF PSYCHOLOGICAL TREATMENT FOR CHRONIC PAIN IN SINGAPORE: SKEPTICISM, AMBIVALENCE, SATISFACTION, AND POTENTIAL. PAIN MEDICINE, 16(7), 1290–1300. http://doi.org/10.1111/pme.12745 
There is little research in Southeast Asia focusing on patients’ experiences of seeking psychological treatment for chronic pain.  Objective:- This study aims to understand the experiences of patients seeking psychological treatment for chronic pain in this region.  Setting:- Outpatient pain clinic at a tertiary hospital in Singapore.  Subjects:- People with experiences of attending psychological treatment for chronic pain, including some who were not receiving this type of treatment.  Study design and methods. Fifteen inductive semi-structured interviews were conducted to explore patients’ experiences regarding psychological treatment for their chronic pain. Thematic analysis was then applied.  Results:- Three main themes were identified: ‘Expectations and Realities of Health Professionals,’ ‘Patients’ Attitudes and Beliefs,’ and ‘Practical and Social Factors.’ From the patients’ perspectives, an empathetic health professional who was willing to listen contributed to a positive treatment seeking experience. Patients felt that health professionals’ lack of knowledge about appropriate treatment contributed to their frustration. Patients could not understand how psychological treatment was related to pain treatment and queried why they were ‘paying just to talk.’ Conversely, their experiences were quite positive, and they found psychological treatments helpful when they participated in them.  Conclusion Education for both patients and health professionals unfamiliar with psychological treatments for pain may improve access to these treatments.