More seniors in Singapore taking own lives

Nearly 60% jump from figure in 2000; social isolation and physical and mental ill health may be contributing factors
By Janice Tai, The Straits Times, 17 Dec 2015

The golden years are losing their lustre for a rising number of the elderly here, with more taking their lives in the later phase of life.

Last year (2014), 126 seniors aged 60 and above killed themselves. This is a jump of nearly 60 per cent from the 79 seniors who committed suicide in 2000. There were 95 of them in 2010.

While the suicide rate in Singapore has remained at between eight and 10 suicides per 100,000 residents over the past decade, the proportion of the elderly among those who take their lives each year has risen.

In 2000, 23 per cent of suicides here were from among the elderly. By 2010, the group made up 27 per cent, and the number grew to 30 per cent last year.

"It worries us that more of the elderly are turning to suicide as the only choice to end their pain and struggles," said Ms Chan Wai Ping, counsellor at Tsao Foundation's Hua Mei Centre for Successful Ageing.

Ms Christine Wong, executive director of suicide prevention agency Samaritans of Singapore, said suicides among the elderly are "a disturbing indicator of the level of distress they were experiencing in what should be the golden years of their lives". "The majority of the elderly clients who called our 24-hour hotline expressed concerns such as physical and mental ill health, financial and relationship issues, and loneliness," said Ms Wong.

Ms Chan added: "They lose a sense of purpose, lack confidence in coping with further deterioration and don't want to be a burden as their care needs get more demanding."

About a third of the elderly that the centre counselled over the past three years experienced social isolation, a major issue for older adults here. About 32 per cent of older Singaporeans aged 60 and older report being sometimes lonely, and 19 per cent report being mostly lonely, said a study led by Associate Professor Angelique Chan of the Duke-NUS Graduate Medical School.

The study, released last year, found that feeling lonely raised one's risk of dying by 34 per cent over a four-year period, compared with those who were not lonely.

The number of people aged 65 and above who live by themselves has nearly tripled from 14,500 in 2000 to 42,100 last year. The elderly make up about a third of all one- person households here.

While some of these seniors are single from the start, counsellors say many others struggle with adjusting to life after the death of their spouses.

But loneliness is a state of mind and can affect even those who live with family. Prof Chan's study showed that individuals who live alone or live with children are most likely to be lonely, but living with a spouse helps to stave off loneliness.

It is not known if the depression rate among the elderly has risen, but the Institute of Mental Health is working on a $4.4 million study on the well-being of the elderly here to examine this aspect, among others.

Prof Chan said: "As loneliness is a more powerful predictor of mortality compared with living arrangements, programmes that focus solely on older adults living alone may miss a large group of lonely older adults living with children."

Busy schedules and caring for their own children could make adult children less available to their parents, she added.

Experts say people should be trained in mental "CPR".

"It would be helpful for staff and volunteers in welfare organisations to be trained in identifying symptoms of depression, and family members to be able to spot signs of cognitive decline," said Mr Edmund Song, executive director of RSVP Singapore, a non-profit organisation of senior volunteers.

Ms Chan said: "Even when providing services, we need to actively involve and empower the elderly in their own health management rather than have them as passive recipients."

Sometimes, what old people need is simply friendship, as in the case of a man befriended by Mr Tan Chor Koon, 57, who has been making home visits to the elderly with Lions Befrienders since 2009.

The assistant property manager recalled an old man who expressed a wish to visit a friend in Thailand after finding out he had late-stage liver cancer. Dr Chey Chor Khoon, executive director of Lions Befrienders, said: "Mr Tan's friendship has brought meaning, assurance and comfort to his befriendee. He even helped his befriendee to fulfil that extraordinary last wish."

Number of suicides among people aged 60 and above
The Straits Times, 17 Dec 2015

2014 - 126

30% of all suicides

2010 - 95

27% of all suicides

2000 - 79

23% of all suicides

Helplines

• Samaritans of Singapore (SOS): 1800- 221-4444 (24-hour)

• Singapore Association for Mental Health: 1800-283-7019

• IMH Mobile Crisis Service: 6389-2222 (24-hour)

• Care Corner Counselling Centre (Mandarin): 1800-353-5800

• Seniors Helpline: 1800-555-5555

• Touchline (Touch Youth Service): 1800-377-2252

• Tinkle Friend: Children can call 1800- 274-4788 on weekdays

• Aware: 1800-774-5935

• Family Service Centre: 1800-838-0100

His world collapsed when he couldn't walk
By Janice Tai, The Straits Times, 17 Dec 2015

For 30 years, Mr Ho Soon Chye was fine living on his own. But his world collapsed three years ago when his arthritic knees gave way.

He had to use a wheelchair and did away with his usual daily walks to the market to chat with his friends because the journey there involved too many steps for him to manage in a wheelchair.

He could not do simple tasks, such as cooking, and had to turn to his neighbours for help.

"I was in pain and felt so helpless. I did not see any meaning in life any more as I couldn't do what I used to do and there was nobody around," the 75-year-old said in Mandarin. He is divorced and is estranged from his only daughter.

The former odd-job worker slipped into such a deep funk that he needed to take sleeping pills to fall asleep. In the day, he battled loneliness by reading newspapers and watching television.

"I kept worrying about my future and how I was going to cope as the doctor said my legs had no rehabilitation potential," said Mr Ho, who lives in a one-room rental flat in Telok Blangah.

The social worker from the community hospital where he was treated for his limbs referred him to Hua Mei Care Management under Tsao Foundation, which promotes successful ageing.

His counsellor, Ms Loh Yan Zhu, said: "When I first met him, he was teary and anxious."

She helped him deal with his emotions and sought to improve his self-esteem and confidence.

The care management team also arranged for a hospital reassessment of his knees, which were subsequently operated on. After a year of rehabilitation, he can now walk without a walking stick.

"The team encouraged me to take things slowly, and I found the strength to believe in walking again," said Mr Ho.

He is now his jovial self again, and constantly cracks jokes with his neighbours. Whenever Tsao Foundation organises any gathering, he would be the first to sign up. Last year, he travelled to China on his own for a holiday.

Mr Ho said: "I am happier now, and I live day by day. Money is tight as I live on my savings, but I don't think too much. As long as I can walk and eat, I am contented."

Suicides among the elderly

Those who feel lonely 'more prone'
Experts cite loss of loved ones and lack of purpose due to living alone
By Linette Lai and Priscilla Goy, The Sunday Times, 20 Dec 2015

Every once in a while, Mr Wong would see a blue police tent in his grey Kallang neighbourhood.

Once, the body inside the tent was that of someone he knew, an elderly neighbour, said the 60-year-old, who wanted to be known only by his surname.

"He went up to the highest floor, took off his slippers, and jumped down," said Mr Wong, who discovered the details from other neighbours. At least two elderly people commit suicide every year in his area, added Mr Wong, a retired businessman who used to sell bottled water in Indonesia.

His neighbourhood, which lies across the river behind the Immigration and Checkpoints Authority building, has an estimated 3,000 seniors living in one- or two-room rental flats, often alone.

"A lot of these people have nothing to look forward to," said Mr Wong, a single who has been living alone in a rental flat for nearly 15 years. He spends his time reading newspapers or taking walks around the neighbourhood.

Last Thursday, The Straits Times reported that more people aged 60 and above are taking their own lives. Last year, 126 people from this age group killed themselves, up from 79 in 2000.

While the suicide rate among seniors has stayed relatively stable over the past five years - the proportion of elderly suicides has risen in tandem with the proportion of elderly people - there is concern that the absolute numbers could rise further as Singapore's population ages.

There are now around 460,000 Singapore residents aged 65 and older. This figure is expected to double to more than 900,000 in 15 years.

Ms Chan Wai Ping, a counsellor at Tsao Foundation's Hua Mei Centre for Successful Ageing, said: "Some of the elderly folk who have lost their loved ones or friends of many decades feel generally less needed and useful, and they find their new stage of life meaningless.

"When they are not connected with others, they may also have less opportunity to be exposed to more life-affirming perspectives."

In many cases, loneliness, illness or financial woes play a role in driving seniors to take their own lives.

A study of more than 2,500 elderly Singaporeans released on Friday found that those who lived alone were 1.7 times more likely to die prematurely - although not necessarily by suicide - compared with those living with others.

Men who lived alone were nearly three times more likely to die prematurely than their counterparts who lived with others.

The study also found that elderly people who lived alone were about twice as likely to suffer from depression and loneliness.

Mr Edmund Song, executive director of RSVP Singapore, a non- profit organisation of senior volunteers, said: "Some seniors feel lonely as they may be new retirees adjusting to a new phase of life or experiencing the 'empty nest syndrome'."

Elderly people with limited eyesight and mobility issues are also more likely to feel lonely, said Associate Professor Angelique Chan of Duke-NUS Graduate Medical School. She led a study, released last year, which found that feeling lonely raised a person's risk of dying by 34 per cent over a four-year period, compared with those who were not lonely.

The feeling that one's life lacks purpose arises partly from living alone, said experts.

Mr Wong added: "Some people can be very desperate and not know who to go to for help when they run into financial problems."

Others may not want to be helped, for fear of being a burden to their loved ones, said Ms Chan.

Ms Christine Wong, executive director of suicide prevention agency Samaritans of Singapore, said: "The sense of hopelessness and despair at the height of a crisis can cause people to contemplate suicide as a means of escaping their emotional pain and from being a burden to their families."

Experts said many helping hands are required, and members of the public could be educated on identifying signs of suicide risk.

There are welfare groups that organise programmes for the elderly at senior activity centres (SACs) and send volunteers to visit them or take them to their medical appointments.

Prof Chan suggested that more resources be channelled to befriender schemes which specifically reach out to elderly people who may not go to day-care centres or SACs.

But what about those who may not even be willing to open their doors to well-meaning visitors?

Ms Tin Pei Ling, Member of Parliament for MacPherson which has a high proportion of elderly residents, said it is a "labour-intensive" effort for help groups and grassroots leaders to reach out to the elderly. "You need to spend a lot of effort to keep knocking and hopefully break the ice. There are no shortcuts, especially if there aren't family members to help," she said.

As for Mr Wong, he occasionally takes part in activities organised by the SAC located at the void deck of a block near his home, or simply drops by to read the newspapers.

But others, like 69-year-old Mr Ling Teng Hua, prefer the solitary life and do not like group activities. Mr Ling lives alone and has never been married. The retiree used to do odd jobs such as selling fruit and washing cars.

"It's in my character, I don't need to rely on anyone," he said. "By living alone, I can do whatever I like, and there are no problems or quarrels."

Retired tailor Chee Ng Mooi, 67, shares a rental flat with a friend. She is separated from her husband, and sees her three children only occasionally. But she said she is too busy to feel lonely.

She goes for dance classes and karaoke twice a week, and singing lessons once a week.

"To be honest, my children don't take much care of me. Sometimes when I call them for a meal, they don't pick up or they say they're busy," she told The Sunday Times.

"But if you take these things too much to heart, you will die. You have to try your best to find happiness where you can - who else is going to give it to you?"

Additional reporting by Janice Tai

Elderly people more likely to die earlier if living alone
First such study in Singapore says premature deaths may be related to poor care, support
By Kok Xing Hui, The Straits Times, 19 Dec 2015

Elderly Singaporeans who live alone are 1.7 times as likely to die prematurely as those living with friends or family. This is despite both groups having similar number of illnesses, and levels of physical and social activities.

Elderly men, in particular, are almost three times as likely to die earlier if they live alone compared with living with others. Elderly women who live alone, meanwhile, are 1.2 times more likely to die earlier than those who live with others.

These findings, from the ongoing Singapore Longitudinal Ageing Studies, was shared yesterday by Associate Professor Ng Tze Pin from the Department of Psychological Medicine at the National University of Singapore. The study, which was started in 2003, collected data from 2,553 people aged above 55. Of these, 189 lived alone. It followed them up to December 2011. A total of 227 of them died in the period.

Prof Ng said: "They most likely had more serious illnesses that we were not able to measure. And they may have had more serious illnesses mainly because of poor treatment, poor care and support."

He pegged the poor care and support to the lack or loss of a spouse - especially among men - who could have helped to monitor health conditions, adherence to medication routines and keeping medical appointments.

The research also found that elderly people who live alone are about twice as likely to suffer depression and loneliness.

This is the first time research has been done in Singapore on the mortality of the elderly who live alone.

Government projections show that the number of seniors living alone is expected to grow from 35,000 in 2012 to 83,000 by 2030.

Social workers said Singapore should better engage the elderly so that living alone becomes only a housing issue and need not mean that seniors are also without help.

Mr Isaac Teo, manager at Transition Plus interim housing at AMKFSC Community Services, suggested more elderly services be taken into their homes.

He said: "We should create more accessible services, befriend them in their homes, hold activities near their blocks, so they are more visible to voluntary welfare organisations that can help manage their health problems."

Mr Edwin Yim, director of AWWA Family Service Centre, said: "Even a younger person who lives alone needs to be socially connected. But voluntary welfare organisations like Lions Befrienders cannot be doing everything. Neighbours should be able to step in, have a bit of kampung spirit and help keep watch over the elderly, remind them to take their medication and keep doctors' appointments."

South Korea's growing problem of elderly poor
Seniors struggle to survive as tradition of the young caring for the old is dying out amid flagging economy and high living costs
By Chang May Choon, South Korea Correspondent, The Straits Times, 19 Dec 2015

Every morning, be it rain, shine or snow, 81-year-old Im Kwi Ho would travel for an hour on the subway from his home in the western city of Gimpo to Jongmyo Park in central Seoul 18km away, to spend time with his friends there.

On some days, they would join a queue to get free lunch at a nearby charity kitchen.

"I come here every day, 365 days a year. There's lots to do here, like chatting with friends or playing a game of Korean chess, and we can get free meals sometimes," says Mr Im with a hearty laugh.

It's a laugh that belies the harsh realities of ageing in a country where the life expectancy is one of the world's highest at 82.4 years but the fertility rate is one of the world's lowest at 1.21 children per woman, and where the tradition of the young caring for the old is ebbing away amid a flagging economy and high living costs.

After decades of hard work to build Asia's fourth-largest economy with a per capita GDP of US$27,970 (S$39,500), South Korea's elderly are struggling to survive with little savings and high debts.

Nearly half of the country's 6.4 million senior citizens aged 65 and above live in poverty, according to government data.

Those aged 60 and above also have the highest household debt burden among 15 advanced countries, a recent study by the Korea Development Institute (KDI) showed. Their debt-to-income ratio of 161 per cent is the result of a poor pension scheme and the habit of delaying housing loan repayments until after retirement, said the think-tank.

Mr Im, who lives with his wife and daughter, shakes his head when asked if he has enough money to get by. He has not worked for more than 30 years. He has no pension. The money that he had scrimped and saved from years of working as a construction worker has run out.

He says his two children give him some cash, and he gets 130,000 won (S$155) every month in disability claims from the govern-ment for his knee injuries. He spends it mostly on food - a bowl of noodles costs around 3,000 won in the neighbourhood of Jongmyo.

"Life is hard. The government should take better care of us, but their excuse is always that they don't have enough money," he laments.

The administration of President Park Geun Hye had promised in 2013 to provide broader welfare to the young and old without a tax hike, but has shown limited result, given the stagnating economy.

A basic pension programme was launched last year to give up to 200,000 won to people aged 65 and above whose income bracket falls within the lowest 70 per cent. Low-income earners are often defined as those who take home less than 250,000 won a month.

By the end of last year, nearly 67 per cent of all the elderly, or 4.35 million of them, were receiving a basic pension, the Health Ministry said. Over 93 per cent of them receive the maximum amount of 200,000 won, but critics say the money is barely enough to cover living expenses, not to mention healthcare.

Proposals to raise the retirement age from 65 to 70 have been criticised as the government trying to stint on welfare spending.

AGEING TOO FAST

Ms Yun Hee Suk, director of KDI's public finance and social policy department, says: "The government is trying to address the issue, but the problem is that Korea is ageing too fast and the physical condition of the elderly is deteriorating too quickly. It's not easy to put a lot of money in elderly welfare, we have to find the right policies."

Time is not on their side.

In May, the government revealed that senior citizens in Seoul have outnumbered children for the first time. There were 1,234,181 people aged 65 and above living in the capital city, slightly higher than the under-15 age group figure of 1,232,194.

If the elderly population in Seoul continues to grow by about 60,000 a year, they will make up 14 per cent of the total population in the capital city by 2018, according to estimates.

The figure for the whole country is set to be even higher, with projections that senior citizens will comprise 24.3 per cent of the total population by 2030 - similar to Singapore and Taiwan - and 32.3 per cent by 2040. This would create a big burden for the workforce that is shrinking due to low fertility rates.

It is also worrying to see that about 74 per cent of these poverty-stricken elderly folk live alone, and many of them are not socially active and have no social support.

Figures from Statistics Korea show that 39 per cent of all Koreans aged 85 and above, as well as 55.7 per cent of unmarried elderly folk and 47.8 per cent of elderly divorcees, live in isolation.

Loneliness has been cited as a main reason for suicide by senior citizens. They have the highest suicide rate in the country, with 50.3 out of every 100,000 elderly folk killing themselves, compared with the national average of 29.1.

A study this year by the Korea Institute of Criminology shows that elderly men are especially prone to suicide, partly due to a loss of social status and economic power, illness and loneliness. The most vulner-able group was men in their 80s, followed by those in their 70s and 60s.

Some poverty-stricken old folk have been forced to live in the streets. There were 12,656 home-less people of all ages as of 2013.

Odd-job worker Chung Chang Gil, 63, has been living out of two suitcases for two years. This reporter found him resting in a corner of Yongsan Station, a major railway station which provides shelter to dozens of homeless men at night, especially in winter.

He says he has been travelling around the country to look for his parents, who abandoned him when he was a baby. He would find temporary work in warmer months, but has stopped since the weather turned cold.

Mr Chung, who never married, now survives on monthly disability claims of 220,000 won, for injuries he suffered on the right side of his body while doing construction work. He spends the money mainly on food. "I don't drink or smoke. I have no friends. I'd write every day to record my life," he says.

When asked if he is worried about his future, he replies: "No, I just want to find my parents if I can."

Mr Ham Ik Soo, 62, has also been living in the streets for two years. He left his son's house after he divorced his wife. "Life is hard, but I'd rather live by myself. I can still find work to do, so I'm okay," he tells The Straits Times at Seoul Station, another major railway station, where he was spotted alongside three other homeless men.

LONG-TERM CARE

Elderly folk rejoining the work- force have contributed to an increase in the number of temporary workers in South Korea. In August, there were about 1.32 million people aged 60 and above engaged in temporary work, an 11.1 per cent hike from the year before.

More senior citizens have to fend for themselves now, with the erosion of Confucian values and the tradition of children taking care of their parents in old age. Govern-ment polls show that the percent-age of children who are willing to look after their parents has declined sharply, from 90 per cent to 37 per cent over the past 15 years.

"The older generation lived through hard times and they are poor compared to the younger generation, but the young take it for granted that they don't have to care for their parents," says Ms Yun.

As of 2012, 103,973 elderly Koreans lived in 4,079 nursing homes, according to the Health Ministry. These figures are expected to grow steadily in the future, as family bonds weaken and the demand for such long-term care rises. In 2001, only 7,864 elderly folk lived in 128 nursing homes. The increase is attributed to the country's rapidly ageing population in a Woosuk University study published in 2013.

The government introduced a long-term care insurance system in 2008 to ease the burden on home caregivers and improve the quality of life for the elderly.

It has also been encouraging senior citizens to remain economically active, setting up elderly support centres in key districts in Seoul to create customised jobs for retirees and organise activities for them. The centres also provide free meals and aid to the poor and frail.

There is also help from more ground-up initiatives, like the Korea Legacy Committee that was founded in July by eight young professionals led by senior corporate development director Mike Kim.

The organisation has raised 3 million won from two fundraising events for the Seoul Senior Welfare Centre, and Mr Kim said they plan to expand next year to involve thousands of young people donating money or volunteering at the welfare centre. "We are able to enjoy our lives now because of sacrifices that our grandparents' generation made for us. It's our responsibility to give back to them," he said.

Separately, the privately run National Volunteer Federation operates 26 charity kitchens around the country to provide free meals to 6,000 senior citizens.

The kitchen in Seoul, named Angel Free Food Service, can be found opposite Jongmyo Park. A staff member, who declined to be named, says they provide lunch to 300 elderly folk on Tuesdays, Thursdays and Saturdays. They serve oxtail soup, seaweed, kimchi, acorn jelly and rice.

"Our menu is catered to the needs of the elderly. For example, oxtail soup is good for their knees," she says. She declined to reveal the cost of each meal, but oxtail soup can easily cost 10,000 won at eateries.

Mr Chang In Soo, 83, raves about the oxtail soup when approached by The Straits Times, calling it the best he has eaten. The retiree, who lives with his son's family, has been visiting Jongmyo Park to meet friends since his wife died two years ago.

Retiring from construction work five years ago, Mr Chang gets a basic pension of 200,000 won a month, and his daughter-in-law gives him an allowance too. "I have to ration my spending because the money is not enough, but I'd rather be thrifty because greed knows no bounds."

When asked if he thinks his pension should be raised, he says: "I don't wish for it, but if I do get more money, I'd give it to my two grand-daughters who are in university. It's more important to be happy and thankful for what you have."