Why Mental Health in Older Adults Often Gets Missed in Singapore
In Singapore today one in four citizens will soon be aged 65 or above. So we see a lot of talk about healthy aging, chronic diseases and dementia. But strangely often mental health in our seniors goes unnoticed. On the surface it might even look like nothing’s wrong – yet inside an older person might be struggling. Why does this happen?
It turns out there are many reasons. Partly it’s generational. Older Singaporeans grew up in a time when talking about feelings wasn’t the norm. Saying “I feel sad” might be seen as weakness or simply “old age”. In fact a national survey found seniors (those 60–74) are least likely to seek help for mental health, compared to younger groups. Many elders tend to keep their emotional pain to themselves, thinking it’s just something that comes with getting older. This stigma or “tough-it-out” mindset can hide depression or anxiety under the guise of normal aging.
There’s also the way symptoms show up. Sometimes depression in the elderly looks very different from how it does in young people. General practitioners in Singapore note that older patients often complain of aches, pains or insomnia instead of saying they feel “depressed”. So a senior might say “My head hurts” or “I’m not sleeping”, and the doctor could chalk it up to arthritis or old age. The mood changes are subtle. GPs describe late-life depression as “insidious”, showing through physical complaints and small behavioral shifts. Because of this, even health professionals can miss the signs unless they dig a little deeper.
Another issue is the healthcare gap. Trust and regular check-ups are crucial for spotting these quiet struggles. According to recent research, having a good rapport with a family doctor is key to finding mental suffering in seniors. But here’s the catch - some older adults simply don’t visit the doctor often, unless something is very wrong. When they do go, the visit may focus on physical issues (blood pressure, sugar levels, aches). There might not be time to talk about mood or loneliness. If seniors skip regular check-ups or only see doctors for urgent issues, opportunities to detect depression early are lost.
Social factors play a big part too. It’s estimated about 34% of older Singaporeans feel lonely. Many live alone or have lost friends and spouses. Without close family around, there may be nobody to notice changes in their behaviour or mood. An older person who is isolated might keep quiet about feeling down, and no one sees the signs. And social isolation itself is a risk for depression. If a senior is not part of community activities and is homebound, it’s easy for family and doctors to be unaware of any decline.
Cultural and language gaps add more barriers. Outreach programs exist (for example, Silver Generation volunteers do home visits, and the government runs mental well-being workshops in community centers). But if the older person speaks mainly a dialect or isn’t tuned into English media, they might not learn about these resources. Singapore’s health messages are often in English, so seniors who read Chinese, Malay or Tamil news might simply miss them. This “language barrier” means some vulnerable seniors slip through the net.
Putting it all together, mental health in older adults can be overlooked for quite a few reasons. Some of the common ones include:
Stigma and misconceptions. Many older folks (and even their family members) see mental illness as a personal weakness or “just being old”. They may not think of depression as treatable.
Subtle or physical symptoms. Seniors often complain of aches, headaches, tiredness or not wanting to get out of bed. Doctors might attribute this to chronic illness or aging, not to depression.
Reluctance to seek help. Some elders worry about bothering others or fear medication costs, so they suffer in silence. They might say “I’m fine” even when they aren’t.
Limited healthcare contact. If an older person rarely visits a clinic, or only comes in for physical check-ups, their doctor has fewer chances to spot any emotional distress. Good doctor-patient trust takes time, but seniors often see many different clinics or skip appointments.
Isolation and loneliness. A third of seniors feel lonely. When there’s nobody checking in, depression can go unnoticed. Family members who do see them might talk only about practical issues (bills, medicine) and miss the emotional cues.
Language/cultural gaps. Seniors more comfortable in dialects or with certain beliefs may not be reached by typical health campaigns. Without culturally relevant information, they may not know depression symptoms or available help.
All of these factors add up. It’s not usually just one thing, but a mix and sometimes the issues reinforce each other.
Caring for Seniors’ Minds - What Can Help
So if someone is wondering why an elderly relative’s mental health was missed, now the reasons make sense. The question then becomes: what can we do about it? Firstly, it helps if family and friends stay alert. Try to notice changes: loss of interest in hobbies, changes in sleep or appetite, more forgetfulness or frequent upset. Gentle, open-ended questions (“How have you been feeling these days?”) can give an elder a chance to talk. Even if they brush it off, that response itself is a clue. Experts say educating ourselves to recognize these signs is important. If a senior mentions feeling useless or excessively worried, don’t just dismiss it as normal aging - it could be the start of depression.
Healthcare providers can also play a bigger role. It’s encouraging that today 17 out of 24 polyclinics in Singapore offer some mental health services, with plans for all to have them by 2030. This means seniors can get psychological help alongside their regular health check-ups. Still, older patients themselves can help by speaking up. Even a symptom sheet for an older patient could include a few simple mood questions.
At Alami Clinic, we see these issues firsthand. Our team specializes in caring for older adults, at home or in the clinic. We know seniors have unique needs, and mental health is part of that. That’s why our approach is inter-professional. Pharmacists, nurses, physiotherapists and psychologists all work together to support each patient. We even have a senior consultant psychiatrist, Dr Chua Sze Ming, who has over 20 years experience treating elderly patients. Having such a team means questions about mood, memory or loneliness are not forgotten during an appointment. We also offer home-based care for patients who prefer it. This way, even seniors who have trouble traveling can get regular check-ins.
What can family or caregivers do right now? If you think a loved one might be depressed or anxious, consider gently encouraging them to see someone. It might help to frame it as a routine check-up: doctors can ask the right questions and suggest counseling or therapy if needed. Community support is also growing - there are befriending groups, exercise classes and peer support services aimed at seniors. The Ministry of Health runs outreach programs in different languages to reach older folks, and there are hotlines (like Silverline or AIC’s CREST team) that provide advice and help. Even if it feels awkward, starting the conversation can make a difference.
The bottom line is that mental health should be part of how we care for seniors, just like checking their blood pressure or diet. By paying attention, talking more, and using the community resources available, we make it less likely that an older person’s struggles will go unnoticed. With the right support, many seniors can feel more connected and even overcome depression or anxiety. Our elders have much to share, and they deserve the peace of mind that comes from knowing someone is looking out for them - in every way, body and mind.