'Support the elderly socially but let them control their lives'

Giving an elderly parent or older sibling a hand with cooking dinner or household chores may not help them in their battle with depression, a new study has found.

When older adults receive various forms of social support such as money, food, clothing and help with housework from family members, their depressive symptoms went down, the findings show. But there was also an opposite effect. Being the recipients of help made them feel they were not in control of their lives. This loss of control in turn also increased their depressive symptoms, counteracting the positive effect of receiving the aid.

This "mixed blessing" was discovered by researchers Rahul Malhotra and Shannon Ang, from the Centre for Ageing Research and Education (Care) at Duke-NUS Medical School, who analysed data from surveys of 2,766 adults aged 62 to 97.

It is the first study in Singapore to demonstrate the simultaneous negative and positive effects of social support among older adults, and the researchers say it has implications for policymaking.

Existing studies have shown that receiving social support can help to improve a person's mental health, but other studies have also found that obtaining social support may not have an effect.

Findings from this new study, published recently in the journal Social Science And Medicine, also found a gender difference. Women tend to lose more of their sense of control over life when they receive help, compared to men.

The researchers said the difference could be because traditional cultural expectations situate the female primarily within the household. So older females may attach more importance to their roles in the family and therefore feel a keener sense of loss when they become recipients of help instead.

"Our findings have implications for policymakers because they point towards the importance of crafting policies and encouraging ways to provide support to older persons that can help them maintain their sense of control over their own lives," said Assistant Professor Malhotra, Care's head of research.

"We need to think of ways in which we can help older adults without increasing their sense of dependence."

Asked how much social support ought to be offered to older adults, he said: "It depends on each individual but we need to talk to and listen to them so that they either participate in the process or have a voice in it."

Duke-NUS' Associate Professor Angelique Chan, who is also an associate professor at the sociology department of the National University of Singapore, said the findings show the provision of social services ought not to be too heavy- handed. For instance, if volunteers were to show up to help clean up a house, they should not do everything for the elderly.

"They can help buy the cleaning agents or move heavy furniture for them but they should involve the elderly in cleaning up parts of their own houses," she said.

On a larger scale, infrastructure in the community should encourage older adults to stay autonomous as long as possible.

Fostering a dementia-friendly community in Yishun, where shop owners and people in the neighbourhood know how to tend to dementia sufferers, is one example of empowering the elderly to get out of the house and remain independent despite their illnesses.

"Beyond basic subsistence and safety, what we yearn for is purpose, meaning and self-actualisation," said Ms Peh Kim Choo, chief of programmes at Tsao Foundation.

"The challenge is for systems and services to leverage on this positive drive for self-mastery and independence."

jantai@sph.com.sg

This article was first published on March 5, 2016.
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