Housewife Linda Loh felt lonely when first her mum and then her dad died more than a decade ago.
Ms Loh, 60, used to spend her free time with her parents as her husband was based overseas for work as a regional accountant.
Then her 32-year-old daughter married in 2012 and moved out. Three years later, her son aged 28 did the same.
"The first few months after they moved out, the house felt so empty," she said.
"I stayed home alone and just did housework or I would go to the market to walk around. I had started to do taiji in the morning, but I didn't know the group well."
She realised then that she wanted to do something about her loneliness. It started with asking one person in the taiji group to go for a community Zumba class.
Today, she attends workout sessions in the community with a group of exercise enthusiasts who call themselves Bedok Sweeties.
Ms Loh is an example of what some Singaporeans are doing to banish that perceived sense of isolation called loneliness.
Singapore's population may be fast ageing and more older people are living alone, but research released earlier this month by the Duke-NUS Medical School showed that while a significant proportion of older adults here are lonely, they are less lonely than before.
One in three Singaporeans aged 60 and older feels somewhat or mostly lonely.
This is a clear improvement from 2009, when one in two older Singaporeans told a survey they were sometimes lonely or mostly lonely.
Associate Professor Angelique Chan, executive director of Duke-NUS Medical School's Centre for Ageing Research and Education, said this is because older adults today are more educated and more likely to be living alone or with only their spouse.
"When you're more educated, if you feel left out, you can think of more creative ways of getting around that."
Befriending programmes have also helped to make them feel less excluded.
To measure loneliness, people were asked if they felt left out, isolated from others and lacked companionship.
Society here generally thinks well of those who live with their parents, but it appears that this arrangement is not always ideal for all the parties.
"Older persons living with children actually had some of the highest levels of loneliness," Prof Chan said. "We can only hypothesise that the children are out at work all day, they come back exhausted and say only a few words to mum or dad... It's more stressful now for adult children than before."
Mum or dad may also have functional limitations, she said.
"Now, fewer people are living with their children and that's why the prevalence of loneliness has declined. It is contrary to what one would expect," noted Prof Chan.
Prof Chan said the decline in the rate of loneliness was more evident for men than women.
This is because older men are more likely to stay in the labour force for a longer period while more women tend to retire at a younger age to care for elderly parents or their children, she added.
"The key thing is that the men are working longer. You see more of them driving taxis or working as security guards, for example. They have more social interaction."
There are cultural differences when it comes to loneliness, with the Chinese the most likely to be lonely while Malays are the least likely to be so. Indians are in between.
It is possibly because Malays have a wider support network, said Prof Chan. The Chinese are more nuclear family-focused and there could be a language barrier between the elderly and their grandchildren, which makes it hard for them to bond, she said.
Many people will not readily admit to being lonely, but loneliness is no small matter.
Studies have associated it with impaired sleep, symptoms of depression, anxiety, poorer health and premature death.
It is linked to increased risk of coronary heart disease and stroke, cognitive decline and an increased risk of Alzheimer's disease.
The problems the elderly have with their health and mobility can make it hard for them to commute and socialise.
Due to their low mood, they may withdraw from people and activities. It is a vicious circle, as the loneliness can worsen their mood, said Dr Neo Li Fang, a senior clinical psychologist at Alexandra Hospital.
And there is evidence showing loneliness can be as bad for health as obesity or smoking.
There is even a group of researchers who think there is a loneliness gene, said Prof Chan.
"It's an area of intense research. Some people are saying it's the new chronic disease," she added.
Loneliness has been labelled an epidemic in the United States. A survey by global health service company Cigna of more than 20,000 Americans aged 18 and older found that nearly half reported sometimes or always feeling alone or left out.
In Britain, where almost one-fifth of the population have said they are always or often lonely, loneliness is taken very seriously.
The government appointed the world's first Minister for Loneliness last year and has come up with a strategy that includes letting children in primary and secondary schools learn about loneliness and the value of social relationships.
In Singapore, community befriending programmes have helped make the disadvantaged elderly less lonely.
"There are about 4,000 ambassadors who go out and talk to people. It's about letting the older people feel that someone cares for them, that they are not left out," said Prof Chan.
She cited the Care Close To Home programme that is offered at 15 locations, including Ang Mo Kio and Kreta Ayer, as an excellent initiative in reaching out to vulnerable older adults who rarely step out of their public rental flats.
"A nurse and five nursing practitioners are embedded in the community and they literally know almost everyone in that neighbourhood," said Prof Chan.
Under the scheme, seniors in rental flats can be cared for while continuing to live in their own homes.
Dr Neo said care and concern shown through actions or even simple conversations can help someone feel less lonely.
Apart from befriending services, the elderly can also get counselling, visit Senior Activity Centres and call The Seniors Helpline, said Mr Lim Wee Onn, a senior clinical psychologist at the Department of Psychology at the Institute of Mental Health.
He added that the strategies to help combat loneliness as suggested by a few overseas studies include raising public awareness of normal and active ageing, apart from the accessibility of community support.
Prof Chan said: "It's also the way buildings are built. We live in high-rise buildings and most people don't say hello. But the Government has been trying to create spaces for people to get together."
Elsewhere, other approaches have also been used. In countries like the US, Britain and Australia, loneliness has been treated with anti-depressants and cognitive behavioural therapy, said Prof Chan.
"Doing both works... It's changing your state of mind."
However, cost is a big barrier, considering an hour of cognitive behavioural therapy in private practice can easily cost $200, she said.
Ms Loh feels the Government's free community exercise programmes have been a godsend.
"I enjoy my exercise and have my kakis (friends)," she said. "I feel happier and healthier now."
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