In Singapore, with its rapidly ageing population, many of those caring for elderly family members are themselves old and frail.

According to a new study, nearly half of all caregivers are aged 55 and older. About two in three of these older caregivers have at least one chronic disease - like arthritis, diabetes or heart problems - and about one in three described his or her health as poor or fair.

Some 20.3 per cent of the older caregivers show clinically significant symptoms of depression, compared with 15.8 per cent of caregivers aged between 21 and 54.

One of the study's authors, Assistant Professor Rahul Malhotra, head of research at the Centre for Ageing Research and Education (Care), said: "Caregivers are not Supermen. They are also humans, ageing and in need of care themselves. We should not neglect the physical and mental health of these older caregivers."

He and his colleagues polled 1,190 caregivers of Singaporeans and permanent residents aged 75 and older who have problems with at least one activity of daily living, such as walking or going to the toilet by themselves.

They found that 5 per cent of all caregivers were 80 years old and above. The oldest was a 95-year-old man looking after his 83-year-old wife.

This is the first large-scale study of older caregivers here and Care, based in the Duke-NUS Medical School, plans to publish its findings by the end of the year .

The researchers found that:

• 69.4 per cent of older caregivers had at least one chronic disease, compared with 36.5 per cent of caregivers under the age of 55.

• Older caregivers were less likely to receive help from another person, such as a maid, in the past month to help them attend to their loved ones' activities of daily living, than younger caregivers.

• Older caregivers spent an average of 45.6 hours a week on caregiving, compared with 35.1 hours for younger caregivers.

Associate Professor Angelique Chan, Care's executive director and another of the study's authors, said it would be timely to provide more support and services for older caregivers. "We will see more and more of these ageing caregivers who have health issues in an ageing society, as families are getting smaller and more couples are remaining childless."

Besides Prof Chan and Prof Malhotra, the other Care researchers are Dr Bina Gubhaju and Professor Truls Ostbye.

Mr Kelvin Lee, manager at Touch Caregiver Support, said more older caregivers may show signs of depression as they have to cope with the stressful demands of caregiving while dealing with their own declining health.

They also have fewer friends or loved ones to turn to as some of their peers would have died, leaving them even more alone than others.

Ms Anita Ho, assistant director of family and caregiver support at Awwa, pointed out that many of the older caregivers may not know - or want - to seek assistance to help them look after their loved ones.

Many cannot afford to hire a maid, while others feel it is their responsibility to care for their loved ones by themselves. They end up struggling in silence when they cannot cope.

Elderly parents may also not feel comfortable with a stranger looking after them, Ms Ho said.

She added: "The older caregivers tend not to seek help, so we have to find ways to reach out to them."

Miss Sim Shot Wheel, 85, who looks after her younger sister, is perhaps typical of her generation. She is stoic about her situation and does not feel comfortable asking others for help.

Her younger sister, Ms Sim Ah Mooi, 76, a childless widow, suffers from Alzheimer's disease, arthritis and heart problems, and walks with the help of a walking aid.

The older Miss Sim, who never married, also suffers from arthritis, which makes walking painful.

She cooks their meals, does all the chores in their one-room rental flat, watches over her sister and makes sure she takes her medicine, which she is likely to forget.

However, they do take part in activities run by the Awwa Senior Activity Centre, so there are people in the community watching out for them. Awwa staff members also take them for their medical appointments, among other things.

Miss Sim said: "I feel a bit stressed (by the caregiving) as she keeps forgetting about things. I also worry about our finances but I try not to think so much."