An ageing Malaysia
As the nation’s population becomes older, we need more integrated solutions for our elderly to live healthily.
IN the 60 years since independence, Malaysia has managed to increase the life expectancy of its citizens by about 20 years.
And according to Health deputy director-general Datuk Dr Jeyaindran Sinnadurai, this was with a modest budget for healthcare.
“We were able to make these dramatic strides in healthcare despite only spending between 3% to 4.2% of GDP (gross domestic product).
“It goes to show that it is not how much is spent, but how efficiently it is spent, that matters,” he tells Fit for life after attending the “Transforming Ageing With Health Innovation” forum organised by the National University of Singapore (NUS), NUS Enterprise and pharmaceutical company Bayer in Singapore recently.
By targeting primary public health concerns like sanitation, food safety and protection against infectious diseases via vaccination, the Government was able to achieve good outcomes, despite the limited monies.
Dr Jeyaindran notes that while most developed nations took almost a hundred years to achieve this increase in life expectancy, Malaysia and most other Asian countries only took around 50 to 60 years, thanks in part to the many advances in medicine.
However, the country now faces a different healthcare problem as a result.
The increasing incidence of non-communicable diseases (NCDs) like diabetes, hypertension, obesity and cancer, means that more and more people are ageing unhealthily and living longer in ill health.
It also means that we have not had the time to develop the infrastructure and train enough people to handle such a situation.
Dr Jeyaindran says: “Many older Malaysians have not one, but typically three NCDs.
“As such, in order to get significant improvement in quality of life, we need to spend very much more; in health economic terms, we’re facing a situation of diminishing returns – meaning we need to spend far more to see the same degree of benefit!”
It doesn’t help that our demographic is also slowly being tilted towards the older age group with the reduced birth rate, smaller families and couples opting to have children at a later age.
“So we need to take proactive measures to try and be ready to face these challenges of the present and future.
“We need to act now before we are too late,” he says.
Seamless care needed
One measure could be to restructure the wards in our hospitals.
Dr Jeyaindran says: “When older patients get admitted, their average length of stay in hospital is usually much longer.
“There any multiple factors that contribute to this, but we need to find workable solutions.”
He notes that most elderly patients who need to be admitted do not necessarily require an acute ward, suggesting that something called an intermediate care ward might be more suitable.
“Most developed countries have such facilities, referred to by different names such as community hospitals, intermediate care wards or step down care wards.
“All of these entities are designed to optimise the delivery of care in a cost-efficient manner without compromising quality and patient safety,” he explains.
He adds that while this can be delivered in part through the implementation of the proposed Aged Healthcare Act, it also needs to be integrated into the Health Ministry’s healthcare delivery plan.
The act, which is slated to be presented in Parliament soon, is meant to address the care of the elderly.
“This act is needed as the current acts under the Health and Welfare Ministries do not allow for the seamless movement and care of the elderly.
“This is because as one ages, one may move from a state of being independent to semi-dependent and totally dependent.
“This is a dynamic process that can go both ways.
“If a mobile elderly person has a fall and fractures his or her hip, then they suddenly become totally dependent.
“As they recover, they may move to a state of semi-dependency, and finally, may regain independence in movement.
“This new act allows for an individual to be cared for in one facility if it is so designed, or maybe within two facilities,” says Dr Jeyaindran.
He adds that we also need to move from being a doctor-centric system to patient-focused care.
Continuing the earlier example of a patient with a fractured hip, he says that the attending orthopaedic surgeon’s main concerns would be that the hip has been operated on safely and that it is now functional with no sign of infection.
Once that is accomplished, the patient is deemed well enough to be discharged in the eyes of the surgeon.
However, the patient is now bedbound while recovering from the operation and needs help to move about with a wheelchair, impacting directly on themselves and their family.
It may actually be weeks before they are able to get on their feet with the aid of a walking frame.
Dr Jeyaindran shares that this is a situation he has faced personally with an elderly relative.
“So, where does this patient go?” he asks.
Working together
Dr Jeyaindran also notes that there are many other challenges an ageing society faces that are beyond the purview of the Health Ministry.
“We need to make our building and streets elderly-friendly,” he says, citing lift doors that close too fast, pedestrian crossing lights that change from green to red too fast – leaving elderly persons stuck in the middle of the road, and escalators that move too fast.
“Just look around and you will see many elderly people who are still relatively mobile, being challenged by what we younger people take for granted.
“If you have an elderly parent or grandparent, you will know what I am talking about.
“So, there are many other aspects that we need to address when we have a situation where 10% or 20% of the population is over the age of 60 or 65.
“Many are still very alert mentally, so why should they be denied access to public places and restaurants?”
He says that any lasting solution requires the close cooperation of the various ministries and public and private agencies to find a comprehensive solution.
“We need to have a clear vision to face the challenges of an ageing population, and we can learn from other countries like Japan, Korea and Singapore, who have faced these challenges and not repeat their mistakes, as we have the advantage in picking what really works,” he says.