An age­ing Malaysia

As the na­tion’s pop­u­la­tion be­comes older, we need more in­te­grated so­lu­tions for our el­derly to live healthily.

The Star Malaysia - - Senior Health - By TAN SHIOW CHIN starhealth@thes­

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.

El­derly and mid­dle-aged peo­ple ex­er­cise with wooden dumb­bells dur­ing a health pro­mo­tion event to mark Ja­pan’s “Re­spect for the Aged Day” at a tem­ple in Tokyo’s Sug­amo district. Dr Jeyain­dran says that we only have to look to Ja­pan to see where Malaysia...

Dr Jeyain­dran, shown here in a filepic, says that we need to take proac­tive mea­sures to try and be ready to face both present and fu­ture health­care chal­lenges. “We need to act now be­fore we are too late.”

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