Janet Gunasekera Jansen is 81 and has high blood pressure, diabetes, glaucoma and arthritis. Medical check-ups are very much a part of her routine, but she is not so mobile now. She doesn’t drive and is not fit to deal with the rigours of taking public transportation.
“When I was younger, I used to travel everywhere by bus and train. These days, it’s harder as my knees are weak and I’m not as agile as I used to be. As I have poor balance, I have fallen on uneven pavements numerous times,” says Janet who lives with her son.
He takes her for check-ups but there are times when he can’t get away from his work commitments.
Fortunately, the grandmother-of-three is a member of the Happy Garden Basic Ecclesial Communities (BEC), whose members are Catholics living around Happy Garden in Old Klang Road, Kuala Lumpur.
One of BEC’s core objectives is to help those in need, such as the elderly and the poor. BEC has long recognised mobility is an issue with the elderly, and its members offer them lifts to church meetings and events.
They also help drive them for their medical check-ups. Janet knows she can call on her neighbour and fellow BEC member Sonia Michael whenever she needs transportation to the clinic.
For the past five years, the 30-year-old businesswoman has been driving Janet to the clinic, BEC meetings and church events. Janet has offered to pay Sonia for driving her, but she has refused any form of payment from her elderly neighbour. To Sonia, it’s all part of providing community support for the elderly.
“How can I accept money from Aunty Janet? She’s like my grandmother. The cost of living is rising, and many senior citizens feel the pinch as they don’t earn a steady income. Many of our BEC youths do our bit to help our seniors. We have helped them move furniture, accompany them to the post office or home visits whenever they are unwell,” says Sonia, adding they organised a dinner for Janet on her 81st birthday last month.
As of 2017, the number of people aged 65 years and above is about two million or 6.3% of the total population. Universiti Malaya’s Social Wellbeing Research Centre projects that the number of Malaysians aged 60 and above will reach 3.5 million in 2020 and 6.3 million in 2040.
As our population ages rapidly, there is more and more need for support services for the elderly. Traditionally, the family is expected to take care of their elderly members’ needs but that is not always feasible these days with growing lifestyle demands and smaller family units. More of the elderly are also living on their own, whether by choice or circumstances.
And as much as the elderly try to be independent, there will come a time when they may require help. Family neglect of elderly patients is one of the concerns of University Malaya Medical Centre (UMMC)’s Department of Medical Social Work, says its medical social worker Suriani Mohamad Hasim, 53.
“Some patients in the geriatrics ward don’t have any visitors, be it family members or friends. This problem could be due to factors like poor family support, family dynamics and financial constraints.”
Often, Suriani steps in after receiving reports of neglected elderly patients. She’d contact the patient’s next of kin to determine the next plan of action.
“A family conference, with the patient’s family, will be organised at our department. We will discuss the best possible caretaking actions once the patient is discharged,” says Suriani, who also does home visits to check on how ‘environmentally friendly’ the patient’s living arrangements are.
In our Asian culture, the responsibility of caring for the elderly often falls on their children’s shoulders, says Suriani. But she has seen how this can be challenging, especially as children have to juggle between work and raising their own families. Often, a foreign helper is hired as the primary carer.
“To enable senior citizens to live comfortably, geriatric nurses and occupational therapists can help train caregivers on caring for the physical and mental needs of the elderly.”
Community and structural support
UMMC’s head of medicine and consultant geriatrician Prof Shahrul Bahyah Kamaruzzaman is all too familiar with Janet’s plight. Many of her senior patients also face transportation problems getting to clinics and hospitals.
“Failing to turn up for follow-up treatments could worsen their health problems, and lead to a host of other medical issues. On an average week, UMMC sees easily over 3,000 outpatients, within various specialties. It is the patient’s and their family’s responsibility to keep tabs on these appointments,” says Prof Shahrul.
Lily Fu, 70, who blogs on elderly issues at SeniorsAloud, says there should be more emphasis on transportation services for seniors.
“While there are transportation services available to pick up senior citizens for their medical checkups, there is no coordinated effort to promote these services for better public awareness of their existence. Few elderly know that Grab and some start-ups with apps offer such transport services. All hospital websites should provide a contact list of such transport services,” says the retired teacher.
There is a need to not only address the elderly’s transportation needs, but also to look at all the issues associated with ageing in a more comprehensive manner.
Prof Shahrul says Malaysia need better infrastructure, and we need to devise stronger policies and spur community engagement to cater to the growing number of seniors.
“A cohesive and inclusive medical support system is crucial for all citizens, especially those who are vulnerable like the elderly. There should be awareness and understanding of the value in elderly care, as we will all be facing old age. We are making progress in certain areas of care including access to health clinics, awareness of problems in the elderly like falls, dementia care in tertiary centers, senior citizen counters at pharmacies and senior citizens activity centre (PAWE) to name a few.”
She adds that the family/caregiver who cares for senior citizens should explore options within the community and hospitals.
“At hospital level, there should be a move towards creating age friendly facilities and services not just for the old but across ages and abilities. An older person may not just have mobility problems but also other issues like forgetfulness and have visual and hearing difficulties. The flow of services provided should consider all these factors. It would help greatly if friends or family accompany such patients.”
Fu also suggests practical steps such as setting up a National Healthcare Registry so that patients’ medical records would be readily accessible to all doctors.
“This will help, instead of having patients bring along all their medical records, or fill in their particulars each time they see a different doctor. With a growing ageing population, we also need more healthcare professionals trained in geriatric care and palliative care, and also more gerontologists. The latter will help to promote active healthy living to senior citizens,” says Fu, adding Malaysia needs more health awareness campaigns, talks and road shows.
Fu believes it is equally important to drum into every Malaysian that we are ultimately responsible for our own health.
“The government cannot be expected to provide long term care for every elderly with chronic illnesses. Resources are always limited. So it makes good sense to focus on promoting healthy lifestyle. Have a five-year Action Plan for Healthy Living. We must adopt a broader perspective that goes beyond physiological needs.”