Our nation is ageing rapidly. Thanks to medical advances, improvements in hygiene and food supply, Malaysians are living longer. But our infrastructure and services haven’t moved in tandem to keep up with the needs of the elderly.
The concern is not only about the size of the ageing population, but also their health, welfare, care and living arrangements.
Malaysia’s Healthcare National Key Economic Area estimated that the country will reach ageing nation status in just 10 years, with more than 15% of the population being aged 60 and over by then.
Malaysia is not alone in facing the prospect of having an ageing population, nor is this a recent trend. A United Nations report issued in 2002 states that by 2050, the number of older persons in the world will exceed the number of young for the first time in history.
Universiti Putra Malaysia’s Institute of Gerontology director Prof Datuk Dr Tengku Aizan Hamid, says, “We have the policies but they haven’t been implemented. We need to experiment with small things first, then scale up, but our government always starts with a bang and then things fizzle out.
“If you do things incrementally, there will be no hard questioning. Don’t waste the limited resources we have. We will have nothing in place if we don’t plan ahead. The elderly have a heterogeneous background. Less than 5% of Malaysians are poor and eligible for welfare, so they are taken care of.
“Many of our services are in urban areas where people can afford them. So the rich and the poor are taken care of, but there is nothing affordable for those in between. And what about the rural areas?”
She points out that Malaysia needs more social care than clinical care.
“You don’t need to be medically trained but be equipped with caregiving skills to look at these issues. Unfortunately, our insurance doesn’t cover social care. Care in ageing is very different from curative and medical care,” she says.
Look after yourself
Prof Tengku Aizan, who is also the supreme management committee member of the National Council of Welfare and Social Development Malaysia, highlighted data showing that many seniors do not practise self-care.
“If you live alone, have no non-communicable diseases and don’t suffer, then it’s fine. If not, the family also suffers. We have to educate the young to prepare for old age in terms of health and finances.
“Don’t depend on your children. If they’re there, then consider it a bonus. If not, what are your alternatives? The elderly must also change their perspective about being old. Many of us think we are old before we are actually old!
“Allow your parents to work or do volunteer activities to fill up their time. That gives them a more positive impact than just ‘waiting to die’. Don’t worry about what others say by allowing your parents to work,” she advises.
Prof Tengku Aizan suggests that community cooperatives be set up to cater for the elderly.
According to a Universiti Malaya survey conducted in 2014, one in 10 seniors are abused in urban areas, while the figure is one in 20 in rural areas.
“Family members may not necessarily live together, but all forms of abuse happens, e.g. neglect, physical, emotional, psychological and financial.
“Neglect is especially rampant though it may be unintentional, but what is really sad is there are Malaysians who have no access to food, clothing and shelter,” says Dr Rajini Sooryanarayana, a public health medicine specialist and researcher from the Institute for Public Health.
Many unseen problems are also not addressed. She says, “For example, one in six elderly need assistance in feeding, toileting, grooming, etc. All of us will age one day so awareness and training is important.”
The results of the National Health and Morbidity Survey 2018 with a focus on elderly (aged 60 and above) health is expected to be released in March 2019.
A care professional’s story
When Prabjoth Kaur – or Jo, as she prefers to be called – was asked to pay a visit to an elderly lady, she took it on as another job. The care recipient was a former matron in her 80s, single, lived alone, had Parkinson’s disease and refused to take baths.
For more than a month, she hadn’t take a shower and reeked. The nephew, who acted as sole caregiver, was in a tizzy and sought professional help. As a nurse with a decade of experience working in hospitals, Jo had seen plenty such cases.
She recalls, “During the first visit, I introduced myself as a caregiver; she let me in, but refused to talk because she couldn’t accept that I had come to assist. The next time, I wore normal clothes and introduced myself as a friend. I told her we were going for lunch and that she needed to shower.
“She had been surviving on biscuits and coffee daily. Her nephew would take her out once a week and she looked forward to these outings. That made her shower. After a few visits, she’s so much more cheerful and doesn’t feel as isolated.
“The elderly are like smart kids – they know everything – they’re also terribly sensitive so you need to be extremely patient. Don’t shout at them because that makes them aggressive.”
From her experience, Jo says none of the elderly want to live in nursing homes, but are forced to do so by their children or relatives.
“When they are hospitalised, many cry and say they want to stay longer because they don’t want to return to the old folk’s home. It’s really heartbreaking to hear them say that,” says Jo, who spends between three and eight hours a day with the care recipients.
It is dangerous for the elderly to be living alone, but sometimes, they have no choice. Every elder person’s goal, Jo opines, should be not to trip and fall. She says, “The high risk ones are those above 60 and can walk. The ones above 80 need more help so they cannot walk as fast.”
For dementia patients, they may turn on the gas stove and forget about it, thus, their living space needs to be modified for safety.
“Some are stubborn and don’t want to change their routine. They don’t want to use a bedpan, don’t want to take their medicines or only want a particular child to feed them. Usually, if they refuse to eat, I won’t eat either, so that turns them around,” says Jo.
Another care professional-cum-physiotherapist Vijita Sivanjanam adds, “Initially when we go in, there is a bit of awkwardness. You’ve got to be friendly, make the seniors realise they’re not in need but that we’re here to assist.
“The more they grow fond of you, the more they will open up and allow you to help.”
Ageing in place
Research shows that most elderly want to “age in place”, i.e. have the ability to live independently in their own home safely and comfortably, regardless of age, income or ability level.
Packed with people of all different physical abilities, nursing homes can be overcrowded, limiting the amount of attention and care that the staff can provide at any one time.
“Even the daily simple living needs are a challenge for service providers. Some people are also very resistant to care. That’s why we need different care professionals with different skill sets,” says Gillian Tee, CEO and co-founder of Homage, a Singapore-based caregiving services platform.
All the experts above were speaking at a panel discussion on “How Malaysia Is Preparing For Its Ageing Future” during the launch of Homage in Malaysia on Feb 14, 2019.
Homage melds qualified care professional with smart technology to provide on-demand home caregiving for seniors, in Kuala Lumpur and selected areas in Selangor.
Tee says, “My co-founder Lily Phang and I saw the pressing need for holistic care services that not only met our seniors’ medical needs, but also helped them be more mobile and functional, providing emotional and social care to them in the comfort of their own homes.
“So we started Homage to help our loved ones age with grace, control and dignity. We wanted to build a service we could trust our own parents with. Ultimately, we also want to help give family members and primary caregivers respite, helping them self-care so they can continue to be a support to those around them.”
Planning ahead is hard because you never know how your needs might change. The first step is to think about the kinds of help you might want in the near future. One way to begin planning is to look at any illnesses you might have, e.g. diabetes.
Talk with your doctor about how these health problems could make it hard for someone to get around . If you’re a caregiver for an older adult, learn how you can get them the support they need to stay in their own home.