FEW of us like to dwell on how we will fare once we become senior citizens.
Ageing is not a pleasant subject. In many cases it can turn out to be the most challenging period of our lives as we struggle with loss of independence, health problems and often, loneliness and isolation too.
The things we took for granted for most of our lives can become lost to us in our golden years.
“Life is tough when you’re old and it can be doubly so if you’re a widower and live on your own,” says Datuk Amir Hamzah Mohd Khalid.
At 75, he is one of the many senior citizens aged 65 and above who make up our country’s ageing population.
And like his peers, Amir faces his fair share of health-related challenges, the majority of which are simply the result of growing old.
He suffers from wet age-related macular degeneration (wAMD), a chronic, degenerative eye disease.
“Life took a turn a few years ago when I underwent cataract surgery and began to suffer from ‘wavy vision’ a few months later. I was at my wits’ end as it was harrowing to experience eyesight problems since I live alone.”
The proportion of older Malaysians (aged 60 years and above) is expected to rise from 6.2 per cent (1.4 million) in 2000 to 13.6 per cent (4.9 million) by 2030, doubling in proportion but more than tripling in number.
The figure is currently hovering around eight per cent, just two points away from making us an ageing society, explains Prof Dr Philip George, president of the Malaysian Healthy Ageing Society (MHAS).
Rapid population ageing in Malaysia can be attributed to the dramatic decline in fertility and mortality rates associated with longer life expectancy.
However, we are ageing at a lower level of development compared to many other developed countries and this makes us less prepared, stresses Dr Philip.
In Malaysia, ageing is often overlooked. Infrastructure, work opportunities, mobility, finances, family support and healthcare facilities are among some of the important areas that require change to help meet the expected needs of a growing ageing population.
Healthy ageing will help to decrease morbidity and dependence when we age and that is the focus of MHAS.
Health innovations can also help to encourage and instil healthy ageing practises as well as support the elderly in areas of health and autonomy.
“Maintaining the health of the elderly, their productivity and autonomy for as long as possible, as well as increasing social participation, dignity, preventing diseases, functional and cognitive decline, reducing institutionalisation and improving quality of life has become an immense public health challenge in the 21st century,” says Dr Philip.
The gradual demographic shift in Malaysia has resulted in changes of disease patterns, and the age structure of the population. The longer life expectancy is accompanied by a wave of Non-Communicable Diseases (NCD’s) and increased susceptibility to disabilities.
In 2013, among the 10 leading causes of death in Malaysia, cancers and cardiovascular diseases topped the chart. In addition, NCDs are also the leading cause of hospitalisation in both private and government hospitals in Malaysia.
With current retirement age at 60, and a long post-retirement life, the elderly population is at increased risk of financial dependency, despite the existence of a Public Pension Fund, and Employees Provident Fund (EPF) for public and private sectors respectively.
A greater part of retirees exhaust their EPF savings within three to five years and are at risk of a lower standard of living following retirement which impacts their quality of life.
Dr Philip adds that in Malaysia, unlike most developed countries, the family has always been the fundamental source of support for the elderly, and this is also the norm in many Asian countries. Younger family members care for the older ones.
However, this extended family structure which is the core of elderly care in Malaysia, is gradually fizzling out.
Dr Philip says in 2010, the nuclear family household constituted about 62.8 per cent of households in Malaysia, while the extended family household constituted only about 20.5 per cent.
Families are gradually becoming smaller and the average household size is dropping.
With declining fertility rates, smaller families, longer life expectancy, special care needs for the elderly, higher cost of living, increased participation of women in the labour force and migration to distant places for work, it is becoming taxing and untenable for families to provide support as well as cater for the healthcare needs of their elderly relatives.
In 2010, a survey conducted by the National Population and Family Development Board found that one in three elderly people aged 60 and above were abandoned and devoid of financial support from their children.
Key to better quality of life
AMIR’S story was highlighted at a recent forum titled Malaysia’s Ageing Population and the Value of Health Innovation, which addressed the social and economic challenges facing the region’s ageing population.
It was organised by MHAS in partnership with Bayer Co.
One of the key issues related to ageing is that it is driving an increase in chronic diseases but the adoption of health innovations can play an integral role in addressing this worrying trend.
Commenting on Amir’s case, Dr Nor Fariza Ngah, the national head of ophthalmology services at the Ministry of Health, says his vision improved when the right assistance was offered. Within a few months, he regained his independence and enthusiasm to continue on life’s journey without burdening others.
Dr Nor Fariza explains that the early symptoms of diseases such as wAMD and diabetic macular edema (DME), can lead to progressive vision loss and are among the key reasons for severe vision impairment among the working class. But new technology and innovative medicines can lead to earlier detection, improved outcomes and a better quality of life for senior patients.
Datuk Seri Dr Jeyaindran Sinnadurai, deputy director general of the Ministry of Health, says despite the World Health Organisation’s projection that the annual number of deaths from chronic diseases in Southeast Asia and the Western Pacific will continue to be the highest globally (with a projected increase of 13 million and 14 million respectively in 2030), there are many reasons to remain optimistic about ageing.
“For example, Malaysian women who celebrated their 65th birthday this year are expected to live for another 17.11 years while the percentage of Malaysians aged 60 is expected to reach 23.6 per cent in 2050,” he says.
This higher life expectancy is a result of healthcare advancements compared to what was available 50 years ago.
“It goes to show that Malaysians are indeed living longer,” adds Dr Jeyaindran.
He further explains that while the country records better life expectancy rates, there is still much to be done to combat the rising incidence of non-communicable diseases (NCDs) such as diabetes, hypertension, obesity and cancer, which result in more people ageing unhealthily and living longer in ill health. These chronic diseases prevent an ageing person from living an active and productive life.
Healthy ageing is not a life without diseases. It is a life where we are able to maintain the daily activities and functions that we need to do what we value most,” says Professor Nathan Vytialingam of the Global Coalition on Aging Advisory Council and dean of Perdana University’s School of Occupational Therapy (PUScOT).
Over this century, older people will live longer, be more resilient and less frail, explains Nathan, who’s also an advisor to MHAS.
“Although research and care have advanced to identify and treat diseases, it is equally important to maintain functional capacities such as mobility, cognition and immune functions during the process of ageing,” he says.
Towards a longer, more active life
THE world’s population is facing a demographic shift at an exceptional pace. This phenomenon is particularly critical in East Asia and Pacific which is ageing faster than any other region.
Closer to home, according to the Department of Statistics, Malaysia will reach ageing population status by 2020 with the percentage of people aged 65 and above exceeding 7 per cent.
With the average life expectancy continuously increasing, countries are facing challenges presented by this demographic shift with increased demand for healthcare for the elderly.
At the same time, a larger older population will pose a major healthcare challenge as chronic diseases such as stroke, diabetes, age-related eye diseases and certain type of cancers are projected to rise as well.
So how can we make it possible for older people to live a longer, active life?
Health innovations such as innovative medicines and healthcare technologies have an important role to play in addressing the challenges of ageing societies and transforming the health outcomes of older people living with chronic diseases, says Jennifer Yong, managing director of Bayer Malaysia.
The results of this innovation could make it possible for older people to live a high-quality life that’s as active, productive and independent as possible.
About 50 per cent of complications from diabetes for example can now be prevented with treatment and today, in many cases, even cancer is no longer a death sentence.
Two out of three people diagnosed with cancer now survive at least five years. Innovative therapeutic options have also made it possible for cancer patients to have a good quality of life.
The Ministry of Health also recognises that health innovations can enhance the quality of life of those living with chronic diseases. Initiatives taken include improving the delivery of medicines and patient care and outcomes as well as encouraging public and private partnerships in health technologies to meet the needs of our ageing population.