How Should Malaysia Respond to its Ageing Society?
D R Forsyth, FRCP*, Y C Chia, FRCP** *Box 135, Department of Medicine for the Elderly, Addenbrooke’s Hospital, Cambridge University Hospitals Foundation Trust, Hills Road, Cambridge, CB2 2QQ, England, **Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
SUMMARY As Malaysia ages its health and social care systems will have to adapt to a changing pattern of disease and dependency. Improved public health measures extend life expectancy at the relative expense of increased prevalence of currently incurable conditions such as dementia and Parkinson’s disease. In this article we discuss how these demographic changes will impact and suggest possible means of coping with the altered epidemiology of disease and disability. Malaysia will need to swiftly develop sufficient expertise in acute Geriatric Medicine, rehabilitation of older people; the management of long-term conditions in older people with multiple complex problems within Primary Care; as well as an infrastructure for home and institutional care. KEY WORDS: Older people, Elderly, Malaysia, Ageing, Geriatric Medicine, Primary Care
INTRODUCTION The world is ageing and Malaysia is no exception. The total population of Malaysia increased by an average of 2.6% per annum between 1980 and 2000 and continues to grow at a similar rate (2.4%)1. In 1991 the proportion of the Malaysian population aged 65 years and over was 3.7% and in 2000 was 3.9%1. Current (year 2008) estimates are that out of a total population of some 27.7 million, approximately 1.2 million Malaysians (4.2%) are aged over 65 years1,2 . Improvements in nutrition and public health, reduced perinatal mortality, coupled with advances in medicine have contributed to an increased life expectancy and to the demographic changes in this country. Whilst chronological age may not demarcate biological old age, 65 years and over provides a convenient benchmark for demographers; as despite the relative good health and vigour of many of those aged over 65 years, this age group are more likely than any other to suffer from multiple chronic degenerative diseases. Indeed, recent UK data showed that life expectancy increased at a faster rate than healthy life expectancy (expected years of life in good or fairly good health) such that the total expected time lived in poor health rose from 6.5 years (M) and 10.1 years (F) in 1981 to 8.7 years (M) and 11.6 years (F) in 2001 (Figure 1)3. Between 1981 and 2001, whilst healthy life expectancy at age 65 rose by 1.7 years to 11.6 years for men and by 1.3 years to 13.2 years for women, the expected time lived in poor health from age 65 onwards rose from 3.1 years to 4.3 years for men and from 5.0 years to 5.8 for women (Figure 2) 3.
Since many illnesses become more common with increasing age, these demographic changes have considerable implications for health care. An ageing population brings with it a disproportionate increase in common conditions such as degenerative disorders, stroke, cancer and dementia with their attendant disabilities4. The difference between life expectancy and health expectancy is an estimate of the number of years a person can expect to live in poor health or with a limiting illness or disability. To cope with the ageing of its population Malaysia needs to develop sufficient expertise in acute Geriatric Medicine, rehabilitation of older people; the management of long-term conditions in older people with multiple complex problems within Primary Care; as well as an infrastructure for home and institutional care. There is an urgent need to train physicians, nurses, allied health professionals, and care home workers to enable them to deliver a safe and effective system of health and social care for older people. Whilst public health measures may extend life expectancy further they will do so at the relative expense of increased prevalence...