This document outlines geriatric health and aging issues in Malaysia. It defines key terms like geriatrics and gerontology. It then discusses Malaysia's aging population trends like increasing life expectancy and decreasing fertility rates. Common health problems among the elderly are also covered, such as multiple chronic illnesses, functional decline, and increased healthcare costs. The national policy for older persons aims to ensure their dignity, well-being, and access to opportunities as valued members of society.

1. Geriatric Health
Dr Nik Nor Ronaidi bin
Nik Mahdi

2. Outlines
• Definition
• Demographic changes
• Common health (including sexual health), social
& economic problems/ implications
• National policy for older person
• Health care programme for elderly in Malaysia
(objective, strategies, medical, health &
institutional care, agencies involved)
• Social & economic supportive program
• Programs for older person in other countries

3. Definitions

4. Definition
• Geriatrics
 A branch of medicine that deals with the
problems of aging and the diseases of the
elderly
• Gerontology
 A branch of study that look into the social
aspect of ageing including its related
policy

5. • What is ageing?
 A progressive state beginning from
conception and ending with death.
Associated with it are certain physical,
social and psychological changes.

6. • Terminology
– Elderly
– The aged
– Older people
– Senior citizen
– ‘Wargatua’
– ‘Orang tua’
– ‘Warga emas’

7. • Elderly:
- WHO defines old age as those who are
≥60 years ( developing countries) or ≥65
years (developed countries).

8. Demographic Changes

9. Why older people?
Ageing population:
Global phenomenon
A phenomenon occurring both in developed and
developing countries
Challenge of increase longevity but compressed
morbidity
 Major sources of population ageing include:
• declining fertility and mortality rate
• improved health and life expectancy

10. Ageing population
• Today, there are 600 million people in the world
aged 60 years and over.
• This figure is expected to double by 2025 and to
reach 2 billion by 2050.
• Population ageing is characteristically
accompanied by an increase in the burden of
chronic noncommunicable diseases (NCDs)
such as cardiovascular diseases, diabetes,
Alzheimer's disease and other ageing-associated
mental health conditions, cancers, chronic
obstructive pulmonary disease and
musculoskeletal problems.

14. Ageing Population in Malaysia

15. Source: Department of statistics, Malaysia (2003)

17. Piramid Kependudukan Malaysia
Tahun 2000 Dan 2050
Malaysia Population 2050 (Medium Variant)
Malaysia Population 2000
100+
100+
90-94
90-94
80-84
80-84
70-74
70-74
60-64
60-64
Age Group
Age Group
50-54
50-54
40-44
40-44
30-34
30-34
20-24
20-24
10-14
10-14
0-4
0-4
1500 1000 500 0 500 1000 1500
1500 1000 500 0 500 1000 1500
Number (Thousands)
Number (Thousands)
Male Female
Male Female

18. Total Fertility Rate by ethnic group, Malaysia, 1991-1998
Source: Vital Statistics Time Series, Malaysia, 1963-1998
Year Total Malay Chinese Indian
1991 3.4 4.2 2.5 2.8
1992 3.5 4.2 2.5 2.8
1993 3.5 4.1 2.6 2.8
1994 3.4 4.0 2.6 2.7
1995 3.4 3.9 2.5 2.7
1996 3.3 3.9 2.6 2.7
1997 3.3 3.8 2.5 2.7
1998 3.1 3.7 2.2 2.6

19. Life Expectancy at birth, Peninsular Malaysia,1966-1995
Source: Vital statistics time series, 1963-1998
Year Male Female
1966 63.1 66.0
1970 61.6 65.6
1975 64.3 68.7
1980 66.4 70.5
1985 67.7 72.4
1990 68.9 73.5
1995 69.1 74.4
2004 72 76

21. Illness and Older People

22. Illness and Older People
• Growing old is a life long process
– Does not occur suddenly
• Involves physiological, psychological
changes and physical changes
• Involves senses and all the systems
– Skin – less elastic and wrinkles
– Eyes, hearing, taste, smell – less sensitive
– Physical – loss height, stooping walk

23. • Bones – brittle and prone to fracture
• Muscle – loss bulk
• Immune function - compromised
• Nutrition - malnutrition and under nutrition
are common

24. • Sexuality
– Studies show that 74% of married men and
56% of married women over 60 years of age
remain sexually active. (Diokno AC et al)
– Common problems : arthritis, diabetes, fatigue,
fear of precipitating a MI and side effects from
prescription drugs
• Brain function
– cognitive decline and depression.

25. GIANTS OF GERIATRIC (Bernard Isaacs, 1975)
• Bernard Isaacs described the "giants" of geriatrics:
incontinence, immobility, impaired cognitive
function and instability.
• He asserted that if we look closely enough, all
common problems with older people relate back to
one of these giants.
• The GIANTS are disabilities that lower the quality
of living.
• In common: multiple causes, chronic nature,
reduced independence, no simple cure.
• The ‘final pathway’ that affect elderly with
diminished ability to recover, make them
DEPENDANT on others.

26. 1. Incontinence
- Urinary & Fecal
2. Instability/Immobility
- Risk of fall & Osteoporotic fracture
3. Impaired cognitive function
- Dementia/depression

27. •A study by the Public Health Institute, Malaysia in 1995
showed:-
- 81.4% suffered from at least from one chronic
medical illness.
- 12.7% had 3 or more chronic diseases.
•The commonest medical illness:-
- joint paint 50.1%
- eyesight problem 40%
- hearing problem 21%
- hypertension 26%
- heart diseases 16.3%
- diabetes 11.6%

28. Socio- economic implications
1. Social security
• In Malaysia, the social security covers
only employees in the formal sector.
• Pension scheme for civil servants while the EPF
for private sector employees.
• Only 61.8% of total employed persons
covered by these two schemes leaving the
remaining 38.2 per cent without known
source of coverage. (Labor Force Survey Report, 1998)

29. 2. Growing Burden of Non communicable
Diseases
– In the next 10 to 15 years, the loss of health
and life in every region of the world,
including Africa, will be greater from
noncommunicable or chronic diseases,
such as heart disease, cancer, and diabetes,
than from infectious and parasitic diseases.

31. 1. Changing Family Structure
• As people live longer and have fewer
children, family structures are
transformed.
• People will have less familial care and
support as they age.

32. 4. Financing for Health Care
• Increase health care expenditures
• On the average, Malaysian’s visit to the
public and private primary care service
sector is about 2.3 visits per year. The
elderly made an average of 6 visits per
year (Chin 1996)

33. National policy for older person in
Malaysia
• Approved in October 1995
• Malaysia one of the earliest countries in the
Asia Pacific region to have policy for older
person.

34. The policy statement…
“To ensure the social status, dignity and
well-being of older persons as
members of family, society and nation
by enabling them to optimize their self
potential, have access to all
opportunities and have provision for
care and protection”

35. Objectives
• To establish and develop the dignity and
respect for the elderly in the family,
community and country.
• To develop the potential among the elderly
to maintain their activeness and
productivity in the process of developing
the country.
• Encouraging to create facilities to ensure
care and protection for the elderly towards
a better living.

36. Strategies
• Respect and dignity
– Enable older people to live with respect and self
worth, safe and free from exploitation and abuse
– Ensure older people are given fair and equal
treatment irrespective of age, sex, ethnicity,
religion, disability or their ability to contribute
– Enable older people to optimize their potential
– Enable older people to have access to
educational, cultural, spiritual and recreational
resources in society.

37. Strategies
• Self reliance
– Able to fulfill their basic needs through income
sources, family and societal support and self effort.
– Have access to opportunities to continue to serve and
contribute.
– Enjoy an environment that is safe and conducive in
accordance to their needs and changing capacities
– Able to reside within their community without having to
resort to institutional care
– Able to make early preparation to plan their
continuous contributions towards national
development based on their expertise and capabilities.

38. Strategies
• Participation
– Enable OP to play a role in society and be actively
involved in the formulation and implementation of
policies relating to their well-being and to pass on
their knowledge and skills to younger generations
– Provide opportunities to OP to voluntarily contribute to
society in accordance with their abilities and interest
– Encourage OP to establish associations and
organizations that conduct activities for their own well-
being.

39. Strategies
• Care and protection
– Establish facilities for care and protection within the
family and society in line with local socio-cultural
systems
– Enable OP to have access to health care to enable
them to maintain or restore their optimum physical,
mental and emotional health and prevention of
ailment.
– Access to services of institutions that provide care,
protection and social and mental stimulation in a safe
and comfortable environment

40. • Access to social and legal services
towards advancement of their individual
rights, protection and care
• Enjoy the basic rights of individuals while
in care and under treatment by taking into
consideration their self-respect, beliefs
and needs
• Establish a comprehensive Social Security
System to ensure the financial security
and welfare of OP.

41. Research and development
• Encourage research on OP for the
purposes of compiling information for use
in planning programs for their
development
• Establish a National Advisory and
Consultative Council for OP to identify and
coordinate the programs and activities for
OP

42. Health care programme for elderly
in Malaysia

43. Health Care Program for the
Elderly
• Introduced in 1995 - aimed at improving
and maintaining the health and functional
outcome of the elderly with the ultimate
objective of promoting quality of life as
well as forging productive ageing among
the elderly.

44. • Specific objectives:
– To improve the health of the elderly to enable
them to lead and enjoy full and active life through
promotive and preventive health care;
– To establish Geriatric Specialist Services at the
regional and state levels
– To develop a comprehensive plan of action on
training and research needs in the care of the
elderly
– To provide quality health care for the elderly
using community-based approaches to enable
them to live as independently as possible within
the community

45. Strategies
1. Promotive and preventive health care
• information dissemination regarding the pathologies
and disabilities related to age.
• Screening programs
2. Medical and rehabilitative care
• strengthening of care to the elderly at primary,
secondary and tertiary level
• provide holistic specialized medical, psychological,
social and rehabilitative geriatric services in selected
hospitals using a multidisciplinary team approach.
• Private Hospital Act, 1971 and Private Hospital
Regulations, 1973, will be enforced to ensure quality
care to the elderly.

46. Strategies
1. Training and research
• to formulate and strengthen the existing curricula on
care of the elderly for basic, post-basic and continuing
medical education.
• Training in specialized areas relating to health care of
the elderly is planned.
2. Program planning, monitoring, coordination and
evaluation
• proper data collection in hospitals and health centers in
order to obtain more accurate information about the
elderly people.
• setting up a special Unit on Health Care for the Elderly
in the Family Health Development Division of the
Ministry of Health.

48. • Among the activities carried out are:
1. The National Mental Health Policy was approved in 1998 and 58
health clinics have been identified to implement the program.
3. Healthy lifestyle campaign aimed at preventing and controlling
chronic diseases such as diabetes mellitus and cardiovascular
disease.
5. Setting up of special health clinics for the diabetic and
hypertension within the health clinics in rural areas.
7. Rehabilitative programs – physiotherapy and occupational therapy
are provided to older people as a supportive service to the medical
care or in-patient care in hospitals.
9. Health center or community-based activities. They include: home
visits, health screening for high risk groups, referral to
geriatricians, counseling on exercise, nutrition, diabetics and
social support needs, home mobility and rehabilitative facilities,
special care management such as incontinence, day care nursing,
and community education on issues associated with health of the
elderly.

49. • The main agencies involved in these
activities and programs are:
– Ministry of Health
– Ministry of Women, Family and Community
Development
– Ministry of Education
– Department of Social Welfare
– NGOs

50. Social & Economic Supportive
Program

51. SOCIAL WELFARE
DEPARTMENT
• The care and protection for older persons
through institutional service provides health
care, guidance, counseling, recreation and
religious teachings.
• Other programmes included:
– Financial Assistance
– Day Care Centre for Older Persons
– Homes for Older Persons Without Next of Kin
– Programs and activities undertaken by NGOs
– National Celebration Day For Older Persons

52. Homes for the Older Persons
• The objective is to provide a proper care and
protection for the needy elderly to ensure their
security, treatment and getting better quality of
life.
PROCESS OF ADMISSION:
• All application will be investigated and will be
considered base on the following criteria:
– Needy elderly, aged 60 years and above
– Not suffering from contagious diseases
– Not having relatives or guardians
– No permanent shelter
– Able to look after him/herself

53. • The Old Persons’ Home provides various
services or facilities as follow:
– Care and protection
– Counseling and Guidance
– Occupational Therapy
– Religious Facilities
– Recreation
– Medical Care

54. THE ROLE OF NGOs
• NGOs play a complementary role in helping
the Government to meet the social needs of
older persons
• Based on data from the Registrar of
Societies, there were 30,907 NGOs
registered in May 2000, of which 3,218
were welfare related.
• The majority of NGOs provide institutional
care and shelter for older persons in need.

55. Employees Provident Fund
(KWSP)
• Government-sanctioned statutory body founded in 1951
• Act as a social protection
• Compulsory savings scheme in Malaysia for the formal
sector: monthly contributions from employers and
employees - (Employers:12%, Employees: 11%)
• Contributions from self-employed are on voluntary
basis
• The contributions are cumulative; annual dividend paid
(Dividends of a minimum 2.5% per annum guaranteed
on savings)
• EPF savings can be withdrawn upon retirement (age 55
yrs and above)
• EPF funds used for investments in sectors like equity,
securities, property and currency as well as financing of
large-scale government projects

56. • Objectives of the EPF:
– Provide a measure of security for retired
elderly
– Provide retirement benefits
– Provide an easy and efficient system for
employers to fulfill legal and moral obligation
to contribute to the EPF of their employees
– Contribute to the country’s socio-economic
development through careful investments

57. • Limitations of EPF:
– Provide coverage only for employees from the formal
sector
• Many of the elderly are in the informal sector where contribution
are not mandatory
– Contributions from self-employed are on voluntary basis
– Rising cost associated with longer life expectancy and
the effect of inflation will diminish the size of savings from
EPF
– The lump sum nature of withdrawals tends to have high
exposure to improper management or investment that
does not provide the insurance needed for old age

58. Public Sector Pension Scheme
• Non-contributory social security scheme for civil
servants
• Pensions expenditure is fully borne by the
Government via annual allocation from the Federal
Budget
• Provide security for old age and financial
assistance to the dependents of those in the
Government service if government employee
passes away while in service or after retirement
• In 2005, the scheme covers only 9% of the
workforce

59. Recommendation to improve our
current services
1. Census-type information will have to be
gathered to facilitate the formulation and
implementation of policies and programs.
2. Continuous monitoring of activities as guided by
the National Policy for the Elderly
3. Training of manpower in the health sector
4. Education and retraining for the elderly
• Education to prepare the elderly to face the
challenges of ageing can be introduced as a pre-
retirement course. Retraining should be introduced to
promote productive ageing.

60. Programs for older person in other
countries

61. Programs for older person in other
countries – Mississippi, USA
Division of Aging and Adult Services
Programs:
– Senior transportation programs
• Continued independence of older adults in the state is
facilitated by transportation services offered in their
communities.
• Senior transportation programs make it possible for
individuals who do not drive and cannot use public
transportation to obtain rides for essential trips, such
as medical appointments.
• Nearly 300 vehicles (from vans to mini-buses) provide
transportation service to older riders

62. – Elderly Nutrition Program (ENP)
• The ENP provides funding for two senior nutrition programs:
congregate meals and home-delivered meals.
• Congregate meals
– They are offered at social and community centers such as senior
centers, and churches
– provide seniors with social interaction and stimulation, and the
chance to get involved in the community.
• Home-delivered meals
– meals are delivered to homebound seniors who are unable to travel
to a congregate meal site.
– during a meal delivery the volunteers are able to monitor the health
of the homebound seniors and make sure that they are getting the
help they need.
• Both of these services are offered to seniors at no cost.
• The meals must provide recipients with at least one third of their
daily recommended dietary allowances, and are cooked to take
into account special senior nutrition considerations (such as low-
fat, low-sodium diets).
• ENP volunteers also provide nutrition screening, nutrition
education, and meal-planning counseling.

63. – Legal services programs
• Legal advice, consultation or representation, legal
assistance may be obtained from lawyers or
paralegals who have agreed to provide services to
the state's elderly
• Many of the services are available without charge or
reduced fees for referred elderly clients.
– Senior Community Service Employment
Program (SCSEP)
• The program identifies employment opportunities for
older persons whose incomes place them at or below
the federal poverty level; who are unemployed or
underemployed; or who have difficulty finding a job.
• Adults in the program generally work an average of
20 hours a week, receiving at least minimum wage.

64. – The Homemaker program
• The program gives older citizens the option of having
homemakers perform the housekeeping tasks they can
no longer do or need assistance in doing.
• Homemakers perform routine household tasks such as
cooking, cleaning, grocery shopping, laundry,
consumer education, bathing, dressing, safety
education and oral hygiene assistance.
• This service is provided at no cost to the older person
– Adult Day Care
• Adult day care centers specialize in supervised care
for functionally impaired elderly adults.
• Their programs focus on health maintenance,
prevention/intervention and rehabilitation needs of
older adults capable of only limited self-care.