U n i v e r s a l h e a l t h c o v e r a g e a n d h e a l t h y a g e i n g Love on Wheels Malaysia urgently needs nursing homes with varying levels of care as well as improved facilities for the disabled and mobile services for older people. The first effort to provide mobile services to old people above 60 years of age was initiated by a private company, Love on Wheels Healthcare Services (LOWHS), in 2013. Through its KASIH (Kasih Atas Sumbangan Ikhlas dan Hemat) project, the elderly are able to recover in the comfort of their own homes, while also being able to access nursing and rehabilitation services. LOWHS expects to roll out its services to major cities in Malaysia over the next few years. caregivers. This policy later evolved into the National Policy for the Elderly (1995), which aimed to ‘create a society of elderly people who are contented and possess a high sense of self worth and dignity, by optimising their self potential and ensuring they enjoy every opportunity as well as care and protection from members of their family, society and nation’. However, in view of increased societal pressures and changing cultural norms and values, it is time for Malaysia to revisit its policies and prepare to meet the demand for quality comprehensive aged care services. According to the Ministry of Health, Malaysia, the Aged Healthcare Act, which was expected to be tabled at the end of 2014, will serve as a guideline for the provision of services and facilities for the aged care industry. To date, there has been no public announcement on the status of this act. Within the Asia-Pacific region, Australia provides a good policy model. Australia’s ageing policy focuses on consolidating and taking forward reforms to guarantee choice and access to quality aged care services, while relying on the role of informal support from the community. There are indications, however, that this is changing towards person-centred approaches that promote independence. What is becoming increasingly clear is that, when designing country-specific policies and programmes for older populations, policy-makers must use a comprehensive public health approach that considers the health status, participation and levels of independence among older people of the same age; an approach that is needs-based as opposed to one-size-fits-all, where the functional capabilities and aspirations of older people are the main considerations. Admittedly, such an approach is complex and challenging, and for developing countries with limited resources, the challenges are multiplied further. Health systems could therefore be redesigned to provide aged care services that enable older people to stay at home and ‘age in place’. If these services can be seamlessly linked with social and long-term care, then the aged will be assured of continuity of services from community to the institution. Health issues of the aged in Malaysia Like many other countries in the Asia-Pacific region, the major causes of death and disability in the ageing population in Malaysia are non-communicable diseases (NCDs). Older people are commonly affected by multiple chronic NCDs, such as hypertension, type two diabetes, coronary heart disease, stroke and dementia. Visual impairment and blindness is high in this age group, making it imperative that ophthalmic and optometric services are part of comprehensive health care for the aged. There is also an increasing pattern of orthopaedic diseases in this population and functional impairment is common. According to the Third National Health and Morbidity Survey 2006 report, the greatest impact of reduced functional independence in the elderly is on mobility, self care, housework and access to public places. A high prevalence of chronic pain that interfered with daily activities was also reported. Psychological health problems are also prevalent among older people in Malaysia. Depression often co-exists with other chronic illnesses, and health care providers can play a key role in detection and management at the primary care level. 30 Commonwealth Health Partnerships 2015 Viewpoint – Datuk Dr T. Devaraj Developing countries face a bigger problem in caring for the aged compared to developed countries. Developed countries grew rich before becoming old, while we are growing old before becoming rich. Developing countries are only now benefiting from socio-economic and medical changes of the last 50 years. By the year 2030 we will have a population over 60 years of age exceeding those under five years of age. We have to prepare for this certainty. What do old people want? Old people want their physical needs to be met and they want to be healthy until the end. Take the example of Australia, where there is support for the aged patient after an episode of hospitalisation. Home visits are made by allied health care personnel. We do not have this continuity of care in Malaysia due to stretched human and financial resources in the public health sector. But what must be made clear in everybody’s mind is that aged care cannot be just the responsibility of the individual/family, or the state alone; both have roles to play. In Australia, independence is a cultural trait. The government says, ‘Stand on your own feet until you need help’. One of the challenges policy-makers must overcome is lumping all old people into one monolithic structure. Aged-care policy should be based on the functionality of the old person and not on chronological age. Health care must be seamless. We have in fact been doing this in the rural health service in Malaysia for many years through the maternity and child care services, where health care professionals visit the houses of patients. This can be easily extended to include others with health care needs including the aged, or in other words domiciliary care. But this will have to be done through a combined effort by a health care team and the community. Datuk Dr T. Devaraj is a former president of the Malaysian Medical Association. Despite having retired from public service and being 90 years of age, he remains actively engaged and is currently the vice chairman of the Penang Hospice Society, where he oversees the management of Hospice Penang, Malaysia.
Commonwealth Health Partnerships 2015
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