Looking after our elderly


(From left) Nor Syafawati Ahmad Sukhari, Syahiroh Said, Casey Gan, Syed Mohammad Iqbal and Nur Syakira are among the trained data collectors from the Health Ministry conducting the National Health and Morbidity Survey at the Flat Sri Negri Sembilan in Bandar Baru Sentul. — Photos: ONG SOON HIN/The Star

SOME 31.9% of the elderly aged 60 and above have reported themselves as having low support in terms of social interaction and satisfaction derived from their support system. Meanwhile, 10.4% senior citizens experience food insecurity.

These were among the findings gathered through the National Health and Morbidity Survey (NHMS) 2018 on elderly health.

The survey is part of research conducted by the Health Ministry’s Institute for Public Health. The first health survey was carried out in 1986 followed by another in 1996 and annually since 2011.

It is found that Malaysia is a rapidly ageing society and will achieve that status in a shorter time span than developed countries.

Currently, 2.3 million Malaysians or about 6.5% of the population are above 65 years old.

According to experts, this number is expected to double within 23 years.

NHMS principal investigator Dr Rajini Sooryanarayana said it took 138 years before France saw the number of its elderly doubled, 85 years in Sweden, 73 years in Australia and 69 years in the United States.

Data collector Syahiroh Said (left) gathering health information from a survey respondent.Data collector Syahiroh Said (left) gathering health information from a survey respondent.

“Elderly population in countries such as Brazil, China, India and Japan doubled in 25 years.

“Rapid ageing has an impact on the social, cultural and economic landscapes as well as the delivery of the healthcare system in the country, so it needs planning and preparation for,” said Dr Rajini.

Institute director Dr Tahir Aris said the purpose of these surveys was to provide community-based data on the health and morbidity status of the Malaysian population.

“Since 2011, the survey has been conducted yearly based on an identified scope. In 2018 the survey focused on elderly health.

“Institute for Public Health, through the national steering committee chaired by the Deputy General of Health, oversees this survey.

“This year’s survey is focused on non-communicable diseases and healthcare demand. The survey produces good quality data that will be used to plan for healthcare services for the entire nation.

“The data is used by stakeholders to determine the prevalence, monitor the trends of diseases and risk factors as well as monitor and evaluate the current healthcare-related programmes,” he said.

Nur Syakira examining a respondent under the National Health and Morbidity Survey 2019.

Dr Rajini said the 2018 survey involved pre-elderly aged 50 to 59 and elderly aged 60 and above.

Data was successfully gathered from 7,117 respondents, of whom 3,977 were aged 60 and above. Among the key areas that were surveyed were their functional status, geriatric syndromes, non-communicable diseases (NCD), NCD factors, nutrition, dietary practices and quality of life.

“The terms successful ageing, healthy ageing and active ageing are often used in recent times. It basically describes the same concept of maximising the desired outcomes and minimising negative outcomes such as decreasing the risk of disease and disability, maintaining physical and mental functions and being actively engaged with life.

“The terms refer to health and ageing as not just a matter of being free from physical diseases, disability and ailments but being in a good frame of mind and body as a person ages.

“Various components such as having satisfaction in life, continued participation within the community, the importance of social networks and quality of life are all equally important.

“Put simply, we should add life to years and not years to life. This is important so that older persons are able to age in place, in their own homes, with the same quality of life they have enjoyed before and avoid institutionalisation,” said Dr Rajini.

Based on the survey conducted, some 30.8% of elderly suffer from malnutrition or are at risk of malnutrition.

This figure was gathered when respondents were asked about their decline in food intake, weight loss over three months, how they described their mobility, stress or illness experienced in the past three months and with their muscle-wasting taken into account.

Food security was also examined among the elderly, where one in 10 was found to experience food insecurity on a daily basis.

“Among the reasons cited for lack of food were related to lack of finances and not having enough money to enjoy a balanced diet. The elderly also reported occasions of being hungry in the past 12 months,” said Dr Rajini.

The survey also highlighted that 27.7% of the elderly were told by a medical practitioner that they have diabetes, 51.1% reported hypertension or high blood pressure and 41.8% had reported having high cholesterol levels.

The majority of elderly utilised government health clinics, while the next major group went to government hospitals and only 10% visited private general practitioners for those conditions.

One in 10 were screened positive for dementia, 5.3% screened positive for depressive symptoms.“The deterioration of function has led dementia to be one of the major causes of disability among the elderly,” said Dr Rajini.

One in six elderly interviewed were facing functional limitation. This is in terms of 10 basic daily activities a person commonly engage in such as climbing stairs, control over bladder, transfer in and out of a chair, mobility, ability to use the toilet, feeding themselves, dressing, bowel control, grooming and bathing.

Close to 43% of elderly faced limitation in terms of instrumental activities of daily living such as shopping, preparing food, the ability to use transport, doing laundry, handling own finances, ability to use a telephone, housekeeping and being responsible for their own medication.

In terms of disability, 4.5% have self-reported vision disabilities, 6.4% have self-reported hearing disabilities, 15% of the elderly have sustained a fall in the past 12 months and three percent suffer from urinary incontinence.

The survey also found 39.3% of the elderly reported experiencing poor quality of life.

Nurse Nur Syakira Hazwani Mohamad Rudian (left)  and trained interviewer Syed Mohammad Iqbal Syed Mazlan checking the vital statistics of a baby in one of the houses visited during the national survey that involves about 12,000 households.

A third of the elderly –- 34% -– rated their oral health as poor, with one in five said they needed dental treatment and only one in 10 said they would visit a dentist.

One in 10 elderly also reported experiencing abuse at the hands of someone known to them in the past 12 months.

“Elder abuse is defined as a single or repeated act, or lack of appropriate action occurring whenever there is an expectation of trust, which causes harm or distress to an older person.

“This includes any incident of neglect, psychological and physical abuse, financial exploitation as well as sexual abuse in the past 12 months.

“In our context neglect was the most common experienced, comprising lack of cooked food, lack of access to clean clothes, shelter or medication,” Dr Rajini explained.

“This study also emphasises the importance of social networks among the elderly such as their family, friends and the community.

Dr Rajini: We should add life to years and not years to life.

“They could be provided with avenues to participate and engage with society more.

“It is important for the community to provide support to the elderly through community activities and empowerment programmes.

“Related agencies and also non-profit organisations could host more activities for this age group, which will help to prevent social isolation,” she added.

Meanwhile, this year’s non-communicable diseases and healthcare demand survey principal investigator Dr Shubash Shander Ganapathy said some 12,000 households with almost 30,000 respondents all over the country, including Sabah and Sarawak, were randomly selected by Statistics Department for this year’s survey.

The survey for 2019 began on July 14 and it is being simulta-neously carried out throughout Malaysia until Oct 2.

“Don’t be surprised if you get a team of officers knocking on your doors to gather health-related details.

“Before we conduct the survey in any area, we will always inform the local police station.

“If we are visiting a remote area, we will likely inform the village head before heading to the houses. If it is in the urban setting, we will contact the residents leaders first,” said Dr Shubash.

The survey will be carried out by 70 teams of data collectors trained by Health Ministry.

They travel only in vehicles bearing the NHMS car sticker.

Each team member will be wearing NHMS name tags that contain the data collectors’ photograph, identity card number and signature of the Institute for Public Health director on the back of the card.

A letter of introduction will also be provided to be shown to the respondent. The details of every data collector involved can also be verified online at iku.gov.my/nhms

“Each team of the surveyors comprise up to five persons, who will include a nurse and four interviewers.

“We respect the privacy and rights of the respondents, so participation in the survey is voluntary and with the agreement of the respondent,” Dr Shubash assured.

“The process consists of the use of questionnaires and physical examination.

“The respondents’ answers will be recorded into handheld tablets provided to the data collectors.

“In the meantime, the officers may also conduct basic health screening including measuring blood pressure and a finger prick for blood test to check glucose, cholesterol and haemoglobin levels.

“Each session is estimated to take about an hour and those found with health or social issues will be referred to the nearest government health facility,” he said.


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