Active ageing: A file photo of patients at the Cheras Geriatric Centre socialising with a ball game.
PETALING JAYA: Delays in geriatric care and a strained healthcare system are some of the potential repercussions that Malaysia would have to face if it is unable to produce enough geriatric specialists to meet the needs of an ageing nation, say experts.
As it stands, the country has 67 geriatric specialists in hospitals nationwide, including those in private practice.
This number translates to one doctor per population of 40,000 people aged above 65.
Senator Dr RA Lingeshwaran said the country has fallen short of the target of one specialist per population of 10,000, especially with the country undergoing a demographic shift towards an ageing population and the percentage of citizens aged 65 and above being projected to rise from 8.1% in 2024 to 14.5% by 2040.
Based on a population estimate of 36.6 million by 2030, he said the country would need 549 geriatricians in just five years.
“At the current rate of producing an average of eight geriatricians per year, it will be impossible to meet this demand,” he added.
Prof Dr Tan Maw Pin, a professor in geriatrics and consultant geriatrician at Universiti Malaya Medical Centre (UMMC), echoed concerns over the dire shortage of specialists, warning that Malaysia’s “accelerated ageing” would strain the healthcare system unless immediate interventions were made.
She said the growth of the number of geriatricians is not in tandem with the rate of the ageing population – despite the government developing policies to increase the number of geriatricians in Malaysia over the past 30 years.
“It is looking bleak, as it does look like we are never going to have enough geriatricians,” Dr Tan said, adding that senior citizens generally suffer from multiple medical conditions, which will increase the likelihood of disability and healthcare costs.
The absence of geriatricians, she warned, could lead to inefficiencies in treatment and suboptimal care for the elderly, all of which could also negatively impact Malaysia’s economic growth and overall well-being.
Dr Tan said doctors are generally trained to focus on specific organs instead of comprehensive elderly care – which she said is a flaw in the system.
“The average 60-year-old has two or more medical conditions, while an 80-year-old has four or more. Without geriatricians, these patients may see multiple specialists who treat each condition separately, often resulting in conflicting treatments and unnecessary medical procedures.”
She said Malaysia should be producing 23 geriatricians this year if it were to follow the Malaysian Society of Geriatric Medicine’s formula and eventually meet the target of 350 geriatricians by 2030.
“However, we seem to be stuck at eight, which was the number projected for 2019. Clearly we are no longer able to get to 350 by 2030, and unless there are conscious whole-of-society approaches to encourage and allow more doctors to train as geriatricians, we can’t meet our commitments to our older population, our nation builders,” she added.
Dr Tan attributed the lack of geriatricians to factors such as the field’s perceived lack of financial reward, as the fees do not adequately reflect the workload.
“Young doctors are drawn to fields with financial incentives and prestige. If we want more geriatricians, we need to elevate the importance of elderly care.
“The government’s so-called incentives are not tangible. Australia has addressed this issue by assigning the highest payment to geriatricians.”
Dr Wong Teck Wee, a consultant interventional cardiologist and physician, said the lack of geriatricians would lead to delayed and inadequate treatment for the elderly and increase the workload of non-specialist doctors under the Health Ministry.
It would also increase hospital re-admissions and prolonged stays and result in greater stress on caregivers.
He said age-related conditions such as dementia, frailty, incontinence and medication-related complications may go undiagnosed or be poorly managed without proper expertise.
“General physicians and internists in public hospitals, who may lack specialised geriatric training, manage complex elderly patients.
“Such circumstances can lead to fragmented care.
“The absence of holistic geriatric care also increases the risk of complications, resulting in more frequent hospitalisations and longer recovery times,” the Malaysia Healthy Ageing Society vice-president said.
He said the ministry should consider expanding geriatric training and scholarship programmes by providing more training slots and financial incentives to encourage doctors to specialise in the field.
Primary healthcare geriatric services must be strengthened whereby general practitioners and family medicine doctors should be trained in elderly care to enhance early intervention.
“More investment and private incentives are needed in home-based geriatric services, day care centres, and integrated elderly care models to reduce hospital dependency.
“The geriatric care ecosystem requires more specialised nurses, physiotherapists and social workers to provide comprehensive support.”
