BY SARAH HAFIZAH CHANDRA AND GABRIEL LIHAN
IT is an open secret that Malaysia will be an ageing nation in 2030 when 15 per cent of its population is expected to be in the senior citizen category.
This means one in every eight people would be 60 years and older.
While the Ministry of Health (MoH) has a systematic healthcare system spanning across all ages from womb to tomb, presently, there are some gaps to access holistic care for the elderly, so they are often left to navigate by themselves.
The Geriatric Community (GeKo) Unit in Klinik Kesihatan Kota Samarahan is a first in the nation dealing specifically with geriatric patients who are 60 years old and above with complex health care needs, in the primary care setting.
The unit was established in 2019 with the objectives of improving the older person’s health status, encouraging the participation of the elderly in healthy activities and disease prevention, empowering the elderly, their families and communities with knowledge, skills, and environment that support healthy ageing.
Besides that, the unit also strives to provide health services that are public-friendly, cost-effective, equitable, easily accessible as well as advocate and support the creation of an environment that enables independent living for the elderly.
Family Medicine and Community Geriatrics Specialist Dr Sally Suriani Ahip and her team run the GeKo Unit’s services once a week on every Thursday and they currently have 105 patients under their wings.
Dr Sally explained that as one ages, one is bound to get diseases thus rendering the elderly vulnerable and frail.
She pointed out that this vulnerable group in fact has good potential for frailty reversibility and optimisation of their health conditions.
“This means if you detect frailty early and institute timely intervention, you can optimise their health status so that they are able to be independent for as long as possible.
“By ensuring that they are independent, you can shorten the period when they become bed bound or dependent.
“Once they are bed bound or dependent, there are many implications – they have poor quality of life and cannot contribute to the society.
“Their children might not be able to contribute either as they have to take care of their elderly,” she told New Sarawak Tribune.
SERVICES FOR THE ELDERLY
The GeKo Unit manages frail elderly patients with complex healthcare needs, and institutes personalised care plans and clinical intervention for a period of six months and up to one year.
The team is determined to optimise the health status of their patients while under the unit and subsequently return them to the standard clinic care.
Due to limitations such as space and healthcare professionals, the unit is limited to seeing highly complex cases.
There are approximately six to eight patients during group activities like physiotherapy, occupational therapy, nutrition and medication counselling.
Dr Sally said assisting these highly complex cases by catching them early is always beneficial for the patients, their family members and the society in general.
“The highly complex cases are the ones who are not sick enough to go to the hospital, but they are vulnerable and a potential timebomb in the community.
“We are trying to reverse their conditions as best as we can, so they are able to maintain their independence and optimum capacity.
“For instance, we want to catch those with memory problems early because they will start to decline and worsen if there is no intervention – this could lead to dementia with behaviour and psychological symptoms, which is another domain that is going to be challenging to manage,” she explained.
OF INDEPENDENCE AND AUTONOMY
When dealing with the elderly, shared and informed decisions must be made with the patient and their family members to ensure the patient is able to follow through with the care plan.
While clinicians often have the patient’s best interest in managing patient care, they must also take into consideration what is important to the patient and make shared decisions.
Dr Sally said it is important to communicate and allow the elderly the autonomy to decide as this relates to their dignity.
In saying this, she pointed out that the senior citizens’ autonomy often diminishes as family members or caretakers would make the decision for them.
“We would inform the elderly on clinical issues identified and ask which one is most important to them.
“Hypertension may be an important issue that must be primarily addressed in our view, but they want to see their grandchildren so dealing with vision loss is a priority to them”, she said.
Similarly, Dr Sally said some of the elderly were not given the autonomy to decide for themselves during the Covid-19 vaccination.
“They have good cognitive ability and the capacity to make their own decision, so it is puzzling that there were some who had the decision made for them.
“The elderly should be informed about the vaccination – its importance and risk – then let them decide for themselves whether to go for it or otherwise,” she said.
On their discipline in following prescriptions and treatment plans from their clinicians, Dr Sally stated that these must be simple and easy for them to remember.
It is common for the elderly with complexities to be prescribed with six and more medications.
However, it is important to trim the prescription down to by making it simple for them to understand and they would be able to comply better.
To entice the elderly to comply, she reiterated that it is crucial to communicate and find out what issues are most concerning to them.
“If you were to give them five medications compared to 10 or 15 medications, of course they will understand the former better and prefer it.
“When there is a shared decision on their treatment plan and management where they are given the autonomy, they will know that you are listening – this enhances their compliance.
“As clinicians, you weigh the risks and benefits then help your patients to decide together – this goes a long way in ensuring that they stick with treatment plan and management,” she added.
STRONG SUPPORT SYSTEM
A strong support system also contributes to the success of their treatment plan and management.
Noting how some of the elderly do not drive and depend on their family members for transportation to attend appointments, Dr Sally said engaging the family members is crucial.
She said most of the patients who stick to the GeKo Unit’s programmes are the ones with good family support, or they are still able to drive a car or ride a motorcycle.
“Engagements with their families are very important because they need to know what the benefits are in sticking to the treatment plan or programme.
“There are patients with four to five children, but it is always the same son or daughter who takes them to the appointments.
“It would be best if their children can take turns, so they are aware and able to understand better and share the care of their parents together,” she said.
AWARENESS FOR THE ELDERY
In the Samarahan area, most of the elderly fall into the B40 group (low income) so there are financial constraints especially when it comes to getting vision and hearing aids.
Dr Sally said the elderly who have vision problems often do not have the money to go for cataract surgery while those with hearing problems cannot get hearing aid.
As such, the GeKo Unit also functions as a single entry-point for the older person to receive holistic care and be assisted to navigate themselves through a complex health and social care system.
Under the Skim Peduli Kesihatan healthcare scheme for the B40 group or PeKA B40, there are subsidies such as for intra-ocular lenses and hearing aids for the elderly, to name a few.
“The elderly who are referred to the GeKo Unit would be thoroughly evaluated on the problems they have then we personalise the treatment and management plan for them including access to PeKa B40 subsidies for elderly in the B40 group,” she explained.
Dr Sally pointed out that not many of the elderly are aware of such assistance thus there is a need to raise awareness on this.
In pointing this out, she said there is also a need to raise awareness on how maintaining independence is crucial despite ageing.
While it is natural to get weaker and vulnerable as one goes through ageing, she said getting oneself checked and informing clinicians on the problems faced is significant.
“The elderly must come to terms that they are ageing and there are bound to be problems, but they must not think that this is the way to go for them.
“The average lifespan of a Malaysian is 76 so when you are 60 years old you should not have the perception or accept that it is going to be grey and gloomy for the next 10 or 16 years” she said.
CHANGING THE MINDSET ON AGEING
Sarawak’s growing ageing population is concerning and there have been calls for prompt improvements on medical care.
Despite this, Dr Sally pointed out changing the mentality and attitude on ageing is also a main priority.
The common perceptions of how ageing is equivalent to being old and weak must be debunked as the elderly can and should practice an active lifestyle.
When asked whether the perception is prevalent in Asian society, Dr Sally responded yes.
“We usually think that we have worked so hard all our life, so by the time we become an elderly we are supposed to rest and do nothing.
“This is a cardinal sin,” she emphasised.
When the elderly decide to just rest instead of continue being active, it will affect their body.
Dr Sally said people should look forward to their retirement days, but they must have plans on what they are going to do.
“When you decide to just rest and do nothing, everything in your body will be affected –your brain will shrink if you do not stimulate it, same goes with your muscles if you are not moving around.
“The moment you do not do mental or physical workouts, you will start to become weak,” she explained.
On her experience of studying and living abroad, she said such perception on ageing differs in the Western society.
“I was training in Adelaide, Australia and there was this one incident where I wanted to help a senior to carry her bag.
“She looked at me in disbelief and told me that she can handle it herself – to her it was as if I was undermining her.
“In comparison to Asian society, the elderly love the attention of getting fussed over by others,” she said.
While it is common for the elderly to take care of their grandchildren by babysitting, she said this is a good activity as it helps them with their mind and body.
However, she said doing this should not lead to the point of stressing them out as it can affect their overall health.
She stressed that the mentality change is needed across the Asian society including in Malaysia.
“If you observe the parks in Vietnam, the parks are full of seniors engaging in group fitness.
“Malaysians need to change their overall perception on ageing.
“The elderly cannot see themselves as weak and think that the society should accept them as they are,” she said.
She said if the elderly have the mindset of ‘this is it, I am supposed to be resting and do nothing’, it is worrying because that is when health problems will come.
HOPES AND FUTURE UNDERTAKING
On her hopes and wishes for the clinic and her patients, Dr Sally said the team would like the elderly and community to know that there is a service in the primary care clinic that helps them navigate through the complex system.
Touching on the current challenges faced, she hopes for a bigger space such as a dedicated building so it would not be too crammed and the unit can see more patients.
“We cannot do more than six or eight patients now for group therapies with the social distancing measures in place.
“During the peak of the Covid-19 pandemic, we could only see four or five patients – previously we could see 10 to 12 patients, but it was a bit crowded,” she said.
Another hope is the need to have more manpower to expand the multidisciplinary team.
“We are working within our limits – our staff is enough for the current workload but with expansion, we need to double or triple depending on how big it becomes.
“We started the unit in one clinic three years ago, the progress has been a bit delayed due to the Covid-19.
“We have expanded to three clinics in Samarahan in 2022, and I hope next year we will expand to Kuching and eventually throughout the state,” she said.
“To address the concerns on ageing population in the nation, early frailty detection and timely intervention through primary healthcare clinics and strengthening aged-care services in the community is going to be the way forward,” she said.
