I had a long chat with my friend today over coffee - one of those where you share about life and everything under the sun. One of the topic happened to be about ageing and retirement. While the both of us were not exactly near that corner of life (yet) but it was something we both had personally spared some serious thoughts on be it for ourselves or for our parents.
It reminded me of the time when I co- wrote an article for Penang Monthly about the ageing population in Penang. It was one of the most profound article which I had ever written had to be the one about the ageing population in Penang. The process of researching for this article has opened my eyes to learn so much more than I could ever thought about ageing - as it is multifaceted, and often with a heartbreaking undertone because senescence is an unforgiving phase of life that constantly reminds you that your days (which once seems infinite) are numbered. Conversations about ageing is crucial, as much as it is unavoidable - even as we try to be optimistic in this race against time.
There's just so much that can be covered in an article which I co-authored, so I decided to publish my part here in my blog instead of letting it lay dormant and forgotten in my laptop. The first draft was a (painfully) long article (which is probably a fault on my end as I tend to be quite wordy!) but for this blog post, I will just upload one of the section which I wrote that wasn't published (and unedited, so please pardon any jarring mistakes!) in the original article, and this one is about health and well being of the ageing population. I am planning to also post another unpublished part, which is about the 'sandwich generation' sometime soon after this one.
I am not sure how many people will come across this post, but I can only hope that this can be an effort, albeit a small one, which will somehow spur some conversations among people, and inspire a more caring, kind and inclusive society wherever we are.
HEALTH AND WELL BEING AS WEALTH
Wealth comes in many forms, and it could mean differently to different people. However, it is no longer a cliché to regard health as wealth when senescence becomes a daily reality that one has to live with.
Although there are more people in the world today are surviving past their seventh decade than any time in recorded human history – the diseases and disorders associated to ageing are numerous. Some of them include arthritis, cardiovascular disease including hypertension, respiratory diseases, Alzheimer’s disease and osteoporosis. Oftentimes, an individual may even live with multiple health conditions at a given time. As cellular senescence leads to ageing and the development and progression of diseases, physiological degeneration of an elderly is inevitable.
Alzheimer’s disease in particular, accounts to has high as 60 – 80% cases reported among elderly. It is also called as the disease of "The Long Goodbye" as it deteriorates the patient progressively over the length of many years, even up to 10 years or more. While the Alzheimer's Disease Foundation of Malaysia estimated that as many as 50,000 people suffers from the disease, there are also many of those who were not clinically diagnosed and therefore does not receive medical advice on proper caregiving. Elderly with Alzheimer’s disease often struggle to remember recent events or conversations – often coupled with apathy and depression. Over the years, their communication will be further impaired, with a high tendency of making poor judgement, suffer from disorientation, and may face difficulty in swallowing and walking. Caring for elderly with Alzheimer’s disease, either by caregivers or by family members, requires an in-depth understanding of the condition and proper management which the patient requires.
It is crucial and urgent for the health systems to start preparing now to address health concerns of the elderly given the inevitable rise of the ageing population in this country. Such necessary reform is especially needed as it affects the redistributive ability of public spending in supporting consumption for the elderly. As the public sector financing of the elderly’s health consumption increases with the level of national income, the low-income and lower-middle-income countries’ spending for such matter is expected to be marginal. Generally, Malaysia’s percentage of GDP on public expenditure was at an average of 4.0% between 2009 and 2013, and increased to 4.2% in 2014 (Figure 3). The rising cost of healthcare, coupled with the increasing number of non-communicable diseases (NCD), also known as chronic diseases such as cardiovascular diseases (i.e. heart attacks and stroke), cancers, chronic respiratory diseases (i.e. chronic obstructive pulmonary disease and asthma) and diabetes; would add significant stress to the country’s public spending.
Depression is also a prevalent mental health condition among the elderly (Figure 4), however not much is being spoken about this. Depression is more than just a state of emotional sadness; depression has the ability to strip away a person’s vigour and vitality - and finally, the will to live. This is especially true for elderly who had previously lived a comfortable life but now confined and institutionalised in nursing homes as they tend to display a higher risk and level of depression.
Dr Richard Ng, physician & geriatrician stated in the news that many of these cases are undiagnosed or not reported, as elderly are less likely to tell people they are depressed. The depression could be triggered by several situations such as the anxiety of being alone at home, the lack of attention given by family members, loss of spouses or friends, or even the gradual loss of physical ability to perform daily activities and the deterioration in overall health. Sometimes, depression is even caused by the abnormality of chemical composition in the human brain. In a study conducted by the UCLA Neuropsychiatric Research Institute, the cognitive performance observed during depressive episodes were found to have potential association with biochemistry changes within the frontostriatal neuronal circuitry. Treatments are available in various forms, such as medicines (e.g. anti-depressant), psychotherapy, counselling and even electroconvulsive therapy. Family members could watch out for telling signs of depression in the elderly through their interrupted sleeping patterns (either insomnia or having too much sleep), losing interest in daily activities, extreme mood swings without a cause, changes in eating habits (i.e. having excessive appetite or none).
It is common in Asian culture to stigmatise depression as conversations on mental disorders are usually avoided and awareness on mental conditions are scarcely available among the society. Depression is often not acknowledged as a disease and typically brushed aside as harmless mood swings – which makes it all the harder for elderly who are silently suffering from depression to receive the help they need. Families and caregiver – it is a responsibility to help the elderly age gracefully and live the rest of their lives with dignity by seeking medical help as it is treatable. Help can be sought from public mental health screening services in primary health clinics or public and private hospitals.
One way to reduce the risks of mental degenerative diseases is to allow the elderlies to engage in a daily routine of active lifestyle. “As you know, a person sitting down one whole day, only eating and sleeping, will go downhill after some time,” said Datuk Lawrence. “The bottom line is love and care. You need to provide them with love and tender care, converse with them – as they need people to talk to, and keep them busy.”
 United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Ageing 2015 (ST/ESA/SER.A/390).
 New Straits Times. 2016. “Depression among elderly increasing.” Published on August 23, 2016. Accessed on March 8, 2017. <http://www.nst.com.my/news/2016/08/167702/depression-among-elderly-increasing>
 Elderkin-Thompson, V., Thomas, M. A., Binesh, N., Mintz, J., Haroon, E., Dunkin, J. J., & Kumar, A. (2004). Brain metabolites and cognitive function among older depressed and healthy individuals using 2D MR spectroscopy. Neuropsychopharmacology, 29(12), 2251.