Let's talk about ageing, Part 1: Health is wealth
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 topics happened to be about ageing and retirement. While 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. If there was one profound article which I had ever written, it has 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 think 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 are crucial, as much as it is unavoidable - even as we try to be optimistic in this race against time.
One for the memories. (During a birthday celebration at the Senior Citizens Association which I was invited to. I remembered it as warm and joyful celebration, almost childlike, to celebrate yet another glorious year together with their friends, although in the absence of their family members)
There's just so much that can be covered in an article I co-authored, so I decided to publish my part here in my blog instead of letting it lay dormant and forgotten on 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 sections I wrote that wasn't published (and unedited, so please pardon any jarring mistakes!) in the original article. 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 I am planning to also post another unpublished part, which is about the 'sandwich generation' sometime soon after this one.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 IS WEALTH
Wealth comes in many forms, and it could mean differently to different people. However, it is no longer a cliché to see health as wealth when senescence becomes a daily reality that one has to live with.
Although there are more people in the world today surviving past their seventh decade than at any time in recorded human history – the diseases and disorders associated with ageing are numerous. To name some, they include arthritis, cardiovascular disease including hypertension, respiratory diseases, Alzheimer’s disease and osteoporosis. Often, an individual may even live with multiple health conditions at a given time. As cellular senescence leads to ageing, including the development and progression of diseases - physiological degeneration of the elderly is inevitable.
Alzheimer’s disease, in particular, accounts for as high as 60 – 80% of cases reported among the elderly population. It is also called 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 suffer from the disease, there are also many those who were not clinically diagnosed and therefore do 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 to make poor judgements, suffer from disorientation, and may face difficulty in swallowing and walking. Caring for the 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 the 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 that is crucial to support the well-being consumption of the elderly. As the public sector financing of the elderly’s health consumption should increase with the level of national income, the situation in low-income and lower-middle-income countries’ spending on this matter is expected to be marginal [1]. 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; all these would add significant stress to the country’s public spending.
Source: World Health Organization Global Health Expenditure database
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 the elderly who had previously lived a comfortable life but are 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 the elderly are less likely to tell people they are depressed [2]. 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, the 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 [3], the cognitive performance observed during depressive episodes was found to have a potential association with biochemistry changes within the frontostriatal neuronal circuitry. Treatments are available in various forms, such as medicines (e.g. anti-depressants), 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, and changes in eating habits (i.e. having an excessive appetite or none).
It is common in Asian culture to stigmatise depression, especially among the older generations. Conversations on mental disorders are usually avoided, and awareness of mental conditions is scarcely available among society. Depression is often not acknowledged as a disease and typically brushed aside as harmless mood swings – which makes it all the harder for the elderly who are silently suffering from depression to receive the help they need. Families and caregivers – 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.
Source: National Health and Morbidity Survey 2015: Non- Communicable Diseases, Risk Factors and Other Health Problems (Volume II). Institute for Public Health, Ministry of Health Malaysia
One way to reduce the risks of mental degenerative diseases is to allow the elderlies to engage in a daily routine of an 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.”
References:
[1] United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Ageing 2015 (ST/ESA/SER.A/390).
[2] 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>
[3] 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.