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Aging With Grace: A Focus On The Quality Of Life Among The Malaysian Elderly

AGING WITH GRACE: A FOCUS ON THE QUALITY OF LIFE AMONG THE


MALAYSIAN ELDERLY

Malaysia

ABSTRACT

INTRODUCTION: Developing countries experience the “aging” phenomenon and Malaysia


is no different. In 2000, about 6% of the Malaysian population is aged 60 and above. The
number of elderly citizens is expected to double. Seven states in Malaysia have an elderly
population exceeding 7%, putting it under the category of an aging population. The objective
of our paper is to explore the problems of geriatric care in Malaysia, assess quality of life of
elderly and identify factors associated with their quality of life. With the current Malaysian
trend of more women going to work, there is decrease ability of children to care for elderly
parents, causing nursing homes to become increasingly important. There are currently nine
government supported nursing homes for elderly in Malaysia, a number clearly inadequate to
accommodate the vast 1.6 million elderly in the country. The country also faces a major
problem of having small number of geriatricians and centres providing geriatric care, thus
affecting the quality of life of the elderly. MATERIALS AND METHODS: A comparative
cross sectional study was conducted using SF-36 questionnaire to assess the quality of life of
elderly people under institutional care and in the community. A hundred samples were each
collected in government nursing homes for elderly and the community respectively through
convenient sampling. Association and correlation of quality of life with factors such as
disease burden, education level and ethnicity were tested. Literature review on medical
journals and interviews with administrative staff of nursing homes and the president of The
National Council of Senior Citizens‟ Organisations, Malaysia (NACSCOM) were done.
RESULTS: The emotional health of elderly in old folks homes is better than those living in
the community (p=0.031, t=2.171). The quality of life of elderly in the community is better
than that in old folks homes, although not significant (p=0.461, t=-0.739). Education level of
the elderly correlates with their quality of life (p=0.01, r=0.225). There is correlation between

*QOL – Quality of Life; GH - General Health Perception; PF - Physical Functioning; REP - Role
Limitation due to Physical Problems; REE - Role Limitation due to Emotional Problems; SF - Social
Functioning; BP - Bodily Pain; VT – Vitality; MH - Mental Health
Aging With Grace: A Focus On The Quality Of Life Among The Malaysian Elderly

the physical health and emotional health of elderly (p=.000, r=0.409). In terms of ethnicity,
Malay elderly have better social functioning (p=.000, t=0.014) but poorer mental health
(p=0.011, t=2.554). CONCLUSION: Given the multi factorial nature of quality of life of
elderly, we explore approaches of the government and non-governmental organizations such
as NACSCOM and Gerontology Association of Malaysia (GeM) in meeting the varying
needs of Malaysian elderly, their challenges, future potential approaches and the role of
medical students in this field. In order to counter the aging boom, the Malaysian healthcare
providers have to step up in order to meet the challenges of improving the quality of life of
our elderly.

INTRODUCTION

Malaysia’s Aging Problem

As most developing countries, the Malaysian population inevitably ages. Economic growth
leads to social change such as improvements in women‟s education level, healthcare
facilities, changes in fertility, occupation and family formation patterns resulting in a reduced
birth rate and an increased life expectancy, which eventually contribute to the trend of
Malaysian population towards an aging population.

2000 Census of Malaysia found that Malaysian population is still considered „youthful‟ with
6.3% or 1.4 million of population aged 60 years and above. However, growth rates of the
elderly population increase continuously despite declining growth rates for the total
population in Malaysia causing an aging bloom of Malaysian population in coming years.
The census also recorded that 7 states of Malaysia (Kedah, Kelantan, Melaka, Negeri
Sembilan, Perak, Perlis and Pulau Pinang) has reached above 7% of elderly proportion, which
is recognised as „aging‟ population, with significant increase of elderly component in rural
areas from 1991 to 2000. (Malaysian 2000 Census)

*QOL – Quality of Life; GH - General Health Perception; PF - Physical Functioning; REP - Role
Limitation due to Physical Problems; REE - Role Limitation due to Emotional Problems; SF - Social
Functioning; BP - Bodily Pain; VT – Vitality; MH - Mental Health
Aging With Grace: A Focus On The Quality Of Life Among The Malaysian Elderly

The elderly is further divided into two groups, young-old (aged 60-74 years) and old-old
(aged 75 years and above). The number in the old-old group is projected from 277,000 in
2000 to 651,000 in 2020, which implicates a greater need for health facilities and care catered
for the aged.

Malaysian Healthcare System

Malaysia has comprehensive medical and health care services for the general population, but
special programmes for the aged are lacking, including geriatric services and rehabilitation.
(Arokiasamy J T, 1997) The current health care system which focuses on short term care and
hospitalisation is not addressing the needs of the elderly with chronic problems effectively.
(Poi P J H, 1997) This poses difficulty in providing preventive medicine for the elderly,
adding to the fact that the elderly are less reachable through primary prevention of diseases,
where education is the major preventive measure in Malaysia.

Despite the increasing needs of elderly in Malaysia, there are currently only a handful of
hospitals with a Geriatric Care Unit. While it is recommended to have 1 geriatrician for every
4000 elderly, Malaysia has only nine geriatricians at present, meaning that most elderly are
seen by general practitioners who do not understand their needs fully. Some healthcare
providers are also ignorant to the needs of elderly patients. A comparative study of first and
third year nursing students‟ revealed that only 10% of the third year students and none of the
first year students would choose to nurse the older patient as a first preference. (Poi P J H,
1997).

Psycho-geriatricians are also not readily available in Malaysia. General Practitioners and the
patient's family presently bear the brunt of providing care without having the appropriate
support in the community. Rehabilitation from the diseases to help return the elderly patient
to premorbid function is often lacking in hospitals. (Poi P J H, 1997)

Perception of the Society

*QOL – Quality of Life; GH - General Health Perception; PF - Physical Functioning; REP - Role
Limitation due to Physical Problems; REE - Role Limitation due to Emotional Problems; SF - Social
Functioning; BP - Bodily Pain; VT – Vitality; MH - Mental Health
Aging With Grace: A Focus On The Quality Of Life Among The Malaysian Elderly

Malaysian norm that focuses on the young has lead to marginalisation of the elderly.
Examples include early retirement and non-elderly-friendly infrastructures. Generally,
Malaysians retire at the age of 55. This early retirement has lead to the perception of the
elderly as being dependent and even a burden. The society now focuses more on their career
and no longer takes care of the elderly as the yesteryears. The household and family
structures are also changing rapidly to smaller family units and nuclear family household,
leaving the elderly to live alone. The traditional practice in which married children live with
their parents is declining with years. Together with the effect of population aging, this result
in a neglected aging community emphasising on the increasing importance of nursing homes
in Malaysia.

Perception of the Elderly

Current Malaysian elderly are from a generation where spending money on themselves will
be considered crass. A majority of them also have minimum education. 51% of Malaysian
elderly never receive any formal schooling (Malaysian 2000 Census). Therefore, they lack
awareness and have very low expectation on aging where most elderly think that diseases and
dysfunctions are part of the normal aging process and only seek treatment during a crisis.
This results in the under-reporting of symptoms and progress of disease to later stages,
increasing mortality and morbidity in this group of citizens. Other reasons may be due to a
fear that findings of diseases presence and treatment would produce functional loss and
jeopardize independent living.

Poor life satisfaction and self-esteem correlated with abandoned self-care behaviour among
elderly (Backman and Hentinen, 2008). It is important for elderly to have satisfying quality of
life and an practice active aging as elderly people with high levels of habitual physical
activity live longer and have better general health and higher levels of wellbeing than do those
who are inactive (Kerse et al., 2008).

*QOL – Quality of Life; GH - General Health Perception; PF - Physical Functioning; REP - Role
Limitation due to Physical Problems; REE - Role Limitation due to Emotional Problems; SF - Social
Functioning; BP - Bodily Pain; VT – Vitality; MH - Mental Health
Aging With Grace: A Focus On The Quality Of Life Among The Malaysian Elderly

Factors Affecting QOL Among Elderly

Physical Illness

Physical changes in the elderly is associated with multiple diseases, especially chronic
diseases such as cardiovascular disease, cerebrovascular disease, urinary and fecal
incontinence, injuries from accidents, visual and hearing losses, dental deficits, psychosocial
problems, depression, dementia, and foot problems. A study done in Sepang, Selangor found
that 60.1% of elderly have chronic illness. (Sidik et al., 2003).

Disability is associated with increasing age (Nget al, 2006; Reyes-Ortiz et al, 2006; Pèréset
al, 2005; Walter-Ginzburg et al, 2004). Prevalence of disability among Malaysian‟s
community-dwelling population was observed at 22.8 percent. (Sidiah Siop, 2008). Disability
increases risk for dependence at home, hospitalization, nursing home admission and
premature death (Quinn, 1999; Fried et al, 1997; Ferruci et al, 1996).

Malnutrition is prevalent among the elderly due to changes in dietary habits, poor dentitions
and types and amount of food consumed (Mafalzi, 2000).

Mental Disorder

A study in Kampung Bahru, Kuala Lumpur, showed the prevalence of psychiatric disorders
in those above 65 as 5% with dementia, 13% with depression (4% major depression) and
12% with anxiety states (7% phobic). A study looking at the elderly in an institution in the
Klang Valley revealed a higher proportion of demented elderly (14.7%) in homes not meant
for them. (Saroja Krishnaswamy, 1997). Alzheimer's disease is an increasingly recognized
problem, being the most common form of dementia affecting possibly at least 5% of the
population over 65 years of age. (Saroja Krishnaswamy,1997) There is a positive relationship
between chronic stress and depression that affects quality of life (Fon and Phillips, 2003).

*QOL – Quality of Life; GH - General Health Perception; PF - Physical Functioning; REP - Role
Limitation due to Physical Problems; REE - Role Limitation due to Emotional Problems; SF - Social
Functioning; BP - Bodily Pain; VT – Vitality; MH - Mental Health
Aging With Grace: A Focus On The Quality Of Life Among The Malaysian Elderly

The onset of depression in the elderly is often preceded by severe life events for example
bereavement, loss of income and illness.

Polypharmacy

With greater drug usage and polypharmacy, the incidence of adverse drug reactions is more
prevalent in the elderly. In the University Hospital elderly study, 50% of the elderly patients
were noted to be on multiple drug therapy on discharge. Physiological changes in the ageing
kidney, memory deficits, altered eating habits, and multiple drug regimens make drug therapy
more difficult in the elderly. (Poi P J H, 1997)

Social Factors

The elderly are a heterogeneous group whose quality of life is affected by both medical and
non-medical factors which include work, retirement and income, housing and
institutionalization, family and the community, lifestyles and leisure activities, and personal
characteristics such as gender, ethnic background, personality and widowhood. (Arokiasamy
J T, 1997)

Socio-economic security is important. Depression occurred eight times more frequently


among the elderly with low family income, (Sidek et al., 2003) due to inadequate diet, poor
housing, poor health and medical care and the combination of family and community
disorganization (Lobo et al., 1995; Ramachandran et al., 1982).

A World Health Organization (WHO) study and ASEAN study revealed that about 70% of
males, 60-64 years of age, felt that the elderly should be active in work, while about 40%
aged 75 years and over desired the same. Continued employment is associated with higher
morale, happiness, better adjustment, longevity, larger social network, and better perceived
health among the elderly (Arokiasamy J T, 1997).

For most elderly, families are the most important source of support. Depression occurred
more frequently among the elderly who lived alone compared to those who lived with their

*QOL – Quality of Life; GH - General Health Perception; PF - Physical Functioning; REP - Role
Limitation due to Physical Problems; REE - Role Limitation due to Emotional Problems; SF - Social
Functioning; BP - Bodily Pain; VT – Vitality; MH - Mental Health
Aging With Grace: A Focus On The Quality Of Life Among The Malaysian Elderly

family. (Sidek et al., 2003) Loneliness is common in the elderly, whether living alone or
otherwise. Isolation can be a serious problem in medical emergencies where late treatment
could lead to disability, handicap and even death.

The elderly prefer to live in their own homes and in their familiar neighbourhood.
Institutionalized elderly often experience excess morbidity and mortality. (Arokiasamy J T,
1997). The lack of adequate contact with family and friends, the tendency for excessive
custodial attention and financial or fiscal disability can result in the institutionalized elderly
being depressed and withdrawn.

OBJECTIVES OF STUDY
Seeing that the importance of nursing homes for elderly is increasing, a research was done to
study the quality of life (QOL) among the elderly and the association factors. A comparison
was done to assess QOL between elderly under institutional care and those in the community.

MATERIALS AND METHODS

A cross sectional survey was conducted on the elderly aged above 60 years old at two
government nursing homes for the elderly, Rumah Sri Kenangan Seremban and Rumah Sri
Kenangan Cheng Melacca and the community of Sabah through convenient sampling. 100
respondents from the nursing homes and 109 respondents from the community participated in
the survey. Both of the nursing homes are under the Social Welfare Department of Malaysia,
catering for elderly who are single or come from families who are unable to care for them.

Socio-demographic and medical characteristics of the patients were recorded and the Malay
language version of SF-36 form was either self-administered or led by an interviewer (face-
to-face). Proxy respondents were not entertained as the validity of SF-36 will be
compromised. All respondents were asked to answer based on what they understood of the
question.

*QOL – Quality of Life; GH - General Health Perception; PF - Physical Functioning; REP - Role
Limitation due to Physical Problems; REE - Role Limitation due to Emotional Problems; SF - Social
Functioning; BP - Bodily Pain; VT – Vitality; MH - Mental Health
Aging With Grace: A Focus On The Quality Of Life Among The Malaysian Elderly

SF-36 assesses quality of life subdivided into eight domains which are General Health
Perception (GH), Physical Functioning (PF), Role Limitation due to Physical Problems
(REP) and Role Limitation due to Emotional Problems (REE) under Physical Component; as
well as Social Functioning (SF), Bodily Pain (BP), Vitality (VT) and Mental Health (MH)
under Emotional Component (Appendix I). Scores were given through a Likert Scale with
higher scores reflecting better quality of life and adjusted to a total of 100 QOL units as
maximum score for each QOL component.

The statistical analyses of the study were done using Statistical Package for the Social
Sciences (SPSS) version 13.0. Correlation and Independent T-tests were used in this study.
The level of significance is set at 0.05.

RESULTS

The study included 100 samples of elderly from the nursing homes and 109 samples from the
community. The proportion of males and females in both settings are similar at around 50%.
In terms of race, two third of respondents in the nursing homes were Malays but more than
90% of respondents in the community were of the indigenous race. All respondents in the
community are married in contrast to only 38.0% of respondents in nursing homes being
married. Young-old and old-old respondents were of nearly equal proportion in both settings
at around 50%. A majority of the respondents did not receive any formal education, a higher
majority found in the community. A higher proportion of respondents in the nursing homes
did not suffer from any disease. (Table 1.1)

The mean overall QOL of elderly in this study is 73.82 QOL units, 25% of respondents
having a score of 81.82 QOL units and above (Table 1.2). There is significant correlation
between the education level of elderly and the number of diseases suffered with components

*QOL – Quality of Life; GH - General Health Perception; PF - Physical Functioning; REP - Role
Limitation due to Physical Problems; REE - Role Limitation due to Emotional Problems; SF - Social
Functioning; BP - Bodily Pain; VT – Vitality; MH - Mental Health
Aging With Grace: A Focus On The Quality Of Life Among The Malaysian Elderly

of QOL of respondents (p<0.05). (Table 1.3) Factors such as being under institutional care,
gender, being married and education level affect QOL components significantly (p<0.05).
(Tables 1.4 to 1.7)

DISCUSSION

Elderly who live in the community have better QOL (Mean=74.43 QOL unit) compared to
those living in nursing homes (Mean=73.13 QOL unit) although this is not significant (Table
1.4). This is similar to a study by J T Arokiasamy. (J T Arokiasamy, 1997) PF (t=-2.115,
p=0.036), VT (t=-2.226, p=0.027) and MH (t=-3.118, p=0.002) are significantly better in the
community. This could be due to the common perception of elderly people that living in
nursing home is less desirable as nursing homes are deemed as a dumpsite for those who are
unwanted. Lack of contact with family members, feelings of resentment and loneliness can
affect the mental health of elderly in nursing homes. However, SF (t=8.417, p=0.000) is
better and BP (t=2.233, p=0.027) is less in nursing homes. This could be because elderly in
nursing homes have the privilege of having their daily needs provided for and face fewer
challenges. They live in a homogenous setting of elderly people and are more accessible to
social connections of their age group that they can relate to better. Those who live in the
community however may lack social contact of people of their age group if they are less
active and prone to stay indoors or if family members passively neglect them due to hectic
lifestyles.

In general, the mean scores for all scales were above 60.0 QOL units, similar to the QOL
score of elderly aged 60 and above (N=253) in a national survey done to assess the QOL
among the Malaysian general population in 2000 (Azman A B, 2003) (Table 1.2). In
comparison, the QOL score in this study is higher than that in the national survey in all
domains except in SF and MH.

*QOL – Quality of Life; GH - General Health Perception; PF - Physical Functioning; REP - Role
Limitation due to Physical Problems; REE - Role Limitation due to Emotional Problems; SF - Social
Functioning; BP - Bodily Pain; VT – Vitality; MH - Mental Health
Aging With Grace: A Focus On The Quality Of Life Among The Malaysian Elderly

There is correlation between physical component and emotional component of QOL of the
elderly (p=.000, r=0.554). It indicates that these two factors are interrelated and are
dependent upon each other in affecting the quality of life of elderly (Table 1.3).

The young-old elderly scored higher quality of life compared to their old-old counterparts.
However, these findings are found to be not significant (Table 1.5). Cumulative health–
related chronic life strains set a constraint on the potential of old-old individuals to
experience the positive side of life (Smith J. et al, 2003).

In terms of gender, the female elderly studied have a higher disease burden (t=-2.564,
p=0.011) (Table 1.5). Male elderly experience less REE compared to females and conversely,
females face less REP although these results are not found to be significant. These findings
are supported by studies done by Harolhanam, Orfilla et al., Suzuki et al., Ahamad and
Norhafiza (Harolhanam, 2009; Orfilla et al., 2006; Suzuki et al., 2002; Ahamad, 2005;
Norhafiza, 2006). It indicates that females are more affected by emotional problems and
males by physical problems. It is suggested that interventions can be tailored to suit different
gender needs. Male elderly have better quality of life than females although this is not
significant (Table 1.6).

QOL is higher among the married elderly compared to those who are single, divorced or
widowed, although not significant. (Table 1.7) This is consistent with studies by Harolhanam,
Tan and Chia (Harolhanam, 2009; Tan, 1992; Chia, 1995). Scores for VT (t=-2.345, p=0.020)
and MH (t=-2.891, p=0.004) are significantly higher for the married elderly. However, SF is
higher among those who are single, divorced or widowed (t=4.404, p=0.000). Marital status
affects many aspects of a person‟s life especially for older persons. Changes in marital status
have bearing on living arrangements, nature of care-giving and financial support of the
individual. (Malaysia 2000 Census)

*QOL – Quality of Life; GH - General Health Perception; PF - Physical Functioning; REP - Role
Limitation due to Physical Problems; REE - Role Limitation due to Emotional Problems; SF - Social
Functioning; BP - Bodily Pain; VT – Vitality; MH - Mental Health
Aging With Grace: A Focus On The Quality Of Life Among The Malaysian Elderly

There is correlation between education level and QOL where those with higher education
level have better QOL (p=0.001, r=0.226). (Table 1.3) This is supported by a study done by
Harolhanam in which those with higher education level have better QOL (Harolhanam,
2009). QOL is better in all aspects except in REE and in disability in a study by Chapman et
al. (Chapman et al., 2007) Education determines the QOL of elderly as it helps them in
continuous education and increases social relationship in community (Usman et al., 2001).

Limitations
The study was done in old folks homes and the community are located in different areas, the
old folks home located in urban areas while the community in villages in Kota Belud and
Kudat resulting in a comparison of QOL of elderly between non homogeneous socio
demographic settings. Sampling was limited to two out of nine nursing homes for elderly in
Malaysia. The findings from our study are limited by small sample size, inadequate time of
study and the use of convenient sampling method. The results of this study therefore may not
represent the actual quality of life of elderly in nursing homes and the Malaysian community.
Nevertheless, it provides a useful insight on the conditions of elderly in Malaysia, enabling us
to identify areas of intervention to improve quality of life among elderly as a whole.

Government Policies and Effort

The National Policy for Older Persons was approved by the government in 1995 with
the objectives to enhance and focus on promotive and preventive health care among elderly,
establishment of specialist geriatric services in regional and state levels, plan of action on
training and research needs in care of elderly, and enhancing quality of life through
community-based approach. (Zaimi, 2007) The latest policy focuses on optimising their self
potential, provide access to all opportunities and have provision for care and protection.”
(National Policy for the Elderly, 2001)

*QOL – Quality of Life; GH - General Health Perception; PF - Physical Functioning; REP - Role
Limitation due to Physical Problems; REE - Role Limitation due to Emotional Problems; SF - Social
Functioning; BP - Bodily Pain; VT – Vitality; MH - Mental Health
Aging With Grace: A Focus On The Quality Of Life Among The Malaysian Elderly

In concordance with policy, the National Advisory and Consultative Council for Older
Persons was established in May 1996 with the Technical Committee of The National Policy
for Older Persons in July 1996, to work on the Plan of Action and ensure the integration and
participation of the elderly in the country‟s development (Zaimi, 2007). The Plan of Action
calls for all parties to work towards implementation of the policy which involve education
and training, employment, participation in the community, facilities, health, social security,
research and development.

Institute of Gerontology was established in 2002 at Putra University of Malaysia for


continuous research and to provide recommendations on the needs of the elderly to the
government and non-governmental agencies. The Eighth Malaysia Plan planned to establish
Geriatric Care Units in all district hospitals by year 2020.

In public sectors, pre-retirement courses have been carried out preparing the
upcoming retiree for the challenges of aging and changing of lifestyle physically,
economically, socially and psychologically. Employees in public sector can take a maximum
of two years leave from work with half-pay to care for ill parents. Government hospitals also
provide free medical treatment for parents of government employees.

Roles of Social Welfare Department

The Social Welfare Department (SWD) provides financial assistance scheme-Aid for
Older Persons (BOT) for the poor elderly especially those without next of Kin, giving a
monthly allowance of RM 200 and other assistance such as artificial or orthopaedic
appliances and spectacles.

At present there are 15 Day Care Centres for older persons and 13 Homes for the
Older Persons directly under SWD throughout the country. (Zaimi, 2007) The Care Centre
Act 1993 under the SWD ensures the standards of care and services in NGO-run and private
nursing homes. However, of the hundreds of nursing homes estimated to be in operation

*QOL – Quality of Life; GH - General Health Perception; PF - Physical Functioning; REP - Role
Limitation due to Physical Problems; REE - Role Limitation due to Emotional Problems; SF - Social
Functioning; BP - Bodily Pain; VT – Vitality; MH - Mental Health
Aging With Grace: A Focus On The Quality Of Life Among The Malaysian Elderly

throughout Malaysia, only 188 are licensed by the Social Welfare Department as qualified
care centres.

Social Security Schemes

Currently, there are two social security schemes that cover only those employed in the
formal sector, namely the Pension and Employees Provident Fund (EPF). Pension is wholly
borne by federal government through annual allocation from federal budget for retired
government employees. A government employee is entitled for a life-long monthly pension
after serving at least 10 years with the amount receivable being half of the last drawn salary
after 25 years of services. EPF is a defined contribution plan based on a prescribed rate of
contributions by employers and employees, accumulated as savings in a personal account
with full withdrawal upon retirement

These two schemes only manage to cover around 60% of the labour force in
Malaysia, leaving another 40% mostly from the informal sector or self employed people
uncovered or without a known source of coverage. (Zaimi, 2007) It is essential for an
approach to be formulated especially for those from the informal sector group. However, the
government cannot guarantee adequate income security as EPF is not inflation indexed. The
popular lump-sum nature of withdrawal posts a risk as well.

Non Government Organizations (NGO)

There are various NGOs that contribute to the field of geriatrics in Malaysia,
including the National Council of Senior Citizens‟ Organisations, Malaysia (NACSCOM),
Gerontology Association of Malaysia (GeM) and Persatuan Usiamas Malaysia.

NACSCOM is an umbrella body for various localised group of elderly in Malaysia


which regularly makes representation to the government on many issues concerning the aged.
NACSCOM aims to advocate the development of policies and services that enhance the
quality of life and well-being of the elderly. It is active in joining or hosting conference
locally and or internationally, such as NACSCOM Biennial Delegates Conference in Kuala

*QOL – Quality of Life; GH - General Health Perception; PF - Physical Functioning; REP - Role
Limitation due to Physical Problems; REE - Role Limitation due to Emotional Problems; SF - Social
Functioning; BP - Bodily Pain; VT – Vitality; MH - Mental Health
Aging With Grace: A Focus On The Quality Of Life Among The Malaysian Elderly

Lumpur and HelpAge International Conference in Melbourne, Australia and summiting


proposals to the government in matters regarding the elderly. It provides day care centres,
home visits and organise events to enlighten elderly on healthy lifestyle.

USIAMAS promotes active living in elements of mental health, physical health and
social involvement. Their activities include 1 Home Help for The Aged which identifies,
trains and develops volunteers to visit poor older persons living alone and provide
motivation, companionship and other services such as basic house-keeping, shopping,
correspondence and running errands. Besides that, it has a Day Centre Programme where
older persons can gather and involve themselves in activities developing their mental,
physical and socio-emotional health.

GeM aims to enhance the well being of the elderly through health promotion,
research, information dissemination and community support services. They produce research
reports, training of informal care-givers for elderly, seminars and talks on love and inter-
generation care.

Role of Medical Students

Medical students have a responsibility to equip themselves with comprehensive


knowledge of geriatric field, become role models in caring for the elderly, disseminate proper
information to the community and in future become front liners of geriatric healthcare by sub
specializing in geriatrics in order to meet geriatric care demands in the country. Conducting
researches and publishing papers on local geriatric issues bring geriatric care to light and
increase its emphasis in the continuous medical education of medical practitioners. This is an
area where medical students can become a channel to voice out the needs of elderly to the
government, parallel with the works of NACSCOM.

Medical students play a role to volunteer and support for carers in nursing homes,
take part in NGO activities and Promotion of healthy aging can be done through primary,
secondary and tertiary prevention of diseases which includes education, active disease

*QOL – Quality of Life; GH - General Health Perception; PF - Physical Functioning; REP - Role
Limitation due to Physical Problems; REE - Role Limitation due to Emotional Problems; SF - Social
Functioning; BP - Bodily Pain; VT – Vitality; MH - Mental Health
Aging With Grace: A Focus On The Quality Of Life Among The Malaysian Elderly

detection and rehabilitation. AMSA Malaysia has organised a Geriatric Awareness Campaign
in July 2010 themed „Love Your Age, Love Your Health‟ with talks by geriatricians and
National Diabetic Association and free health screening. The campaign focuses on family
centric themes where there is pledging on elderly care with follow ups, distribution of
bumper stickers, t-shirts, badges, mural painting, family photo booth and competitions i.e.
Best Hugs and talks on proper elderly care, „Tai-Chi‟ and exercising methods.

CONCLUSION AND SUGGESTIONS

Despite having lesser disease and the readiness of basic need such as accommodation
and food, elderly in nursing homes have lower quality of life. Perception of the society has to
be changed and policies promoting elderly as a valuable resource have to be strengthened.
Malaysia is fortunate to be aware of and prepare for the aging bloom of its population by the
policies which provide the framework of the services for the elderly. However, the delivery
and implementation of the policies have to be emphasised. There is a need for more hospitals
to be equipped with ambulatory, rehabilitative and day care services. The introduction of
retirement homes can promote independence while providing social support and a sense of
security among the elderly. It is recommended that geriatric care be integrated in the
undergraduate medical curriculum such as in Universiti Putra Malaysia. Healthcare
professionals should be aware on the increasing need of the aging population of Malaysia for
a better quality of life of our elderly, helping them to live fulfilling lives.

*QOL – Quality of Life; GH - General Health Perception; PF - Physical Functioning; REP - Role
Limitation due to Physical Problems; REE - Role Limitation due to Emotional Problems; SF - Social
Functioning; BP - Bodily Pain; VT – Vitality; MH - Mental Health
Aging With Grace: A Focus On The Quality Of Life Among The Malaysian Elderly

Acknowledgement

The authors gracefully acknowledge Assoc. Prof. Rahmah Mohd. Amin, Department of
Public Health, National University of Malaysia for the guidance and advice given throughout
this research, Faculty of Medicine of National Universiti of Malaysia for the support, Mr.
Jaya Raman from the Social Welfare Department, staff of Rumah Seri Kenangan Cheng and
Seremban, volunteers from various NGOs and AMSA colleagues for the help in this research.
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