ARE we prepared to be an aging society in 2035?

"Yes and no," says geriatrician Dr N. Jeyaraj.

He said Malaysia was heading towards an aging population as people were now living longer with better healthcare.

"Twenty to 30 years ago, having 10 to 15 children was considered the norm," said Dr Jeyaraj.

"So if you have 10 children, one child will definitely look after the parents. But there is decreasing fertility now with people choosing to have smaller families.
"This problem of fewer children and people who are living longer is a problem all over the world."



European countries and Japan, said Dr Jeyaraj, had faced this problem many years ago and had since adjusted to it.

But countries closer to home like Thailand, Singapore and Indonesia are looking at percentage increases of 200 per cent in their elderly population in the coming years, said Dr Jeyaraj.

"The trend of children looking after their parents is also on the decline. We are also facing problems of migration of those from smaller towns to urban areas.

"So parents are being left alone in smaller towns when their children move into big towns. Parents in big cities are also being left alone when their children go abroad to work

"Compared with first-world countries we are not prepared to face an aging society. Only those who are self-funded are prepared."

So what can we do?

The government, said Dr Jeyaraj, could increase financial security for senior citizens.

"On average, your EPF (Employees Provident Fund) lasts only three years after retirement.

"And what about your char koay teow seller or taxi driver who has no EPF?"

Dr Jeyaraj suggested having a National Health Financing Scheme for all.

"With such a scheme, the community is taxed and the government uses the money for the people's medical services," he said.

(After 24 years, numerous feasibility studies and a substantial amount of money spent, the Health Ministry has said it is now "relooking" the National Health Financing Scheme. Health Minister Datuk Liow Tiong Lai was quoted as saying that he would make public the draft plan by the end of 2008 and the public could debate it.)

Another system which could be followed, said Dr Jeyaraj, was the one in Australia where it is mandatory to subscribe to an insurance scheme which the government subsidises.

"This would cover health and placement for those who need nursing homes," he said.

The elderly, said Dr Jeyaraj, should also be provided with social security.

"That means a basic policy for elderly persons to allow them to live their lives the best way they can independently."

One model to emulate, said Dr Jeyaraj, was the domiciliary services provided in some western countries like Britain.

"There they have government funded 'meals on wheels' where the local council sends healthy food to the elderly who stay at home as the biggest problem for the senior citizens is going out to buy food.

"Laundry services are provided once a week and a nurse checks on them daily by phone and visits them once a week."

Another problem the elderly face in Malaysia, he said, is housing.

"We want the elderly to be able to live independently but Malaysian houses are not safe.

"For example, we have walk-up apartments without lifts and we have elderly patients who only come out once every three months just for their medical appointments.

"We also have split-level houses which increase the risk of falls among the elderly. Statistics show that one in every three elderly people will fall.

"What we need is safe houses and people to be aware. A young couple purchasing a house now should think about what is going to happen in 20 to 30 years time."

Legislation, said Dr Jeyaraj, is important and should provide for safe houses for the elderly.

The elderly with no family and money, he said, have no choice but to go to the government old folks home Rumah Seri Kenangan.

"These homes just provide food and shelter. There is no privacy and no individual rooms. It does not cater for the emotional needs of the elderly, but it is better than them being out on the streets."

Another problem, said Dr Jeyaraj, was that Rumah Seri Kenangan only takes in those who are relatively healthy but 30 per cent of those above 80 and five per cent of those above 65 face some sort of memory problems.

"Rumah Seri Kenangan is not capable of taking care of those with this type of problems.

"And they can't cater to those who are severely disabled or with medical problems like a stroke or fracture as they are not a nursing home."

So where do they go?

"If a patient has a stroke and can't take care of himself and is abandoned by his family, he will be kept in the government hospital until his condition improves.

"If he still needs to be fed through a tube, he will be transferred to a district hospital until he dies which defeats the purpose of hospitals being for acute and temporary care."

Currently there are only three Malaysian hospitals with geriatric care where the elderly patients can be kept for long periods.

They are University Malaya Medical Centre, Seremban General Hospital and Hospital Kuala Lumpur.