Geriatrics is a specialty dedicated to the diagnosis, treatment and prevention of disorders in the elderly. Feature published in The Star, July 2, 2006.
In Malaysia, the small number of geriatricians means that most elderly people are assessed by their family doctors or general practitioners, says Assoc Prof Dr Philip Poi.
WHAT is age but a number?
“Ageing, as defined by demographers, is a person who is over 60 or 65,” says Assoc Prof Dr Philip Poi, Head of the Division of Geriatrics at Universiti Malaya Medical Centre.
However, he thinks that the number itself doesn’t really lend much meaning to the concept of ageing.
“It just allows you to quantify the number of people over a certain age, and for demographers to allow statistics to be developed,” he notes.
Dr Philip, one of only nine geriatricians in the country, prefers to determine whether someone is ageing by assessing that individual’s ability, function, and health or disease status. You can also use these parameters as a simple yardstick to assess whether someone is “young old” or “old old”.
“The ‘young old’ are classically between 65 and 75 years of age, who are still active in the community. The ‘old old’ are mostly in the band of 75 and above, who are increasingly more frail, more likely to suffer falls, develop intellectual frailty, incontinence, and other conditions,” he explains.
The problems he describes are those that are common in, and usually specific to, elderly people. These should not merely be brushed off as “growing old”, but should be paid attention to by the general physician, specialist or geriatrician treating the elderly person.
Ageing boom
In Malaysia, 7% of our population will be over age 65 by year 2020. Our country is preparing for this ageing “boom” with the establishment of the National Policy for the Elderly (1995) and the National Health for the Elderly Council (1997).
Geriatric care through hospital-based healthcare services, such as geriatric clinics and memory clinics, are now available, albeit only in a handful of hospitals.
Dr Philip refers to these as mostly “fire-fighting” efforts, as the clinics focus only on the care of elderly people who are already ill. In terms of maintaining the health of elderly persons, he believes that the main thrust of this should be through community programmes.
“The Ministry of Health has established health centres (in government clinics like the Pusat Kesihatan), which even have facilities for the elderly such as exercise machines,” he says.
“However, there is a substantial number of elderly who do not use health centres”, so the ball falls back into the general practitioner’s court again, says Dr Philip.
We should be encouraging our elderly population to be more independent, empowered and aware of their own health issues. – Reuters photo
“Elderly people need to be assessed more effectively by the GPs, rather than just having their symptoms treated. Hopefully, this will help reduce the number of people who will turn up in hospital because of a crisis.”
Does our society create an environment that encourages elderly people to stay healthy and independent? Dr Philip chuckles and accepts the question resignedly.
“In Malaysia, we have an obsession with youth and youthfulness, which has caused marginalisation of the elderly person,” he says frankly.
Policies that don’t help, he says, are early retirement (Dr Philip considers 56 to be “early”) and the environment (non-elderly-friendly infrastructure like buildings, walkways and public transport).
However, Dr Philip recognises the importance of the Health Ministry’s focus on mid-life health issues, such as healthy lifestyle for the prevention of chronic diseases.
“The issues that appear in the elderly actually all derive from mid-life issues, mainly hypertension and diabetes,” he reasons.
Special care
The health needs of the elderly person is gaining importance in the medical community, giving rise to a specialisation dedicated to the diagnosis, treatment and prevention of disorders in this demographic of society.
Geriatrics developed in response to the growing number of old people in this world. In Japan, one of the most aged nations in the world, approximately 20% of their population is above age 65.
Malaysia will soon catch up, although, ironically, the field of geriatrics in our country is still young. Many elderly patients are seen by their family or general physicians instead.
“(Elderly people) tend to accumulate diseases, and they need someone like a GP with an interest in elderly care or a geriatrician to help manage the diseases, and prioritise which ones need to be managed first,” explains Dr Philip, who admits he went into geriatrics because he appreciated the fact that it was a more holistic form of medicine.
While elderly patients usually have specialists like cardiologists or neurologists for their individual diseases, he points out that “it’s not easy for a ? cardiologist to say “You should check your hearing aid” or ‘You should lengthen your walking stick’.”
So we may have an elderly patient who has his cholesterol, glucose, kidney and heart function well under control. However, nobody has advised him that his muscles are growing weaker and his balance is worsening, so he continues to navigate slippery staircases until he falls and fractures his hip one day.
Elderly people need to be assessed more effectively by the GPs, rather than just having their symptoms treated. Hopefully, this will help reduce the number of people who will turn up in hospital because of a crisis. – AP photo
Dr Philip provides another example of a chronic heart patient who continues to take the heart medication prescribed to him by his cardiologist, even though he is undergoing physiological changes that make him more sensitive to the drugs now.
Unfortunately, not all GPs can take on the role of managing their elderly patients’ various ailments and perils.
“In many situations, GPs have not had much geriatric training. So, many of them project what they learn for adult medicine (onto elderly patients) and treat the elderly the same way,” he reveals.
On a positive note, the field of geriatrics is slowly developing in Malaysia, and GPs, as well as other specialists, are becoming more aware of the needs of the ageing population.
Crossed wires
Try telling your parents that you want to take them to the doctor, just for a check-up.
If they scoff and tell you that there’s absolutely no need to spend “that kind of money”, don’t be frustrated. They probably come from a generation where spending money, time and effort on themselves would be considered crass.
“This present cohort of elderly are people who had little or no opportunity to have education, and they have a different perception of what ageing is, compared to what the following generation will have,” says Dr Philip.
“This present generation has very low expectations of what ageing means. They always feel that it’s not necessary to spend any money on them, that it’s not necessary to look after their health needs. They have the misconception that ‘I’m going to die, so what’s the point?’
“By not demanding anything, they are actually undermining their own cause,” he believes.
As a result, their own children (inadvertently) neglect them, leaving them in front of the TV set, even if they don’t like to watch TV, or if they are deaf!
“Their low expectations are also translated to their carers or their children. Because the parents are undemanding, the children tend to assume that ‘they didn’t ask, so we don’t give’,” says Prof Philip.
However, you may not realise that your parents actually are asking, but through means you do not recognise.
“They may complain of aches and pains, but the underlying reason for the complaint is for company, some attention, or some love. It’s up to the children to recognise (the hidden meaning) behind these physical complaints.” In fact, many of us are probably guilty of being oblivious to, or ignoring, these signs.
“Then there are children who are over-loving and overprotective of their parents,” says Dr Philip, sharing the tale of an elderly parent who was brought from his hometown to Klang Valley to stay with his son. The new town was completely alien to him, and he had no friends or familiar routine. His son would do everything for him and he never really left the house.
“He became profoundly depressed (because he) couldn’t cope with the new status of being ‘pampered’,” explains Dr Philip.
You are hard-pressed to lay fault at the son’s door, as he was simply acting out of love and filial duty. However, Dr Philip cautions that overprotectiveness of a parent who is still able to be independent can stop that person from thriving as an individual.
Just as teenagers and their parents need to understand each other, even adult children and their elderly parents should still strive to close that generation gap.
Not too old to learn
Elderly people who are not educated tend to depend on word-of-mouth amongst their friends for information and advice, says Dr Philip.
“Even medicines are purveyed from one to another in this way!” he says, half-jokingly.
He notes that this group of people will not go out of their way to seek healthcare until there is a crisis. “They only come to the clinic if they are persuaded by their children.”
In that light, it is the children of those with elderly parents who would benefit from educating themselves about aged health with books like the Merck Manual of Health & Aging.
“They are the ones who will see if their mother or father needs to see the doctor, and be aware of issues that need to be nipped in the bud.”
Dr Philip urges people to use the Merck Manual as a reference so that they can better discuss issues with their doctors, clear some of the misconceptions about their diseases, and think about what questions to ask when they see their doctors.
By
Tee Shiao Eek
© 1995-2005
Star Publications (Malaysia) Bhd
In Malaysia, the small number of geriatricians means that most elderly people are assessed by their family doctors or general practitioners, says Assoc Prof Dr Philip Poi.
WHAT is age but a number?
“Ageing, as defined by demographers, is a person who is over 60 or 65,” says Assoc Prof Dr Philip Poi, Head of the Division of Geriatrics at Universiti Malaya Medical Centre.
However, he thinks that the number itself doesn’t really lend much meaning to the concept of ageing.
“It just allows you to quantify the number of people over a certain age, and for demographers to allow statistics to be developed,” he notes.
Dr Philip, one of only nine geriatricians in the country, prefers to determine whether someone is ageing by assessing that individual’s ability, function, and health or disease status. You can also use these parameters as a simple yardstick to assess whether someone is “young old” or “old old”.
“The ‘young old’ are classically between 65 and 75 years of age, who are still active in the community. The ‘old old’ are mostly in the band of 75 and above, who are increasingly more frail, more likely to suffer falls, develop intellectual frailty, incontinence, and other conditions,” he explains.
The problems he describes are those that are common in, and usually specific to, elderly people. These should not merely be brushed off as “growing old”, but should be paid attention to by the general physician, specialist or geriatrician treating the elderly person.
Ageing boom
In Malaysia, 7% of our population will be over age 65 by year 2020. Our country is preparing for this ageing “boom” with the establishment of the National Policy for the Elderly (1995) and the National Health for the Elderly Council (1997).
Geriatric care through hospital-based healthcare services, such as geriatric clinics and memory clinics, are now available, albeit only in a handful of hospitals.
Dr Philip refers to these as mostly “fire-fighting” efforts, as the clinics focus only on the care of elderly people who are already ill. In terms of maintaining the health of elderly persons, he believes that the main thrust of this should be through community programmes.
“The Ministry of Health has established health centres (in government clinics like the Pusat Kesihatan), which even have facilities for the elderly such as exercise machines,” he says.
“However, there is a substantial number of elderly who do not use health centres”, so the ball falls back into the general practitioner’s court again, says Dr Philip.
We should be encouraging our elderly population to be more independent, empowered and aware of their own health issues. – Reuters photo
“Elderly people need to be assessed more effectively by the GPs, rather than just having their symptoms treated. Hopefully, this will help reduce the number of people who will turn up in hospital because of a crisis.”
Does our society create an environment that encourages elderly people to stay healthy and independent? Dr Philip chuckles and accepts the question resignedly.
“In Malaysia, we have an obsession with youth and youthfulness, which has caused marginalisation of the elderly person,” he says frankly.
Policies that don’t help, he says, are early retirement (Dr Philip considers 56 to be “early”) and the environment (non-elderly-friendly infrastructure like buildings, walkways and public transport).
However, Dr Philip recognises the importance of the Health Ministry’s focus on mid-life health issues, such as healthy lifestyle for the prevention of chronic diseases.
“The issues that appear in the elderly actually all derive from mid-life issues, mainly hypertension and diabetes,” he reasons.
Special care
The health needs of the elderly person is gaining importance in the medical community, giving rise to a specialisation dedicated to the diagnosis, treatment and prevention of disorders in this demographic of society.
Geriatrics developed in response to the growing number of old people in this world. In Japan, one of the most aged nations in the world, approximately 20% of their population is above age 65.
Malaysia will soon catch up, although, ironically, the field of geriatrics in our country is still young. Many elderly patients are seen by their family or general physicians instead.
“(Elderly people) tend to accumulate diseases, and they need someone like a GP with an interest in elderly care or a geriatrician to help manage the diseases, and prioritise which ones need to be managed first,” explains Dr Philip, who admits he went into geriatrics because he appreciated the fact that it was a more holistic form of medicine.
While elderly patients usually have specialists like cardiologists or neurologists for their individual diseases, he points out that “it’s not easy for a ? cardiologist to say “You should check your hearing aid” or ‘You should lengthen your walking stick’.”
So we may have an elderly patient who has his cholesterol, glucose, kidney and heart function well under control. However, nobody has advised him that his muscles are growing weaker and his balance is worsening, so he continues to navigate slippery staircases until he falls and fractures his hip one day.
Elderly people need to be assessed more effectively by the GPs, rather than just having their symptoms treated. Hopefully, this will help reduce the number of people who will turn up in hospital because of a crisis. – AP photo
Dr Philip provides another example of a chronic heart patient who continues to take the heart medication prescribed to him by his cardiologist, even though he is undergoing physiological changes that make him more sensitive to the drugs now.
Unfortunately, not all GPs can take on the role of managing their elderly patients’ various ailments and perils.
“In many situations, GPs have not had much geriatric training. So, many of them project what they learn for adult medicine (onto elderly patients) and treat the elderly the same way,” he reveals.
On a positive note, the field of geriatrics is slowly developing in Malaysia, and GPs, as well as other specialists, are becoming more aware of the needs of the ageing population.
Crossed wires
Try telling your parents that you want to take them to the doctor, just for a check-up.
If they scoff and tell you that there’s absolutely no need to spend “that kind of money”, don’t be frustrated. They probably come from a generation where spending money, time and effort on themselves would be considered crass.
“This present cohort of elderly are people who had little or no opportunity to have education, and they have a different perception of what ageing is, compared to what the following generation will have,” says Dr Philip.
“This present generation has very low expectations of what ageing means. They always feel that it’s not necessary to spend any money on them, that it’s not necessary to look after their health needs. They have the misconception that ‘I’m going to die, so what’s the point?’
“By not demanding anything, they are actually undermining their own cause,” he believes.
As a result, their own children (inadvertently) neglect them, leaving them in front of the TV set, even if they don’t like to watch TV, or if they are deaf!
“Their low expectations are also translated to their carers or their children. Because the parents are undemanding, the children tend to assume that ‘they didn’t ask, so we don’t give’,” says Prof Philip.
However, you may not realise that your parents actually are asking, but through means you do not recognise.
“They may complain of aches and pains, but the underlying reason for the complaint is for company, some attention, or some love. It’s up to the children to recognise (the hidden meaning) behind these physical complaints.” In fact, many of us are probably guilty of being oblivious to, or ignoring, these signs.
“Then there are children who are over-loving and overprotective of their parents,” says Dr Philip, sharing the tale of an elderly parent who was brought from his hometown to Klang Valley to stay with his son. The new town was completely alien to him, and he had no friends or familiar routine. His son would do everything for him and he never really left the house.
“He became profoundly depressed (because he) couldn’t cope with the new status of being ‘pampered’,” explains Dr Philip.
You are hard-pressed to lay fault at the son’s door, as he was simply acting out of love and filial duty. However, Dr Philip cautions that overprotectiveness of a parent who is still able to be independent can stop that person from thriving as an individual.
Just as teenagers and their parents need to understand each other, even adult children and their elderly parents should still strive to close that generation gap.
Not too old to learn
Elderly people who are not educated tend to depend on word-of-mouth amongst their friends for information and advice, says Dr Philip.
“Even medicines are purveyed from one to another in this way!” he says, half-jokingly.
He notes that this group of people will not go out of their way to seek healthcare until there is a crisis. “They only come to the clinic if they are persuaded by their children.”
In that light, it is the children of those with elderly parents who would benefit from educating themselves about aged health with books like the Merck Manual of Health & Aging.
“They are the ones who will see if their mother or father needs to see the doctor, and be aware of issues that need to be nipped in the bud.”
Dr Philip urges people to use the Merck Manual as a reference so that they can better discuss issues with their doctors, clear some of the misconceptions about their diseases, and think about what questions to ask when they see their doctors.
By Tee Shiao Eek
© 1995-2005
Star Publications (Malaysia) Bhd
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