1. FUTURE OF AGED CARE IN MALAYSIA
ASEAN CONFERENCE ON SUCCESSFUL AGING
10 OCTOBER 2017
PULLMAN HOTEL, KUCHING, SARAWAK By
DATO’ Dr CHONG CHEE KHEONG
DIRECTOR , DISEASE CONTROL DIVISION
Acting DEPUTY DIRECTOR GENERAL OF HEALTH
(PUBLIC HEALTH)
DEPARTMENT OF PUBLIC HEALTH, MINISTRY OF HEALTH MALAYSIA

2. Malaysia’s population demographic is transitioning
to an aged nation by 2030
Malaysian Population Growth, ( )
Life Expectancy at Birth, Malaysia ( )
13.6%
11.1%
9.2%
7.9%
64.3%
65.5%
65.8%
64.8%
6.2%
59.8%
5.6%
Total Fertility Rate, Malaysia
56.9%
5.5%
5.4%
54.6%
50%
34.1%
27.4%
25%
23.4%
22.2%
21.6%
37.5%
39.9%
44.6%
Malaysia is expected to become an aged nation (15% population is above 60 years) in due to drastic decline in fertility rate and increased in life expectancy
Increase in old age dependency pose great challenges to social and economic development, health care, and social protection system
Source: Department of Statistics, Malaysia.

3. How many years can older person expect to live in good health?
HEALTHY LIFE EXPECTANCY
(HALE)
How many years can older person expect to live in good health?
Malaysia, 2010
HALE at birth was 66.4 years for women, and 62.6 years for men.
Life Expectancy At Birth, Malaysia,
66.4
62.6

4. Chronic Diseases Among Elderly Population
Source : NHMS 2015 Report , MOH

5. Source : NHMS 2015 (National Health and Morbidity Survey)

6. Projection Of Elderly With Chronic Diseases In Malaysia, 2015-2030
Malaysian Research Inst. Of Ageing (My Ageing)

8. ISU -ISU

9. 14 10 7 Dependency Ratio in Malaysia 2030 = 28.3% 2010 2020
Youth dependency ratio
2010 = 40.4%
2030 = 28.3%
2010
2010 = 7.4%
2030 = 16.6% 14 10 7
2020
2030
What is the 'Dependency Ratio'
The dependency ratio is a measure showing the number of dependents, aged zero to 14 and over the age of 65, to the total population, aged 15 to 64. It is also referred to as the "total dependency ratio." This indicator gives insight into the amount of people of nonworking age compared to the number of those of working age.
BREAKING DOWN 'Dependency Ratio'
A high ratio means those of working age, and the overall economy, face a greater burden in supporting the aging population. The young dependency ratio includes those only under 15, and the elderly dependency ratio focuses on those over 64. For example, if in a population of 1,000, there are 250 people under the age of 15 and 500 people between the ages of 15 and 64, the youth dependency ratio is 50%, or 250/500.
Old-age dependency ratio

10. Ageism How to combact Ageism:
Defined as : stereotyping of and discrimination against individuals or groups based on their age.
Ageism can take many form. Eg. prejucidial attitudes, discriminatory practices, or institutional policies and practices that perpetuate strereotypical beliefs.
Some prejudices may be arise from observable biological declines (dementia, which may be mistakenly thought to reflect normal ageing).
How to combact Ageism:
Dissemination of appropriate information on ageing
Encourage participation of elderly in community
Maintain respect for elderly
Acknowledge the wide diversity of the experience of older person

11. Coordinated Approach Of Addressing Aged Nation
Structure
National Advisory and Consultative Council
YB KPWKM
Secretariat/Steering Committee
DSW, KPWKM
KPWKM, Policy Division (Technical Committee)
Roles and Responsibilities
To oversees the implementation of the National Policy For Elderly
To formulate new policy and to advice government on the national ageing issues and challenges
Meetings
Once A Year
National Level- KPWKM, MOH, MOE, KPKT, EPU, JPM, MOHR, MOSTI
States Level - State Government, Districts and Local Authorities
Members/Level of Implementation
6 Core Strategies (20 Strategies) programmes
Initiative/Strategies

12. PRIORITIES AREAS FOR COORDINATED INTERAGENCY EFFORTS OF
ADDRESSING NEEDS OF AGING POPULATION
Health
Social & Recreation
Education & Sprituality
Housing & Environment
Strenghtening policies & legislation of facilities for healthcare
Community empowerment
Promote life long learning
Increase mobility
Improve facilities & infra
Economy
Employment
R&D
Ensure financial security at old-age
Provide means for youths to care
Extend retirement age
Enhance institution development & capacity building

13. A Public Health Framework for Healthy Ageing: OPPORTUNITIES for Public Health Action

14. Elderly Health - Ageing and Life Course
Promoting good health through life course : healthcare from womb to tomb
Maintenance of health from young , optimising opportunity for healthy ageing.
Aim for older population that is actively participating in society and enjoying an independent and high quality life.

15. National Health Policy for Older Persons, 2008
Commitment to ensure the older persons will achieve optimal health through integrated and comprehensive health and health related services
To improve the health status of older persons
To encourage participation in health promoting and disease prevention activities throughout the life course
To provide age friendly, affordable, equitable, accessible, cultural acceptable, gender sensitive, seamless health care services in a holistic manner at all levels.
To advocate and support the development of enabling environment for independent living (ageing- in-place)
7 strategies identified:
Health Promotion
Provision of a continuum of comprehensive health care services
Human resource planning and development
Information system
Research and development
Interagency and inter-sectoral collaboration
Legislation
UNIVERSAL HEALTH COVERAGE FOR ACTIVE AGEING
National Health Policy for Older Persons
Concomitant to the National Policy for Older Persons 1995, the Government has developed the National Plan of Action Plan for Health Care of Older Persons in In view of the need of a more effective, coordinated and comprehensive health care has led to the development of the National Health Policy for Older Persons in In the formulation of this Policy, 6 guiding principles were adopted as follows:
Maintaining Autonomy and Self Reliance;
Recognizing the Distinctive needs of Older Persons;
Supporting carers;
Promoting Healthy Ageing;
Providing Continuity of Care; and
Maintaining the Rights of Older Person to Quality of Life and Death.
Through this Policy, the Government has made a commitment to ensure older persons will achieve the optimal health through integrated and comprehensive health and health related services. Seven strategies were identified, namely:
Health Promotion;
Provision of a Continuum of Comprehensive Health Care Services;
Human Resource Planning and Development;
Information System;
Research and Development;
Interagency and Inter- sectoral Collaboration; and
Legislation.

17. Domiciliary Care Services
CARE – caregivers will be trained on how to prevent bed sore, wound care and management, correct technique on changing and care of Nasogastric Tube / catheter urethral as well as hygiene education. This service will also provide laboratory test and vital signs monitoring (e.g. blood glucose level, blood pressure ) and emotional support by trained professionals.
REHABILITATION – active and passive movement, activity of daily living (ADL)
PALLIATIVE – include basic palliative care, pain management, counselling and emotional support to the patient and their family members

18. NBOS 7 initiatives : 1MALAYSIA FAMILY CARE
Single parent (female)
- Building resilience : mental health interventions
Persons with Disabilities
- Maintaining health : settings approach
Chronic Bedridden Elderly
- Outreach services : at home and
Institution

19. ESCALATING FISCAL EXPENDITURE TO SUPPORT CITIZENS’ WELL-BEING
Higher healthcare cost
Higher pension expenditure
More public assistance needed
Projected increase 10 times in 25 years ( )
RM8.3 bil to RM88.4 bil*
Doubled in 15 years
( )
RM19 bil to RM33 bil*
Projected to increase if social protection is not in place
(increase in elderly poverty)
*Ministry of Health
Frost & Sullivan
*Ministry of Finance
KWAP Annual Report
*Department of Social Welfare

22. Health care perspectives : New Scope of Care for Older Persons : Community Health care

23. LONG TERM CARE Many facilities and homes are not registered ….
Being unregistered means that the institutions are not monitored, and as a result:
Unlicensed institutions function with varying infrastructure and standards of care.
No uniform processes for admission, management and discharge of the residents.
Lack of training for care-givers and others categories of staff.
Abuse cases at the institutions.
Roles, responsibilities and accountabilities of family members, operators and enforcement agencies are not clear.
No clear demarcation/classification/separation of special needs residents.
Doubtful quality of care by the institutions.

24. REGULATING AGED CARE
To create an Act on Aged Healthcare under Ministry of Health to regulate facilities and services on aged care in a holistic manner.
Current position:
“Care centres”  Care Centre Act 1993 [Act 506] under the Department of Social Welfare.
“Nursing homes”  Private Healthcare Facilities and Services Act 1998 [Act 586] under the Ministry of Health.

25. CONCLUSION
Increasing awareness of aging population and related issues among public – combatting Ageism
Empowerment community for self reliance through development of community based programme
Strengthening Health Care through the implementation of “Healthy Ageing and Community Health Care”
Strengthening the development of social support system and social security system for the older persons
Monitoring and enforcement of Legislation / Standards of quality of care provided by nursing home / healthcare home for the elderly.

26. references References
1. World Report on Ageing and Health National Policy for Older Persons National Health Policy For Older Persons, Eleventh Malaysia Plan