KUALA LUMPUR, Nov 24 — Malaysia has an acute shortage of doctors that are systematically trained in treating elderly patients, or in the field of geriatrics, as more of the nation’s population grow older.
Malaysian Society of Geriatric Medicine (MSGM) data showed that Malaysia has a geriatrician ratio of 0.19 per 10,000 population, far below levels seen in developed countries such as the United Kingdom and Canada.
In Canada, the geriatrician ratio is 0.5 per 10,000 population, while in the U.K., the proportion is slightly better at 0.85 per 10,000 population.
“So, we’re not totally devoid of geriatricians, so that’s the good news. But we’re really very far from other people’s numbers, if you like, and there is a huge geographical divide.
“In Kuala Lumpur and Selangor, we are already at the Canadian ratio. But for Terengganu and Perlis, there are no geriatricians, so they are devoid of geriatricians,” University Malaya Medical Centre (UMMC) consultant geriatrician Prof Dr Tan Maw Pin said in her presentation at the Employees Provident Fund’s International Social Wellbeing Conference (ISWC) 2021 held in hybrid format today.
Malaysia has an estimated 40 geriatricians in 2018, including one doctor who retired that year, with more than half of the listed geriatricians (21 geriatricians) based in Kuala Lumpur and Selangor, according to MSGM.
Eight are in the northern states of Perak, Penang, and Kedah, while four are in the southern states of Johor and Melaka. Pahang and Kelantan have one geriatrician each, while in East Malaysia, there are four geriatricians – two each in Sabah and Sarawak.
By sector, 20 geriatricians were serving in the public sector under the Ministry of Health, six under the Ministry of Education, and 13 in the private sector.
Malaysia is expected to become an aged country by 2035. Dr Tan said current data showed that the country has over two million people above the age of 65 in 2020, with the number likely to double to five million by 2035.
By 2040, the figure would have risen further to six million — triple the number recorded last year.
“No one would have imagined such a fast and rapid increase, and are we ready for it is the question,” Dr Tan said.
MSGM projects the number of practising geriatricians in Malaysia to hit Canadian levels at 168 in 2026 and U.K. levels by 2030 with 348 geriatricians.
“This is based on a formula that 70 per cent of all geriatricians in Malaysia trains at least one geriatrician every three years. It’s not a very tall order because they can train more than one, of course.
“But even with that very humble expectation, we should be getting to Canadian levels in five years’ time, 168 geriatricians is what we need, and by 2030, in 10 years’ time, we will be at UK levels at 348 geriatricians, provided nobody throws any spanners in our works,” Dr Tan said.
However, in addition to growing the number of local geriatricians, Dr Tan said there is also a need for a team of allied health professionals in the form of nurses, physiotherapists, occupational therapists, speech therapists, as well as social workers, to better prepare the health system for an ageing nation.
Where Does Malaysia’s Policy Stand?
Dr Tan pointed out that only two per cent of Budget 2022, which was passed last week at the policy stage, were devoted to the social care of senior citizens.
“And geriatric medicine does not have a budget. It’s part of the larger internal medicine budget, but cancer has a budget, heart disease has a budget, rehabilitation has a budget. In terms of social support, there was increased allocation to the senior citizens’ activity centres and home health programmes, which goes a little bit in the way towards reaching our goal of the decade of healthy ageing,” she said.
Focus on older persons was also limited in the 532-page 12th Malaysia Plan (12MP) document, though it did talk about establishing a long-term comprehensive care framework, broadening palliative care services via public-private partnerships, and introducing modernised health services in terms of home care monitoring and virtual medical consultations.
“So yes, we are actually building this into our policies, but we need a whole lot more,” Dr Tan said.
Beyond Health Care: Investing In City Designs, Technology
University of British Columbia clinical professor Dr Roger Wong said apart from health care, there are many other “very powerful” determinants of elderly health, including city designs.
Dr Wong said there have been studies that indicate how postal codes or geographic locations of where seniors reside correlate with their health status.
“We know that there are certain things that really help to promote healthy ageing. We spoke about the importance of physical exercise so infrastructure and city designs that really enable and empower people to participate in physical activity will be really important.
“We spoke about the importance of socialisation, and in fact, all of us around the world have learned that during the Covid-19 pandemic, as a result of physical distancing, social isolation and loneliness really have become an unintended consequence and can have damaging effects on people’s health,” he said.
Dr Wong said there is good data to show that isolation and loneliness can reduce the average life expectancy by up to eight years. “That’s a significant number. It’s like smoking 15 cigarettes in a day – and this is the pure effect of social isolation.”
He also encouraged policymakers and the general public at large to think outside the box in forming collaborative approaches across different sectors to deal with an ageing nation.
“Again, we spoke about the importance of technology and the tech sector. There are many wearable devices, we know remotes and Wi-Fi devices, for example, that can really ensure the homes of older adults become safer.”
“Dr Tan was talking about falls in seniors. We now know that there are wearable devices, sensors that can be installed within homes within the floorings, for example, that can really be helpful in not only reducing the frequency of falls but also alerting health care providers when these falls occur and you can further risk stratifying using artificial intelligence and big data to determine which groups of seniors are more at risk for breaking bones or fractures.”
“And so technology and data can really intersect with homes of older adults,” Dr Wong said.
In order to achieve healthy ageing, Dr Tan recommends exercises of up to 150 minutes per week that not only covers cardiovascular activities like walking, but some resistance exercises as well to increase muscle strength.
“We should also build in some kind of, we call it mentally challenging, cognitively challenging approaches, and usually the best way to do this is to be a volunteer and continue contributing to society.
“And if finances are an issue, you should actually consider working but maybe work flexibly so that it’s not too much of a [load] and you can still enjoy your semi-retirement,” she said.