K.S.

Chew, MD, MMED Senior Lecturer/ Emergency Medicine Physician, School of Medical Sciences, Universiti Sains Malaysia

DEFINITION OF ELDERLY
60 years and over
- United Nations World Assembly on Ageing, Vienna, 1982

Young old - 55-75 years old Old old - >75 years old

DEFINITION OF HEALTH
Health is defined as: the state of complete physical, mental and social well-being (World Health Organization,1995) Absence of disease - Sidell, M. (1995) Health in Old Age: Myth, Mystery and Management, Buckingham: Open University Press.

ELDERLY POPULATION IN MALAYSIA

The elderly population in Malaysia has increased from 5.9% in 1991 to 6.5% in 2000. The expected proportion of people age 60 and above in year 2020 is 9.5%.
Sherina M, Sidik Rampal L, Aini M, Norhidayati MH. The prevalence of depression among elderly in an urban area of Selangor, Malaysia. Int Med J. 2005;4(2):57-63.

DEMOGRAPHICS IN MALAYSIA
Population of those 60 years old and above: 6.5% in the year 2000 and is expected to double to 12.2% in the year 2025
(Department of Statistics Malaysia)

DEMOGRAPHICS IN MALAYSIA

Department of Statistics Malaysia, 2010

LIFE EXPECTANCY
The life expectancy of Malaysian men and women in 1957 was 55.8 years and 58.2 years respectively. Today, it is 71 for men and 74 for women.

PHYSIOLOGICAL, ANATOMICAL AND PSYCHOLOGICAL CHANGES OF THE ELDERLY

PHYSIOLOGICAL CHANGES

HEARING-IMPAIRED OR DEAF PATIENTS

An invisible disability Communication
Speak clearly and maintain eye contact. Do not shout. Offer paper and pencil or use sign language.

VISUALLY IMPAIRED OR BLIND PATIENTS

Tell patient what is happening. Provide psychological support. Keep glasses with patient if possible.

MUSCULOSKELETAL AND MOBILITY ISSUES

Muscles and bones lose strength as people age. Osteoporosis
Common in postmenopausal women

Together with decreased balance, these conditions result in more falls among older people.

SLOWED MOVEMENTS
Movements may be slowed in older patients. Lend a helping hand. Do not rush elderly patients.

FRACTURES
Fractures of the wrist, spine, and hip are common. Geriatric patients may not realize the seriousness of their injury. Every elderly patient who complains of pain after a fall must be x-rayed.

CARDIOVASCULAR DISEASES
Conditions that affect the heart and blood vessels
Heart attack, angina, heart failure Stroke

Geriatric patients may not have the classic signs and symptoms.

RESPIRATORY SYSTEM
Reduced Strength and Endurance of Respiratory Muscles Decreased Chest Wall Flexibility Loss of Lung Elasticity Collapse of Smaller Airway Structures

MEDICATIONS
Many older people take a large number of medications daily. Medications may interact or cause side effects. Determine what medications are being taken and transport them with patient.

DEPRESSION
Most common psychiatric condition in older adults Silent disorder Contributing factors:
Living alone Loss of loved ones Loss of independence Declining health

DEMENTIA
Progressive and usually irreversible decline in mental function Marked by impairment in memory May result in decreases in reasoning, judgment, comprehension, and ability to communicate

CARING FOR PATIENTS WITH DEMENTIA

Speak clearly and communicate what you are doing. Rely on family members or caregivers to provide medical history. Use a kind and caring approach.

ELDERLY ABUSE

ELDER ABUSE
May be physical, sexual, or emotional abuse or neglect Signs and symptoms:
Bruises Burns Malnourished appearance

DEFINITION OF ELDERLY ABUSE

'a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person' (World Report on Violence and Health, World Health Organization, 2002)

DEFINITION OF ELDERLY ABUSE

intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended), to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder; or failure by a caregiver to satisfy the elder's basic needs or to protect the elder from harm.
(US National Academy of Sciences)

TYPES OF ELDERLY ABUSE

Physical abuse Sexual abuse Emotional and psychological abuse Financial exploitation Neglect Abandonment
(US National Center of Elder Abuse)

MYTHS ABOUT ELDERLY ABUSE

Myth: Elderly abuse only occurs in nursing homes Truth: more often, the abuser is a close relative 80% being spouses and children of the victims or a close relative with mental illness or substance abuse problems

MYTHS ABOUT ELDERLY ABUSE

Myth: elderly abuse would not happen in rich families Truth: elderly affects all ethnic groups and cuts across all socioeconomic and religious lines. Studies suggest that those at risk are most likely to be female, widowed, frail, cognitively impaired, and chronically ill.

MYTHS ABOUT ELDERLY ABUSE

Myth: elderly abuse happens, there will be signs of bruises and distress Truth: elderly abuse can occurs in the form of neglect, abandonment, financial exploitation, etc

ELDERLY ABUSE IN MALAYSIA

One in three people (33%) of elderly aged 60 and above in Malaysia are abandoned and do not receive financial support from their children
Source: 4th Malaysian Population and Family Survey, by the National Population and Family Development Board (LPPKN), 2011

IS ELDERLY ABUSE AN OFFENCE IN MALAYSIA?

Elder abuse per se is not an offence in Malaysia. This is because there is no law explicitly dealing with this. The only way is to charge under the Penal Code or Domestic Violence Act for physical abuse

DOMESTIC VIOLENCE ACT 1994 (ACT 521)

Domestic violence' means the commission of any of the following acts: a. willfully or knowingly placing, or attempting to place, the victim in fear of physical injury;

DOMESTIC VIOLENCE ACT 1994 (ACT 521)

b. causing physical injury to the victim by such act which is known or ought to have been known would result in physical injury; c. compelling the victim by force or threat to engage in any conduct or act, sexual or otherwise, from which the victim has a right to abstain;

DOMESTIC VIOLENCE ACT 1994 (ACT 521)

d. confining or detaining the victim against the victim's will; or e. causing mischief or destruction or damage to property with intent to cause or knowing that it is likely to cause distress or annoyance to the victim,

DOMESTIC VIOLENCE ACT 1994 (ACT 521)

by a person against I. his or her spouse; II. his or her former spouse; III. a child; IV. an incapacitated adult; or V. any other member of the family.

NEW ACT IN MALAYSIA NEEDED?

Elderly protection act? Senior citizen Act? Elderly abuse act? Amendments to Domestic Violence Act