The percentage of the population that is 60 years and above in Malaysia has increased over the years from 5.2% in 1970, 5.7% in 1990 to 6.3% in 2000. In the year 2020, this percentage is expected to be 9.8% of the population. By 2030, Malaysia is forecasted to have an ageing population when 15% of her population is in the elderly bracket. Apart from an increase in the aged population, the aged are also living longer. Physical and social changes associated with ageing are combined with the debilitating effects of multiple co-existing illnesses. The increase in the prevalence of ill health will impose new challenges and demands on the healthcare and social services.
Ageing is a process involving physical, psychological, and social changes. It is a major risk factor for many diseases. How the body ages is determined by environmental, lifestyle and genetic factors. Some of the following changes may occur with ageing:
The skin becomes less elastic and more lined and wrinkled with age. Fingernail growth also slows. The oil glands gradually produce less oil, making the skin drier. Skin aging can be slowed down by using moisturizer and protecting the skin from the sun with sunscreen and sun-protective clothing, such as a hat or cap.
Over time, changes in the ear make high-frequency sounds harder to hear and changes in tone and speech less clear. Appropriate usage of hearing aid may overcome the hearing difficulty.
Most elderly develop a need for reading glasses as the lenses in the eyes become less flexible. It's also normal for night vision and visual sharpness to decline. Also in the later years, glare increasingly interferes with clear vision.
Changes in sleep occur with aging. Elderly will probably sleep less at night, and may not sleep as deeply as they did when they were younger. And it's more likely that they will wake up during the night and/or wake up earlier in the morning.
Men and women gradually lose some of the mineral content in their bones with age. The bones get less dense and strong. Natural bone loss and risk of osteoporosis can be reduced by getting regular, weight-bearing exercise, getting enough calcium and vitamin D and avoiding lifestyle choices that weaken bones (such as smoking).
Metabolism and body composition
Over time, the body typically needs less energy, and metabolism slows. Hormone changes in the aging body result in a shift to more body fat and less muscle mass. The best approach is to take in fewer calories while keeping up or increasing physical activities. Strength training is a good way to build or keep muscle mass.
Brain and nervous system
With aging the brain’s weight, the size of its nerve network, and its blood flow decrease. But the brain adapts to these changes, growing new patterns of nerve endings. Memory changes are a normal part of the aging process—it's common to have less recall of recent memories and to be slower remembering names and details.
Heart and blood circulation
The heart naturally becomes less efficient as it ages, and it has to work a little harder during activity. This makes the heart muscle a little larger. This results in a gradual decline in energy or endurance from one decade to the next.
The lungs become less efficient over time, supplying the body with less oxygen especially inactive people. Regular exercise plays a key role in keeping lungs strong.
With advancing age, the kidney’s function declined. It doesn’t clear wastes and some medicines from the blood as quickly and it can’t handle dehydration as well as in the past. Hence it is important to minimize the toxins, alcohol, and unnecessary medicine intake and ensure adequate hydration.
A healthy lifestyle may slow many of these changes of ageing.
Transitions in life such as retirement, separation and moving to new places may create anxiety and make them feel helpless. Those who bade a final farewell to their love one may experience grief and fears about inevitability of death. Many of them also struggle and concern about loss of purpose of life, loss of independency, and becoming a burden to family.
Memory and learning
Older people will experience some difficulty in memory and slowness in processing new information. However, that does not preclude them from learning new skills and knowledge or interfering their daily activities. Forgetfulness, especially if interfering significantly his or her function is not part of the normal ageing. Seeking help early is pertinent to evaluate for possibility of dementia and identify treatable conditions such as depression, Vitamin B12 deficiency, thyroid disorder, and remove the unnecessary drugs that cause memory impairment.
Loss of independence and freedom
For variety of reasons, older people may become less physically able to engage in social activities, hobbies and activities of daily living. Some lose their freedom when they need to take care of their grandchildren or others whose health have declined more rapidly than their own.
Grief and loss
Friends and family members may pass away ahead of him or her. Depression among older people following separation is common and often left unrecognized. Seeking help early is important for them to overcome this and move on with life.
Helping Your Loved One Cope
It is important to listen to their wishes, concerns, feelings and fears respectfully and attentively. Support, encourage and empower them making their own decision about their medical treatment preference, living arrangement and other welfare is important to promote their sense of autonomy and preserve their dignity. Encourage and help them participate in social activities will avoid social isolation and promote psychological wellbeing.
Seven tips provided by the Mayo Clinic can be used to keep a sharp memory:
• Stay mentally active
• Socialize regularly
• Get organized
• Sleep well
• Eat a healthy diet
• Daily physical activity
• Manage chronic illnesses
Last but not the least, be prepared to act as an advocate for older people to combat the negative effect of ageism as well as helping those in need to gain access to welfare services that are available.
With your assistance, your elderly friend or relative will be able to face the challenges of growing older and enjoy a successful ageing.
DR. TIONG ING KHIENG is a Geriatrician based at Sarawak General Hospital, Kuching.