The New Straits Times, December 26, 1999
As the year draws to a close, so is the International Year of Older Persons 1999. As stated by the National Council for Senior Citizens of Malaysia (NASCOM) recently: "Many seniors are still capable of contributing to the community but too many people - including the seniors themselves - don't seem to fully appreciate this."
Indeed, it precisely for reasons like this that the UN General Assembly decided to observe the year 1999 as the International Year of Older Persons (IYOP).
This is in recognition of humanity's demographic coming of age.
With the theme "Towards a Society for All Ages", the International Plan of Action on Ageing recognises that "... the transition to a positive, active and developmentally oriented view of ageing may well result from action by elderly people themselves, through the sheer force of their growing numbers and influence. The collective consciousness of being elderly, as a socially unifying concept, can in that way become a positive factor."
The Plan of Action discusses the multi-dimensional nature of ageing and draws attention to the potential of older persons to take action. Thus the concern about their general health status is an important one.
However as pointed out an editorial (NST, Nov. 14), the country is reportedly facing a "critical shortage" of geriatricians and gerontologists.
According to the World Health Organisation, by the next decade, year 2010, Malaysia is expected to be recognised as an "ageing society".
Life expectancy for Malaysian men is 70 years, and 74 years for women.
Almost six per cent of the population is now over 60 years old, with the proportion projected to increase to 11.3 per cent of an estimated 32 million people in the year 2020.
This underscores the importance of preparing forward for both infrastructure and supply of health care personnel at all levels with the population making the transition from a mainly young one to an increasingly older profile.
This however should include a comprehensive drug audit system affecting the elderly.
Many older people are exposed to some form of medications, usually for their chronic ailments. In US for example, the greatest risk for medication-related problems are older populations. And this would be the same for us.
In the US, the economic impact of medication-related problems in persons over the age of 65 now is said to rival that of Alzheimer's disease, cancer, cardiovascular disease, and diabetes. These medication-related problems are estimated to be one of the top four causes of death in that age group, and a major cause of confusion, depression, falls, loss of independence, and physical disability.
In short, though medications are probably the single most important factor in improving the quality of life for older people, they remain especially susceptible to medication-related problems due to physiological changes, higher incidences of multiple chronic diseases and conditions, and greater consumption of prescription and over-the-counter medications.
Thus, while the goal of medication is to improve patients' quality of life through the cure or prevention of disease, the reduction or elimination of symptoms, or the arresting or slowing of a disease process; it is often undermined by the occurrence of medication-related problems.
This point is further highlighted in a study citing inappropriate drug prescribings for Americans aged 65 years or older.
Potentially inappropriate medications were prescribed for nearly a quarter of all older people living in the community, placing them at risk of drug adverse effects such as cognitive impairment and sedation.
Fortunately, even though many medication-related problems are unpredictable, there is a growing body of literature suggesting that a host of medication-related problems can be anticipated and prevented.
This is because medication-related death, illness, and disability frequently result from a number of controllable factors, including inappropriate prescribing, inappropriate monitoring, noncompliance with drug regimens, and dispensing and administration errors.
An article in the British Medical Journal recently, even argued that there is also little evidence to support the treatment of older people because those aged 65 years and older have been largely excluded from research trials to determine clinical effectiveness.
It noted that this contributes to older people not being treated equitably where the rates of use of potentially life saving and enhancing treatments decline as patients get older. The development of explicit criteria for determining inappropriate medication use by the elderly is one way to minimise the potential problems as well inappropriate use.
One report indicated that in US, when criteria for classes of medication that should be avoided in frail, elderly residents of nursing facilities were published in 1991, the use of inappropriate medications was reduced by more than half.
Malaysia lacks data on drug use among older.
There is thus a pressing need to follow up on this and, at the same time, further consider systems that would minimise potentially preventable medication-related problems.
It is not just the question of ensuring adequate infrastructure and facilities.
As we step into the information-age, strategies to improve drug use for the elderly urgently need a broader educational and regulatory framework.
They will go along way to show our older people that we do care.
