Ageing in Malaysi1
Content
AGEING IN MALAYSIA: NATIONAL POLICY AND FUTURE DIRECTION
By
Ong Fon Sim Faculty o Bu!in"!! an# Accountancy Uni$"%!ity o Malaya &uala Lum'u%
May( )**+
+, INTRODUCTION
In 1990, 9% or almost half a billion of world population were over 60 years old. By 2030, this fi ure is e!pe"ted to in"rease to 1.# billion $%orld Ban&, 199#'. (ue to the broad diffusion of medi"al &nowled e and the resultant improvement in health, as well as de"linin fertility, developin "ountries are a ein mu"h faster than the developed nations. )t present, althou h the *alaysian population has not rea"hed the a ein proportion, the a ein phenomenon will eventually o""ur. By year 2020, 9.+% of its population will be 60 years and over. ,he time span ta&en to rea"h an a ein so"iety may be hastened with the "ontinuous improvement in the medi"al field, the availability and a""essibility of health "are, lon er life e!pe"tan"y as well as de"linin birth rate. According to the United Nations World Assembly on Ageing held in Vienna, 1982, “60 years and over is the c!t"o## age !sed #or deliberating iss!es on ageing$ %n &alaysia, 'olicy ma(ers have ado'ted this demarcation in #orm!lating and im'lementing 'lans #or its senior citi)ens$ *or the '!r'ose o# this re'ort, the c!t"o## age o# 60 is !sed altho!gh the retirement age o# ++ seems to s!ggest that the threshold to ageing begins at ++ years o# age in &alaysia$ &a,or so!rces o# ageing incl!de declining #ertility and mortality rate, im'roved health and li#e e-'ectancy$ .ence, indicators o# ageing incl!de increase in median age o# the 'o'!lation, longer li#e e-'ectancy, and 'ro'ortion o# de'endency ratio o# elderly 'eo'le
com'ared to the 'ro'ortion o# yo!th de'endency$ &alaysia, ,!st li(e other develo'ing co!ntries in the /orld, has been e-'eriencing im'roved health, longer li#e e-'ectancy, lo/ mortality as /ell as declining #ertility$ 0he e##ect o# all these changes has bro!ght abo!t a change in the demogra'hic 'ro#ile o# its 'o'!lation$ 1verall, the age str!ct!re #or the 'ast three cens!s, 1920, 1980 and 1991, sho/s that the 'ro'ortion o# yo!nger age gro!'s 31+ years and belo/4 is decreasing /hile the 'ro'ortion o# elderly is on the rise$ 0he median age /as 12$5 in 1920, 21$9 in 1991 and is 'ro,ected to increase to 22$1 in year 2020$ Within a s'an o# 60 years 3#rom 1991 to year 20204, the median age increased averagely by 1$2 'er decade$ 0he old age de'endency ratio is e-'ected to increase to 1+$2 in 2020 #rom 10$+ in 1920$ 0his is high com'ared to other A78AN co!ntries s!ch as %ndonesia 310$14, 0hailand 316$54, and the 9hili''ines 39$04, e-ce't 7inga'ore, /hich has an even higher ratio o# old age de'endency 326$94 /hile :a'an has a de'endency ratio o# 51$+$ 1ver a 'eriod o# +0 years, the median age o# &alaysian 'o'!lation /ill increase by 10 /hile the old age de'endency ratio, by + 3;e'artment o# 7tatistics, 19984$ <!rrently, &alaysia=s 'o'!lation may be considered as “yo!th#!l as 'ro,ections #rom the 1990 <ens!s sho/s that 6$1> o# the total 'o'!lation /as 60 and above 3;e'artment o# 7tatistics, 19984$ ?y year 2020 &alaysia /ill be a mat!red society /ith 9$+> o# its 'o'!lation aged 60 and above$ Altho!gh the rate o# increase o# its ageing 'o'!lation is not as 'henomenal as in co!ntries s!ch as <hina and 7inga'ore, the considerably ra'id and h!ge increase in the 'ro'ortion o# elderly 'eo'le /o!ld ma(e it im'ossible #or the government to ignore the im'act o# social and economic changes bro!ght abo!t by 'o'!lation ageing$
O-."cti$"! an# Sco'" o R"'o%t
0his re'ort is the co!ntry st!dy o# ageing in &alaysia and it is a com'onent o# the bigger research 'ro,ect coordinated by @ingnan University, .ong Aong, #or Asia ;evelo'ment Besearch *or!m 3A;B*4 Asia 9aci#ic Ageing Besearch Net/or( 3ABN4$ 0he main ob,ective o# this re'ort is to revie/ national 'olicy on ageing$ 0he #ollo/ing iss!es are s'eci#ic to this re'ortC D Bevie/ o# the sit!ation o# ageing in &alaysia #rom the 'ers'ectives o# social sec!rity, health, and comm!nity care and social servicesE D D Bevie/ o# 'olicies and 'rograms #or the elderlyE 8-amine the main #eat!res o# the 'olicies and 'rogramsE
D
8-amine the role o# civil society or NF1s in 'roviding in'!ts into the #orm!lation o# 'olicyE and
D
;isc!ss the li(ely develo'ments /ith res'ect to 'olicies and 'rograms #or the elderly and s!ggest recommendations #or the consideration o# 'olicy ma(ers
M"t/o#ology 0his re'ort relies heavily on secondary data as /ell as disc!ssions and intervie/s /ith e-'erts in s'eci#ic areas s!ch as social sec!rity, health care and social services$ As iss!es concerning the elderly are m!ltidisci'linary in nat!re, data and in#ormation are obtained #rom di##erent ministries and de'artments$ ;ata 'ertaining to the elderly are dra/n #rom the 'o'!lation cens!s cond!cted in 1980 and 1991$ 0he cens!s cond!cted in year 2000 has yet to be '!blished$ 0he only disadvantage abo!t !sing the cens!s is that it does not cover details abo!t iss!es s'eci#ic to the elderly s!ch as their health stat!s 3morbidity and mobility, activities o# daily living etc4, their contrib!tion to/ards society and #amily, involvement in social and charitable activities etc$ Where data ga's e-ist, they are s!''lemented /ith research #indings #rom smaller st!dies /ith limited geogra'hical coverage$ Altho!gh these st!dies may be small, the #indings 'rovide !se#!l in#ormation and hint at im'lications #or 'olicy ma(ing$
Lit"%atu%" R"$i"0
9o'!lation ageing is re'resented by an increase in the relative n!mber o# older 'ersons in a 'o'!lation$ 0reatment o# 'o'!lation ageing is com'licated by the #act that 'o'!lation ageing is a concomitant o# the a''roach o# a 'o'!lation to stationarity, and that some e##ects o# each 'henomenon are rein#orced by those o# the other 3<lar( and 7'engler, 19804$ A common de#inition o# ageing is the c!t"o## age o# “60 years and over $ Another de#inition re#ers to those over retirement age, /hich is !s!ally meas!red by the age at /hich a 'erson is eligible #or 'ension 30in(er, 19964$ %n the United Aingdom, the retirement age is 6+, /hile the 8!ro'ean <ommission !ses 60, and the United 7tates o# America ?!rea! o# <ens!s, ++ 30in(er, 19964$ .o/ever, it has been stated that /hatever c!t"o## age is selected to de#ine the “elderly 'o'!lation, it does not adeG!ately de#ine the diversity and com'le-ity o# s(ills, attit!des, needs and 'otential o# this gro!' o# 'eo'le 3Aro(iasamy, 19924$ 0he U$7$ ?!rea! o# <ens!s 319964 'ro,ected that by year 202+ the 'henomenon o# ageing /o!ld have s'read across the North American Begion as /ell as the Asian region$
0he increase in the 60"and"over 'o'!lation in the ind!striali)ed nations o# 8!ro'e and North America has generally o!t'aced total 'o'!lation gro/th in recent decades$ 0he 'ro'ortion o# older 'ersons to the total 'o'!lation di##ers bet/een Asian co!ntries, #rom abo!t 5 'ercent o# the 'o'!lation in <ambodia to abo!t 20 'ercent in :a'an 3W.1, 19984$ @ess develo'ed co!ntries in the Asian region sho/ that gro/th rates o# the elderly accelerated shar'ly a#ter 1960$ ?y 199+, the 'o'!lation o# those aged 60 and above in Asia /as almost com'arable to that o# the /orld, at abo!t 9 'ercent$ ?y 20+0, Asia is e-'ected to have 20 'ercent o# its 'o'!lation over the age o# 60 years, com'ared to the global 'ercentage o# 16 'ercent 3W.1, 19984$ &alaysia has not been s'ared #rom demogra'hic transition as e-'erienced /orld/ide$ <r!de death rates declined #rom 12$5 'er 1000 'o'!lation in 19+2 to 5$2 'er 1000 'o'!lation in 1990$ %n#ant mortality rate also #ell #rom 26 'er 1000 live"births to 12 'er 1000 live"births and the e-'ectation o# li#e at birth increased #rom +2 years to 21$2 years over the same 'eriod 3;e'artment o# 7tatistics, vario!s years4$ As a res!lt o# this demogra'hic transition, an increasing 'ro'ortion o# the 'o'!lation is at ris( o# certain chronic health 'roblems$ 0his is associated /ith a change in morbidity and disease 'attern #rom one o# mainly in#ectio!s diseases to one /here chronic degenerative and non"comm!nicable diseases 'redominate$ %n addition to this e'idemiological and demogra'hic transition, socioeconomic develo'ment also brings abo!t changes in li#e style, behavior and environment /hich lead to changing 'atterns o# ris( to the 'o'!lation 3World .ealth 7tatistics H!arterly, 19904$ 0he #irst ma,or st!dy on ageing too( 'lace in &alaysia in 198+ !nder the World .ealth 1rgani)ation$
Social Security 1ld"age 'ension schemes have become social instit!tions in many, i# not most, co!ntries thro!gho!t the /orld$ 0he goal o# these schemes is to 'rovide all G!ali#ying individ!als /ith an income stream d!ring their retirement years, /hich is contin!o!s, adeG!ate, constant 3in terms o# '!rchasing 'o/er4 and ca'able o# maintaining the socio" economic 'osition o# the retired in relation to that o# the active 'o'!lation 3U$7$ 7ocial 7ec!rity Administration, 19954$ 0he im'ortance o# social sec!rity schemes increased /ith the increase in li#e e-'ectancy$ <o/gill and .olmes 31922 in 1ga/a, 19954 'ointed o!t that /ith moderni)ation, the res'onsibility #or the 'rovision o# economic sec!rity #or the de'endent aged tends to be shi#ted #rom the #amily to the Fovernment$ As develo'ment 'roceeds, the so!rce o# old"age sec!rity #or the aged is li(ely to be s/itched #rom the #amily s!''ort system to '!blic s!''ort system 3United Nations, 19954$ 1ga/a 319954 in his re'ort, cited a st!dy carried o!t by the %@1 and World ?an( in the 1980s #or selected co!ntries 3both develo'ed and develo'ing regions4 to ill!strate that there are s!bstantial di##erences in the develo'ment
o# social sec!rity schemes among di##erent co!ntries even /hen their economic develo'ment are com'arable$ 0his st!dy regresses social sec!rity bene#its relative to F;9 and 'er ca'ita income$ *indings s!ggest that the com'ositional change in so!rces o# s!''ort #or the elderly over the co!rse o# economic develo'ment is a##ected by a n!mber o# non"economic #actors, incl!ding demogra'hic, socio"c!lt!ral, ideological and historical ones$ 0his st!dy #o!nd that social sec!rity 'rograms in the develo'ing /orld have limited coverage$ 7t!dies by &artin 319884 and :ones 319884 #!rther s!bstantiated this 'oint$ 0hey #o!nd that only 6 'ercent o# the /or(ing 'o'!lation is covered by 'ensions in 0hailand, 11$+ 'ercent in %ndonesia, and 22$8 'ercent in <hina$ %n other develo'ing co!ntries in Asia, these #ig!res /ere corres'ondingly higherC +0 'ercent in 7ri @an(a, +6$2 'ercent in the 9hili''ines, and 86 'ercent in 7inga'ore$ *or develo'ing co!ntries, the #inancing schemes are !s!ally di##erent #rom those ado'ted in develo'ed nations$ 9rovident #!nd systems are /idely em'loyed in develo'ing regions, /hereas 'ay"as"yo!"go schemes are generally in o'eration among the develo'ed co!ntries 3United Nations, 19954$ 9rovident #!nds are commonly ado'ted in #ormer ?ritish colonies incl!ding co!ntries in Asia, s!ch as %ndia, 7inga'ore and &alaysia$ 7inga'ore=s <entral 9rovident *!nds /or(s on ro!ghly the same 'rinci'les as the &alaysian 8m'loyee 9rovident *!nd 389* Website4$
Health Care .ealth is de#ined by World .ealth 1rgani)ation as the state o# com'lete 'hysical, mental and social /ell"being 3W.1, 199+4$ 0his holistic acco!nt is one very broad vie/ that meas!res the state o# com'lete 'hysical, social and mental /ell"being 3W.1 198+4$ 1n the other hand, there is the sim'le and narro/ de#inition o# biomedical acco!nt o# health, /hich sim'ly re#ers to the absence o# disease 37idell 199+4$ While the sim'le biomedical meas!re loo(s only at the 'hysical as'ect, the state o# health, /hich determines the state o# /ell"being is de#initely a #ar more encom'assing domain than mere 'hysical health, albeit the inse'arability o# one #rom the other$ ?o/ling 319914 'oints o!t that there is a con#lict bet/een researchers and 'olicy ma(ers in relation to the de#inition and meas!rement o# health$ 9olicy ma(ers desire straight#or/ard, G!antitative meas!res o# health /hereas researchers are more inclined to/ards G!alitative meas!res$ A move to/ards sel#"ratings o# health is 're#erred over the e-'licit indicators o# health 37idell 199+4$ <ertainly some balance bet/een these t/o a''roaches is desired$ *or the '!r'ose o# this st!dy, the 'hysical health stat!s o# the elderly is assessed by loo(ing at three s!bcategories o# 'hysical healthC 314 general 'hysical health, 324 the ability to 'er#orm basic sel#"care activities, and 364 the ability to 'er#orm more com'le- sel#"care activities that allo/ #or greater inde'endence 3Aart 19924$ 0he other as'ect o# health, social health is related to sense o# belonging and state o# #elt loneliness$ &ental health re#ers to the
ca'acity o# individ!al, the gro!' and the environment to interact /ith one another to 'romote s!b,ective /ell"being and o'timal #!nctioning, and the !se o# cognitive, a##ective and rational abilities to/ards the achievement o# individ!al and collective goals consistent /ith ,!stice 3&inistry o# .ealth, &alaysia 20004$ ;e'ression, /hich is a '!blic health 'roblem, a''ears to be the most common o# the #!nctional 'sychiatric disorders in the later years, yet it is not o#ten recogni)ed in older 'eo'le 3Aart 1992C1264$ ;ementia dominates old age 'sychiatry$ *e/ elderly 'ersons esca'e the acc!m!lation o# chronic 'athologies and long term non"#atal diseases, /hich are degenerative in nat!re, as they gro/ older$ <onseG!ently, m!lti'le 'athologies res!lting in m!lti'le sym'toms are a common 'henomenon among the elderly 3Aro(iasamy, 19964$ 0hey are at ris(s !nder the circ!mstances o# a lac( o# 'olicies, or at best, inadeG!ate '!blic 'olicies, that co!ld at least ens!re some degree o# G!ality o# li#e in old age$ .ealth care is not a 'roblem to the /ealthy as they have the means to '!rchase /hereas #or those /ho are certi#iably 'oor, they have to de'end on city hos'itals and clinics 3Avale 19964$ 8s'ecially #or the case o# older /omen, in /hich ageing a''roaches /hat is termed the #emini)ation o# ageing 3?!tler and Fleason 198+4, they are li(ely to #ace greater ris(s$ *rom the #indings o# several st!dies in &alaysia, /omen remain /ido/ed, no #inancial sec!rity, and e-'erience greater health 'roblems /hen they enter the old"old category$ %n res'onse to the health care needs o# the elderly, geriatric medicine, de#ined by the ?ritish Feriatrics 7ociety as Ithat branch o# general medicine concerned /ith the clinical, rehabilitation, social and 'reventive as'ects o# illness and health on the elderly=, has been develo'ed$ 0he aim evolves #rom the c!rative to the 'reservation and restoration #!nction$ &any o# the degenerative diseases o# old age are not res'onsive to c!rative actions and the im'ortant goal is to enable an elderly 'erson to #!nction e##ectively in the environment o# their choice as long as 'ossible$ 9rogrammes have been develo'ed thro!gho!t the Asian region #or health o# older 'ersons$ 0he demogra'hically “middle"aged ne/ly ind!strialised co!ntries and areas, /hich sho/ clear evidence o# 'o'!lation ageing, s!ch as .ong Aong, <hina and 7inga'ore, have their o/n systems$ 0he ra'idly develo'ing co!ntries, s!ch as &alaysia and the ne/ly ind!striali)ed economy s!ch as the Be'!blic o# Aorea, have made recent initiatives in the develo'ment o# health services #or older 'ersons 3%@1, 19924$
Community Care %nstit!tional care brings to mind the tho!ght o# old #ol(s= homes$ 1ne o# the main develo'ments in terms o# care #or the elderly is the shi#t #rom instit!tional care to /hat is loosely called comm!nity care 30in(er, 19964$ 8-'lanations #or this shi#t areC #irstly, there /ere
vie/s abo!t the 'ositive val!e in terms o# G!ality o# li#e o# being at home$ 0here /as a general reaction against instit!tional care, /hich led to the belie# that alternatives /ere made available #or both e-isting and 'otential inhabitants o# instit!tions$ 7econdly, there /ere 'ractical 'roblems s!ch as di##ic!lty in obtaining man'o/er$ 0hird, there /as no necessity to se'arate the elderly #rom society$ *o!rth, the cost o# instit!tional care is rather high$ *inally, there /as a gro/ing recognition that 'eo'le had the right to live among society and not isolated in an instit!tion 30in(er 19964$ 0here seems to be a lac( o# satis#actory de#inition o# comm!nity care and some con#!sion to its meaning$ 0here is a narro/ de#inition o# comm!nity care as the 'rovision o# domiciliary rather than instit!tional services and there is the ill"de#ined co)y 'ict!re o# a gro!' o# local 'eo'le Icaring= #or their neighbors 30in(er, 19964$ 0he /ider de#inition o# comm!nity care came #rom the 7eebohm Be'ort 30in(er 19964$ 0he o##icial de#inition is comm!nity care re#ers to treatment and care o!tside hos'itals or residential homes 3.ome 1##ice et al 1968 in 0in(er 19964$ %t /as also noted that the notion o# comm!nity care im'lies the e-istence o# a net/or( o# reci'rocal social relationshi's, /hich among other things ens!re m!t!al aid and give those /ho e-'erience it a sense o# /ell"being$ 0hese comm!nity services incl!de comm!nity n!rsing, occ!'ational and s'eech thera'y, 'hysiothera'y and 'harmace!tical, o'hthalmic, chiro'ody and dental services and services #or 'eo'le /ith hearing loss$ 0hese services are highly val!ed by 'atients b!t are o#ten overloo(ed in long term 'lanning$
1rgani)ation o# Be'ort 7ection % introd!ces the broad sit!ation o# 'o'!lation ageing aro!nd the /orld and in &alaysia$ %t also states the ob,ectives o# st!dy, describes brie#ly the methodology em'loyed, and revie/s the literat!re on ageing$ %n 7ection %%, the 'ro#ile, demogra'hic, economic and health, o# the elderly brings #orth the reality o# ageing in &alaysia$ 0he National 9olicy #or the 8lderly 199+ is o!tlined in this section$ Ageing, reG!iring a m!ltidisci'linary a''roach has to be e-amined #rom di##erent 'ers'ectivesC social sec!rity is disc!ssed in 7ection %%%, health care in 7ection %V$ <omm!nity and social services are brie#ly 'resented in 7ection V, /hile detailed disc!ssions on comm!nity care /ill be covered in the second 'art o# the re'ort !nder “@ong"term <are $ 7ection V% disc!sses the im'lications o# ageing and 'resents the concl!sion and s!ggestions #or #!t!re direction in 're'aring #or an ageing society$
), PROFILE OF AGEING AND NATIONAL POLICY FOR T1E ELDERLY
9ro#ile o# Ageing
Ageing by Geographical Distribution Within the nation, the rate o# gro/th o# senior citi)ens is di##erent, /ith the r!ral 'o'!lation #acing a higher rate o# gro/th com'ared to the !rban 'o'!lation$ %n 1991, the rate o# gro/th o# ageing 'o'!lation in the r!ral areas is 6$+> com'ared to +$6> in the !rban areas 3;e'artment o# 7tatistics, 19984$ 0his is d!e in 'art to the o!t"migration o# yo!ng r!ral 'o'!lation to the !rban areas in search #or em'loyment and ed!cation o''ort!nities, leaving behind the elderly$ 0he states that have a higher incidence o# ageing incl!de 9erlis, 9era(, &ela(a, 9!la! 9inang, and Aedah, in /hich the 'ro'ortion o# ageing 'o'!lation is 2> com'ared to the national average o# +$9> in 1991 3;e'artment o# 7tatistics, 19984$ 7tates that receive large n!mbers o# internal migrants, /ho are !s!ally yo!ng, as /ell as #oreign migrant /or(ers sho/ a signi#icantly lo/er 'ro'ortion o# elderly 'eo'le$ 0hese states incl!de 7elangor, *ederal 0erritory o# A!ala @!m'!r, 7abah, and *ederal 0erritory o# @ab!an$
Ethnic Variations ;!e in 'art to the inter"gro!' socio"economic di##erences, as /ell as the in#l!ence o# historical, instit!tional, and economic #actors, e-'eriences o# demogra'hic transition vary in both intensity and timing among the three ma,or ethnic gro!'s$ Among them, ageing is signi#icantly more serio!s among the <hinese than the other t/o gro!'s$ 0able 1 gives an indication o# di##erences in the ageing sit!ation by ethnic gro!'s and strat!m$ %n 1991, 2$6 'er cent o# the <hinese /ere elderly, a 'ercentage that /as m!ch higher than the 'ro'ortions o# senior citi)ens among the &alays 3+$5 'er cent4 and %ndians 3+$5 'er cent4$ 0his is d!e to the 'revalence o# lo/ mortality and longer li#e e-'ectancy among the <hinese /hile the lo/ #ertility red!ced the n!mber o# yo!ng 'o'!lation s!bstantially$ 0his t/o"/ay e##ect has been aro!nd #or a m!ch longer 'eriod #or the <hinese than the other ethnic gro!'s$ 0his trend is e-'ected to contin!e and the 'ro'ortion o# elderly <hinese is 'ro,ected to be aro!nd 15$5 'er cent in the year 2020$ 0he 'ro'ortion o# %ndian senior citi)ens is 'ro,ected to be 10$5 'er cent in the same year /hereas the &alays /ill have 2$9 'er cent o# senior citi)ens in 2020$
Ta-l" +: P"%c"ntag" Di!t%i-ution o S"nio% Citi2"n! -y Et/nic G%ou' an# St%atum( Malay!ian +33+ an# )*)*
Et/nic G%ou'
+33+ U%-an
)*)* Ru%al P"% c"nt Total -umber 45***6 .er "ent
Malaysian citizens ?!mi'!tera <hinese %ndian 1thers 0otal Non"&alaysian ,otal N!mber 3I0004 6$+ 2$5 +$8 5$+ +$5 6$2 +$6 3520$84 6$6 8$0 5$8 8$0 6$2 1$9 6$+ 3+61$+4 +$5 2$6 +$5 6$9 6$0 2$2 +$9 31,062$64 ++2$1 658$5 21$1 69$+ 1,012$1 20$2 1,062$6 2$9 15$5 10$5 8$6 9$+ 9$+ 9$+ 36,209$84
7o!rceC 7enior <iti)ens and 9o'!lation Ageing in &alaysia, ;e'artment o# 7tatistics, 1998
Variations by Age: the Young- l! an! the
l!- l!
0he elderly are classi#ied into t/o gro!'s, namely, the yo!ng"old 360"25 years4 and the old"old 3those aged 2+ and above4$ 0he 1991 <ens!s recorded 816 tho!sand yo!ng"old /hile the old"old /ere n!mbered at 219 tho!sand 3;e'artment o# 7tatistics, 19984$ <omes year 2020, the n!mber o# old"old is e-'ected to increase to +25 tho!sand /hereas the yo!ng" old is estimated at 2,66+ tho!sand 30able 24$ 0he gro/th rate /ill be 6$9 and 5$+ 'er cent res'ectively, #or the old"old and the yo!ng"old$ 0his sho/s that the yo!ng"old is e-'anding at a #aster rate than the old"old s!ggesting that the trend /ill e-hibit an !'/ard t!rn once the cohort o# yo!ng"old advances in age$ 0he 'ro'ortion o# yo!ng"old and old"old di##ers among the three ma,or ethnic gro!'s$ 0he <hinese comm!nity has a m!ch higher 'ro'ortion o# old"old 'ersons com'ared to the other ethnic gro!'s$ Among the elderly 'o'!lation, the 'ro'ortion o# old"old /as 26$1 'er cent #or the <hinese, 18$+ 'er cent #or the &alays and 12$2 'er cent #or the %ndians in 1991$ %t is th!s clear that the ageing 'henomenon is more ac!te among the <hinese than any o# the other ethnic gro!'s 30able 64$
Ta-l" ): Num-"% an# P"%c"ntag" o S"nio% Citi2"n! in 7Young8ol#9 4:*8;< y"a%!6 an# 7Ol#8ol#9 4;= y"a%! an# o$"%6 Co/o%t!( Malay!ia( +3>* ? )*)*
Y"a%
Total 45***6
Num-"%! 45***6 Young8 Ol# Ol#8 ol# 150$2 219$2 262$5 682$2 +25$8
@ Young8 ol# 81$1 28$8 81$1 81$6 82$1
@ Ol#8 ol# 18$9 21$1 18$9 18$2 12$9
G%o0t/ Rat" Young8 ol# " 2$2 6$9 6$8 5$+ Ol#8 Ol# " 5$0 2$2 6$2 6$9
1980 1991 2000 2010 2020
25+$2 1,062$6 1,518$2 2,026$1 6,209$8
605$+ 816$1 1,1+0$8 1,688$5 2,66+$0
7o!rceC 7enior <iti)ens and 9o'!lation Ageing in &alaysia, ;e'artment o# 7tatistics, 1998
Ta-l" A: P"%c"ntag" Di!t%i-ution o S"nio% Citi2"n! in 7Young8ol#9 an# 7Ol#8ol#9 Co/o%t! -y Et/nic G%ou'( Malay!ia( +33+
Et/nic G%ou' &alaysian <iti)ens ?!mi'!tera <hinese %ndians 1thers Non"&alaysian <iti)ens 0otal
Young8ol# 81$+ 26$9 82$6 22$8 28$6 28$8
Ol#8ol# 18$+ 26$1 12$2 22$2 21$2 21$2
Total 100$0 100$0 100$0 100$0 100$0 100$0
7o!rceC 7enior <iti)ens and 9o'!lation Ageing in &alaysia, ;e'artment o# 7tatistics, 1998
Gen!er Di""erences Altho!gh ageing is inevitable, the sit!ations #acing males and #emales can be very di##erent$ 0able 5 indicates the decline in the se- ratio among the elderly$ %n 1920, there /ere more elderly males com'ared to #emales 3108$54, b!t in year 2000 the ratio has dro''ed to 88$6$ Among the ma,or ethnic gro!'s, the case #acing the %ndian comm!nity is most drastic in that the male"#emale ratio /as 216$6 in 1920, 89$1 in 2000 and is e-'ected to dro' to 25$8 in 2020$ 0his means that there /ill be #ar more #emale elderly 'ersons com'ared to males and the im'lications on social sec!rity /ill be 'ro#o!nd$ Among the #umiputeras or the indigeno!s
'eo'le the ratio o# male to #emale elderly 'ersons /as 102$8 in 1920 and it dro''ed to 88$0 in 2000 and is e-'ected to decrease to 86$8 in 2020$ 0he <hinese comm!nity e-'erienced a similar sit!ation in /hich the ratio /as 102$8 in 1920, 85$6 in 2000 and 82$6 in 2020$ 0he 'roblem o# ageing seems to e-hibit a s(e/ to/ards more #emales among the %ndians com'ared to the other t/o ethnic gro!'s, indicating that the 'roblem o# /ido/hood /ill be more serio!s among the %ndians$
0able 5C 7e- Batio #or 7enior <iti)ens by Age Fro!' and 8thnic Fro!', &alaysia, 1920"2020
Age gro!' 0otal 360J4 60"25 2+J 8thnic gro!' ?!mi'!tea <hinese %ndians
+3;* 7e- ratio 108$5 112$1 89$+ 102$8 102$8 216$6
+3>* 7e- ratio 92$2 98$2 96$5 99$6 86$6 166$+
+33+ 7e- ratio 89$6 91$2 82$2 91$6 29$5 115$6
)*** 7e- ratio 88$6 92$1 26$5 88$0 85$6 89$1
)*)* 7e- ratio 8+$2 89$0 8+$2 86$8 82$6 25$8
NoteC 0he classi#ication o# ethnic gro!'s #or 1920 and 1980 di##ers #rom the classi#ication !sed in 1991 on/ards$ 0he main ethnic gro!'s only incl!de &alaysian citi)ens since the 1991 <ens!s, /hereas, 'revio!sly the classi#ication incl!ded both citi)ens and non"citi)ens$ 7o!rceC 7enior <iti)ens and 9o'!lation Ageing in &alaysia, ;e'artment o# 7tatistics, 1998
Marital Status 0able + sho/s that in 1991, almost one in three senior citi)ens /as classi#ied in the “/ido/ed category$ 0here /as a strong contrast bet/een /ido/ed male elderly, /ho constit!ted only 12 'er cent o# male elderly /hile #emale /ido/ed /ho constit!ted over hal# 3+1 'er cent4 o# the #emale elderly$ 0his trend becomes more 'rono!nced among those in the old"old age gro!'$ <om'aring males and #emales, it is obvio!s that a #ar greater 'ercentage o# the males are married and the di##erence in marital stat!s became even more 'rono!nced in the old"old age gro!'s /here 21$1 'ercent o# the males are married com'ared to only 25$0 'er cent o# #emales$ Wido/hood /as highest among elderly %ndian /omen 3+2 'er cent4 in 1991 /hile the &alays had the lo/est 'ro'ortion o# /ido/s 311 'er cent4$ 0he <hinese had the highest 'ro'ortion o# “never married , both among the males and #emales$
Ta-l" =: P"%c"ntag" Di!t%i-ution o S"nio% Citi2"n! -y Ma%ital Statu!( S"B an# B%oa# Ag" G%ou'( Malay!ia( +33+
Ma%ital Statu! 60"25 Kears Never married <!rrently married Wido/ed ;ivorcedL'ermanently 7e'arated 0otal 2$1 82$5 9$6 1$6 100$0
Mal" 2+J years 2$0 21$1 25$8 2$1 2$0 85$1 12$5 1$5 0otal 60"25 years 1$+ 59$2 5+$2 6$6
F"mal" 2+J years 1$+ 25$0 20$2 5$6 100$0 1$+ 55$0 +0$2 6$8 0otal 60"25 years 1$8 62$2 28$0 2$+
Total 2+J years 1$2 5+$6 59$8 6$6 100$0 1$8 62$9 62$8 2$2 100$0 0otal
100$0 100$0 100$0
100$0 100$0
7o!rceC 7enior <iti)ens and 9o'!lation Ageing in &alaysia, ;e'artment o# 7tatistics, 1998
E!ucational Achie$ement %n the case o# &alaysia, the 'resent cohort o# elderly does not have m!ch ed!cational achievement 31991 <ens!s4 d!e to the limited ed!cational #acilities, /hich is e-'lained by the economic develo'ment o# the nation in the early decades o# the 20 th cent!ry$ 7ome 66 'er cent o# the elderly received no schooling at all$ .o/ever, this re'resents an im'rovement com'ared to the #ig!res in 1920 and 1980, in /hich the 'ercentage o# those /ith no ed!cation /as 2+ and 26 'er cent, res'ectively 30able 64$ 0his trend is not e-'ected to contin!e into the #!t!re as ed!cation became /idely available and the #!t!re cohorts o# elderly /ill be more ed!cated$ Ass!ming that the 'resent cohort o# 'o'!lation aged bet/een 6+"+5 /ill move into the aged gro!' and ass!ming that their 'resent ed!cational achievement remains the same #or this cohort, by year 2020, the ed!cational 'ro#ile o# the senior citi)ens /ill be largely ed!cated /ith 6 'er cent having tertiary ed!cation /hile only 20 'er cent /o!ld have no schooling$
Ta-l" :: P"%c"ntag" Di!t%i-ution o S"nio% Citi2"n! -y E#ucation L"$"l( Malay!ia( +3;*( +3>*( +33+ an# )*)*
E#ucation l"$"l No schooling 9rimary @o/er secondary U''er secondary 0ertiary 0otal % %%
+3;* 2+$0 22$6 1$6 1$2 0$6 100$0
+3>* 26$2 26$1 1$8 1$+ 0$5 100$0
+33+ 66$1MM 61$+ 2$5 2$1 0$9 100$0
)*)*C 20$6MM 5+$+ 1+$1 16$2 +$9 100$0
Appro&imate estimation 'nclu!es one percent o" cases (here e!ucational le$el (as un)no(n
7o!rceC 7enior <iti)ens and 9o'!lation Ageing in &alaysia, ;e'artment o# 7tatistics, 1998
8d!cational attainment by gender sho/s that a m!ch lo/er 'ercentage o# #emales /ere ed!cated com'ared to males, consistent /ith the 'ast social c!lt!ral environment, /hich gave 're#erence #or boys to be ed!cated$ According to the 1991 <ens!s, close to hal# 352 'er cent4 o# elderly males had basic schooling /hereas only 18 'er cent o# #emales had similar ed!cation$ Among the three ma,or gro!'s, the %ndian senior citi)ens /ere better ed!cated com'ared to the other t/o ethnic gro!'s$ Abo!t hal# o# the %ndians had received some ed!cation com'ared to 65 'er cent #or #umiputeras and 52 'er cent #or <hinese$ <lose to 6 'er cent o# the elderly %ndians had tertiary ed!cation /hile another 6 'er cent had com'leted !''er secondary ed!cation$ Among the <hinese, 6 'er cent had !''er secondary school ed!cation /hile 1 'er cent had tertiary ed!cation$
Economic Acti$ities
Altho!gh it is recogni)ed that labor #orce 'artici'ation declines as age increases, the decline that &alaysia e-'erienced bet/een the last t/o cens!s 31980 and 19914 has been signi#icant, not only in terms o# 'ercentage decline b!t also in absol!te n!mbers$ 0able 2
sho/s that labor #orce 'artici'ation rate 3@*9B4 declined #rom 69$1 in 1980 to 2+$6 in 1991$ %n absol!te n!mbers, total n!mber decreased #rom 290 tho!sand in 1980 to 266 tho!sand in 1991 3;e'artment o# 7tatistics 19984$ %n the case o# #emales, the decrease has been even #ar more signi#icant /ith a decline o# almost +0> #rom 1980 to 1991$ 8ven among the yo!ng olds 3aged 60"654, @*9B sho/ed a decline #rom 69 'er cent to +6 'er cent among the males and #rom 22 'er cent to 16 'er cent #or the #emales$
Ta-l" ;: La-o% Fo%c" Pa%tici'ation Rat"! 4LFPR6 o S"nio% Citi2"n! By S"B( an# Ag" G%ou'( Malay!ia( +3;*( +3>* an# +33+
Y"a% an# ag" 1920 1980 1991 1980 60"65 6+J years 1991 60"65 6+J years
Mal" +5$2 +6$8 51$9 69$5 59$2 ++$6 66$8
F"mal" 18$5 21$8 10$9 26$2 19$0 16$1 8$1
Total 62$6 69$1 2+$6 52$2 65$2 6+$2 20$1
7o!rceC 7enior <iti)ens and 9o'!lation Ageing in &alaysia, ;e'artment o# 7tatistics, 1998
0he economic activities o# the 'resent cohort o# elderly still e-hibit the 'ast economic str!ct!re o# &alaysia in /hich agric!lt!re /as the ma,or sector 'roviding the greatest n!mber o# em'loyment$ 62 'er cent o# the elderly /or(ed in the agric!lt!ral sector 31991 <ens!s4, /hile sales occ!'ations /ere the ne-t most common occ!'ation 316 'er cent4, #ollo/ed by the 'rod!ction, trans'ort eG!i'ment o'erators and laborers category 311 'er cent4$ %n terms o# em'loyment stat!s, slightly more than 20 'ercent o# the elderly /ere sel#" em'loyed 30able 84$ 0his re'resents a signi#icant increase #rom 1980 in /hich the 'ercentage o# sel#"em'loyed /as abo!t 60 'er cent$ .o/ever, the most notable change has been the decline in the 'ercentage o# !n'aid #amily /or(ers #rom 15$8 'er cent in 1980 to +$2 'ercent in 1991$ 0he decreasing 'ro'ortion o# !n'aid #amily /or(ers is tr!e #or both males and #emales, /ith the males e-hibiting a more ra'id decline$
0able 8C 9ercentage ;istrib!tion o# 8m'loyed 7enior <iti)ens by 8m'loyment 7tat!s and 7e-, &alaysia, 1980 and 1991$
/mployment Statu! 8m'loyer 8m'loyee 7el#"em'loyed Un'aid #amily /or(er Un(no/n 0otal 1980 5$5 25$6 60$6 11$0 " 100$0
Mal" 1991 6$9 21$1 21$2 1$6 1$5 100$0
F"mal" 1980 1$5 16$2 ++$6 26$6 " 100$0 1991 1$2 16$1 61$8 18$8 2$0 100$0 1980 6$2 22$2 +9$1 15$8 " 100$0
Total 1991 6$6 20$6 69$6 +$2 1$+ 100$0
7o!rceC 7enior <iti)ens and 9o'!lation Ageing in &alaysia, ;e'artment o# 7tatistics, 1998
National 9olicy #or the 8lderly
U' till 199+, there /as no s'eci#ic 'olicy #or older 'ersons in &alaysia$ At best, 'olicies or 'rograms catering to the needs o# the elderly have largely been incor'orated into social /el#are 'olicy develo'ment in this co!ntry$ 0he National Wel#are 9olicy 'rom!lgated in 1990 identi#ies the elderly, de#ined as those 60 years and over, as one o# its many target gro!'s$ Altho!gh this mar(s an initial ste' in the 'rovision o# care #or the elderly, instit!tional e##orts are at its minim!m as #amily and comm!nity are enco!raged or e-'ected to 'rovide care to the elderly$ 0he 'rinci'le is that instit!tional s!''ort is the last resort$ %n 199+, the Fovernment #orm!lated the National 9olicy #or the 8lderly aimed at “creating a society o# elderly 'eo'le /ho are contented and 'ossess a high sense o# sel# /orth and dignity, by o'timi)ing their sel# 'otential and ens!ring that they en,oy every o''ort!nity as /ell as care and 'rotection as members o# their #amily, society and nation 3F1&, 1996 '$+214$ 7'eci#ically, the 9olicy has the ob,ectives o# !'grading the dignity and sel#"/orth o# senior citi)ens /ithin the #amily, society and nation, and im'roving the 'otential o# the elderly so that they can contin!e to be 'rod!ctive in national develo'ment$ 0he 'olicy also aims at enco!raging the 'rovision o# #acilities #or the elderly so as to ens!re care and 'rotection #or them$ %n line /ith these ob,ectives, several action 'lans are initiated and several s!b"committees have been set !' to loo( into the vario!s as'ects related to ageing and the
/el#are o# the elderly in &alaysia$ 0hey incl!deC social and recreational, health, ed!cation and training, religion, ho!sing and research$ ;etails o# the 'rograms !nder each s!b"committee are 'rovided in A''endi- A$ ?esides 'olicy, 'rograms and activities, a monitoring system has been '!t in 'lace to monitor the 'rogress o# all activities #or the 'eriod 1992"200+$ 0his control mechanism 'rovides chec(s and balance as /ell as eval!ates the 'rogress o# 'rograms and activities$ Vario!s ministries and de'artments !nderta(e action 'lans and activities #or the elderly, b!t the agency that oversees all matters is the ;e'artment o# 7ocial Wel#are$ 0his /ill ens!re that ga's and short#alls are identi#ied and corrective actions ta(en #or #!t!re develo'ment o# a s!stainable national 'olicy #or the elderly$ Altho!gh the National 9olicy #or the 8lderly is a great ste' #or/ard in 're'aring the &alaysian society #or a transition into an ageing society, one ma,or iss!e that a##ects the /el#are o# the elderly is cons'ic!o!sly absent #rom the 9olicy " social sec!rity /hich is incl!ded as a s!b"'rogram$ Altho!gh health care receives s!bstantial attention, the #inancing as'ect is not covered$ 0he em'hasis o# the 9olicy a''ears to be on social as'ects, not denying that these too contrib!te to/ard the /ell"being o# the elderly$
6$ 71<%A@ 78<UB%0K AN; 8<1N1&%< W8@@"?8%NF
%n &alaysia, #ormal social 'rotection system incl!desC the 8m'loyees 9rovident *!nd 389*4, 19+1, the 7ocial 7ec!rity 1rgani)ation 371<714 established in 1969, Fovernment 'ension scheme #or <ivil servants, 1ld Age ?ene#it 7cheme #or the Armed *orces, and 'rivate sector 'rovident and 'ension #!nds$ 0hese di##erent schemes 'rovide 'rotection #or di##erent contingencies s!ch as disability as in the case o# 71<71, old age 3'ension and 89*4 and deaths$ While these schemes 'rovide coverage #or the #ormal sector, the 'rovision is not mandatory #or those in the in#ormal sector, /hich is s!bstantially large in &alaysia$ Altho!gh 89* is e-tended to the sel#"em'loyed on a vol!ntary contrib!tion basis, the 'artici'ation rate is lo/$ 0here#ore, those in the in#ormal sector have to rely on savings, dra/ing do/n on 'ast /ealth and #inancial s!''ort #rom children to 'rovide them /ith income sec!rity in their old age$ ;!e to the lac( o# data abo!t the in#ormal sector, there is no /ay o# assessing the e-tent o# 'rotection available$ 0his re'ort /ill cover the t/o 'illars o# 'ension systemsC 9illar 1, 'ension, /hich is based on de#ined bene#its and 9illar 2, 89*, a de#ined contrib!tion system, in /hich bene#its de'end on the assets in the individ!al=s acco!nt at retirement 3*o- and 9almer 20014$
.ension 9ension is a non"contrib!tory social sec!rity scheme #or government em'loyees$ 9ensions e-'endit!re is /holly borne by the *ederal Fovernment thro!gh ann!al allocation #rom the *ederal ?!dget$ %t is the 'ay"as"yo!"go 'lan$ An em'loyee /ho has served at least 10 years is entitled to receive a li#e"long monthly 'ension !'on retirement$ 0he G!ant!m receivable by an em'loyee /ho has com'leted at least 2+ years o# service is hal# o# the last dra/n salary$ 0his scheme serves not only as a sec!rity #or old age, it is designed to 'rovide #inancial assistance to the de'endents o# those in the Fovernment service in the event that the government em'loyee 'asses a/ay /hile in service or a#ter retirement$ %t also 'rovides com'ensation to o##icers /ho are #orced to retire or 'ass a/ay d!e to in,!ries or sic(ness in the co!rse o# 'er#orming their o##icial d!ties$ 0he ty'es o# retirement bene#its o##ered in the 'ension scheme incl!de service 'ension and service grat!ity /hich is a l!m' s!m 'ayment granted to a 'ensionable o##icer !'on retirement$ 0he other ty'e o# bene#it is in the #orm o# derivative 'ension, /hich is granted to the /ido/L/ido/erLchild o# a 'ermanent and con#irmed o##icer /ho dies in service$ 7imilarly, derivative grat!ity is 'ayable to the /ido/L/ido/er, child, and motherLde'endant #ather o# the deceased or legal 'ersonal re'resentative o# the deceased o##icer i# the o##icer dies in service$ %t is a sa#ety net #or the /ido/ed s'o!ses and it is 'artic!larly bene#icial in 'roviding #or the #emales as they generally e-'erience a higher incidence o# /ido/hood$ %n terms o# coverage, only less than one 'ercent o# the 'eo'le are 'rotected$ %n vie/ o# the large 'ension 'ayo!t, the government has ta(en ste's to ens!re that 'ensions 'ayment do not become a b!rden #or the government in the #!t!re$ As s!ch a 0he 9ensions 0r!st *!nd /as set !' in 1991 !nder the 9ensions 0r!st *!nd Act, 1991$
8m'loyee 9rovident *!nd 389*4
0he 89* is a 0r!st *!nd 3#!nctions as a tr!stee #or its members4 established !nder the 89* 1rdinance, 19+1$ %t /as amended to the 89* Act in 1991$ 0he 89* is a de#ined contrib!tion 'lan based on a 'rescribed rate o# contrib!tion by em'loyers and em'loyees, acc!m!lated as savings in a 'ersonal acco!nt and #!ll /ithdra/al !'on retirement$ 0he scheme is mandatory #or those in the #ormal sector, b!t it also allo/s those /ho are sel#" em'loyed to contrib!te to/ards the #!nd$ 0his #le-ibility is aimed at enco!raging savings #or old age$ 0he rate o# contrib!tion is 12> and 11> #or em'loyers and em'loyees res'ectively, regardless o# age o# em'loyee$ 0he rate o# contrib!tion has increased si- 'ercentage 'oints over the last t/o decades$ <ontrib!tion by em'loyee has been revised to 9 'er cent in A'ril 2001, in an attem't to boost domestic demand in res'onse to the global economic slo/do/n$
.o/ever, 89* members can choose to contrib!te the revised rate o# 9> or the old rate at 11>$ 0he 89* is str!ct!red into three ty'es o# acco!nts, namely Acco!nt % 360>4, Acco!nt %% 360>4 and Acco!nt %%% 310>4$ 8ach acco!nt is designed to serve the di##erent needs o# contrib!tors and conditions !nder /hich a certain amo!nt can be /ithdra/n #rom these acco!nts are as #ollo/sC D Acco!nt % constit!tes 60> o# member=s savings #or retirement in accordance to the 'rimary ob,ective o# the scheme, i$e$, to ens!re that members have s!##icient cash savings #or retirement$ U' to 20> o# the balance in Acco!nt % can be trans#erred #or investment '!r'oses$ 0his is a ne/ #eat!re introd!ced in 1996 to allo/ contrib!tors to invest !nder &embers= 7aving %nvestment 7cheme$ D Acco!nt %% allo/s a member to /ithdra/ hisLher savings once #or b!ying or b!ilding a ho!se$ 0his /ithdra/al is limited to 20> o# the 'rice o# the ho!se or 5+> o# the savings b!t not e-ceeding B&20,000$ *!rther /ithdra/als to red!ce or to settle balance o# the ho!sing loan is allo/ed every #ive years #rom the date o# the 'revio!s /ithdra/al !ntil the member attains the age o# ++ years$ Under this acco!nt, members /ill also be allo/ed to /ithdra/ some money to #inance the cost o# their children=s ed!cation$ D Acco!nt %%% is intended to hel' members to 'ay #or their medical e-'enses o# critical illness$ 0his assistance in the #orm o# emergency medical e-'enses allo/s 10> o# contrib!tion to be /ithdra/n and it is not limited to the member only, b!t is e-tended to member=s s'o!se, children, 'arents and siblings$ As the 89* aims to cater to non"'ensionable em'loyees #or #inancial sec!rity !'on retirement and to assist them thro!gh till the end, it introd!ced the 9eriodical 9ayment Withdra/al 7cheme in 1995 to allo/ members /ho have reached retirement age to /ithdra/ their savings 'eriodically 3once a month4, !ntil all savings are /ithdra/n$ 0his is similar to the monthly 'ayment #or government 'ensions$ .o/ever, this scheme is not 'o'!lar 3Ne/ 7traits 0imes, 9$+$994$ As at ;ecember 61, 1999, only 126 members re'resenting 0$25 'er cent o# overall members o'ted #or the l!m'"s!m 'ayment have chosen the monthly 'ayment o'tion 30he 8dge, 9ersonal &oney, 6$11$2000, '$ 264$ ?esides the l!m' s!m /ithdra/al at retirement and the 'eriodic 'ayment, the 89* also 'rovides t/o other schemes$ 1ne o# the other t/o o'tions is 'art l!m' s!m and 'art 'eriodic 'ayment /hile the other allo/s contrib!tors to maintain the 'rinci'al amo!nt /ith 89*, /ithdra/ing only the ann!al dividends$
%n :!ly 2000 89* introd!ced yet another o'tion, /hich is the ann!ity scheme com'rising t/o ty'es o# schemes to s!it the 're#erence o# contrib!tors$ 0he #irst one is (no/n as the <onventional Ann!ity 7cheme and the other is the *a)a"ul Ann!ity 7cheme$ 0hese schemes are aimed at 'roviding members an even income stream thro!gho!t their retirement years$ 0hey are o'en to contrib!tors bet/een the ages o# 16 and 20$ &embers o# 89* may choose to b!y one or both the schemes$ *ollo/ing the anno!ncement o# this ne/ ann!ity scheme, mi-ed res'onses have been received by 89*$ &ost do not !nderstand ho/ the ann!ity scheme /or(s /hile others #elt that they co!ld be better o## by (ee'ing the s!m o# money in 89* or save it in #i-ed de'osit and earned a ret!rn higher than the ann!ity scheme, that is, #or the case o# a yo!ng ins!red$ *or a 'erson /ho is ++ years old to #!lly bene#it #rom the ann!ity scheme, the 'erson has to live beyond 20 years old$ Another disadvantage abo!t the scheme is the moral ha)ards in these mar(ets$ 0he #!t!re develo'ment o# this scheme de'ends on the con#idence contrib!tors have to/ard the scheme$ 0his co!ld 'robably im'rove /ith some reg!latory intervention on the 'art o# the government, as /ell as individ!al 're#erence /ith regards to the mode o# /ithdra/al, individ!al so!rces o# #inancial sec!rity, and etc$ 0he acce'tance o# this scheme is not a '!rely economic decision, b!t one that also concerns the social and 'sychological as'ects o# h!man behavior$ E+, - Co$erage As at the end o# ;ecember 1999 the total n!mber o# members /as 9$+5 million, com'rising o# 5$28 million 3or +0$1>4 o# active members com'ared to 6$99 million 3or +1$5>4 o# active members in 199+ 30able 94$ 0his re'resents an increase o# 19$8>$ Active members are those /ho have at least one contrib!tion in the last t/elve month$ 0he total labor #orce N1O in &alaysia sa/ a dro' o# a''ro-imately 2 'ercent #rom 1992 to 1998 d!e 'robably to the Asian 8conomic <risis$ %n 1999, total labor #orce o# &alaysia is 9$01 million and the active members made !' +6$1 'ercent o# the total labor #orce$ 0he 'ercentage o# total members as /ell as active members has increased over the #ive"year time #rame$
Ta-l" 3: Num-"% o EPF M"m-"%!( +33= ? +333
Y"a%
Total num-"% o m"m-"%! 4million6
Num-"% o acti$" m"m-"%! 4million6 6$99
.er"enta e of acti$" m"m-"%! +1$5>
Total La-o% Fo%c" 4million6 8$26
P"%c"ntag" o acti$" m"m-"%! to la-o% o%c" 58$6>
199+
2$26
1996 1992 1998 1999
8$0+ 8$22 9$16 9$+5
5$18 5$61 5$66 5$28
+1$9> +2$1> +0$9> +0$1>
8$65 9$05 8$88 9$01
58$5> 52$2> +2$+> +6$1>
7o!rceC 8m'loyees 9rovident *!nd Ann!al Be'ort 1999 Economic -eport .//01// 2 344414.5 Ministry o" ,inance
0he relevance o# the 89* scheme #or the 'resent cohort o# elderly as a so!rce o# #inancial s!''ort thro!gh till the end may not be signi#icant$ 0here are three reasons #or thisC #irstly, a large 'ro'ortion o# the elderly in the 'resent cohort are in the in#ormal sector in /hich contrib!tion is not made mandatory$ Altho!gh they are given a choice to ma(e contrib!tions to/ard their old age, most do not do so d!e 'robably to their #inancial needs and alternative aven!es o# !tili)ation o# #!nds$ Wor(ers in the in#ormal sector /here retirement does not a''ly, !s!ally /or( !ntil they are !nable to do so d!e to ill health$ 7econdly, there al/ays remains the G!estion o# /hether 'eo'le /ill have eno!gh in their 89* acco!nt to see them thro!gh till the end, i# 89* is the only so!rce o# income 3&ehta, 19924$ Bising cost associated /ith longer li#e e-'ectancy and the e##ect o# in#lation /ill diminish the si)e o# savings$ %t is then essential to raise the G!estion o# adeG!acy$ Unli(e the sit!ation in &alaysia, the elderly 'eo'le in develo'ed co!ntries are /ell 'rotected in their old age #inancially$ *or e-am'le, in the U7, in 1925 over 90> o# all #amilies /hose head /as 6+ years and older /ere receiving social sec!rity bene#its$ Abo!t 20> /ere receiving income either #rom 'rivate 'ensions, ann!ities, or other #orms o# 'rivately attained income, income #rom acc!m!lated assets, #rom dra/ing do/n their stoc( o# /ealth, and or #rom c!rrent earnings 3<hen and :ones 19894$ 0hirdly, the l!m' s!m nat!re o# /ithdra/als tends to have high e-'os!re to im'ro'er management or investment that does not 'rovide the ins!rance needed #or old age$ Will the ne/ly introd!ced ann!ity scheme be able to #ill this need"ga'P An ans/er is not immediately available$ %n res'onse to the G!estion o# adeG!acy, the 89* has cond!cted several in"ho!se sim!lations to assess the e-tent to /hich the #!nd addresses the iss!e o# adeG!acy 3A!mar 19964$ ?ased on the %@1 <onvention, 19+2 No$ 102, the minim!m re'lacement rate is at least 50> o# the last dra/n salary$ 7im!lations cond!cted in 199+ on vario!s categories o# contrib!tors sho/ that the monthly ann!ity 'ayment receivable #or a 'eriod o# 20 years #or the man!al, clerical and e-ec!tive categories /ere +8>, +6> and 50> o# the last dra/n salary be#ore retirement, res'ectively, indicating a s!##icient level o# re'lacement rate 3A!mar 19964$
As a social sec!rity instit!tion, the main concern o# the 89* is ho/ it can overcome the inadeG!acies o# the schemes in order #or it to 'rovide adeG!ate long"term retirement savings #or its members and de'endents$ *or a start, Acco!nt % /here 60> o# the 'ool o# monies available to members sho!ld be set aside and can only be dra/n !'on reaching retirement age instead o# the 'resent arrangement that allo/s #or 20> /ithdra/al #or investment$ 0his ens!res that 'remat!re /ithdra/als are limited only to 50> o# total savings 30he 8dge, 9ersonal &oney, 2$10$2000, '$ 284$ %n addition, the amo!nt 'ermissible #or 're" retirement /ithdra/al !nder the remaining acco!nt sho!ld be revie/ed #!rther$ &ore stringent conditions can be introd!ced as a meas!re to/ard ens!ring adeG!acy #or old age$
7avings, %nvestments and %ns!rance A'art #rom social sec!rity as the 'rimary so!rce o# income #or the aged, savings, 'ersonal li#e ins!rance and !nit tr!st #!nds are alternative #orms o# so!rces o# 'rotection available to the elderly$ 0he national investment schemes 'rovide attractive ret!rns /ith the aim to enco!rage /ider 'artici'ation, 'artic!larly, 'artici'ation #rom the lo/er income gro!'$ All these are vol!ntary schemes and hence individ!al decision is critical in in#l!encing 'artici'ation$ %ns!rance is another alternative to/ard saving #or old age, altho!gh it 'rovides 'rotection to other sections o# the 'o'!lation as /ell$ %ns!rance is a /ay o# 'rotection against interr!'tion or elimination o# earning ca'acity o# h!man, ca'ital and 'ro'erty reso!rces$ %t is !sed as a shield against !ne-'ected e-'enses that might diminish dis'osable income available #or #inancial 'lanning ob,ectives incl!ding those #or retirement$ 9ossessing an ins!rance 'olicy minimi)es and ens!res against !nnecessary economic hardshi's d!ring ones /or(ing li#e as /ell as d!ring retirement$ No s'eci#ic ins!rance scheme is tailored #or the elderly$ 0he ty'e o# ins!rance s!itable #or old age 'rotection is the endo/ment 'olicy or the investment"lin(ed ones$ A s!rvey carried o!t by 0aylor Nelson 7o#res *inancial &onitor to investigate the o/nershi' by ins!rance ty'e in &alaysia is as sho/n in *ig!re 1$ 0he coverage !nder li#e ins!rance is only 66> o# /hich details abo!t the ins!red are not available$ ;!e to data limitation, there is no /ay o# assessing the e-tent o# 'rotection available to the elderly$
Figu%" +: O0n"%!/i' -y In!u%anc" Ty'"
Source: *he E!ge5 +ersonal Money5
ctober 65 .///5 p78
#. 0/)1,0 2)3/
.ealth is im'ortant sim'ly beca!se it a##ects the elderly directly in that the lin( bet/een 'hysical health and li#e satis#action have long been made 39almore and Aivett 19224$ %n 'ersonal terms, ill health can bring many lossesC the loss o# inde'endence and a!tonomy, loss o# mobility, loss o# dignity and 'rivacy, and loss o# con#idence and sel#"esteem 37idell 199+4$ %ndirectly, the iss!e o# health a##ects the #ormation o# h!man ca'ital, ho!sehold and government b!dgets$ 0he mobili)ation o# reso!rces #or health care #or the elderly is an o''ort!nity cost that co!ld other/ise be em'loyed in alternative a''lications$ 0here#ore, the iss!e o# health is m!ch o# a matter o# '!blic 'olicy debate$ &!ch o# the concern e-'ressed over the iss!e o# health and ageing 'o'!lation is the b!rden that this '!ts on the health care system$ With the increasing 'ro'ortion o# elderly in &alaysia and im'rovement in li#e e-'ectancy, care #or the elderly /ill have to be 'rovided by ad!lt children /ho /o!ld 'robably be in their #i#ties and si-ties Q /ho are either entering or already in the aged gro!' 3Nor Aini 19924$ 0his ca!ses strain on caregivers /ho might have health 'roblems o# their o/n and yet have to care #or the elderly /ho are li(ely to s!##er #rom chronic illnesses$ While the demand #or health and medical 'rod!cts and services /ill be increasing, the costs o# obtaining care are also rising$
.ealth 7tat!s o# 0he 8lderly in &alaysia ?ased on sel#"assessment, ma,ority o# the elderly #elt that they /ere healthy /ith a higher 'ercentage o# the !rban elderly com'ared to r!ral elderly e-'ressed the same 3<hen
et al$ 1986, <hin 1996, 0an et al$ 19994$ A higher 'ro'ortion o# males rated their health as “very good or “good com'ared to the #emales 3<hen and :ones 19894$ <ommon health 'roblems /ere eyesight 'roblem /ith /omen over 2+ years being the /orst a##ected, evidence o# cataracts, di##ic!lty che/ing, and some need dental 'rosthesis 3<hen et al$ 1986, <hen and :ones 1989, 0an et al$ 19994$ 8yesight 'roblems /ere more serio!s among the elderly com'ared /ith hearing 'roblems$ Altho!gh there /ere no changes in hearing"abilities among /omen /ith increasing age, there /as mar(ed decrease /ith age in the 'ercentage o# men /ho indicated they co!ld hear /ell$ According to 0an et al$ 319994, abo!t 50> o# the elderly 'eo'le indicted that they have s'eci#ic health 'roblems, /ith a higher 'ercentage o# /omen com'ared to men indicated so$ .igh blood 'ress!re seemed to be the most common 'roblem a##ecting them$ Again, more o# the #emales /ere a##ected com'ared to males$ While rhe!matism /as a 'roblem #or /omen, it hardly a##ected the males$ :oint 'roblems also seem to a##ect the #emales more than the males 3<hin 19964$ A higher 'ro'ortion o# the old"old /ere a##ected com'ared to the yo!ng old$
Acti$ities o" Daily 9i$ing :AD9s; 1n the /hole, a high 'ercentage o# the elderly co!ld do all the activities o# daily living 3A;@s4 30able 104$ A higher 'ro'ortion o# male old"old 32+ years or more4 com'ared to #emales co!ld do so 3<hen et al$ 19864$ 7imilarly, in a se'arate st!dy 3<hin 19964 o# a semi" r!ral district, it /as #o!nd that 80 'er cent o# men bet/een 6+"25 and 65 'er cent o# men over 2+ co!ld do all the A;@s$ *or the #emales, the 'ercentage /as 21 'er cent and 68 'er cent, res'ectively$ 0he ability to 'er#orm A;@s deteriorated /ith age$ *or those /ho co!ld not 'er#orm all the A;@s, the main di##ic!lty enco!ntered /ere /al(ing and go sho''ing, an activity that is related to the ability to /al($ “Fetting inLo!t o# bed /as a 'roblem only to the old"old gro!', more so #or the #emales than males$ &ales had better 'hysical health com'ared to the #emales, more so at the older age gro!'s o# more than 20 years$
0able 10C N!mber and 9ercentage o# 8lderly Who are Unable to 9er#orm Activities o# ;aily @iving, by Age and 7e-
0y'e o# activity 0ravel beyond
60"25 N3>4 +314
N!mber and 'ercentage in each age gro!' &ale *emale 0otal 0otal 2+J &ale 60"25 2+J *emale N3>4 N3>4 N3>4 N3>4 N3>4 +3+4 10324 5314 2324 11324
0otal &ale R *emale N3>4 21324
/al(ing distance Fo sho''ing .andle o/n money 8at ;ress sel# 0a(e care o# a''earance Wal( Fet inLo!t o# bed 0a(e bath Fet to toilet on time 7am'le si)e
11364 8324 130$64 130$64 130$64 2314 0304 130$64 12364 696
1+364 +3+4 1314 +3+4 6364 1314 1314 5354 8394 96
263+4 16364 230$54 6314 5314 630$64 130$24 +314 20354 589
15364 2324 1304 0304 0304 130$24 0304 0304 9324 511
193194 113114 2324 2324 2324 5354 6364 6364 9394 101
66364 18354 630$64 230$54 230$54 +314 630$64 630$64 18354 +12
+9364 61364 +30$+4 830$84 630$64 830$84 530$54 830$84 68354 1001
7o!rceC <hen et al 319864, .ealth and Ageing in &alaysia, '$ 20
&ental .ealth Using cognitive score, the elderly aged 2+ years and over 'er#ormed /orst in res'ect o# mental health 3<hen et al$ 19864$ %n terms o# gender, cognitive score #or elderly men /ere higher than that #or /omen 30able 114$ 0hey re'orted being /orried"tense, having lost interest, #eeling tired, being #orget#!l and 'aranoid$ %n the cognitive assessment o# the elderly, the 'ro'ortion o# elderly /ho managed a normal score decreased /ith age, and /omen a''eared to be more cognitively im'aired than men 3<hin 19964$ <ontrolling the e##ect o# age, this cognitive score /as signi#icantly correlated to A;@s, regardless o# gender 3<hin 19964$ <ognitive #!nction is related to other socio"economic variables$ 0hose /ho have inadeG!ate income /ere more li(ely than those /ho /ere stable economically to re'ort slee' di##ic!lties, loss o# enth!siasm in li#e and /ere more li(ely to have a cognitive score o# less than 11 o!t o# 15 3<hen et al$ 19864$
Ta-l" ++: Num-"% an# P"%c"ntag" o El#"%ly 0/o /a$" M"ntal P%o-l"m!( -y Ag" an# S"B
0y'e o# 'roblems
60"25 N3>4
N!mber and 'ercentage in each age gro!' &ale *emale 0otal 0otal 2+J &ale 60"25 2+J *emale N3>4 N3>4 N3>4 N3>4 N3>4
0otal &ale R *emale N3>4
7lee' di##ic!lties Worried"tense @ost interest ;e'ressed *eels tired *orget#!l .ears things 7ees things 9aranoid 7am'le si)e
1103284 +93+4 1083224 16364 1663514 +023+24 6324 8324 2324 696
6633694 183194 693524 +3+4 523+14 +63+24 6364 2324 6364 96
1563604 223164 1523604 18354 2103564 2+83+64 9324 10324 10324 589
1+03664 11+3284 1193294 8324 2093+14 2593614 6314 6314 11364 511
503504 623624 513514 1314 +63++4 693694 +3+4 +3+4 1314 101
1903624 1523294 1603614 9324 26+3++4 6183624 11324 11324 12324 +12
6663664 2253224 6023614 22364 52+3524 +263+84 20324 21324 22324 1001
7o!rceC <hen et al 319864, .ealth and Ageing in &alaysia, '$22
As'ects o# 7ocial .ealth As'ects o# social health incl!ded areC 'erce'tion o# environment, activity 'artici'ation and /ay o# li#e$ Almost all o# the elderly, males and #emales, rated their home environment as #air, good or e-cellent e-ce't #or a small 'ercentage that did not #eel sa#e in their homes 3<hen et al$ 19864$ 0an et al$ 319994 #o!nd that the ma,ority o# the older 'eo'le /ere staying /ith s'o!se or children, indicating that s!''ort are available to them be it emotional, social or #inancial$ 1nly a marginal 'ercentage e-'ressed that they did not have anyone to 'rovide care /hen they /ere ill, /hereas the ma,ority had someone to care #or them, s'o!se, or children$ 0he elderly /ere still able to care #or their grandchildren 3<hen et al$ 19864$ 7lightly more than hal# o# them hel'ed to ma(e #amily decisions, /ith the males 'laying a greater role com'ared to #emales$
Acti$ity +articipation an! <ay o" 9i"e *or the 'artici'ation in comm!nity activities, some si-ty 'er cent o# the elderly indicated that they are interested /ith a higher 'ro'ortion o# males com'ared to #emales indicated so 30an et al$ 19994$ 0he &alays a''ear to be more interested than the non"&alays$ 0he r!ral #ol(s are more interested than the !rban d/ellers$ .o/ever, the 'ercentage that act!ally did so is rather lo/$ Abo!t one G!arter o# the elderly /ere members o# social organi)ations$ 1!t o# this, ma,ority o# them did not 'artici'ate or 'artici'ated only occasionally$ 1nly 5 'er cent re'orted that they belonged to some gro!', meeting or society #or elderly or retired 'eo'le 3<hen et al$ 19864$ &ore o# the elderly 'artici'ated in 'rivate #!nctions s!ch as #amily #!nction$ %n both se-es, attendance declines /ith age, /ith the decline being more 'rono!nced #or /omen$ 0here /ere no r!ral !rban di##erences$ 7lightly more than 50 'er cent o# elderly men and almost 20 'er cent o# /omen re'orted that they smo(ed 3<hen et al$ 19864$ 1ne #i#th o# the elderly men and only 6 'er cent
o# /omen indicated that they smo(ed 1+ or more cigarettes 'er day$ ?!t many o# them /ere light smo(ers, b!rning only less than 1+ cigarettes a day$
Use o# .ealth 7ervices
1n the average, &alaysians= visit to the '!blic and 'rivate 'rimary care service sector is abo!t 2$6 visits 'er year$ 0he elderly made an average o# 6 visits 'er year 3<hin 19964$ Fovernment health service /ere the most 'o'!lar choice #or all age gro!'s regardless o# gender$ 7t!dies by <hen et al$ 319864 and 0an et al$ 319994 sho/ that less than +0 'er cent o# the elderly s!rveyed re'orted having #allen ill$ 1nly a negligible 'ercentage had been hos'itali)ed$ &ore #emales #ell ill com'ared to males across the age gro!'s$ Abo!t hal# o# them had ta(en 'rescribed medicine, /ith no age, se- or !rban"r!ral di##erences$ 7ome 're#erred to see( the hel' o# traditional medication, either &alay herbal medicine or <hinese herbal medicine #rom <hinese dr!g stores$ 7ome ,!st bo!ght over"the"co!nter 310<4 medicine, 'res!mably #or minor ailments that co!ld be treated /ith 10<$ 0he !se o# 10< is related 'ositively to #eelings o# ill health, /ith 'eo'le /ho re'orted that they did not #eel /ell to be 10"1+ 'er cent more li(ely to ta(e 10< than those /ho re'orted that they #elt healthy$ 0here is no di##erence in the 'erce'tion o# need #or more health aids in terms o# age and se-, b!t the r!ral residents are t/ice as li(ely as !rban residents to e-'ress their need #or more health services$ 0his co!ld be d!e to the r!ral"!rban di##erences in terms o# G!antity and ty'e o# #acilities #or health$
8-isting 9olicies and 9rograms #or .ealth <are
A revie/ o# e-isting 'olicies and 'rograms is to be 'receded /ith a revie/ o# the '!blic s!''ort #or health care in terms o# the total man'o/er available, #inancial allocation #or health services, and '!blic health #acility and coverage$ <!rrently, there is a dearth o# e-'ertise, only three geriatricians, three gerontologists and 2 'sycho"geriatricians to care #or the increasing n!mber o# elderly 30able 124$
,able 124 )vailable ,rained *anpower in 0ealth 2are for the /lderly
Cat"go%y Feriatricians Ferontologists 9sycho"geriatricians Behabilitation 9hysicians 9hysiothera'ists 1cc!'ational thera'ists 7'eech thera'ists <linical 9sychologists
Num-"% 6 6 2 + 260 120 15 10
7o!rceC *irst National 7ym'osi!m on Ferontology 199+, '$81 and intervie/ /ith 0he *amily .ealth ;ivision o# the &inistry o# .ealth$
%t is obvio!s that &alaysia still e-'eriences a shortage o# medical 'ersonnel, /here the ratio o# doctor to 'o'!lation /as 1C1,516 /ith a shortage o# abo!t 6,296 doctors 38ighth &alaysia 9lan, '$5894$ 0here is also a shortage o# dentist 3de#icit o# 1,2604 and 'harmacists 3de#icit o# 6104$ An im'ortant develo'ment in the care #or the elderly is in the establishment o# geriatric care in &alaysia$ 7ince the mid"90s, geriatric hos'itals and rehabilitation centers are o'en #or services to the elderly$ 0he 7eremban .os'ital is the only '!blic hos'ital that 'rovides geriatric care /hile another one in <heras has been granted a''roval d!ring the 7eventh 9lan 'eriod 38ighth &alaysia 9lan '$5824$ A'art #rom those available !nder government, the 'rivate hos'itals have also set !' geriatric serviceC the <heras Feriatric <enter in 9antai <heras .os'ital began o'eration since 1996, others incl!de <ol!mbia 9aci#ic Feriatric .os'ital in 7hah Alam, and 7trand Feriatric and Behabilitation <entre in 7!ngai 9etani, soon #ollo/ed$ %n terms o# allocation o# #inancial reso!rces, the act!al e-'endit!re #or 'atient care services /as less than the allocated amo!nt #or the 7i-th &alaysia 9lan 'eriod$ 7imilarly, e-'endit!re #or all categories o# '!blic health services /as less than the amo!nt o# allocation #or the 7i-th and 7eventh 9lan 'eriod$ Under the 8ighth &alaysia 9lan, a total s!m o# B&+$+ billion has been allocated o# /hich the ma,ority o# the allocation /ill go to/ards 'atient care services 8ighth &alaysia 9lan, '$5964$ An im'rovement /as made /ith regards to the '!blic health #acility and coverage in almost all areas$ %m'rovements in 'atient care services can be seen, in /hich the n!mber o# hos'itals has increased #rom 9+ in 1990 to 119 in 2000 38ighth &alaysia 9lan '$58+4$ Along /ith this, the n!mber o# ac!te beds has also increased to 25,280 in 2000 #rom 26,226 in 1990 38ighth &alaysia 9lan, '$58+4$
0he net/or( o# hos'itals and clinics in the co!ntry 'rovide medical and health care to all age gro!'s, incl!ding the elderly$ As 'art o# the caring society conce't, 'arents o# civil servants are given #ree medical services in government hos'itals$ Behabilitative services s!ch as 'hysiothera'y and occ!'ational thera'y are 'rovided to older 'eo'le as a s!''ort service$ .o/ever, this #acility is not available in the r!ral areas$ 0here are no s'ecial hos'ital, #acilities or /ards allocated #or elderly 'eo'le$ 0he only available s'ecial service to the elderly is the s'ecial co!nter created #or the elderly to receive medications$
*inancing #or .ealth <are
7ince cost o# health care is a ma,or concern #or individ!als, #amily and the government, it is im'erative to !nderstand the #inancial reso!rces available #or health care$ 0he signi#icance o# #inancing has been a''ro'riately ac(no/ledged in the 8ighth &alaysia 9lan 32001"200+4 as one o# the strategies #or health sector develo'mentC “develo'ing and instit!ting a healthcare #inancing scheme 3'$5914$ .o/ever, no details abo!t the strategy are available$ 7everal so!rces o# #inancing can be disting!ishedC allocation #rom the government, o!t"o#"'oc(et e-'enses, as a bene#it 'rovided by em'loyers 3'rivate sector4 and health ins!rance$ 1# these modes o# #inancing, those that are signi#icant #or the elderly areC allocation #rom the government, and o!t"o#"'oc(et e-'enses$ *or em'loyees in the '!blic sector, retired government servants can contin!e to en,oy medical bene#its at government clinics and hos'itals$ &edical ins!rance is a rather recent develo'ment in &alaysia and hence it is not a signi#icant so!rce o# #inancing$ &ore over, it a''eals to the !rban 'eo'le /ho have the ability to '!rchase$ Allocation #rom the government has been a #eat!re in the ann!al government b!dget and it is an im'ortant so!rce o# health care 'rovision$ 0able 16 sho/s the #ederal government o'erating e-'endit!re #or the health sector #or 199+ to 2000$ 1ver these years, altho!gh the 'ercentage o# o'erating e-'endit!re #or health to total o'erating e-'endit!re remained ro!ghly the same, allocation o# health e-'endit!re has increased #rom B& 2$5 billion to 5$0 billion$
Ta-l" +A: F"#"%al Go$"%nm"nt O'"%ating EB'"n#itu%" o% 1"alt/( +33= ? )***
Y"a% 199+
O'"%ating P"%c"ntag" o Total O'"%ating P"%c"ntag" o EB'"n#itu%" o% O'"%ating .ealth EB'"n#itu%" O'"%ating Social S"%$ic"! EB'"n#itu%" o% 4RM million6 4RM million6 EB'"n#itu%" 4RM million6 Social S"%$ic"! 2,685 66,+26 6$+ 12,151 19$6
1996 1992 1998 19991 2000
1 2
6,01+ 6,228 6,661 6,626 5,050
56,86+ 55,66+ 55,+8+ 56,699 +8,206
6$9 2$6 2$+ 2$8 6$9
15,825 1+,0+1 1+,062 16,612 12,896
20$6 21$8 22$1 21$8 22$6
estimated act!al latest estimate
2
7o!rceC 8conomic Be'ort 1998L99 Q 2000L01, &inistry o# *inance
A national s!rvey has been cond!cted on ho!sehold health e-'endit!re, ho/ever, it is most !n#ort!nate that data are 'rivy to the s'onsoring body and are not made available to the '!blic$ 0his lac( o# in#ormation #or health e-'endit!re is not !niG!e to &alaysia, as it has also been re'orted in many develo'ing co!ntries 3Ne/brander, <arrin and @e 0o!)a, 19954$ Fenerally, so!rces o# 'ayment #or health in &alaysia come #rom o!t"o#"'oc(et 'ayments /hile the least are #rom ins!rance 'ayments 30able 154$ *or those aged 60 and above, 2+ 'ercent o# the 'ayments /ere o!t"o#"'oc(et 'ayments /hile ins!rance did not constit!te a so!rce o# #inancing at all$ Ta-l" +<: Sou%c"! o Paym"nt o% 1"alt/ Ca%"( +33:
C/a%act"%i!tic! S"l 4out8o 8 PocE"t6 U%-anF%u%al Location Urban B!ral Age Fro!' 0"15 1+"+9 60J 62$2 66$5 62$2 60$6 2+$1
Sou%c"! o 'aym"nt 4@6 7el# J F%"" Em'loy"% In!u%anc" Donation Ot/"%
S"l D
Ot/"%
Sou%c"! Em'loy"% Em'loy"% Com-ination! D In!u%anc"
6$1 +$6 +$2 6$6 5$5
18$2 11$2 2$2 22$2 6$9
0$1 0$1 0$1 0$1 0$0
0$0 0$0 0$0 0$0 0$1
+$6 2$0 10$0 6$6 6$8
+$0 6$6 5$1 5$5 +$6
2$9 1$6 1$2 6$2 0$2
2$6 5$1 6$8 2$8 6$1
7o!rceC National .ealth and &orbidity 7!rvey 319964, Vol$ 6, '$26
.ealth <are 9rogram #or the 8lderly 199+
0he 'rogram, introd!ced in 199+, is aimed at im'roving and maintaining the health and #!nctional o!tcome o# the elderly /ith the !ltimate ob,ective o# 'romoting G!ality o# li#e as /ell as #orging 'rod!ctive ageing among the elderly$ Among the s'eci#ic ob,ectives are 3.alil 19964C D 0o im'rove the health o# the elderly to enable them to lead and en,oy #!ll and active li#e thro!gh 'romotive and 'reventive health careE D 0o establish Feriatric 7'ecialist 7ervices at the regional and state levels by year 2000E D 0o develo' a com'rehensive 'lan o# action on training and research needs in the care o# the elderlyE and D 0o 'rovide G!ality health care #or the elderly !sing comm!nity"based a''roaches to enable them to live as inde'endently as 'ossible /ithin the comm!nity$ Vario!s 'rimary and secondary com'onents o# health care to s!''ort the 'rovision o# care have been identi#ied and strategies #orm!lated to achieve the ob,ectives o# the 9rogram$ 0hey are as #ollo/sC 3i4 9romotive and 'reventive health care " in#ormation dissemination regarding the 'athologies and disabilities related to age$ 7creening 'rograms /ill be cond!cted reg!larly to chec( conditions o# vis!al and hearing im'airment, coronary artery diseases, breast cancer, oral cancer etc$ 9re"retirement co!rses /hich are related to health, #inancial sec!rity, vol!nteerism and !se o# leis!re time are also 'lanned #or 'eo'le, /ho are in demogra'hic transition in their li#e$ 3ii4 &edical and rehabilitative care Q strengthening o# care to the elderly at 'rimary, secondary and tertiary level$ Another strategy is to 'rovide holistic s'eciali)ed medical, 'sychological, social and rehabilitative geriatric services in selected state and district hos'itals !sing a m!ltidisci'linary team a''roach$ *rom the en#orcement 'ers'ective, the 9rivate .os'ital Act, 1921 and 9rivate .os'ital Beg!lations, 1926, /ill be en#orced so as to ens!re G!ality care to the elderly$ 3iii4 0raining and research Q to #orm!late and strengthen the e-isting c!rric!la on care o# the elderly #or basic, 'ost"basic and contin!ing medical ed!cation$ 0raining in s'eciali)ed areas relating to health care o# the elderly according to
'ro,ected man'o/er needs is also 'lanned$ %n addition, a #ocal 'oint #or coordinating research activities in medical and social as'ects o# the elderly /ill be established to ens!re coordinated research to/ards iss!es a##ecting the elderly$ 3iv4 9rogram 'lanning, monitoring, coordination and eval!ation Q As ro!tine data collection does not meet the in#ormation needs, actions sho!ld be directed to correct data ga's$ Action 'lan is in 'lace #or 'ro'er data collection in hos'itals and health centers in order to obtain more acc!rate in#ormation abo!t the elderly 'eo'le$ 7trategies incl!de setting !' a s'ecial Unit on .ealth <are #or the 8lderly in the *amily .ealth ;evelo'ment ;ivision o# the &inistry o# .ealth$ *rom the time this 'rogram /as initiated, some 'rogress has been made$ Among the activities carried o!t areC 3i4 A National 9lan o# Action on <omm!nity &ental .ealth 'rogram /as established in 1992 and some 'ilot 'ro,ects have been carried o!t in several health clinics in :ohor, &alacca, Negeri 7embilan, Aedah and 7abah$ 0raining /as cond!cted to !'grade the (no/ledge and s(ills o# health 'ersonnel$ 0he National &ental .ealth 9olicy /as a''roved in 1998 and +8 health clinics have been identi#ied to im'lement the 'rogram$ 7ome o# the activities carried o!t areC tal(s, #or!ms and e-hibitions on mental health, #ollo/"!' #or stable mental cases, early detection o# mental disorders, gro!' thera'y, home visits, co!nseling, rehabilitation, screening, setting !' o# day care center at health clinics and training #or health 'ersonnel, develo' and distrib!te ed!cation materials on as'ects o# mental health$ 3ii4 .ealthy li#estyle cam'aign aimed at 'reventing and controlling chronic diseases s!ch as diabetes mellit!s and cardiovasc!lar disease$ 3iii4 7etting !' o# s'ecial health clinics #or the diabetic and 'atients /ith hy'ertension /ithin the health clinics in r!ral areas$ 3iv4 Behabilitative 'rograms Q rehabilitative services s!ch as 'hysiothera'y and occ!'ational thera'y are 'rovided to older 'eo'le as a s!''ortive service to the medical care or in"'atient care in hos'itals$ .o/ever, these services are not available in the r!ral areas$ 3v4 .ealth center or comm!nity"based activities are cond!cted$ 0hey incl!deC home visits, health screening #or high ris( gro!'s, re#erral to geriatricians, co!nseling on e-ercise, n!trition, diabetics and social s!''ort needs, home mobility and rehabilitative #acilities, s'ecial care management s!ch as
incontinence, day care n!rsing, and comm!nity ed!cation on iss!es associated /ith health o# the elderly$ 3vi4 .os'ital"based activitiesC ac!te medical care, long"term care, 'sycho"geriatric care, thera'y, 'atient ed!cation, etc$ are initiated$ 3vii4 9lans #or 1992 to year 2000 incl!de t/o main servicesC hos'ital services and health centers or comm!nity health services, /hich are mainly delivered by the ;e'artment o# 7ocial Wel#are, NF1s, 'rivate and vol!ntary organi)ations$
%t is obvio!s that m!ch needs to be done #or the elderly in terms o# health care and the 'rograms initiated by the government are slo/ing evolving to/ard meeting the needs o# an emerging large gro!' o# v!lnerable 'eo'le Q the elderly$ <!rrently, health services #or the elderly are 'rovided as 'art o# the health care services in a non"s'eciali)ed and non" str!ct!red manner 3Nor Aini 19924, altho!gh indications 'oint to the more s'eci#ic care #or the elderly in the #!t!re$ <are #or the elderly comes !nder the *amily .ealth ;ivision, /hich is set !' to 'rovide health care to the /hole #amily o# all age gro!'s$ %t is im'ortant to dra/ attention to the !neven availability o# health care #or the elderly in the !rban areas as com'ared to the r!ral areas /here e-'ertise and #acilities are lac(ing$ .ealth and health"related services that are made available to the elderly in the !rban areas thro!gh 'rivate organi)ations are not available to the r!ral elderly 3/here '!rchasing 'o/er is lo/4$ .ence, in the r!ral areas, elderly 'eo'le are seen as o!t"'atients in health centers, /ith re#errals made to hos'itals #or cases /ith more serio!s health 'roblems$ While the geogra'hical divide in health care #or the elderly has to be eliminated, the income di##erential bet/een the /ealthy and the 'oor remains another obstacle in achieving accessibility #or all$ 8-actly ho/ the availability o# G!ality health care can be made accessible to all elderly remains a great challenge$
=, SOCIAL SERGICES AND COMMUNITY CARE
%n caring #or elderly 'eo'le, both the #amily and the comm!nity have long been 'erceived to be o# 'rimary im'ortance 3<ho/ 19924$ %n the case o# develo'ing co!ntries s!ch as &alaysia /here com'eting needs are varied and sometimes more !rgent than the lesser 'riority iss!e o# the elderly, #amily and comm!nity care seem to be the most viable alternative than the /el#are state a''roach$ %n addition the dee'ly rooted Asian c!lt!re that stresses the im'ortance o# #ilial 'iety dictates that care by #amily becomes an a!tomatic old age sec!rity$ .o/ever, the erosion o# the e-tended #amily system, decrease n!mber o# available #emale
members o# the #amily d!e to the increase in #emale labor #orce 'artici'ation, and the smaller #amily si)e have created greater 'ress!re on #amily as care givers$ 0his develo'ment has some/hat served as a catalyst #or the develo'ment o# instit!tional care$ As instit!tional care is only accessible to those /ho can a##ord 3in the case o# 'rivate n!rsing homes4, mostly available only in the !rban areas, and the arg!ment #or the elderly to remain /ith the comm!nity herald the emergence o# comm!nity care #or the elderly in the #ast ind!striali)ing society o# &alaysia$ Admission to '!blic old 'ersons= homes !nder the &inistry o# 7ocial Wel#are is the last resort and it is 'rovided to elderly /ho have no heirs and no o/n shelter, or to those /ho are destit!te$ ?et/een those /ho have the means to '!rchase services and those /ho have limited #inancial reso!rces, there e-ists a need ga' by those /ho cannot be classi#ied into either o# these t/o e-tremes$ 0his 'art o# the re'ort disc!sses '!blic sector involvement in 'roviding social services to the elderly$ Bole and activities o# NF1s and #amily /ill be covered in 9art %% o# the Be'ort, !nder long"term care$
Social <el"are Ser$ices
Under the 7ocial Wel#are ;e'artment, services to the elderly are divided into t/o broad ty'esE e-ternal services and instit!tional services, aimed at 'roviding services to the 'oor elderly$ 0he ty'es o# aid given can be classi#ied as #inancial aidE materials aid incl!ding items s!ch as cane and s'ectacles$ %nstit!tional care re#ers to shelter care in old 'eo'le=s home 3-umah Seri =enangan4$ %nstit!tional services are 'rovided #or n!rsing and shelter to those /ho are 'oor and /ho do not have (in to 'rovide care$ 0here are eleven 3t/o in 8ast &alaysia4 old 'eo'le=s homes in the co!ntry administered by the #ederal government$ 0hese homes o##er the #ollo/ing servicesC n!rsing and shelter, co!nseling and g!idance, occ!'ational rehabilitation, devotion #acilities, recreational activities, and medical treatment$ *or the age gro!' o# 60 and above, the n!mber o# occ!'ants has increased #rom 865 to 1,052, re'resenting an increase o# 21$2 'ercent #or the 'eriod o# 199+ Q 1999 30able 1+4$
Ta-l" +=: Num-"% o 3umah 5eri 6enan an Occu'ant! -y Ag"( +33= ? +333
Age Fro!' 18 Q 60 60 Q 50
+33= 68 152
+33: 26 91
+33; 16 86
+33> 18 90
+333 19 68
50 Q +0 +0 Q 60 :* ? ;* ;* ? >* a-o$" >* 0otal
222 569 <>: ):* ++> 1,82+
262 522 =A+ )3< +A* 1,226
256 699 =)< A:> +); 1,266
2+1 688 =)= A:3 +)A 1,265
2+8 680 =A: <** +++ 1,222
NoteC 0he B!mah 7eri Aenangan also ho!ses other gro!'s o# inmates s!ch as the ,!venile, ab!sed cases o# /omen and girls, etc$ 7o!rceC 0he Wel#are 7tatistics ?!lletin 3199+ Q 19994, 8-ternal 7ervices, ;e'artment o# 7ocial Wel#are
%n the r!ral areas, h!ts or >pon!o)? assistance is given to elderly 'eo'le #or b!ilding ne/ h!ts or re'air old ones so that the elderly can contin!e to stay /ithin the comm!nity instead o# having to be admitted to old 'eo'le=s home$ 0here are abo!t 60 h!ts, ho!sing abo!t 600 residents, !nder the &alaysian Wel#are <entres <o!ncil$ Fovernment allocates #inancial aid to more than 2 million elderly 'eo'le, #rom 199+ to 1999 30able 164$ A total o# B&11 million /as allocated to the elderly in 1999$ ?esides 'roviding #inancial aid to the elderly, the elderly also receives aid in terms o# s'ectacles$ .o/ever, over the 'eriod 199+ to 1999, the n!mber o# aid reci'ients has declined #rom 2+8 to 2++ 366 'ercent4$ Ta-l" +:: EB'"n#itu%" an# Num-"% o Financial Ai# R"ci'i"nt! o% t/" El#"%ly un#"% Go$"%nm"nt Allocation( +33= ? +333
Y"a%
Num-"% o El#"%ly Ai# R"ci'i"nt!
EB'"n#itu%" 4RM6 8,692,660 8,558,160 2,898,625 2,159,000 11,050,555
Num-"% o El#"%ly Ai# R"ci'i"nt! o% S'"ctacl"! 2+8 269 +91 506 2++
EB'"n#itu%" 4RM6 12,605 +2,11+ 62,609 25,09+ 20,922
199+ 1996 1992 1998 1999
10,059 10,529 11,296 11,156 16,906
7o!rceC 0he Wel#are 7tatistics ?!lletin 3199+ Q 19994
8-ternal 7ervices, ;e'artment o# 7ocial Wel#are
Beg!lations on <are #or the 8lderly
0he <are <enter Act 1996 sets o!t g!idelines and minim!m standards 3#or e-am'le, s'ace and n!mber o# sta## reG!ired #or a certain n!mber o# 'atients4 #or elder care centers in the co!ntry that 'rovide basic care, /itho!t medical services$ 0hose that 'rovide medical treatment and #acilities, li(e geriatric hos'itals, are governed by the more stringent reg!lations o# the 9rivate .os'ital Act 1921$ Altho!gh small n!rsing homes do 'rovide some #orm o# medical services, they 're#er to register /ith the 7ocial Wel#are ;e'artment as a care center beca!se the reG!irements are easier to meet$ 0he 9rivate .ealthcare *acilities and 7ervices Act 1998 /as 'assed by the 9arliament b!t has yet to be en#orced$ 0his Act contains g!idelines and reg!lation s'eci#ically #or n!rsing homes, /hich /ill '!t in 'lace reg!lations that are essential to 'rotect the /el#are o# the elderly$ 0his /ill event!ally bring more consistency in the G!ality o# service$
.o!sing 9ro,ects #or the 8lderly
0he idea o# com#ortable retirement homes or retirement comm!nities li(e those #o!nd in the West is at its embryonic stage in &alaysia$ %n the mid"1990s, a ho!sing develo'er 'lanned to mar(et its a'artment as a high"end retirement condomini!m #or the elderly, com'lete /ith a''ro'riate #acilities$ .o/ever, the mar(et /as not ready to acce't the conce't$ Another attractive model is that o# grad!ated retirement comm!nity, or assisted care villages$ Besidents can choose to move into an a'artment or a little villa o# their o/n, /here they can live inde'endently b!t /ith easy access to the amenities in the “village $ As their needs increase /ith age, they can begin to 'ay #or more and more services, s!ch as cleaning, meals and n!rsing$ 0his is totally ne/ to &alaysia and the mar(et has yet to be tested$ A revie/ o# the 'olicies o# the &inistry o# .o!sing and @ocal Fovernment reveals that there is c!rrently no s'eci#ic 'rovision to meet the ho!sing needs o# the elderly 3<heah, 199+4$ 0he recent emergence o# n!rsing homes had ca!sed 'roblems and con#!sion #rom the @ocal A!thorities$ 0he @ocal A!thority loo(ed !'on setting !' s!ch homes #or the care o# the
elderly as “b!siness and there#ore had to be carried o!t in designated commercial 'ro'erties$ With the rela-ation o# the r!le in the early 1990s, residential 'ro'erties are 'ermitted to o'erate as homes #or the elderly$ .o/ever, the validity o# their licenses is on a year"to"year basis /ith the condition that the neighbors do not com'lain$ 0he !ncertainty associated /ith licensing a##ects the G!ality o# home and care #or the elderly in that o'erators o# these homes are not /illing to commit investment on !'grading #acilities, ,!st in case that the licenses are revo(ed$
2ommunity 2are 0he role o# comm!nity care and NF1s /ill not be covered in detail in this re'ort$ 1ver the years, comm!nity care has e-'anded both in sco'e and scale$ <omm!nity care is im'ortant, as the ob,ective o# the government is to allo/ the elderly to live as normal a li#e as 'ossible in their o/n homes or in a homely environment in the local comm!nity$ 0he conce't o# the “h!ts or pon!o) /or(s /ell in the r!ral areas since a /indo/ o# o''ort!nity is o'ened to the elderly #or integration into society, th!s overcoming the 'roblem o# de'ression or loneliness that are so common among the elderly$ At this moment, the #amily remains the main caregiver$ %n order to ens!re contin!o!s #amily s!''ort and to enable the #amily to discharge their tas(s more e##ectively, the role o# comm!nity services can hel' to strengthen #amily care$ *riends and neighbors can be im'ortant too in the case o# comm!nity care, altho!gh services as in the case o# long"term care sho!ld not be e-'ected$
:, IMPLICATIONS OF AGEING AND FUTURE DIRECTION
8conomic develo'ment, higher ed!cational attainment, advancement in the medical #ield, accessibility to medical care and (no/ledge abo!t n!trition have s!ccess#!lly '!t more years into li#e, /hile the 'resent and the #!t!re challenges /ill be '!tting G!ality into the e-tra years$ %n tandem /ith all these changes, the e-'ectations o# the 'eo'le /ill also be changing$ 0he #!t!re cohort o# the elderly /ill e-hibit di##erent e-'ectations and needs$ 0hey /ill be more discerning in terms o# their demand #or goods and services$ *or &alaysia, co'ing /ith 'o'!lation ageing can be a great challenge, as there are many com'eting iss!es that a''ear to deserve more !rgent attention than the iss!e o# im'roving the /ell"being o# the elderly$ 0he recently released 8ight &alaysia 9lan, 2001"200+, has no mention abo!t the elderly$ 0his indicates that ageing has yet to become a 'riority area$ Altho!gh &alaysia still has time on its
side, the 'henomenon o# ageing m!st be vie/ed in the right 'ers'ectives that it deserves d!e to the many m!lti'le and com'le- im'lications$ Ageing is both a health and a social"economic iss!e$ 0he im'ortance o# this interrelationshi' #or the elderly is most #!ndamental to the /ell"being o# the elderly$ 0o lead an inde'endent li#e and be able to 'artici'ate in 'rod!ctive ageing, the elderly need some basic s(ills #or day to day living that incl!de the ability to !nderta(e social activities, and 'er#orm domestic and 'ersonal tas(s 3Aro(iasamy 19924$ 0here#ore, the #oc!s o# 'olicies and 'rograms #or the elderly sho!ld ta(e into consideration the relationshi' o# health and socio" economic state$ %m'lications o# Ageing Social Security %n &alaysia, the social sec!rity covers only em'loyees in the #ormal sector$ 9ension scheme 'rovides coverage to civil servants /hile the 89* gives 'rotection to 'rivate sector em'loyees$ 0he 'ercentage o# total em'loyed 'ersons covered by these t/o schemes is 61$8 'er cent leaving the remaining 68$2 'er cent /itho!t (no/n so!rce o# coverage 3@abor *orce 7!rvey Be'ort, 19984$ Altho!gh the government has initiated vol!ntary contrib!tion in 1922 to enco!rage those in the in#ormal sector to contrib!te to 89*, the 'ercentage o# sel#"em'loyed that o'ted #or this vol!ntary contrib!tion /as negligible$ 1# the 2$29 million o# sel#"em'loyed, only 26,602 have registered /ith 89* in 1998 3A!mar 19994$ As this /or(s on a vol!ntary contrib!tion basis, the ta(e"!' rate largely de'ends on #irstly, the a/areness abo!t the im'ortance o# saving #or old age, the #inancial reG!irements o# individ!als, alternative !se o# #inancial reso!rces, as /ell as the availability o# other income so!rces$ 0/o ma,or obstacles that need to be overcome /hen introd!cing social sec!rity in the in#ormal sector areC e-'anding coverage to ma,ority in the in#ormal sector, in 'artic!lar those /hose income are seasonal 3#armers and #ishermen4, and monitoring com'liance among these contrib!tors$ %ncome per se is only 'art o# the eG!ation in 'rotection$ 0he other im'ortant iss!e is adeG!acy$ *or 89*, the re'lacement rate o# slightly more than +0> is considered adeG!ate$ Altho!gh the re'lacement rate o# slightly more than +0> #or 89* is considered adeG!ate, the G!estion remains as to ho/ the l!m' s!m /ithdra/al can be best investedLsaved till the end o# li#e$ .ere, the government has introd!ced the ann!ity scheme #or 89* members, b!t the s!ccess or the lac( o# it can only be assessed in the #!t!re$
Health an! Health ,inancing
%n &alaysia, A National .ealth #or the 8lderly <o!ncil /as established !nder the &inistry o# .ealth in 1992, /hich acts as the main body #or monitoring 'olicies 'ertaining to health o# the elderly$ 0he *amily .ealth ;evelo'ment ;ivision in the 9!blic .ealth ;e'artment o# the &inistry o# .ealth serves as the secretariat o# the <o!ncil$ %n the 9lan o# Action #or .ealth o# the 8lderly as enshrined in the National 9olicy #or the 8lderly, health #acilities #or the o'tim!m care areC D 7trengthening coordination and collaboration bet/een government and non" government agencies incl!ding 'rivate sectors in 'roviding health servicesE D D D D 9lanning and 'roviding 'romotive, c!rative and rehabilitative servicesE 9roviding a''ro'riate 'hysical, man'o/er and #inancial #acilities #or the 'rogramE 8nco!rage comm!nity involvement in the care and rehabilitation o# the elderlyE and 8nco!rage training and research$
Altho!gh there e-ists a 'lan o# action on health care #or the elderly, the delivery o# care remains integrated in the broader system o# 'rovision o# health thro!gh 'rimary care, secondary and tertiary services$ 0here is no s'ecial hos'ital #or the elderly altho!gh there e-ists 'ositive develo'ment to/ard the 'rovision o# s'eci#ic health care, as in geriatric care, #or the elderly, both by the '!blic and 'rivate sector$ Feriatric care 'rovided by the '!blic sector is at the nascent stage in /hich it is available in the 7eremban .os'ital, /ith another in the develo'ment 'rocess$ 0he 'lan is to introd!ce geriatric care in all district hos'itals by year 2020$ .ealth #inancing remains a great challenge /ith rising needs and costs relating to health care$ 1!t"o#"'oc(et is the main mode o# #inancing$ 0he 8ighth &alaysia 9lan 32001" 200+4 has '!t in 'lace a strategy #or a health care #inancing scheme, b!t details are as yet to be made available$
<oncl!sion and *!t!re ;irection
0he National 9olicy #or the 8lderly 199+ and the National 8lderly .ealth <o!ncil established in 1992 re'resent milestones in &alaysia in 'roviding care and services to the elderly$ 0he t/o ministries that are res'onsible #or services to the elderly are the &inistry o# National Unity and 7ocial ;evelo'ment thro!gh the ;e'artment o# Wel#are 7ervices, and the &inistry o# .ealth$ 0he National 9olicy 'rovides the broad #rame/or( #or the develo'ment o#
care and services to the elderly$ 8G!ally im'ortant is the delivery mechanism that m!st ta(e into acco!nt geogra'hical se'aration, and the varying needs o# di##ering gro!'s s!ch as /omen /ho are 'artic!larly v!lnerable and the old"old /ho have more needs com'ared to the yo!ng old /ho are li(ely to be more inde'endent$ Notable 'rogress has been made over the years as is evident in the develo'ment o# care #or the elderly$ &alaysia /as classi#ied together /ith the Be'!blic o# Aorea and F!am, as co!ntries that have more recent initiatives in the develo'ment o# health services 3W.1, 19984$ %t is ho'ed that &alaysia /ill soon advance into a co!ntry that has an established system o# care #or the elderly, not only in terms o# health, b!t also in other areas that a##ect the overall G!ality o# li#e o# the elderly$ %n attem'ting to 'redict the #!t!re direction #or the elderly in &alaysia, it is essential to begin /ith the so!rces or determinants and im'rovements to the G!ality o# li#e #or the elderly$ While searching #or innovative /ays to 'rovide care #or the elderly, the 'otential o# elderly 'eo'le in develo'ment sho!ld not be ignored$ 0he conce't o# 'rod!ctive ageing, /ith health 'romotion and maintenance as the most #!ndamental #actor, sho!ld be em'hasi)ed$ .ealthy ageing enables the 'artici'ation o# the elderly in the develo'ment o# the nation and as a reso!rce to #amily and comm!nity$ 7!ggestions #or im'rovements in areas that co!ld bring abo!t greater /ell"being o# the elderly are as #ollo/sC D <ens!s"ty'e in#ormation /ill have to be gathered to #acilitate the #orm!lation and im'lementation o# 'olicies and 'rograms$ %t is ho'ed that the research s!b"committee o# the Action 9lan #or the National 9olicy on the 8lderly /ill be able to #ill the data ga's$ D <ontin!o!s monitoring o# activities as g!ided by the National 9olicy #or the 8lderly 2 A monitoring system is essential in ens!ring G!ality o# service to the elderly and #or contin!o!s im'rovements in services and care$ D Fovernment intervention at the macro level " 9otential loss o# 'rod!ctivity and higher social costs are associated /ith ageing, b!t many 'oints o# intervention can mitigate these costs 3:oaG!in"Kasay 19964$ 0hese incl!de ad,!stments on the age o# retirement, training and e##ective em'loyment o# older /omen, better ed!cation and training #or yo!ng 'eo'le, and a''ro'riate 'olicies #or reg!lating migration and tem'orary #oreign labor$ 7ome o# these interventions are already in e-istence in &alaysia$ ?etter ed!cation and training #or yo!ng 'eo'le and the a''roach to #oreign labor 'oint to some o# the interventions that have been carried o!t$ 0he government has recently anno!nced the ne/ retirement age, /hich is no/ at +6 years instead o#
the ++ years 'revio!sly$ 0he challenges remain #or the elderly /omen, /ho are less ed!cated, less #inancially inde'endent and are e-'osed to greater health ris($ %nterim meas!res can be ta(en to 'rovide 'rotection to this v!lnerable gro!', as the #!t!re cohort o# elderly /omen can be very di##erent$ 0hey are better ed!cated and en,oy better em'loyment o''ort!nities com'ared to their 'redecessors$ D 7ocial sec!rity Q 0a(ing into acco!nt the economic str!ct!re and the develo'ment in &alaysia, a single a''roach, /hether de#ined bene#its or de#ined contrib!tion, to social sec!rity /ill not be #easible as it /ill not 'rovide coverage to all sectors o# the 'o'!lation$ A combination o# a''roaches is highly essential as it can enhance stability$ 0he in#ormal sector remains a great challenge$ D Access to com'rehensive health care Q these services sho!ld be aimed at minimi)ing the e##ects o# diseases and sho!ld 'romote the achievement o# 'ersonal health 'otential$ .ealth 'romotion and 'reventive care sho!ld be em'hasi)ed$ %n addition, the !neven accessibility o# health care services in the !rban and r!ral areas needs !rgent attention$ D 0raining o# man'o/er in the health sector " it is 'artic!larly im'ortant i# better care is to reach a larger n!mber o# elderly$ 0here are vario!s ty'es o# training 'rogramsC 'ost"basic geriatric n!rsing, in"service training #or 'rimary health care sta##, and in" service training #or carers, /ho are medical assistants and n!rses$ %t is im'ortant to introd!ce geriatric medicine and other gerontology disci'lines in the training o# medical 'ersonnel$ %t is envisaged that training to carers sho!ld incl!de 'artici'ants #rom other agencies and NF1s$ D .ealth <are *inancing Q the cost o# health care can be a ma,or barrier to accessibility o# care$ As s!ch, ens!ring an adeG!ate system o# health #inancing is a ma,or decision$ A national a''roach to develo'ment o# 'olicies #or health #inancing, health ins!rance and medical, 'harmace!tical and health care service 'ayment is essential 3W.1 19984$ 0he strategy o# introd!cing a health care #inancing scheme seems to 'oint to/ard the right direction #or &alaysia 38ighth &alaysia 9lan, 20014$ Whatever a''roach or a''roaches that the national 'olicy is modeled, the basic 'rinci'le sho!ld be that no one is denied basic health care$ D 8d!cation and retraining #or the elderly Q develo'ing 'rograms to retrain the elderly can hel' to reali)e the 'rinci'les o# inde'endence, 'artici'ation and sel#"#!l#illment, /hich are in consonance /ith the Vienna=s World Assembly on Ageing, 1982$ 8d!cation to 're'are the elderly to #ace the challenges o# ageing can be introd!ced as a 're"retirement co!rse$ Betraining sho!ld be introd!ced to 'romote 'rod!ctive ageing$
D
%nnovative em'loyment o''ort!nities #or the elderly " in order to 'romote 'rod!ctivity among the elderly, it is 'robably bene#icial to society and the elderly themselves i# innovative /ays o# em'loyment can be initiated$ Altho!gh 'rotecting em'loyment and /el#are o# the old is im'ortant, generating /or( o''ort!nities #or the yo!ng is eG!ally, i# not more im'ortant$ 0h!s, a #le-ible /age str!ct!re may be considered to allo/ the old to contin!e /or(ing, a#ter the mandatory retirement age$ Alternatively, the old can be rede'loyed in other areas o# /or( that reG!ire less 'hysical strength and less mentally demanding, s!ch as, as care givers$ A 'ilot may be necessary$ 9erha's the yo!ng"old can begin to o##er their services to the old"old, or even to yo!ng children, /hether /ith re/ard or other/ise, so that they can “#ree /or(ing age ad!lts to concentrate on their ,obs$ %n this /ay, altho!gh their contrib!tion is indirect, it hel's to instill sense o# /orth and #!l#illment among the elderly$ .o/ever, the G!estion o# mobili)ing them remains$
D
.o!sing and to/n 'lanning Q in antici'ating the gro/th o# an ageing 'o'!lation, 'lanning #or to/nshi' sho!ld ta(e into acco!nt the #acilities #or the elderly$ %n line /ith the advocacy #or the elderly to remain in the comm!nity, in#rastr!ct!re #or the mobility o# the elderly is im'ortant and sho!ld be incor'orated into to/n 'lanning$
D
Avoid d!'lication o# services Q 1'timi)ing the !tili)ation o# scarce reso!rces is cr!cial, /hile leaving ga's o# needs !n#!l#illed can be a barrier to better G!ality o# li#e #or the elderly$ %n order to avoid d!'lication and “!nder"delivery o# services, 'erha's a ne/ ministry is necessary in order to #orm!late 'olicies that /ill o'timi)e the 'rovision o# care and 'rotection to the elderly instead o# s!b"o'timi)ing di##erent #!nctions and activities$
%n concl!sion, a com'rehensive 'olicy #or 'romoting the /ell"being o# the elderly, that ta(es into consideration health, social sec!rity, ho!sing, environment that incl!des the #amily and comm!nity, sho!ld be in 'lace$ &alaysia is #ort!nate in a /ay as it has time to 're'are itsel# #or the challenges o# ageing 'o'!lation$
R" "%"nc"!
Andre/s, F$B$, 8sterman, A$:$, ?ra!nac("&ayer, A$:$ and B!ngie, <$&$ Aging in the <estern +aci"ic, &anilaC World .ealth 1rgani)ation, Begional 1##ice #or the Western 9aci#ic$
Andre/s, F$B$ 319924 “Besearch ;irections in the BegionC 9ast, 9resent and *!t!re in ;$B$ 9hilli's 3eds4 Ageing in East an! South East Asia5 -esearch Stu!ies in Gerontology5 @ondonC .odder and 7to!ghton$
Aro(iasamy$ :$0$ 319924 “Ageing in &alaysia and %ts 9roblems in Ageing +eople in *ransition5 9a'er 'resented in %nternational 7ym'osi!m on a <om'arative 7t!dy o# 0hree <ases in AsiaC Aorea, 0ai/an and :a'an, Advanced Besearch <entre #or .!man 7ciences, Waseda University 1992$
Aro(iasamy$ :$0$ 319924 “7ocial 9roblems and <are o# the 8lderly , Me!ical @ournal Malaysia, Vol +2, No 6, 7e't 1992$
Aro(iasamy, :$0$ and 0eoh, :$7$0$ 319924 Stu!ies Concerning the El!erly in Malaysia: An ine&hausti$e5 <om'ilation o# 9!blished 7t!dies on the <are o# the 8lderly in &alaysia !' to ;ecember 1992$ 0he <learing .o!se 9ro,ect, ;e'artment o# 7ocial and 9reventive &edicine, University o# &alaya &edical <entre, A!ala @!m'!r$
A/ang, .$7$ 319924 “<!rrent 9rogramme %m'lementation and 8val!ation in 9roceedings o# the National 7eminar on <hallenges o# 7enior <iti)ens 0o/ards Vision 2020, 1 1ctober 1992, A!ala @!m'!r$
?engston, V$, Bosenthal, <$ and ?!rton, @$ 319904 “*amilies and AgeingC ;iversity and .eterogeneity in B$ ?instoc( and @$ Feorge 3eds4 Han!boo) o" Aging an! the Social Sciences, @ondonC Academic 9ress, ''$ 266"82$
?o/ling, A$ 319914 Measuring Health: A -e$ie( o" Auality o" 9i"e Measurement Scales , ?!c(inghamC 1'en University 9ress$
?!tler, B$N$ and Fleason, .$9$ 3198+4 +ro!ucti$e Aging, Ne/ Kor(C 7'ringer 9!blishing <om'any$
<han, A$8$ 319964 “;emogra'hic and 7ocio"economic @in(ages in &alaysiaC 0he <ase o# ;emogra'hic Ageing in *irst 7ym'osi!m on Ferontology 199+C %ss!es and <hallenges o# Ageing &!ltidisci'linary 9ers'ectivesC 9roceedings 3199+4, Ferontology Association o# &alaysia, A!ala @!m'!r$
<heah, &$ 3199+4 “.ealth <are #or the Aged Q <ritical %ss!es and Ne/ 1''ort!nities in Betirement and N!rsing .omes $ 9a'er 'resented at the National <on#erence on the 9rivate .ealthcare %nd!stryC 7ha'ing the *!t!re o# &alaysian .ealthcare 0o/ards the 21st <ent!ry, &arch 199+, 9etaling :aya$
<hen, <$K$9$, Andre/s, F$B$, :ose#, B$, <han, A$8$ and Aro(iasamy, :$0$ 319864 Health an! Ageing in Malaysia, A 7t!dy 7'onsored by the World .ealth 1rgani)ation$ *ac!lty o# &edicine, University o# &alaya$ A!ala @!m'!r$
<hen, A$:$ and :ones, F$ 319894 Ageing in ASEAB 'ts Socio-Economic ConseCuences , %nstit!te o# 7o!theast Asian 7t!dies, %nter"<o!ntry Be'ort o# the A78AN Ageing Be'ort, 7inga'ore$
<hia, K$<$ 319964 “9rimary <are in the 8lderly in *irst 7ym'osi!m on Ferontology 199+C %ss!es and <hallenges o# Ageing &!ltidisci'linary 9ers'ectivesC 9roceedings 3199+4, Ferontology Association o# &alaysia, A!ala @!m'!r$
<ho/, N$ 319924 “ .ong AongC <omm!nity <are #or 8lderly 9eo'le in ;$B$ 9hilli's 3eds4 Ageing in East an! South East Asia5 -esearch Stu!ies in Gerontology5 @ondonC .odder and 7to!ghton$
<lar(, B$@$ and 7'engler, :$:$ 319804 *he Economics o" 'n!i$i!ual an! +opulation Aging , <ambridgeC <ambridge University 9ress$
<legg, :$ 319214 Dictionary o" Social Ser$ices, @ondonC ?ed#ord 7G!are 9ress$
;e'artment o# 7ocial Wel#are 3199+ Q 19994 Annual Statistical #ulletin, 199+E 1996E 1992E 1998E 1999$ 8-ternal 7ervices ;ivision, National 9rinting ;e'artment, A!ala @!m'!r$
;e'artment o# 7ocial Wel#are, Vario!s broch!res$
;e'artment o# 7tatistics 319984 Senior Citizens an! +opulation Ageing in Malaysia , 9o'!lation <ens!s &onogra'h 7eries, No$5, National 9rinting ;e'artment, A!ala @!m'!r$
0he 8dge 31999 Q 20004 +ersonal Money, Vario!s %ss!es$
0he 8dge 320014 “Folden 1ldies in Sur$ey an! Gui!e5 *ebr!ary 19, 2001$
0he 8dge 320014 “7elling to the 7ilver"haired , in Sur$ey an! Gui!e5 *ebr!ary 19, 2001$
31999 EmployeesD +ro$i!ent ,un! :.///; Annual -eport7
8m'loyees= 9rovident *!nd Website 3htt'CLL///$(/s'$gov$my4$
Fovernment o# &alaysia 319924 Bational Health an! Morbi!ity Sur$ey '' .//8 , &inistry o# .ealth, National 9rinting ;e'artment, A!ala @!m'!r$
Fovernment o# &alaysia 31998 Q 19994 9abour ,orce Sur$ey -eport, ;e'artment o# 7tatistics, National 9rinting ;e'artment, A!ala @!m'!r$
Fovernment o# &alaysia 319994, Bational Senior Citizens +olicy Action +lan ./// , ;e'artment o# 7ocial Wel#are, &inistry o# National Unity and 7ocial ;evelo'ment, National 9rinting ;e'artment, A!ala @!m'!r$
Fovernment o# &alaysia 319964 Se$enth Malaysia +lan .//8 2 3444, National 9rinting ;e'artment, A!ala @!m'!r$
.ashimoto, A$ 319924 “Ageing in :a'an in ;$B$ 9hilli's 3eds4 Ageing in East an! South East Asia5 -esearch Stu!ies in Gerontology5 @ondonC .odder and 7to!ghton$
319994 Human De$elopment -eport, United Nations ;evelo'ment 9rogramme 3UN;94, Ne/ Kor(C 1-#ord University 9ress$
%nternational *ederation o# Ageing 319994 %*A &ontreal ;eclarationC 5 th Flobal <on#erence 3htt'CLL///$i#a"#iv$orgLmen!1$htm4$
%nternational @abo!r 1rgani)ation 319924 8arly and 9artial Betirement in 8!ro'e and the United 7tates$ ?rie#ing Noted #or the 7enate 7'ecial <ommittee on Ageing :!ly 2+ 1992 Washington ;$<$
Aarim, .$A$ 319924 “0he 8lderly in &alaysiaC ;emogra'hic 0rends , Me!ical @ournal o" Malaysia5 Vol +2, No 6, 7e't 1992, ''$206"212$
Aing, 7$ 319964 “Bole and *!nctions o# Non"Fovernmental 1rgani)ationsC 9rovision o# <omm!nity"?ased 7ervices #or the 8lderlyE 8nhancing National <a'acity in 'mplications o" AsiaDs +opulation ,uture "or l!er +eople in the ,amily $ Be'ort and selected bac(gro!nd 'a'ers #rom the 8-'ert Fro!' &eeting on the %m'lications o# Asia=s 9o'!lation *!t!re #or *amily and the 8lderly, 2+ Q 28 November 1996, Ne/ Kor(C United Nations 9!blications$
:alal, .$ 319964 “*!t!re 7trategies in .ealth <are #or the 8lderly in &alaysia in *irst 7ym'osi!m on Ferontology 199+C %ss!es and <hallenges o# Ageing &!ltidisci'linary 9ers'ectivesC 9roceedings 3199+4, Ferontology Association o# &alaysia, A!ala @!m'!r$
:ohnson, 9$ and *al(ingham, :$ 319924 Ageing an! Economic <el"are, @ondonC 7age 9!blications$
:oaG!in"Kasay, <$ 319964 “<reating A/areness o# the %ss!es and 9roblems o# the 8lderly Among 9lanners and 9olicy &a(ers in 'mplications o" AsiaDs +opulation ,uture "or l!er +eople in the ,amily $ Be'ort and selected bac(gro!nd 'a'ers #rom the 8-'ert Fro!' &eeting on the %m'lications o# Asia=s 9o'!lation *!t!re #or *amily and the 8lderly, 2+ Q 28 November 1996, Ne/ Kor(C United Nations 9!blications$
Aart, F$7$ 319924 *he -ealities o" Aging: An 'ntro!uction to Gerontology , +th ed$ NeedhamC Allyn and ?acon$
A!mar, B$V$ 319924 “0he Bole o# 8m'loyees 9rovident *!nd 389*4 in *inancing 1ld Age in &alaysia in 9roceedings 1996 <elebrationsC National ;ay #or the 8lderly, 12 Q 22 1ctober 1996, A!ala @!m'!r$
A!mar, B$V$ 319994 “1ld Age *inancial 7ec!rity #or the 7el#"8m'loyed $ 9a'er 'resented at the seminar “*inancial 7ec!rity in 1ld Age , 9 R 10 1ctober 1999, 9etaling :aya$
Avale, :$N$ 319964 “.ealth <are as an 8-'ression o# <!lt!re in *irst 7ym'osi!m on Ferontology 199+C %ss!es and <hallenges o# Ageing &!ltidisci'linary 9ers'ectivesC 9roceedings 3199+4, Ferontology Association o# &alaysia, A!ala @!m'!r$
&a,lis 9!sat Aeba,i(an 7emenan,!ng &alaysia 3&9A7&4 Vario!s Becords$
&ehta, A$ 319924 “7ocial 7ec!rity and 8conomic Well"being o# 1lder 9ersons in A78ANC 0he 7inga'ore 7cenario in 9roceedings 1996 <elebrationsC National ;ay #or the 8lderly, 12 Q 22 1ctober 1996, A!ala @!m'!r$
&inistry o# *inance 3199+4 Economic -eport .//E1/8, A!ala @!m'!rC National 9rinting ;e'artment$
&inistry o# *inance 319964 Economic -eport .//81/F, A!ala @!m'!rC National 9rinting ;e'artment$
&inistry o# *inance 319924 Economic -eport .//F1/0, A!ala @!m'!rC National 9rinting ;e'artment$
&inistry o# *inance 319984 Economic -eport .//01//, A!ala @!m'!rC National 9rinting ;e'artment$
&inistry o# *inance 319994 Economic -eport .///144, A!ala @!m'!rC National 9rinting ;e'artment$
&inistry o# *inance 320004 Economic -eport 344414.5 A!ala @!m'!rC National 9rinting ;e'artment$
&inistry o# .ealth 320004 Vario!s broch!res$
&oroney, B$ 319264 *he ,amily an! State, @ondonC @ongman$
&!r'hy, 8$ 319864 “7ocial *actors in @ate @i#e ;e'ression in 8$ &!r'hy, 3ed$4 A""ecti$e Disor!ers in the El!erly, @ondonC <h!rcill @ivingstone, ''$ 29"96$
Ne/ 7traits 0imes 9ress, 2 :!ly 2000, '$16$
Nor Aini 319964 “.ealth <are o# the 8lderly in &alaysia in 9roceedings 1996 <elebrationsC National ;ay #or the 8lderly, 12 Q 22 1ctober 1996, A!ala @!m'!r$
1ga/a, N$, 0s!ya, N$1, Wongsith, &$ and <hoe, 8 319954 “.ealth 7tat!s o# the 8lderly and their @abor *o!rce 9artici'ation in ;evelo'ing <o!ntries along the Asia"9aci#ic Bim , NU9B% Be'rint 7eries No$ +1, &arch 1995, #rom Human -esources in De$elopment along the Asia-+aci"ic -im 319964, ''$ 659 Q 622$
1ga/a, N$ 319954 “<hanging Needs #or 9!blic 7!''ort to *amilies <aring #or the 8lderly in Ageing an! the ,amily, Ne/ Kor(C United Nations 9!blications$
7idell, &$ 3199+4 Health in University 9ress$
l! Age: Myth5 Mystery an! Management , ?!c(inghamC 1'en
Star1Metro 61 :an!ary 2001, '$6$
7!shama, 9$<$ 319924 “.ealth and Wel#are 7ervices #or 8lderly 9eo'le in &alaysia in ;$B$ 9hilli's 3eds4 Ageing in East an! South East Asia5 -esearch Stu!ies in Gerontology5 @ondonC .odder and 7to!ghton$
Sun!ay Star1Sun!ay +lus 15 :an!ary 2001, '$8$
0an, 9$<$ 319954 “*amily <hanges and the 8lderly in Asia in *he Ageing o" Ageing o" Asian +opulations, 9roceedings o# the United Nations Bo!nd 0able on the Ageing o# Asian 9o'!lations, ?ang(o(, 5 Q 6 &ay 1992, Ne/ Kor(C United Nations 9!blication$
0an, 9$<$, Ng, 7$0$, 0ey, N$9 and .alimah, A$ 319994 E$aluating +rogramme Bee!s o" +ersons in Malaysia$ A!ala @!m'!rC *ac!lty o# 8conomics and Administration, University o# &alaya$
l!er
0ey, N$9$ 319924 “7ocial 8G!ityC 9olicies and 9rogrammes A##ecting 1lder 9eo'le in &alaysia $ 9a'er 'resented at the 22nd *ederation o# A78AN 8conomic Associations 3*A8A4 <on#erence “7o!theast Asian ?eyond 2000C .!man ;imension , A!ala @!m'!r$
0in(er, A$ 319964, @td$
l!er +eople in Mo!ern Society, 5th ed$, @ondonC Addison Wesley @ongman
0o!t, A$ 319894 Ageing in De$eloping Countries, Ne/ Kor(C 1-#ord University 9ress #or .el'Age %nternational$
U$7$ ;e'artment o# <ommerce, 8conomic and 7tatistics Administration, ?!rea! o# <ens!s, ;ecember 1996 3htt'CLL///Li#a"#iv$orgLmen!2Sdemogra'hie Lmen!2S ageingSang$htm4$
United Nations 319964 Stu!ies on ConseCuence o" +opulation Change: Malaysia , Asian 9o'!lation 7t!dies 7eries No, 118, 8conomic and 7ocial <ommission #or Asia and the 9aci#ic, United Nations 9!blications$
United Nations 319954 *he Ageing o" Asian +opulations, Ne/ Kor(C United Nations 9!blications$
United Nations 319964, +opulation Ageing an! De$elopment $ Be'ort o# the Begional 7eminar on 9o'!lation Ageing and ;evelo'ment, ?ang(o(, 11 Q 15 ;ecember 199+, U7AC United Nations 9!blication$
Wenger, F$<$ 319954 Gn!erstan!ing Support Bet(or)s an! Community Care , AldershotC Attenae!m 9ress @td$
Williams, 8$%$ 319964 “<are o# 1lder 9eo'le in the <omm!nity in *irst 7ym'osi!m on Ferontology 199+C %ss!es and <hallenges o# Ageing &!ltidisci'linary 9ers'ectivesC 9roceedings 3199+4, Ferontology Association o# &alaysia, A!ala @!m'!r$
World ?an( 9olicy Besearch Be'ort 319954 A$erting the l! Age Crisis: +olicies to +rotect the l! an! +romote Gro(th, Ne/ Kor(C 1-#ord University 9ress$
World .ealth 1rgani)ation 319984, Gui!elines "or Bational +olicies an! +rogramme De$elopment "or Health o" l!er +ersons on the <estern +aci"ic -egion , FenevaC 1##ice o# 9!blications World .ealth 1rgani)ation$
A''endi- A )"tivities and .ro rams for the -ational 5enior 2iti7ens .oli"y )"tion .lan
0he 7ocial Wel#are ;e'artment o# &alaysia established a National 7enior <iti)ens 9olicy 0echnical <ommittee in :!ly 1996$ 0he 0echnical <ommittee has then #ormed si- s!b" committees to ens!re that the action 'lan is e##ective, integrated and com'rehensive to reali)e the aims o# the National 7enior <iti)ens 9olicy$ 0he activities and 'rograms listed belo/ are already in o'eration and #!t!re 'lans have been made to #!rther im'rove the #acilities 'rovided #or the elderly$ 7ome o# the 'rograms are ne/ly introd!ced s!ch as the 7enior <iti)ens= ;ay 319924 and the 7enior <iti)ens= <om'laint <enter 319994$ 0he #ollo/ing table o!tlines the activities and 'rograms o# the si- s!b"committees$
Su-8committ"" A$ 7ocial and Becreation
Acti$iti"!F'%og%am! 1$ 7enior <iti)ens= ;ay
O-."cti$"! <reate general a/areness to the '!blic on the role o# senior citi)ens in the #amily, comm!nity and co!ntry$ 8nco!rage comm!nities to instill the s'irit o# care and res'ect to/ards the elderly$
2$
Visits to %nstit!tions
6$
7enior <iti)ens= <om'laint 0oll"#ree line #acility allo/ing <entre senior citi)ens to com'lain iss!es to res'ective agencies$ <o!nter services and 7'ecial 7eats Available at government agencies, '!blic trans'ort stations, recreational 'ar(s and sho''ing com'le-es$ 8ns!re trans'ortation is more a##ordable to the elderly i$e$ +0> disco!nt #or air travel by &A7, Air Asia, 9elangi Air and ?er,aya AirE 50> disco!nt #or ++ years and above and +0> #or 6+ years and above by A0&?$ 8ns!re elderly and disabled can travel in com#ort$
5$
+$
*are concession
6$ 2$
7'ecial seats in '!blic trans'ort
<reative Betirement <entres9rovide com#ortable homes and #acilities to the elderly, either
alone or /ith s'o!se$
8$
7'orts *acilities
8stablish s'orts #acilities to 'romote health, as /ell as enable senior citi)ens to interact among themselves$ <arry o!t activities that are interesting and bene#icial to senior citi)ens thro!gh recreational cl!bs$
9$
Becreational <l!bs
10$
7ocial <entres
8nco!rage c!lt!ral, s'irit!al and recreational activities among the elderly #or rela-ation and interaction '!r'oses$ 8ns!re senior citi)ens receive basic necessities inde'endently besides assistance #rom other #amily members or local comm!nities$ 0rain the elderly to be inde'endent so that caregivers can rest$ 9rovide assistance and moral s!''ort to senior citi)ens d!ring times /hen caregivers are o!t /or(ing$ 0o enco!rage vol!ntary organi)ations to 'rovide assistance to elderly living alone or /ith #amily e$g$ meal"on" /heels, res'ite care, etc$ 0a- relie# and ta- rebate #or e-'endit!re on elderly and disabled 'arents :ob 'lacements are arranged #or the elderly sho!ld they be interested in s!itable vacancies$
11$
7enior <iti)ens 7!''ort 7cheme
12$
0em'orary <are <entres
16$
;ay <entre #or 7enior <iti)ens
15$
.ome .el' 7ervices
1+$
*amily %ncentive 7cheme
16$
:ob o''ort!nities
12$
8m'loyers= incentive scheme8nco!rage em'loyers to e-tend
services o# their elderly /or(ers and to create #le-ible /or( sched!les #or them$ 18$ 7enior <iti)ens= ;irectory <om'ilation o# senior citi)ens /ho have the 'otential to contrib!te their services to society$ 7enior <iti)ens= involvement 8nco!rage 'artici'ation o# senior citi)ens in vario!s 'rograms incl!ding social /or( and to 'rovide o''ort!nities to allo/ them to !tili)e their e-'ertise$ 9rimary 7ocial Wel#are ?rigade Activities 8nco!rage 'artici'ation o# senior citi)ens to the needy$
19$
20$
21$ 22$ 26$
7!''ort to NF1s U'grade H!ality o# <are
*acilitate NF1s by assisting in social /or($ 9rovide G!ality #acilities to the homes #or the elderly$
%m'rove H!ality o# 7ervices 9rovide training, establish r!les in %nstit!tions and reg!lations and amenities to ens!re the com#ort o# the elderly in homes$ 25$ 7ocial 7ec!rity 7ystem 0o create a system o# social sec!rity to ens!re senior citi)ens receive stable incomes #or retirement$ ?$ .ealth 1$ .ealth 8d!cation <reate a/areness regarding roles o# elderly in #amilies, society and co!ntry$ 8ns!re senior citi)ens have access to medical and o'eration #acilities /hen reG!ired$ 8ns!re senior citi)ens have access to eG!i'ment s!ch as ortho'edic eG!i'ment, hearing aids, s'ectacles, dent!res, etc$ 8-'and home n!rsing services and training #or the #amily to ta(e care o# the elderly$ %ntrod!ce a com'rehensive health care service to the elderly in the co!ntry in stages /ith the
2$
&edical and 1'eration *acilities 7el#"aid eG!i'ment
6$
5$
*amily %ncentive 7cheme
+$
<om'rehensive .ealth 7ervices
co"o'eration o# government agencies, non"government agencies and 'rivate agencies$ 6$ .ealthy @i#estyle 9ractice 0rain senior citi)ens to ado't a healthy li#estyle and to ta(e care o# themselves$
2$
7'eciali)ed <aring 7ystem <reate s'eciali)ed care centers in .os'itals and <omm!nities by increasing n!mber o# government and 'rivate clinics$ 7!##icient #acilities 1+6 home care n!rsing #acilities are available in r!ral areas #or elderly$ ?y 2020, it is e-'ected that district hos'itals /ill be able to 'rovide geriatric services$
8$
9$
7ta## training
0raining health care sta##, g!ardians and /or(ers in instit!tionsLcomm!nities to handle the elderly #or health '!r'oses$
10$
8nco!rage .ealthy @i#estyle 8nco!rage elderly to ado't a healthy li#estyle thro!gh #or!ms and doc!mentaries$ Ferontology and Feriatric 8d!cation 0o e-'and ed!cation in gerontology and geriatric$ .ealth &inistry o##ers short co!rses, 'ost"grad!ate co!rses, basic and 'ost"basic training to sta##$ &inistry o# .ealth, in collaboration /ith the ;e'artment o# 7ocial Wel#are is to ens!re a balanced health care system #or the elderly$ 8-tend health care services to r!ral areas thro!gh additional training #or sta## /ho are c!rrently based at the district level$ Available in all hos'itals and government clinics$ Feriatric services have been
11$
12$
9rimary .ealth <are
16$
B!ral .ealth 7ervices
15$ 1+$
;ental 7ervices Feriatric 7ervices in
.os'itals
integrated in all hos'itals to senior citi)ens /ho reG!ire s'ecial treatment$ <!rrently, this service is available in the 7eremban hos'ital b!t there are #!t!re 'lans to e-'and geriatric services at district hos'itals$
16$
9harmacies
8ns!re medicines, chemicals and other items reG!ired by the elderly are !sed in a correct manner$
12$
“<entre o# 8-cellence &odel8-tend this model co!ntry"/ide to ens!re all senior citi)ens receive necessary medical services and treatment$ 8n#orcement o# 9rivate .os'itals Act 1921 8ns!re G!ality service and care #or elderly in instit!tions$
18$
19$
Bight to ty'e o# medical treatment
Allo/ senior citi)ens to give their o'inion and agreement to ty'e o# treatment they receive and a''ro'riate care given to them$ 0his is an ethical medical 'ractice$ 8nco!rage the sa#e !se o# traditional or alternative medicine$ 8nco!rage 'rivate clinics in assisting the elderly by charging them a minimal s!m o# 'ayment #or treatment$ %ntrod!ce the role and 'roblems o# ageing thro!gh %slamic ed!cation, moral ed!cation in schools at all levels$ <reate a/areness to comm!nity es'ecially to yo!nger generation on roles and res'onsibilities o#
20$
7a#e traditional medication
21$
&inimal medical 'ayment
<$
8d!cation, Beligion and 0raining
1$
Feneral A/areness 8d!cation
2$
*amily 8d!cation 9rogramme
senior citi)ens$ 6$ 7enior <iti)ens= 8d!cation <reate a/areness abo!t the role o# the elderly in the #amily, comm!nity and co!ntry #rom the 'ers'ective o# religion$ %nstill #eelings o# care, love and res'ect to/ards the elderly$ An ed!cation system in school to ens!re the yo!nger generation is bro!ght !' /ith certain living s(ills$ %m'rove and increase s(ills so that retirees can be 'laced into s!itable ne/ ,obs$ 9re'are /or(ers to/ards retirement or 'ost"retirement /or(, and to ens!re that they are able to ada't to a change in their li#estyle as retirees$ 9re'are elderly #or religio!s '!r'oses in times o# sic(ness and death$
5$ +$
9ro,ects at %nstit!tions @iving 7(ills 9rogramme
6$
Vocational 0raining
2$
9re"retirement co!rses
8$
?asic necessities
9$
7enior <iti)ens= Bights
8ns!re that needy senior citi)ens receive /hat they deserve #airly$ 8ns!re that senior citi)ens /ith ed!cational bac(gro!nd can contrib!te to/ards ed!cating others$ 1''ort!nities to all incl!ding elderly to im'rove their (no/ledge in res'ective #ields$
10$
&aintaining A Becord o# Betirees #rom the 8d!cation 7ervices ;istance learning 'rogram
11$
12$
1''ort!nities to retirees #rom A''oint e-'erienced teachers as ed!cation services advisors or cons!ltants in comm!nity /or( es'ecially in social 'roblems$ 1''ort!nities to serve Allo/ senior citi)ens to contin!e serving the comm!nity by e-tending their /or( services$ 9rovide amenities s!ch as li#ts, ram's, )ebra"crossings, non" s'eed )ones and lo/er side/al( 'avements to accommodate senior citi)ens$
16$
;$
.o!sing
1$
U'grade 9!blic amenities
2$
.ome #acilities
.o!sing 'ro,ects are enco!raged to b!ild bathrooms on the gro!nd #loor o# do!ble" storey home, and 'ole gri' to allo/ easy access o# elderly in the home$ 8nco!rage the 'rivate sector to 'rovide #acilities to the elderly by renting o!t lo/ cost ho!ses or #lats located on gro!nd #loors, at lo/er rates$
6$
<ollaboration /ith the 'rivate sector
5$
1ld *ol(s= .omes s'onsored by 'rivate sector and NF1s 7enior <iti)ens= Activity <enter
8nco!rage 'rivate sector and NF1s to b!ild homes #or the elderly thro!gh grants, advice and s!''ort$ @ocal a!thorities are reG!ired to have #acilities #or the elderly s!ch as activity centers and ho!sing schemes$
+$
6$
F!idelines #or b!yerLtenant ;istrict government de'artments and other related agencies are reG!ired to ta(e into acco!nt the 'resence o# disabled and elderly as the basis #or allocating '!blic lo/"cost ho!sing !nits$ 7election o# b!yerLtenant #or 9rivate ho!sing develo'ers are 'rivate ho!sing develo'ers reG!ested to give 'riority to the aged and disabled in the ho!sing 'ro,ects$ .o!se str!ct!re .o!sing develo'ers are enco!raged to ta(e into acco!nt the needs o# the elderly or disabled in 'lanning the str!ct!re o# ho!ses$ *!t!re ho!se 'lans sho!ld incor'orate arrangements #or the elderly or disabled$ 8n#orce la/s in relation to the needs o# the disabled to ens!re that ne/ b!ildings ma(e 'rovisions to allo/ access #or the disabled$ 8ns!re #acilities 'rovided by ho!sing develo'ers allo/ easy access and 'rovide com#ort o# the elderly$
2$
8$
9$
*!t!re ho!sing #acilities
10$
8n#orcement o# la/s
11$
8n#orce r!les and reg!lations
12$
%ntegrated ho!sing 'ro,ects 8nco!rage ho!sing develo'ers to incor'orate ho!sing #or the elderly and their children in the same location$ ;ata reso!rce center #or the 0o create a database o# the elderly elderly in stages$ ?ibliogra'hy o# elderly Ferontology Association o# &alaysia is to 're'are a bibliogra'hy o# research and re'orts #or the elderly$ Besearch #indings are not #!lly !tili)edLanaly)ed to bene#it the elderly$ Analysis is carried o!t to 'oint o!t iss!es relating to senior citi)ens$ %ncl!des research in retirement, retraining o# retirees, #inancial as'ects o# the elderly, health stat!s o# the elderly, etc$
8$
Besearch
1$ 2$
6$
Analysis o# research #indings
5$
Besearch areas that are given 'riority
*$
9!blicity and 9romotions
0his s!b"committee is still in the <reate a/areness o# the needs 'rocess o# '!blici)ing 'rograms #or o# the senior citi)ens the elderly$
0he main agencies involved in these activities and 'rograms areC D D D D D &inistry o# .ealth &inistry o# National Unity and 7ocial ;evelo'ment &inistry o# 8d!cation ;e'artment o# 7ocial Wel#are ;e'artment o# National Unity
By
Ong Fon Sim Faculty o Bu!in"!! an# Accountancy Uni$"%!ity o Malaya &uala Lum'u%
May( )**+
+, INTRODUCTION
In 1990, 9% or almost half a billion of world population were over 60 years old. By 2030, this fi ure is e!pe"ted to in"rease to 1.# billion $%orld Ban&, 199#'. (ue to the broad diffusion of medi"al &nowled e and the resultant improvement in health, as well as de"linin fertility, developin "ountries are a ein mu"h faster than the developed nations. )t present, althou h the *alaysian population has not rea"hed the a ein proportion, the a ein phenomenon will eventually o""ur. By year 2020, 9.+% of its population will be 60 years and over. ,he time span ta&en to rea"h an a ein so"iety may be hastened with the "ontinuous improvement in the medi"al field, the availability and a""essibility of health "are, lon er life e!pe"tan"y as well as de"linin birth rate. According to the United Nations World Assembly on Ageing held in Vienna, 1982, “60 years and over is the c!t"o## age !sed #or deliberating iss!es on ageing$ %n &alaysia, 'olicy ma(ers have ado'ted this demarcation in #orm!lating and im'lementing 'lans #or its senior citi)ens$ *or the '!r'ose o# this re'ort, the c!t"o## age o# 60 is !sed altho!gh the retirement age o# ++ seems to s!ggest that the threshold to ageing begins at ++ years o# age in &alaysia$ &a,or so!rces o# ageing incl!de declining #ertility and mortality rate, im'roved health and li#e e-'ectancy$ .ence, indicators o# ageing incl!de increase in median age o# the 'o'!lation, longer li#e e-'ectancy, and 'ro'ortion o# de'endency ratio o# elderly 'eo'le
com'ared to the 'ro'ortion o# yo!th de'endency$ &alaysia, ,!st li(e other develo'ing co!ntries in the /orld, has been e-'eriencing im'roved health, longer li#e e-'ectancy, lo/ mortality as /ell as declining #ertility$ 0he e##ect o# all these changes has bro!ght abo!t a change in the demogra'hic 'ro#ile o# its 'o'!lation$ 1verall, the age str!ct!re #or the 'ast three cens!s, 1920, 1980 and 1991, sho/s that the 'ro'ortion o# yo!nger age gro!'s 31+ years and belo/4 is decreasing /hile the 'ro'ortion o# elderly is on the rise$ 0he median age /as 12$5 in 1920, 21$9 in 1991 and is 'ro,ected to increase to 22$1 in year 2020$ Within a s'an o# 60 years 3#rom 1991 to year 20204, the median age increased averagely by 1$2 'er decade$ 0he old age de'endency ratio is e-'ected to increase to 1+$2 in 2020 #rom 10$+ in 1920$ 0his is high com'ared to other A78AN co!ntries s!ch as %ndonesia 310$14, 0hailand 316$54, and the 9hili''ines 39$04, e-ce't 7inga'ore, /hich has an even higher ratio o# old age de'endency 326$94 /hile :a'an has a de'endency ratio o# 51$+$ 1ver a 'eriod o# +0 years, the median age o# &alaysian 'o'!lation /ill increase by 10 /hile the old age de'endency ratio, by + 3;e'artment o# 7tatistics, 19984$ <!rrently, &alaysia=s 'o'!lation may be considered as “yo!th#!l as 'ro,ections #rom the 1990 <ens!s sho/s that 6$1> o# the total 'o'!lation /as 60 and above 3;e'artment o# 7tatistics, 19984$ ?y year 2020 &alaysia /ill be a mat!red society /ith 9$+> o# its 'o'!lation aged 60 and above$ Altho!gh the rate o# increase o# its ageing 'o'!lation is not as 'henomenal as in co!ntries s!ch as <hina and 7inga'ore, the considerably ra'id and h!ge increase in the 'ro'ortion o# elderly 'eo'le /o!ld ma(e it im'ossible #or the government to ignore the im'act o# social and economic changes bro!ght abo!t by 'o'!lation ageing$
O-."cti$"! an# Sco'" o R"'o%t
0his re'ort is the co!ntry st!dy o# ageing in &alaysia and it is a com'onent o# the bigger research 'ro,ect coordinated by @ingnan University, .ong Aong, #or Asia ;evelo'ment Besearch *or!m 3A;B*4 Asia 9aci#ic Ageing Besearch Net/or( 3ABN4$ 0he main ob,ective o# this re'ort is to revie/ national 'olicy on ageing$ 0he #ollo/ing iss!es are s'eci#ic to this re'ortC D Bevie/ o# the sit!ation o# ageing in &alaysia #rom the 'ers'ectives o# social sec!rity, health, and comm!nity care and social servicesE D D Bevie/ o# 'olicies and 'rograms #or the elderlyE 8-amine the main #eat!res o# the 'olicies and 'rogramsE
D
8-amine the role o# civil society or NF1s in 'roviding in'!ts into the #orm!lation o# 'olicyE and
D
;isc!ss the li(ely develo'ments /ith res'ect to 'olicies and 'rograms #or the elderly and s!ggest recommendations #or the consideration o# 'olicy ma(ers
M"t/o#ology 0his re'ort relies heavily on secondary data as /ell as disc!ssions and intervie/s /ith e-'erts in s'eci#ic areas s!ch as social sec!rity, health care and social services$ As iss!es concerning the elderly are m!ltidisci'linary in nat!re, data and in#ormation are obtained #rom di##erent ministries and de'artments$ ;ata 'ertaining to the elderly are dra/n #rom the 'o'!lation cens!s cond!cted in 1980 and 1991$ 0he cens!s cond!cted in year 2000 has yet to be '!blished$ 0he only disadvantage abo!t !sing the cens!s is that it does not cover details abo!t iss!es s'eci#ic to the elderly s!ch as their health stat!s 3morbidity and mobility, activities o# daily living etc4, their contrib!tion to/ards society and #amily, involvement in social and charitable activities etc$ Where data ga's e-ist, they are s!''lemented /ith research #indings #rom smaller st!dies /ith limited geogra'hical coverage$ Altho!gh these st!dies may be small, the #indings 'rovide !se#!l in#ormation and hint at im'lications #or 'olicy ma(ing$
Lit"%atu%" R"$i"0
9o'!lation ageing is re'resented by an increase in the relative n!mber o# older 'ersons in a 'o'!lation$ 0reatment o# 'o'!lation ageing is com'licated by the #act that 'o'!lation ageing is a concomitant o# the a''roach o# a 'o'!lation to stationarity, and that some e##ects o# each 'henomenon are rein#orced by those o# the other 3<lar( and 7'engler, 19804$ A common de#inition o# ageing is the c!t"o## age o# “60 years and over $ Another de#inition re#ers to those over retirement age, /hich is !s!ally meas!red by the age at /hich a 'erson is eligible #or 'ension 30in(er, 19964$ %n the United Aingdom, the retirement age is 6+, /hile the 8!ro'ean <ommission !ses 60, and the United 7tates o# America ?!rea! o# <ens!s, ++ 30in(er, 19964$ .o/ever, it has been stated that /hatever c!t"o## age is selected to de#ine the “elderly 'o'!lation, it does not adeG!ately de#ine the diversity and com'le-ity o# s(ills, attit!des, needs and 'otential o# this gro!' o# 'eo'le 3Aro(iasamy, 19924$ 0he U$7$ ?!rea! o# <ens!s 319964 'ro,ected that by year 202+ the 'henomenon o# ageing /o!ld have s'read across the North American Begion as /ell as the Asian region$
0he increase in the 60"and"over 'o'!lation in the ind!striali)ed nations o# 8!ro'e and North America has generally o!t'aced total 'o'!lation gro/th in recent decades$ 0he 'ro'ortion o# older 'ersons to the total 'o'!lation di##ers bet/een Asian co!ntries, #rom abo!t 5 'ercent o# the 'o'!lation in <ambodia to abo!t 20 'ercent in :a'an 3W.1, 19984$ @ess develo'ed co!ntries in the Asian region sho/ that gro/th rates o# the elderly accelerated shar'ly a#ter 1960$ ?y 199+, the 'o'!lation o# those aged 60 and above in Asia /as almost com'arable to that o# the /orld, at abo!t 9 'ercent$ ?y 20+0, Asia is e-'ected to have 20 'ercent o# its 'o'!lation over the age o# 60 years, com'ared to the global 'ercentage o# 16 'ercent 3W.1, 19984$ &alaysia has not been s'ared #rom demogra'hic transition as e-'erienced /orld/ide$ <r!de death rates declined #rom 12$5 'er 1000 'o'!lation in 19+2 to 5$2 'er 1000 'o'!lation in 1990$ %n#ant mortality rate also #ell #rom 26 'er 1000 live"births to 12 'er 1000 live"births and the e-'ectation o# li#e at birth increased #rom +2 years to 21$2 years over the same 'eriod 3;e'artment o# 7tatistics, vario!s years4$ As a res!lt o# this demogra'hic transition, an increasing 'ro'ortion o# the 'o'!lation is at ris( o# certain chronic health 'roblems$ 0his is associated /ith a change in morbidity and disease 'attern #rom one o# mainly in#ectio!s diseases to one /here chronic degenerative and non"comm!nicable diseases 'redominate$ %n addition to this e'idemiological and demogra'hic transition, socioeconomic develo'ment also brings abo!t changes in li#e style, behavior and environment /hich lead to changing 'atterns o# ris( to the 'o'!lation 3World .ealth 7tatistics H!arterly, 19904$ 0he #irst ma,or st!dy on ageing too( 'lace in &alaysia in 198+ !nder the World .ealth 1rgani)ation$
Social Security 1ld"age 'ension schemes have become social instit!tions in many, i# not most, co!ntries thro!gho!t the /orld$ 0he goal o# these schemes is to 'rovide all G!ali#ying individ!als /ith an income stream d!ring their retirement years, /hich is contin!o!s, adeG!ate, constant 3in terms o# '!rchasing 'o/er4 and ca'able o# maintaining the socio" economic 'osition o# the retired in relation to that o# the active 'o'!lation 3U$7$ 7ocial 7ec!rity Administration, 19954$ 0he im'ortance o# social sec!rity schemes increased /ith the increase in li#e e-'ectancy$ <o/gill and .olmes 31922 in 1ga/a, 19954 'ointed o!t that /ith moderni)ation, the res'onsibility #or the 'rovision o# economic sec!rity #or the de'endent aged tends to be shi#ted #rom the #amily to the Fovernment$ As develo'ment 'roceeds, the so!rce o# old"age sec!rity #or the aged is li(ely to be s/itched #rom the #amily s!''ort system to '!blic s!''ort system 3United Nations, 19954$ 1ga/a 319954 in his re'ort, cited a st!dy carried o!t by the %@1 and World ?an( in the 1980s #or selected co!ntries 3both develo'ed and develo'ing regions4 to ill!strate that there are s!bstantial di##erences in the develo'ment
o# social sec!rity schemes among di##erent co!ntries even /hen their economic develo'ment are com'arable$ 0his st!dy regresses social sec!rity bene#its relative to F;9 and 'er ca'ita income$ *indings s!ggest that the com'ositional change in so!rces o# s!''ort #or the elderly over the co!rse o# economic develo'ment is a##ected by a n!mber o# non"economic #actors, incl!ding demogra'hic, socio"c!lt!ral, ideological and historical ones$ 0his st!dy #o!nd that social sec!rity 'rograms in the develo'ing /orld have limited coverage$ 7t!dies by &artin 319884 and :ones 319884 #!rther s!bstantiated this 'oint$ 0hey #o!nd that only 6 'ercent o# the /or(ing 'o'!lation is covered by 'ensions in 0hailand, 11$+ 'ercent in %ndonesia, and 22$8 'ercent in <hina$ %n other develo'ing co!ntries in Asia, these #ig!res /ere corres'ondingly higherC +0 'ercent in 7ri @an(a, +6$2 'ercent in the 9hili''ines, and 86 'ercent in 7inga'ore$ *or develo'ing co!ntries, the #inancing schemes are !s!ally di##erent #rom those ado'ted in develo'ed nations$ 9rovident #!nd systems are /idely em'loyed in develo'ing regions, /hereas 'ay"as"yo!"go schemes are generally in o'eration among the develo'ed co!ntries 3United Nations, 19954$ 9rovident #!nds are commonly ado'ted in #ormer ?ritish colonies incl!ding co!ntries in Asia, s!ch as %ndia, 7inga'ore and &alaysia$ 7inga'ore=s <entral 9rovident *!nds /or(s on ro!ghly the same 'rinci'les as the &alaysian 8m'loyee 9rovident *!nd 389* Website4$
Health Care .ealth is de#ined by World .ealth 1rgani)ation as the state o# com'lete 'hysical, mental and social /ell"being 3W.1, 199+4$ 0his holistic acco!nt is one very broad vie/ that meas!res the state o# com'lete 'hysical, social and mental /ell"being 3W.1 198+4$ 1n the other hand, there is the sim'le and narro/ de#inition o# biomedical acco!nt o# health, /hich sim'ly re#ers to the absence o# disease 37idell 199+4$ While the sim'le biomedical meas!re loo(s only at the 'hysical as'ect, the state o# health, /hich determines the state o# /ell"being is de#initely a #ar more encom'assing domain than mere 'hysical health, albeit the inse'arability o# one #rom the other$ ?o/ling 319914 'oints o!t that there is a con#lict bet/een researchers and 'olicy ma(ers in relation to the de#inition and meas!rement o# health$ 9olicy ma(ers desire straight#or/ard, G!antitative meas!res o# health /hereas researchers are more inclined to/ards G!alitative meas!res$ A move to/ards sel#"ratings o# health is 're#erred over the e-'licit indicators o# health 37idell 199+4$ <ertainly some balance bet/een these t/o a''roaches is desired$ *or the '!r'ose o# this st!dy, the 'hysical health stat!s o# the elderly is assessed by loo(ing at three s!bcategories o# 'hysical healthC 314 general 'hysical health, 324 the ability to 'er#orm basic sel#"care activities, and 364 the ability to 'er#orm more com'le- sel#"care activities that allo/ #or greater inde'endence 3Aart 19924$ 0he other as'ect o# health, social health is related to sense o# belonging and state o# #elt loneliness$ &ental health re#ers to the
ca'acity o# individ!al, the gro!' and the environment to interact /ith one another to 'romote s!b,ective /ell"being and o'timal #!nctioning, and the !se o# cognitive, a##ective and rational abilities to/ards the achievement o# individ!al and collective goals consistent /ith ,!stice 3&inistry o# .ealth, &alaysia 20004$ ;e'ression, /hich is a '!blic health 'roblem, a''ears to be the most common o# the #!nctional 'sychiatric disorders in the later years, yet it is not o#ten recogni)ed in older 'eo'le 3Aart 1992C1264$ ;ementia dominates old age 'sychiatry$ *e/ elderly 'ersons esca'e the acc!m!lation o# chronic 'athologies and long term non"#atal diseases, /hich are degenerative in nat!re, as they gro/ older$ <onseG!ently, m!lti'le 'athologies res!lting in m!lti'le sym'toms are a common 'henomenon among the elderly 3Aro(iasamy, 19964$ 0hey are at ris(s !nder the circ!mstances o# a lac( o# 'olicies, or at best, inadeG!ate '!blic 'olicies, that co!ld at least ens!re some degree o# G!ality o# li#e in old age$ .ealth care is not a 'roblem to the /ealthy as they have the means to '!rchase /hereas #or those /ho are certi#iably 'oor, they have to de'end on city hos'itals and clinics 3Avale 19964$ 8s'ecially #or the case o# older /omen, in /hich ageing a''roaches /hat is termed the #emini)ation o# ageing 3?!tler and Fleason 198+4, they are li(ely to #ace greater ris(s$ *rom the #indings o# several st!dies in &alaysia, /omen remain /ido/ed, no #inancial sec!rity, and e-'erience greater health 'roblems /hen they enter the old"old category$ %n res'onse to the health care needs o# the elderly, geriatric medicine, de#ined by the ?ritish Feriatrics 7ociety as Ithat branch o# general medicine concerned /ith the clinical, rehabilitation, social and 'reventive as'ects o# illness and health on the elderly=, has been develo'ed$ 0he aim evolves #rom the c!rative to the 'reservation and restoration #!nction$ &any o# the degenerative diseases o# old age are not res'onsive to c!rative actions and the im'ortant goal is to enable an elderly 'erson to #!nction e##ectively in the environment o# their choice as long as 'ossible$ 9rogrammes have been develo'ed thro!gho!t the Asian region #or health o# older 'ersons$ 0he demogra'hically “middle"aged ne/ly ind!strialised co!ntries and areas, /hich sho/ clear evidence o# 'o'!lation ageing, s!ch as .ong Aong, <hina and 7inga'ore, have their o/n systems$ 0he ra'idly develo'ing co!ntries, s!ch as &alaysia and the ne/ly ind!striali)ed economy s!ch as the Be'!blic o# Aorea, have made recent initiatives in the develo'ment o# health services #or older 'ersons 3%@1, 19924$
Community Care %nstit!tional care brings to mind the tho!ght o# old #ol(s= homes$ 1ne o# the main develo'ments in terms o# care #or the elderly is the shi#t #rom instit!tional care to /hat is loosely called comm!nity care 30in(er, 19964$ 8-'lanations #or this shi#t areC #irstly, there /ere
vie/s abo!t the 'ositive val!e in terms o# G!ality o# li#e o# being at home$ 0here /as a general reaction against instit!tional care, /hich led to the belie# that alternatives /ere made available #or both e-isting and 'otential inhabitants o# instit!tions$ 7econdly, there /ere 'ractical 'roblems s!ch as di##ic!lty in obtaining man'o/er$ 0hird, there /as no necessity to se'arate the elderly #rom society$ *o!rth, the cost o# instit!tional care is rather high$ *inally, there /as a gro/ing recognition that 'eo'le had the right to live among society and not isolated in an instit!tion 30in(er 19964$ 0here seems to be a lac( o# satis#actory de#inition o# comm!nity care and some con#!sion to its meaning$ 0here is a narro/ de#inition o# comm!nity care as the 'rovision o# domiciliary rather than instit!tional services and there is the ill"de#ined co)y 'ict!re o# a gro!' o# local 'eo'le Icaring= #or their neighbors 30in(er, 19964$ 0he /ider de#inition o# comm!nity care came #rom the 7eebohm Be'ort 30in(er 19964$ 0he o##icial de#inition is comm!nity care re#ers to treatment and care o!tside hos'itals or residential homes 3.ome 1##ice et al 1968 in 0in(er 19964$ %t /as also noted that the notion o# comm!nity care im'lies the e-istence o# a net/or( o# reci'rocal social relationshi's, /hich among other things ens!re m!t!al aid and give those /ho e-'erience it a sense o# /ell"being$ 0hese comm!nity services incl!de comm!nity n!rsing, occ!'ational and s'eech thera'y, 'hysiothera'y and 'harmace!tical, o'hthalmic, chiro'ody and dental services and services #or 'eo'le /ith hearing loss$ 0hese services are highly val!ed by 'atients b!t are o#ten overloo(ed in long term 'lanning$
1rgani)ation o# Be'ort 7ection % introd!ces the broad sit!ation o# 'o'!lation ageing aro!nd the /orld and in &alaysia$ %t also states the ob,ectives o# st!dy, describes brie#ly the methodology em'loyed, and revie/s the literat!re on ageing$ %n 7ection %%, the 'ro#ile, demogra'hic, economic and health, o# the elderly brings #orth the reality o# ageing in &alaysia$ 0he National 9olicy #or the 8lderly 199+ is o!tlined in this section$ Ageing, reG!iring a m!ltidisci'linary a''roach has to be e-amined #rom di##erent 'ers'ectivesC social sec!rity is disc!ssed in 7ection %%%, health care in 7ection %V$ <omm!nity and social services are brie#ly 'resented in 7ection V, /hile detailed disc!ssions on comm!nity care /ill be covered in the second 'art o# the re'ort !nder “@ong"term <are $ 7ection V% disc!sses the im'lications o# ageing and 'resents the concl!sion and s!ggestions #or #!t!re direction in 're'aring #or an ageing society$
), PROFILE OF AGEING AND NATIONAL POLICY FOR T1E ELDERLY
9ro#ile o# Ageing
Ageing by Geographical Distribution Within the nation, the rate o# gro/th o# senior citi)ens is di##erent, /ith the r!ral 'o'!lation #acing a higher rate o# gro/th com'ared to the !rban 'o'!lation$ %n 1991, the rate o# gro/th o# ageing 'o'!lation in the r!ral areas is 6$+> com'ared to +$6> in the !rban areas 3;e'artment o# 7tatistics, 19984$ 0his is d!e in 'art to the o!t"migration o# yo!ng r!ral 'o'!lation to the !rban areas in search #or em'loyment and ed!cation o''ort!nities, leaving behind the elderly$ 0he states that have a higher incidence o# ageing incl!de 9erlis, 9era(, &ela(a, 9!la! 9inang, and Aedah, in /hich the 'ro'ortion o# ageing 'o'!lation is 2> com'ared to the national average o# +$9> in 1991 3;e'artment o# 7tatistics, 19984$ 7tates that receive large n!mbers o# internal migrants, /ho are !s!ally yo!ng, as /ell as #oreign migrant /or(ers sho/ a signi#icantly lo/er 'ro'ortion o# elderly 'eo'le$ 0hese states incl!de 7elangor, *ederal 0erritory o# A!ala @!m'!r, 7abah, and *ederal 0erritory o# @ab!an$
Ethnic Variations ;!e in 'art to the inter"gro!' socio"economic di##erences, as /ell as the in#l!ence o# historical, instit!tional, and economic #actors, e-'eriences o# demogra'hic transition vary in both intensity and timing among the three ma,or ethnic gro!'s$ Among them, ageing is signi#icantly more serio!s among the <hinese than the other t/o gro!'s$ 0able 1 gives an indication o# di##erences in the ageing sit!ation by ethnic gro!'s and strat!m$ %n 1991, 2$6 'er cent o# the <hinese /ere elderly, a 'ercentage that /as m!ch higher than the 'ro'ortions o# senior citi)ens among the &alays 3+$5 'er cent4 and %ndians 3+$5 'er cent4$ 0his is d!e to the 'revalence o# lo/ mortality and longer li#e e-'ectancy among the <hinese /hile the lo/ #ertility red!ced the n!mber o# yo!ng 'o'!lation s!bstantially$ 0his t/o"/ay e##ect has been aro!nd #or a m!ch longer 'eriod #or the <hinese than the other ethnic gro!'s$ 0his trend is e-'ected to contin!e and the 'ro'ortion o# elderly <hinese is 'ro,ected to be aro!nd 15$5 'er cent in the year 2020$ 0he 'ro'ortion o# %ndian senior citi)ens is 'ro,ected to be 10$5 'er cent in the same year /hereas the &alays /ill have 2$9 'er cent o# senior citi)ens in 2020$
Ta-l" +: P"%c"ntag" Di!t%i-ution o S"nio% Citi2"n! -y Et/nic G%ou' an# St%atum( Malay!ian +33+ an# )*)*
Et/nic G%ou'
+33+ U%-an
)*)* Ru%al P"% c"nt Total -umber 45***6 .er "ent
Malaysian citizens ?!mi'!tera <hinese %ndian 1thers 0otal Non"&alaysian ,otal N!mber 3I0004 6$+ 2$5 +$8 5$+ +$5 6$2 +$6 3520$84 6$6 8$0 5$8 8$0 6$2 1$9 6$+ 3+61$+4 +$5 2$6 +$5 6$9 6$0 2$2 +$9 31,062$64 ++2$1 658$5 21$1 69$+ 1,012$1 20$2 1,062$6 2$9 15$5 10$5 8$6 9$+ 9$+ 9$+ 36,209$84
7o!rceC 7enior <iti)ens and 9o'!lation Ageing in &alaysia, ;e'artment o# 7tatistics, 1998
Variations by Age: the Young- l! an! the
l!- l!
0he elderly are classi#ied into t/o gro!'s, namely, the yo!ng"old 360"25 years4 and the old"old 3those aged 2+ and above4$ 0he 1991 <ens!s recorded 816 tho!sand yo!ng"old /hile the old"old /ere n!mbered at 219 tho!sand 3;e'artment o# 7tatistics, 19984$ <omes year 2020, the n!mber o# old"old is e-'ected to increase to +25 tho!sand /hereas the yo!ng" old is estimated at 2,66+ tho!sand 30able 24$ 0he gro/th rate /ill be 6$9 and 5$+ 'er cent res'ectively, #or the old"old and the yo!ng"old$ 0his sho/s that the yo!ng"old is e-'anding at a #aster rate than the old"old s!ggesting that the trend /ill e-hibit an !'/ard t!rn once the cohort o# yo!ng"old advances in age$ 0he 'ro'ortion o# yo!ng"old and old"old di##ers among the three ma,or ethnic gro!'s$ 0he <hinese comm!nity has a m!ch higher 'ro'ortion o# old"old 'ersons com'ared to the other ethnic gro!'s$ Among the elderly 'o'!lation, the 'ro'ortion o# old"old /as 26$1 'er cent #or the <hinese, 18$+ 'er cent #or the &alays and 12$2 'er cent #or the %ndians in 1991$ %t is th!s clear that the ageing 'henomenon is more ac!te among the <hinese than any o# the other ethnic gro!'s 30able 64$
Ta-l" ): Num-"% an# P"%c"ntag" o S"nio% Citi2"n! in 7Young8ol#9 4:*8;< y"a%!6 an# 7Ol#8ol#9 4;= y"a%! an# o$"%6 Co/o%t!( Malay!ia( +3>* ? )*)*
Y"a%
Total 45***6
Num-"%! 45***6 Young8 Ol# Ol#8 ol# 150$2 219$2 262$5 682$2 +25$8
@ Young8 ol# 81$1 28$8 81$1 81$6 82$1
@ Ol#8 ol# 18$9 21$1 18$9 18$2 12$9
G%o0t/ Rat" Young8 ol# " 2$2 6$9 6$8 5$+ Ol#8 Ol# " 5$0 2$2 6$2 6$9
1980 1991 2000 2010 2020
25+$2 1,062$6 1,518$2 2,026$1 6,209$8
605$+ 816$1 1,1+0$8 1,688$5 2,66+$0
7o!rceC 7enior <iti)ens and 9o'!lation Ageing in &alaysia, ;e'artment o# 7tatistics, 1998
Ta-l" A: P"%c"ntag" Di!t%i-ution o S"nio% Citi2"n! in 7Young8ol#9 an# 7Ol#8ol#9 Co/o%t! -y Et/nic G%ou'( Malay!ia( +33+
Et/nic G%ou' &alaysian <iti)ens ?!mi'!tera <hinese %ndians 1thers Non"&alaysian <iti)ens 0otal
Young8ol# 81$+ 26$9 82$6 22$8 28$6 28$8
Ol#8ol# 18$+ 26$1 12$2 22$2 21$2 21$2
Total 100$0 100$0 100$0 100$0 100$0 100$0
7o!rceC 7enior <iti)ens and 9o'!lation Ageing in &alaysia, ;e'artment o# 7tatistics, 1998
Gen!er Di""erences Altho!gh ageing is inevitable, the sit!ations #acing males and #emales can be very di##erent$ 0able 5 indicates the decline in the se- ratio among the elderly$ %n 1920, there /ere more elderly males com'ared to #emales 3108$54, b!t in year 2000 the ratio has dro''ed to 88$6$ Among the ma,or ethnic gro!'s, the case #acing the %ndian comm!nity is most drastic in that the male"#emale ratio /as 216$6 in 1920, 89$1 in 2000 and is e-'ected to dro' to 25$8 in 2020$ 0his means that there /ill be #ar more #emale elderly 'ersons com'ared to males and the im'lications on social sec!rity /ill be 'ro#o!nd$ Among the #umiputeras or the indigeno!s
'eo'le the ratio o# male to #emale elderly 'ersons /as 102$8 in 1920 and it dro''ed to 88$0 in 2000 and is e-'ected to decrease to 86$8 in 2020$ 0he <hinese comm!nity e-'erienced a similar sit!ation in /hich the ratio /as 102$8 in 1920, 85$6 in 2000 and 82$6 in 2020$ 0he 'roblem o# ageing seems to e-hibit a s(e/ to/ards more #emales among the %ndians com'ared to the other t/o ethnic gro!'s, indicating that the 'roblem o# /ido/hood /ill be more serio!s among the %ndians$
0able 5C 7e- Batio #or 7enior <iti)ens by Age Fro!' and 8thnic Fro!', &alaysia, 1920"2020
Age gro!' 0otal 360J4 60"25 2+J 8thnic gro!' ?!mi'!tea <hinese %ndians
+3;* 7e- ratio 108$5 112$1 89$+ 102$8 102$8 216$6
+3>* 7e- ratio 92$2 98$2 96$5 99$6 86$6 166$+
+33+ 7e- ratio 89$6 91$2 82$2 91$6 29$5 115$6
)*** 7e- ratio 88$6 92$1 26$5 88$0 85$6 89$1
)*)* 7e- ratio 8+$2 89$0 8+$2 86$8 82$6 25$8
NoteC 0he classi#ication o# ethnic gro!'s #or 1920 and 1980 di##ers #rom the classi#ication !sed in 1991 on/ards$ 0he main ethnic gro!'s only incl!de &alaysian citi)ens since the 1991 <ens!s, /hereas, 'revio!sly the classi#ication incl!ded both citi)ens and non"citi)ens$ 7o!rceC 7enior <iti)ens and 9o'!lation Ageing in &alaysia, ;e'artment o# 7tatistics, 1998
Marital Status 0able + sho/s that in 1991, almost one in three senior citi)ens /as classi#ied in the “/ido/ed category$ 0here /as a strong contrast bet/een /ido/ed male elderly, /ho constit!ted only 12 'er cent o# male elderly /hile #emale /ido/ed /ho constit!ted over hal# 3+1 'er cent4 o# the #emale elderly$ 0his trend becomes more 'rono!nced among those in the old"old age gro!'$ <om'aring males and #emales, it is obvio!s that a #ar greater 'ercentage o# the males are married and the di##erence in marital stat!s became even more 'rono!nced in the old"old age gro!'s /here 21$1 'ercent o# the males are married com'ared to only 25$0 'er cent o# #emales$ Wido/hood /as highest among elderly %ndian /omen 3+2 'er cent4 in 1991 /hile the &alays had the lo/est 'ro'ortion o# /ido/s 311 'er cent4$ 0he <hinese had the highest 'ro'ortion o# “never married , both among the males and #emales$
Ta-l" =: P"%c"ntag" Di!t%i-ution o S"nio% Citi2"n! -y Ma%ital Statu!( S"B an# B%oa# Ag" G%ou'( Malay!ia( +33+
Ma%ital Statu! 60"25 Kears Never married <!rrently married Wido/ed ;ivorcedL'ermanently 7e'arated 0otal 2$1 82$5 9$6 1$6 100$0
Mal" 2+J years 2$0 21$1 25$8 2$1 2$0 85$1 12$5 1$5 0otal 60"25 years 1$+ 59$2 5+$2 6$6
F"mal" 2+J years 1$+ 25$0 20$2 5$6 100$0 1$+ 55$0 +0$2 6$8 0otal 60"25 years 1$8 62$2 28$0 2$+
Total 2+J years 1$2 5+$6 59$8 6$6 100$0 1$8 62$9 62$8 2$2 100$0 0otal
100$0 100$0 100$0
100$0 100$0
7o!rceC 7enior <iti)ens and 9o'!lation Ageing in &alaysia, ;e'artment o# 7tatistics, 1998
E!ucational Achie$ement %n the case o# &alaysia, the 'resent cohort o# elderly does not have m!ch ed!cational achievement 31991 <ens!s4 d!e to the limited ed!cational #acilities, /hich is e-'lained by the economic develo'ment o# the nation in the early decades o# the 20 th cent!ry$ 7ome 66 'er cent o# the elderly received no schooling at all$ .o/ever, this re'resents an im'rovement com'ared to the #ig!res in 1920 and 1980, in /hich the 'ercentage o# those /ith no ed!cation /as 2+ and 26 'er cent, res'ectively 30able 64$ 0his trend is not e-'ected to contin!e into the #!t!re as ed!cation became /idely available and the #!t!re cohorts o# elderly /ill be more ed!cated$ Ass!ming that the 'resent cohort o# 'o'!lation aged bet/een 6+"+5 /ill move into the aged gro!' and ass!ming that their 'resent ed!cational achievement remains the same #or this cohort, by year 2020, the ed!cational 'ro#ile o# the senior citi)ens /ill be largely ed!cated /ith 6 'er cent having tertiary ed!cation /hile only 20 'er cent /o!ld have no schooling$
Ta-l" :: P"%c"ntag" Di!t%i-ution o S"nio% Citi2"n! -y E#ucation L"$"l( Malay!ia( +3;*( +3>*( +33+ an# )*)*
E#ucation l"$"l No schooling 9rimary @o/er secondary U''er secondary 0ertiary 0otal % %%
+3;* 2+$0 22$6 1$6 1$2 0$6 100$0
+3>* 26$2 26$1 1$8 1$+ 0$5 100$0
+33+ 66$1MM 61$+ 2$5 2$1 0$9 100$0
)*)*C 20$6MM 5+$+ 1+$1 16$2 +$9 100$0
Appro&imate estimation 'nclu!es one percent o" cases (here e!ucational le$el (as un)no(n
7o!rceC 7enior <iti)ens and 9o'!lation Ageing in &alaysia, ;e'artment o# 7tatistics, 1998
8d!cational attainment by gender sho/s that a m!ch lo/er 'ercentage o# #emales /ere ed!cated com'ared to males, consistent /ith the 'ast social c!lt!ral environment, /hich gave 're#erence #or boys to be ed!cated$ According to the 1991 <ens!s, close to hal# 352 'er cent4 o# elderly males had basic schooling /hereas only 18 'er cent o# #emales had similar ed!cation$ Among the three ma,or gro!'s, the %ndian senior citi)ens /ere better ed!cated com'ared to the other t/o ethnic gro!'s$ Abo!t hal# o# the %ndians had received some ed!cation com'ared to 65 'er cent #or #umiputeras and 52 'er cent #or <hinese$ <lose to 6 'er cent o# the elderly %ndians had tertiary ed!cation /hile another 6 'er cent had com'leted !''er secondary ed!cation$ Among the <hinese, 6 'er cent had !''er secondary school ed!cation /hile 1 'er cent had tertiary ed!cation$
Economic Acti$ities
Altho!gh it is recogni)ed that labor #orce 'artici'ation declines as age increases, the decline that &alaysia e-'erienced bet/een the last t/o cens!s 31980 and 19914 has been signi#icant, not only in terms o# 'ercentage decline b!t also in absol!te n!mbers$ 0able 2
sho/s that labor #orce 'artici'ation rate 3@*9B4 declined #rom 69$1 in 1980 to 2+$6 in 1991$ %n absol!te n!mbers, total n!mber decreased #rom 290 tho!sand in 1980 to 266 tho!sand in 1991 3;e'artment o# 7tatistics 19984$ %n the case o# #emales, the decrease has been even #ar more signi#icant /ith a decline o# almost +0> #rom 1980 to 1991$ 8ven among the yo!ng olds 3aged 60"654, @*9B sho/ed a decline #rom 69 'er cent to +6 'er cent among the males and #rom 22 'er cent to 16 'er cent #or the #emales$
Ta-l" ;: La-o% Fo%c" Pa%tici'ation Rat"! 4LFPR6 o S"nio% Citi2"n! By S"B( an# Ag" G%ou'( Malay!ia( +3;*( +3>* an# +33+
Y"a% an# ag" 1920 1980 1991 1980 60"65 6+J years 1991 60"65 6+J years
Mal" +5$2 +6$8 51$9 69$5 59$2 ++$6 66$8
F"mal" 18$5 21$8 10$9 26$2 19$0 16$1 8$1
Total 62$6 69$1 2+$6 52$2 65$2 6+$2 20$1
7o!rceC 7enior <iti)ens and 9o'!lation Ageing in &alaysia, ;e'artment o# 7tatistics, 1998
0he economic activities o# the 'resent cohort o# elderly still e-hibit the 'ast economic str!ct!re o# &alaysia in /hich agric!lt!re /as the ma,or sector 'roviding the greatest n!mber o# em'loyment$ 62 'er cent o# the elderly /or(ed in the agric!lt!ral sector 31991 <ens!s4, /hile sales occ!'ations /ere the ne-t most common occ!'ation 316 'er cent4, #ollo/ed by the 'rod!ction, trans'ort eG!i'ment o'erators and laborers category 311 'er cent4$ %n terms o# em'loyment stat!s, slightly more than 20 'ercent o# the elderly /ere sel#" em'loyed 30able 84$ 0his re'resents a signi#icant increase #rom 1980 in /hich the 'ercentage o# sel#"em'loyed /as abo!t 60 'er cent$ .o/ever, the most notable change has been the decline in the 'ercentage o# !n'aid #amily /or(ers #rom 15$8 'er cent in 1980 to +$2 'ercent in 1991$ 0he decreasing 'ro'ortion o# !n'aid #amily /or(ers is tr!e #or both males and #emales, /ith the males e-hibiting a more ra'id decline$
0able 8C 9ercentage ;istrib!tion o# 8m'loyed 7enior <iti)ens by 8m'loyment 7tat!s and 7e-, &alaysia, 1980 and 1991$
/mployment Statu! 8m'loyer 8m'loyee 7el#"em'loyed Un'aid #amily /or(er Un(no/n 0otal 1980 5$5 25$6 60$6 11$0 " 100$0
Mal" 1991 6$9 21$1 21$2 1$6 1$5 100$0
F"mal" 1980 1$5 16$2 ++$6 26$6 " 100$0 1991 1$2 16$1 61$8 18$8 2$0 100$0 1980 6$2 22$2 +9$1 15$8 " 100$0
Total 1991 6$6 20$6 69$6 +$2 1$+ 100$0
7o!rceC 7enior <iti)ens and 9o'!lation Ageing in &alaysia, ;e'artment o# 7tatistics, 1998
National 9olicy #or the 8lderly
U' till 199+, there /as no s'eci#ic 'olicy #or older 'ersons in &alaysia$ At best, 'olicies or 'rograms catering to the needs o# the elderly have largely been incor'orated into social /el#are 'olicy develo'ment in this co!ntry$ 0he National Wel#are 9olicy 'rom!lgated in 1990 identi#ies the elderly, de#ined as those 60 years and over, as one o# its many target gro!'s$ Altho!gh this mar(s an initial ste' in the 'rovision o# care #or the elderly, instit!tional e##orts are at its minim!m as #amily and comm!nity are enco!raged or e-'ected to 'rovide care to the elderly$ 0he 'rinci'le is that instit!tional s!''ort is the last resort$ %n 199+, the Fovernment #orm!lated the National 9olicy #or the 8lderly aimed at “creating a society o# elderly 'eo'le /ho are contented and 'ossess a high sense o# sel# /orth and dignity, by o'timi)ing their sel# 'otential and ens!ring that they en,oy every o''ort!nity as /ell as care and 'rotection as members o# their #amily, society and nation 3F1&, 1996 '$+214$ 7'eci#ically, the 9olicy has the ob,ectives o# !'grading the dignity and sel#"/orth o# senior citi)ens /ithin the #amily, society and nation, and im'roving the 'otential o# the elderly so that they can contin!e to be 'rod!ctive in national develo'ment$ 0he 'olicy also aims at enco!raging the 'rovision o# #acilities #or the elderly so as to ens!re care and 'rotection #or them$ %n line /ith these ob,ectives, several action 'lans are initiated and several s!b"committees have been set !' to loo( into the vario!s as'ects related to ageing and the
/el#are o# the elderly in &alaysia$ 0hey incl!deC social and recreational, health, ed!cation and training, religion, ho!sing and research$ ;etails o# the 'rograms !nder each s!b"committee are 'rovided in A''endi- A$ ?esides 'olicy, 'rograms and activities, a monitoring system has been '!t in 'lace to monitor the 'rogress o# all activities #or the 'eriod 1992"200+$ 0his control mechanism 'rovides chec(s and balance as /ell as eval!ates the 'rogress o# 'rograms and activities$ Vario!s ministries and de'artments !nderta(e action 'lans and activities #or the elderly, b!t the agency that oversees all matters is the ;e'artment o# 7ocial Wel#are$ 0his /ill ens!re that ga's and short#alls are identi#ied and corrective actions ta(en #or #!t!re develo'ment o# a s!stainable national 'olicy #or the elderly$ Altho!gh the National 9olicy #or the 8lderly is a great ste' #or/ard in 're'aring the &alaysian society #or a transition into an ageing society, one ma,or iss!e that a##ects the /el#are o# the elderly is cons'ic!o!sly absent #rom the 9olicy " social sec!rity /hich is incl!ded as a s!b"'rogram$ Altho!gh health care receives s!bstantial attention, the #inancing as'ect is not covered$ 0he em'hasis o# the 9olicy a''ears to be on social as'ects, not denying that these too contrib!te to/ard the /ell"being o# the elderly$
6$ 71<%A@ 78<UB%0K AN; 8<1N1&%< W8@@"?8%NF
%n &alaysia, #ormal social 'rotection system incl!desC the 8m'loyees 9rovident *!nd 389*4, 19+1, the 7ocial 7ec!rity 1rgani)ation 371<714 established in 1969, Fovernment 'ension scheme #or <ivil servants, 1ld Age ?ene#it 7cheme #or the Armed *orces, and 'rivate sector 'rovident and 'ension #!nds$ 0hese di##erent schemes 'rovide 'rotection #or di##erent contingencies s!ch as disability as in the case o# 71<71, old age 3'ension and 89*4 and deaths$ While these schemes 'rovide coverage #or the #ormal sector, the 'rovision is not mandatory #or those in the in#ormal sector, /hich is s!bstantially large in &alaysia$ Altho!gh 89* is e-tended to the sel#"em'loyed on a vol!ntary contrib!tion basis, the 'artici'ation rate is lo/$ 0here#ore, those in the in#ormal sector have to rely on savings, dra/ing do/n on 'ast /ealth and #inancial s!''ort #rom children to 'rovide them /ith income sec!rity in their old age$ ;!e to the lac( o# data abo!t the in#ormal sector, there is no /ay o# assessing the e-tent o# 'rotection available$ 0his re'ort /ill cover the t/o 'illars o# 'ension systemsC 9illar 1, 'ension, /hich is based on de#ined bene#its and 9illar 2, 89*, a de#ined contrib!tion system, in /hich bene#its de'end on the assets in the individ!al=s acco!nt at retirement 3*o- and 9almer 20014$
.ension 9ension is a non"contrib!tory social sec!rity scheme #or government em'loyees$ 9ensions e-'endit!re is /holly borne by the *ederal Fovernment thro!gh ann!al allocation #rom the *ederal ?!dget$ %t is the 'ay"as"yo!"go 'lan$ An em'loyee /ho has served at least 10 years is entitled to receive a li#e"long monthly 'ension !'on retirement$ 0he G!ant!m receivable by an em'loyee /ho has com'leted at least 2+ years o# service is hal# o# the last dra/n salary$ 0his scheme serves not only as a sec!rity #or old age, it is designed to 'rovide #inancial assistance to the de'endents o# those in the Fovernment service in the event that the government em'loyee 'asses a/ay /hile in service or a#ter retirement$ %t also 'rovides com'ensation to o##icers /ho are #orced to retire or 'ass a/ay d!e to in,!ries or sic(ness in the co!rse o# 'er#orming their o##icial d!ties$ 0he ty'es o# retirement bene#its o##ered in the 'ension scheme incl!de service 'ension and service grat!ity /hich is a l!m' s!m 'ayment granted to a 'ensionable o##icer !'on retirement$ 0he other ty'e o# bene#it is in the #orm o# derivative 'ension, /hich is granted to the /ido/L/ido/erLchild o# a 'ermanent and con#irmed o##icer /ho dies in service$ 7imilarly, derivative grat!ity is 'ayable to the /ido/L/ido/er, child, and motherLde'endant #ather o# the deceased or legal 'ersonal re'resentative o# the deceased o##icer i# the o##icer dies in service$ %t is a sa#ety net #or the /ido/ed s'o!ses and it is 'artic!larly bene#icial in 'roviding #or the #emales as they generally e-'erience a higher incidence o# /ido/hood$ %n terms o# coverage, only less than one 'ercent o# the 'eo'le are 'rotected$ %n vie/ o# the large 'ension 'ayo!t, the government has ta(en ste's to ens!re that 'ensions 'ayment do not become a b!rden #or the government in the #!t!re$ As s!ch a 0he 9ensions 0r!st *!nd /as set !' in 1991 !nder the 9ensions 0r!st *!nd Act, 1991$
8m'loyee 9rovident *!nd 389*4
0he 89* is a 0r!st *!nd 3#!nctions as a tr!stee #or its members4 established !nder the 89* 1rdinance, 19+1$ %t /as amended to the 89* Act in 1991$ 0he 89* is a de#ined contrib!tion 'lan based on a 'rescribed rate o# contrib!tion by em'loyers and em'loyees, acc!m!lated as savings in a 'ersonal acco!nt and #!ll /ithdra/al !'on retirement$ 0he scheme is mandatory #or those in the #ormal sector, b!t it also allo/s those /ho are sel#" em'loyed to contrib!te to/ards the #!nd$ 0his #le-ibility is aimed at enco!raging savings #or old age$ 0he rate o# contrib!tion is 12> and 11> #or em'loyers and em'loyees res'ectively, regardless o# age o# em'loyee$ 0he rate o# contrib!tion has increased si- 'ercentage 'oints over the last t/o decades$ <ontrib!tion by em'loyee has been revised to 9 'er cent in A'ril 2001, in an attem't to boost domestic demand in res'onse to the global economic slo/do/n$
.o/ever, 89* members can choose to contrib!te the revised rate o# 9> or the old rate at 11>$ 0he 89* is str!ct!red into three ty'es o# acco!nts, namely Acco!nt % 360>4, Acco!nt %% 360>4 and Acco!nt %%% 310>4$ 8ach acco!nt is designed to serve the di##erent needs o# contrib!tors and conditions !nder /hich a certain amo!nt can be /ithdra/n #rom these acco!nts are as #ollo/sC D Acco!nt % constit!tes 60> o# member=s savings #or retirement in accordance to the 'rimary ob,ective o# the scheme, i$e$, to ens!re that members have s!##icient cash savings #or retirement$ U' to 20> o# the balance in Acco!nt % can be trans#erred #or investment '!r'oses$ 0his is a ne/ #eat!re introd!ced in 1996 to allo/ contrib!tors to invest !nder &embers= 7aving %nvestment 7cheme$ D Acco!nt %% allo/s a member to /ithdra/ hisLher savings once #or b!ying or b!ilding a ho!se$ 0his /ithdra/al is limited to 20> o# the 'rice o# the ho!se or 5+> o# the savings b!t not e-ceeding B&20,000$ *!rther /ithdra/als to red!ce or to settle balance o# the ho!sing loan is allo/ed every #ive years #rom the date o# the 'revio!s /ithdra/al !ntil the member attains the age o# ++ years$ Under this acco!nt, members /ill also be allo/ed to /ithdra/ some money to #inance the cost o# their children=s ed!cation$ D Acco!nt %%% is intended to hel' members to 'ay #or their medical e-'enses o# critical illness$ 0his assistance in the #orm o# emergency medical e-'enses allo/s 10> o# contrib!tion to be /ithdra/n and it is not limited to the member only, b!t is e-tended to member=s s'o!se, children, 'arents and siblings$ As the 89* aims to cater to non"'ensionable em'loyees #or #inancial sec!rity !'on retirement and to assist them thro!gh till the end, it introd!ced the 9eriodical 9ayment Withdra/al 7cheme in 1995 to allo/ members /ho have reached retirement age to /ithdra/ their savings 'eriodically 3once a month4, !ntil all savings are /ithdra/n$ 0his is similar to the monthly 'ayment #or government 'ensions$ .o/ever, this scheme is not 'o'!lar 3Ne/ 7traits 0imes, 9$+$994$ As at ;ecember 61, 1999, only 126 members re'resenting 0$25 'er cent o# overall members o'ted #or the l!m'"s!m 'ayment have chosen the monthly 'ayment o'tion 30he 8dge, 9ersonal &oney, 6$11$2000, '$ 264$ ?esides the l!m' s!m /ithdra/al at retirement and the 'eriodic 'ayment, the 89* also 'rovides t/o other schemes$ 1ne o# the other t/o o'tions is 'art l!m' s!m and 'art 'eriodic 'ayment /hile the other allo/s contrib!tors to maintain the 'rinci'al amo!nt /ith 89*, /ithdra/ing only the ann!al dividends$
%n :!ly 2000 89* introd!ced yet another o'tion, /hich is the ann!ity scheme com'rising t/o ty'es o# schemes to s!it the 're#erence o# contrib!tors$ 0he #irst one is (no/n as the <onventional Ann!ity 7cheme and the other is the *a)a"ul Ann!ity 7cheme$ 0hese schemes are aimed at 'roviding members an even income stream thro!gho!t their retirement years$ 0hey are o'en to contrib!tors bet/een the ages o# 16 and 20$ &embers o# 89* may choose to b!y one or both the schemes$ *ollo/ing the anno!ncement o# this ne/ ann!ity scheme, mi-ed res'onses have been received by 89*$ &ost do not !nderstand ho/ the ann!ity scheme /or(s /hile others #elt that they co!ld be better o## by (ee'ing the s!m o# money in 89* or save it in #i-ed de'osit and earned a ret!rn higher than the ann!ity scheme, that is, #or the case o# a yo!ng ins!red$ *or a 'erson /ho is ++ years old to #!lly bene#it #rom the ann!ity scheme, the 'erson has to live beyond 20 years old$ Another disadvantage abo!t the scheme is the moral ha)ards in these mar(ets$ 0he #!t!re develo'ment o# this scheme de'ends on the con#idence contrib!tors have to/ard the scheme$ 0his co!ld 'robably im'rove /ith some reg!latory intervention on the 'art o# the government, as /ell as individ!al 're#erence /ith regards to the mode o# /ithdra/al, individ!al so!rces o# #inancial sec!rity, and etc$ 0he acce'tance o# this scheme is not a '!rely economic decision, b!t one that also concerns the social and 'sychological as'ects o# h!man behavior$ E+, - Co$erage As at the end o# ;ecember 1999 the total n!mber o# members /as 9$+5 million, com'rising o# 5$28 million 3or +0$1>4 o# active members com'ared to 6$99 million 3or +1$5>4 o# active members in 199+ 30able 94$ 0his re'resents an increase o# 19$8>$ Active members are those /ho have at least one contrib!tion in the last t/elve month$ 0he total labor #orce N1O in &alaysia sa/ a dro' o# a''ro-imately 2 'ercent #rom 1992 to 1998 d!e 'robably to the Asian 8conomic <risis$ %n 1999, total labor #orce o# &alaysia is 9$01 million and the active members made !' +6$1 'ercent o# the total labor #orce$ 0he 'ercentage o# total members as /ell as active members has increased over the #ive"year time #rame$
Ta-l" 3: Num-"% o EPF M"m-"%!( +33= ? +333
Y"a%
Total num-"% o m"m-"%! 4million6
Num-"% o acti$" m"m-"%! 4million6 6$99
.er"enta e of acti$" m"m-"%! +1$5>
Total La-o% Fo%c" 4million6 8$26
P"%c"ntag" o acti$" m"m-"%! to la-o% o%c" 58$6>
199+
2$26
1996 1992 1998 1999
8$0+ 8$22 9$16 9$+5
5$18 5$61 5$66 5$28
+1$9> +2$1> +0$9> +0$1>
8$65 9$05 8$88 9$01
58$5> 52$2> +2$+> +6$1>
7o!rceC 8m'loyees 9rovident *!nd Ann!al Be'ort 1999 Economic -eport .//01// 2 344414.5 Ministry o" ,inance
0he relevance o# the 89* scheme #or the 'resent cohort o# elderly as a so!rce o# #inancial s!''ort thro!gh till the end may not be signi#icant$ 0here are three reasons #or thisC #irstly, a large 'ro'ortion o# the elderly in the 'resent cohort are in the in#ormal sector in /hich contrib!tion is not made mandatory$ Altho!gh they are given a choice to ma(e contrib!tions to/ard their old age, most do not do so d!e 'robably to their #inancial needs and alternative aven!es o# !tili)ation o# #!nds$ Wor(ers in the in#ormal sector /here retirement does not a''ly, !s!ally /or( !ntil they are !nable to do so d!e to ill health$ 7econdly, there al/ays remains the G!estion o# /hether 'eo'le /ill have eno!gh in their 89* acco!nt to see them thro!gh till the end, i# 89* is the only so!rce o# income 3&ehta, 19924$ Bising cost associated /ith longer li#e e-'ectancy and the e##ect o# in#lation /ill diminish the si)e o# savings$ %t is then essential to raise the G!estion o# adeG!acy$ Unli(e the sit!ation in &alaysia, the elderly 'eo'le in develo'ed co!ntries are /ell 'rotected in their old age #inancially$ *or e-am'le, in the U7, in 1925 over 90> o# all #amilies /hose head /as 6+ years and older /ere receiving social sec!rity bene#its$ Abo!t 20> /ere receiving income either #rom 'rivate 'ensions, ann!ities, or other #orms o# 'rivately attained income, income #rom acc!m!lated assets, #rom dra/ing do/n their stoc( o# /ealth, and or #rom c!rrent earnings 3<hen and :ones 19894$ 0hirdly, the l!m' s!m nat!re o# /ithdra/als tends to have high e-'os!re to im'ro'er management or investment that does not 'rovide the ins!rance needed #or old age$ Will the ne/ly introd!ced ann!ity scheme be able to #ill this need"ga'P An ans/er is not immediately available$ %n res'onse to the G!estion o# adeG!acy, the 89* has cond!cted several in"ho!se sim!lations to assess the e-tent to /hich the #!nd addresses the iss!e o# adeG!acy 3A!mar 19964$ ?ased on the %@1 <onvention, 19+2 No$ 102, the minim!m re'lacement rate is at least 50> o# the last dra/n salary$ 7im!lations cond!cted in 199+ on vario!s categories o# contrib!tors sho/ that the monthly ann!ity 'ayment receivable #or a 'eriod o# 20 years #or the man!al, clerical and e-ec!tive categories /ere +8>, +6> and 50> o# the last dra/n salary be#ore retirement, res'ectively, indicating a s!##icient level o# re'lacement rate 3A!mar 19964$
As a social sec!rity instit!tion, the main concern o# the 89* is ho/ it can overcome the inadeG!acies o# the schemes in order #or it to 'rovide adeG!ate long"term retirement savings #or its members and de'endents$ *or a start, Acco!nt % /here 60> o# the 'ool o# monies available to members sho!ld be set aside and can only be dra/n !'on reaching retirement age instead o# the 'resent arrangement that allo/s #or 20> /ithdra/al #or investment$ 0his ens!res that 'remat!re /ithdra/als are limited only to 50> o# total savings 30he 8dge, 9ersonal &oney, 2$10$2000, '$ 284$ %n addition, the amo!nt 'ermissible #or 're" retirement /ithdra/al !nder the remaining acco!nt sho!ld be revie/ed #!rther$ &ore stringent conditions can be introd!ced as a meas!re to/ard ens!ring adeG!acy #or old age$
7avings, %nvestments and %ns!rance A'art #rom social sec!rity as the 'rimary so!rce o# income #or the aged, savings, 'ersonal li#e ins!rance and !nit tr!st #!nds are alternative #orms o# so!rces o# 'rotection available to the elderly$ 0he national investment schemes 'rovide attractive ret!rns /ith the aim to enco!rage /ider 'artici'ation, 'artic!larly, 'artici'ation #rom the lo/er income gro!'$ All these are vol!ntary schemes and hence individ!al decision is critical in in#l!encing 'artici'ation$ %ns!rance is another alternative to/ard saving #or old age, altho!gh it 'rovides 'rotection to other sections o# the 'o'!lation as /ell$ %ns!rance is a /ay o# 'rotection against interr!'tion or elimination o# earning ca'acity o# h!man, ca'ital and 'ro'erty reso!rces$ %t is !sed as a shield against !ne-'ected e-'enses that might diminish dis'osable income available #or #inancial 'lanning ob,ectives incl!ding those #or retirement$ 9ossessing an ins!rance 'olicy minimi)es and ens!res against !nnecessary economic hardshi's d!ring ones /or(ing li#e as /ell as d!ring retirement$ No s'eci#ic ins!rance scheme is tailored #or the elderly$ 0he ty'e o# ins!rance s!itable #or old age 'rotection is the endo/ment 'olicy or the investment"lin(ed ones$ A s!rvey carried o!t by 0aylor Nelson 7o#res *inancial &onitor to investigate the o/nershi' by ins!rance ty'e in &alaysia is as sho/n in *ig!re 1$ 0he coverage !nder li#e ins!rance is only 66> o# /hich details abo!t the ins!red are not available$ ;!e to data limitation, there is no /ay o# assessing the e-tent o# 'rotection available to the elderly$
Figu%" +: O0n"%!/i' -y In!u%anc" Ty'"
Source: *he E!ge5 +ersonal Money5
ctober 65 .///5 p78
#. 0/)1,0 2)3/
.ealth is im'ortant sim'ly beca!se it a##ects the elderly directly in that the lin( bet/een 'hysical health and li#e satis#action have long been made 39almore and Aivett 19224$ %n 'ersonal terms, ill health can bring many lossesC the loss o# inde'endence and a!tonomy, loss o# mobility, loss o# dignity and 'rivacy, and loss o# con#idence and sel#"esteem 37idell 199+4$ %ndirectly, the iss!e o# health a##ects the #ormation o# h!man ca'ital, ho!sehold and government b!dgets$ 0he mobili)ation o# reso!rces #or health care #or the elderly is an o''ort!nity cost that co!ld other/ise be em'loyed in alternative a''lications$ 0here#ore, the iss!e o# health is m!ch o# a matter o# '!blic 'olicy debate$ &!ch o# the concern e-'ressed over the iss!e o# health and ageing 'o'!lation is the b!rden that this '!ts on the health care system$ With the increasing 'ro'ortion o# elderly in &alaysia and im'rovement in li#e e-'ectancy, care #or the elderly /ill have to be 'rovided by ad!lt children /ho /o!ld 'robably be in their #i#ties and si-ties Q /ho are either entering or already in the aged gro!' 3Nor Aini 19924$ 0his ca!ses strain on caregivers /ho might have health 'roblems o# their o/n and yet have to care #or the elderly /ho are li(ely to s!##er #rom chronic illnesses$ While the demand #or health and medical 'rod!cts and services /ill be increasing, the costs o# obtaining care are also rising$
.ealth 7tat!s o# 0he 8lderly in &alaysia ?ased on sel#"assessment, ma,ority o# the elderly #elt that they /ere healthy /ith a higher 'ercentage o# the !rban elderly com'ared to r!ral elderly e-'ressed the same 3<hen
et al$ 1986, <hin 1996, 0an et al$ 19994$ A higher 'ro'ortion o# males rated their health as “very good or “good com'ared to the #emales 3<hen and :ones 19894$ <ommon health 'roblems /ere eyesight 'roblem /ith /omen over 2+ years being the /orst a##ected, evidence o# cataracts, di##ic!lty che/ing, and some need dental 'rosthesis 3<hen et al$ 1986, <hen and :ones 1989, 0an et al$ 19994$ 8yesight 'roblems /ere more serio!s among the elderly com'ared /ith hearing 'roblems$ Altho!gh there /ere no changes in hearing"abilities among /omen /ith increasing age, there /as mar(ed decrease /ith age in the 'ercentage o# men /ho indicated they co!ld hear /ell$ According to 0an et al$ 319994, abo!t 50> o# the elderly 'eo'le indicted that they have s'eci#ic health 'roblems, /ith a higher 'ercentage o# /omen com'ared to men indicated so$ .igh blood 'ress!re seemed to be the most common 'roblem a##ecting them$ Again, more o# the #emales /ere a##ected com'ared to males$ While rhe!matism /as a 'roblem #or /omen, it hardly a##ected the males$ :oint 'roblems also seem to a##ect the #emales more than the males 3<hin 19964$ A higher 'ro'ortion o# the old"old /ere a##ected com'ared to the yo!ng old$
Acti$ities o" Daily 9i$ing :AD9s; 1n the /hole, a high 'ercentage o# the elderly co!ld do all the activities o# daily living 3A;@s4 30able 104$ A higher 'ro'ortion o# male old"old 32+ years or more4 com'ared to #emales co!ld do so 3<hen et al$ 19864$ 7imilarly, in a se'arate st!dy 3<hin 19964 o# a semi" r!ral district, it /as #o!nd that 80 'er cent o# men bet/een 6+"25 and 65 'er cent o# men over 2+ co!ld do all the A;@s$ *or the #emales, the 'ercentage /as 21 'er cent and 68 'er cent, res'ectively$ 0he ability to 'er#orm A;@s deteriorated /ith age$ *or those /ho co!ld not 'er#orm all the A;@s, the main di##ic!lty enco!ntered /ere /al(ing and go sho''ing, an activity that is related to the ability to /al($ “Fetting inLo!t o# bed /as a 'roblem only to the old"old gro!', more so #or the #emales than males$ &ales had better 'hysical health com'ared to the #emales, more so at the older age gro!'s o# more than 20 years$
0able 10C N!mber and 9ercentage o# 8lderly Who are Unable to 9er#orm Activities o# ;aily @iving, by Age and 7e-
0y'e o# activity 0ravel beyond
60"25 N3>4 +314
N!mber and 'ercentage in each age gro!' &ale *emale 0otal 0otal 2+J &ale 60"25 2+J *emale N3>4 N3>4 N3>4 N3>4 N3>4 +3+4 10324 5314 2324 11324
0otal &ale R *emale N3>4 21324
/al(ing distance Fo sho''ing .andle o/n money 8at ;ress sel# 0a(e care o# a''earance Wal( Fet inLo!t o# bed 0a(e bath Fet to toilet on time 7am'le si)e
11364 8324 130$64 130$64 130$64 2314 0304 130$64 12364 696
1+364 +3+4 1314 +3+4 6364 1314 1314 5354 8394 96
263+4 16364 230$54 6314 5314 630$64 130$24 +314 20354 589
15364 2324 1304 0304 0304 130$24 0304 0304 9324 511
193194 113114 2324 2324 2324 5354 6364 6364 9394 101
66364 18354 630$64 230$54 230$54 +314 630$64 630$64 18354 +12
+9364 61364 +30$+4 830$84 630$64 830$84 530$54 830$84 68354 1001
7o!rceC <hen et al 319864, .ealth and Ageing in &alaysia, '$ 20
&ental .ealth Using cognitive score, the elderly aged 2+ years and over 'er#ormed /orst in res'ect o# mental health 3<hen et al$ 19864$ %n terms o# gender, cognitive score #or elderly men /ere higher than that #or /omen 30able 114$ 0hey re'orted being /orried"tense, having lost interest, #eeling tired, being #orget#!l and 'aranoid$ %n the cognitive assessment o# the elderly, the 'ro'ortion o# elderly /ho managed a normal score decreased /ith age, and /omen a''eared to be more cognitively im'aired than men 3<hin 19964$ <ontrolling the e##ect o# age, this cognitive score /as signi#icantly correlated to A;@s, regardless o# gender 3<hin 19964$ <ognitive #!nction is related to other socio"economic variables$ 0hose /ho have inadeG!ate income /ere more li(ely than those /ho /ere stable economically to re'ort slee' di##ic!lties, loss o# enth!siasm in li#e and /ere more li(ely to have a cognitive score o# less than 11 o!t o# 15 3<hen et al$ 19864$
Ta-l" ++: Num-"% an# P"%c"ntag" o El#"%ly 0/o /a$" M"ntal P%o-l"m!( -y Ag" an# S"B
0y'e o# 'roblems
60"25 N3>4
N!mber and 'ercentage in each age gro!' &ale *emale 0otal 0otal 2+J &ale 60"25 2+J *emale N3>4 N3>4 N3>4 N3>4 N3>4
0otal &ale R *emale N3>4
7lee' di##ic!lties Worried"tense @ost interest ;e'ressed *eels tired *orget#!l .ears things 7ees things 9aranoid 7am'le si)e
1103284 +93+4 1083224 16364 1663514 +023+24 6324 8324 2324 696
6633694 183194 693524 +3+4 523+14 +63+24 6364 2324 6364 96
1563604 223164 1523604 18354 2103564 2+83+64 9324 10324 10324 589
1+03664 11+3284 1193294 8324 2093+14 2593614 6314 6314 11364 511
503504 623624 513514 1314 +63++4 693694 +3+4 +3+4 1314 101
1903624 1523294 1603614 9324 26+3++4 6183624 11324 11324 12324 +12
6663664 2253224 6023614 22364 52+3524 +263+84 20324 21324 22324 1001
7o!rceC <hen et al 319864, .ealth and Ageing in &alaysia, '$22
As'ects o# 7ocial .ealth As'ects o# social health incl!ded areC 'erce'tion o# environment, activity 'artici'ation and /ay o# li#e$ Almost all o# the elderly, males and #emales, rated their home environment as #air, good or e-cellent e-ce't #or a small 'ercentage that did not #eel sa#e in their homes 3<hen et al$ 19864$ 0an et al$ 319994 #o!nd that the ma,ority o# the older 'eo'le /ere staying /ith s'o!se or children, indicating that s!''ort are available to them be it emotional, social or #inancial$ 1nly a marginal 'ercentage e-'ressed that they did not have anyone to 'rovide care /hen they /ere ill, /hereas the ma,ority had someone to care #or them, s'o!se, or children$ 0he elderly /ere still able to care #or their grandchildren 3<hen et al$ 19864$ 7lightly more than hal# o# them hel'ed to ma(e #amily decisions, /ith the males 'laying a greater role com'ared to #emales$
Acti$ity +articipation an! <ay o" 9i"e *or the 'artici'ation in comm!nity activities, some si-ty 'er cent o# the elderly indicated that they are interested /ith a higher 'ro'ortion o# males com'ared to #emales indicated so 30an et al$ 19994$ 0he &alays a''ear to be more interested than the non"&alays$ 0he r!ral #ol(s are more interested than the !rban d/ellers$ .o/ever, the 'ercentage that act!ally did so is rather lo/$ Abo!t one G!arter o# the elderly /ere members o# social organi)ations$ 1!t o# this, ma,ority o# them did not 'artici'ate or 'artici'ated only occasionally$ 1nly 5 'er cent re'orted that they belonged to some gro!', meeting or society #or elderly or retired 'eo'le 3<hen et al$ 19864$ &ore o# the elderly 'artici'ated in 'rivate #!nctions s!ch as #amily #!nction$ %n both se-es, attendance declines /ith age, /ith the decline being more 'rono!nced #or /omen$ 0here /ere no r!ral !rban di##erences$ 7lightly more than 50 'er cent o# elderly men and almost 20 'er cent o# /omen re'orted that they smo(ed 3<hen et al$ 19864$ 1ne #i#th o# the elderly men and only 6 'er cent
o# /omen indicated that they smo(ed 1+ or more cigarettes 'er day$ ?!t many o# them /ere light smo(ers, b!rning only less than 1+ cigarettes a day$
Use o# .ealth 7ervices
1n the average, &alaysians= visit to the '!blic and 'rivate 'rimary care service sector is abo!t 2$6 visits 'er year$ 0he elderly made an average o# 6 visits 'er year 3<hin 19964$ Fovernment health service /ere the most 'o'!lar choice #or all age gro!'s regardless o# gender$ 7t!dies by <hen et al$ 319864 and 0an et al$ 319994 sho/ that less than +0 'er cent o# the elderly s!rveyed re'orted having #allen ill$ 1nly a negligible 'ercentage had been hos'itali)ed$ &ore #emales #ell ill com'ared to males across the age gro!'s$ Abo!t hal# o# them had ta(en 'rescribed medicine, /ith no age, se- or !rban"r!ral di##erences$ 7ome 're#erred to see( the hel' o# traditional medication, either &alay herbal medicine or <hinese herbal medicine #rom <hinese dr!g stores$ 7ome ,!st bo!ght over"the"co!nter 310<4 medicine, 'res!mably #or minor ailments that co!ld be treated /ith 10<$ 0he !se o# 10< is related 'ositively to #eelings o# ill health, /ith 'eo'le /ho re'orted that they did not #eel /ell to be 10"1+ 'er cent more li(ely to ta(e 10< than those /ho re'orted that they #elt healthy$ 0here is no di##erence in the 'erce'tion o# need #or more health aids in terms o# age and se-, b!t the r!ral residents are t/ice as li(ely as !rban residents to e-'ress their need #or more health services$ 0his co!ld be d!e to the r!ral"!rban di##erences in terms o# G!antity and ty'e o# #acilities #or health$
8-isting 9olicies and 9rograms #or .ealth <are
A revie/ o# e-isting 'olicies and 'rograms is to be 'receded /ith a revie/ o# the '!blic s!''ort #or health care in terms o# the total man'o/er available, #inancial allocation #or health services, and '!blic health #acility and coverage$ <!rrently, there is a dearth o# e-'ertise, only three geriatricians, three gerontologists and 2 'sycho"geriatricians to care #or the increasing n!mber o# elderly 30able 124$
,able 124 )vailable ,rained *anpower in 0ealth 2are for the /lderly
Cat"go%y Feriatricians Ferontologists 9sycho"geriatricians Behabilitation 9hysicians 9hysiothera'ists 1cc!'ational thera'ists 7'eech thera'ists <linical 9sychologists
Num-"% 6 6 2 + 260 120 15 10
7o!rceC *irst National 7ym'osi!m on Ferontology 199+, '$81 and intervie/ /ith 0he *amily .ealth ;ivision o# the &inistry o# .ealth$
%t is obvio!s that &alaysia still e-'eriences a shortage o# medical 'ersonnel, /here the ratio o# doctor to 'o'!lation /as 1C1,516 /ith a shortage o# abo!t 6,296 doctors 38ighth &alaysia 9lan, '$5894$ 0here is also a shortage o# dentist 3de#icit o# 1,2604 and 'harmacists 3de#icit o# 6104$ An im'ortant develo'ment in the care #or the elderly is in the establishment o# geriatric care in &alaysia$ 7ince the mid"90s, geriatric hos'itals and rehabilitation centers are o'en #or services to the elderly$ 0he 7eremban .os'ital is the only '!blic hos'ital that 'rovides geriatric care /hile another one in <heras has been granted a''roval d!ring the 7eventh 9lan 'eriod 38ighth &alaysia 9lan '$5824$ A'art #rom those available !nder government, the 'rivate hos'itals have also set !' geriatric serviceC the <heras Feriatric <enter in 9antai <heras .os'ital began o'eration since 1996, others incl!de <ol!mbia 9aci#ic Feriatric .os'ital in 7hah Alam, and 7trand Feriatric and Behabilitation <entre in 7!ngai 9etani, soon #ollo/ed$ %n terms o# allocation o# #inancial reso!rces, the act!al e-'endit!re #or 'atient care services /as less than the allocated amo!nt #or the 7i-th &alaysia 9lan 'eriod$ 7imilarly, e-'endit!re #or all categories o# '!blic health services /as less than the amo!nt o# allocation #or the 7i-th and 7eventh 9lan 'eriod$ Under the 8ighth &alaysia 9lan, a total s!m o# B&+$+ billion has been allocated o# /hich the ma,ority o# the allocation /ill go to/ards 'atient care services 8ighth &alaysia 9lan, '$5964$ An im'rovement /as made /ith regards to the '!blic health #acility and coverage in almost all areas$ %m'rovements in 'atient care services can be seen, in /hich the n!mber o# hos'itals has increased #rom 9+ in 1990 to 119 in 2000 38ighth &alaysia 9lan '$58+4$ Along /ith this, the n!mber o# ac!te beds has also increased to 25,280 in 2000 #rom 26,226 in 1990 38ighth &alaysia 9lan, '$58+4$
0he net/or( o# hos'itals and clinics in the co!ntry 'rovide medical and health care to all age gro!'s, incl!ding the elderly$ As 'art o# the caring society conce't, 'arents o# civil servants are given #ree medical services in government hos'itals$ Behabilitative services s!ch as 'hysiothera'y and occ!'ational thera'y are 'rovided to older 'eo'le as a s!''ort service$ .o/ever, this #acility is not available in the r!ral areas$ 0here are no s'ecial hos'ital, #acilities or /ards allocated #or elderly 'eo'le$ 0he only available s'ecial service to the elderly is the s'ecial co!nter created #or the elderly to receive medications$
*inancing #or .ealth <are
7ince cost o# health care is a ma,or concern #or individ!als, #amily and the government, it is im'erative to !nderstand the #inancial reso!rces available #or health care$ 0he signi#icance o# #inancing has been a''ro'riately ac(no/ledged in the 8ighth &alaysia 9lan 32001"200+4 as one o# the strategies #or health sector develo'mentC “develo'ing and instit!ting a healthcare #inancing scheme 3'$5914$ .o/ever, no details abo!t the strategy are available$ 7everal so!rces o# #inancing can be disting!ishedC allocation #rom the government, o!t"o#"'oc(et e-'enses, as a bene#it 'rovided by em'loyers 3'rivate sector4 and health ins!rance$ 1# these modes o# #inancing, those that are signi#icant #or the elderly areC allocation #rom the government, and o!t"o#"'oc(et e-'enses$ *or em'loyees in the '!blic sector, retired government servants can contin!e to en,oy medical bene#its at government clinics and hos'itals$ &edical ins!rance is a rather recent develo'ment in &alaysia and hence it is not a signi#icant so!rce o# #inancing$ &ore over, it a''eals to the !rban 'eo'le /ho have the ability to '!rchase$ Allocation #rom the government has been a #eat!re in the ann!al government b!dget and it is an im'ortant so!rce o# health care 'rovision$ 0able 16 sho/s the #ederal government o'erating e-'endit!re #or the health sector #or 199+ to 2000$ 1ver these years, altho!gh the 'ercentage o# o'erating e-'endit!re #or health to total o'erating e-'endit!re remained ro!ghly the same, allocation o# health e-'endit!re has increased #rom B& 2$5 billion to 5$0 billion$
Ta-l" +A: F"#"%al Go$"%nm"nt O'"%ating EB'"n#itu%" o% 1"alt/( +33= ? )***
Y"a% 199+
O'"%ating P"%c"ntag" o Total O'"%ating P"%c"ntag" o EB'"n#itu%" o% O'"%ating .ealth EB'"n#itu%" O'"%ating Social S"%$ic"! EB'"n#itu%" o% 4RM million6 4RM million6 EB'"n#itu%" 4RM million6 Social S"%$ic"! 2,685 66,+26 6$+ 12,151 19$6
1996 1992 1998 19991 2000
1 2
6,01+ 6,228 6,661 6,626 5,050
56,86+ 55,66+ 55,+8+ 56,699 +8,206
6$9 2$6 2$+ 2$8 6$9
15,825 1+,0+1 1+,062 16,612 12,896
20$6 21$8 22$1 21$8 22$6
estimated act!al latest estimate
2
7o!rceC 8conomic Be'ort 1998L99 Q 2000L01, &inistry o# *inance
A national s!rvey has been cond!cted on ho!sehold health e-'endit!re, ho/ever, it is most !n#ort!nate that data are 'rivy to the s'onsoring body and are not made available to the '!blic$ 0his lac( o# in#ormation #or health e-'endit!re is not !niG!e to &alaysia, as it has also been re'orted in many develo'ing co!ntries 3Ne/brander, <arrin and @e 0o!)a, 19954$ Fenerally, so!rces o# 'ayment #or health in &alaysia come #rom o!t"o#"'oc(et 'ayments /hile the least are #rom ins!rance 'ayments 30able 154$ *or those aged 60 and above, 2+ 'ercent o# the 'ayments /ere o!t"o#"'oc(et 'ayments /hile ins!rance did not constit!te a so!rce o# #inancing at all$ Ta-l" +<: Sou%c"! o Paym"nt o% 1"alt/ Ca%"( +33:
C/a%act"%i!tic! S"l 4out8o 8 PocE"t6 U%-anF%u%al Location Urban B!ral Age Fro!' 0"15 1+"+9 60J 62$2 66$5 62$2 60$6 2+$1
Sou%c"! o 'aym"nt 4@6 7el# J F%"" Em'loy"% In!u%anc" Donation Ot/"%
S"l D
Ot/"%
Sou%c"! Em'loy"% Em'loy"% Com-ination! D In!u%anc"
6$1 +$6 +$2 6$6 5$5
18$2 11$2 2$2 22$2 6$9
0$1 0$1 0$1 0$1 0$0
0$0 0$0 0$0 0$0 0$1
+$6 2$0 10$0 6$6 6$8
+$0 6$6 5$1 5$5 +$6
2$9 1$6 1$2 6$2 0$2
2$6 5$1 6$8 2$8 6$1
7o!rceC National .ealth and &orbidity 7!rvey 319964, Vol$ 6, '$26
.ealth <are 9rogram #or the 8lderly 199+
0he 'rogram, introd!ced in 199+, is aimed at im'roving and maintaining the health and #!nctional o!tcome o# the elderly /ith the !ltimate ob,ective o# 'romoting G!ality o# li#e as /ell as #orging 'rod!ctive ageing among the elderly$ Among the s'eci#ic ob,ectives are 3.alil 19964C D 0o im'rove the health o# the elderly to enable them to lead and en,oy #!ll and active li#e thro!gh 'romotive and 'reventive health careE D 0o establish Feriatric 7'ecialist 7ervices at the regional and state levels by year 2000E D 0o develo' a com'rehensive 'lan o# action on training and research needs in the care o# the elderlyE and D 0o 'rovide G!ality health care #or the elderly !sing comm!nity"based a''roaches to enable them to live as inde'endently as 'ossible /ithin the comm!nity$ Vario!s 'rimary and secondary com'onents o# health care to s!''ort the 'rovision o# care have been identi#ied and strategies #orm!lated to achieve the ob,ectives o# the 9rogram$ 0hey are as #ollo/sC 3i4 9romotive and 'reventive health care " in#ormation dissemination regarding the 'athologies and disabilities related to age$ 7creening 'rograms /ill be cond!cted reg!larly to chec( conditions o# vis!al and hearing im'airment, coronary artery diseases, breast cancer, oral cancer etc$ 9re"retirement co!rses /hich are related to health, #inancial sec!rity, vol!nteerism and !se o# leis!re time are also 'lanned #or 'eo'le, /ho are in demogra'hic transition in their li#e$ 3ii4 &edical and rehabilitative care Q strengthening o# care to the elderly at 'rimary, secondary and tertiary level$ Another strategy is to 'rovide holistic s'eciali)ed medical, 'sychological, social and rehabilitative geriatric services in selected state and district hos'itals !sing a m!ltidisci'linary team a''roach$ *rom the en#orcement 'ers'ective, the 9rivate .os'ital Act, 1921 and 9rivate .os'ital Beg!lations, 1926, /ill be en#orced so as to ens!re G!ality care to the elderly$ 3iii4 0raining and research Q to #orm!late and strengthen the e-isting c!rric!la on care o# the elderly #or basic, 'ost"basic and contin!ing medical ed!cation$ 0raining in s'eciali)ed areas relating to health care o# the elderly according to
'ro,ected man'o/er needs is also 'lanned$ %n addition, a #ocal 'oint #or coordinating research activities in medical and social as'ects o# the elderly /ill be established to ens!re coordinated research to/ards iss!es a##ecting the elderly$ 3iv4 9rogram 'lanning, monitoring, coordination and eval!ation Q As ro!tine data collection does not meet the in#ormation needs, actions sho!ld be directed to correct data ga's$ Action 'lan is in 'lace #or 'ro'er data collection in hos'itals and health centers in order to obtain more acc!rate in#ormation abo!t the elderly 'eo'le$ 7trategies incl!de setting !' a s'ecial Unit on .ealth <are #or the 8lderly in the *amily .ealth ;evelo'ment ;ivision o# the &inistry o# .ealth$ *rom the time this 'rogram /as initiated, some 'rogress has been made$ Among the activities carried o!t areC 3i4 A National 9lan o# Action on <omm!nity &ental .ealth 'rogram /as established in 1992 and some 'ilot 'ro,ects have been carried o!t in several health clinics in :ohor, &alacca, Negeri 7embilan, Aedah and 7abah$ 0raining /as cond!cted to !'grade the (no/ledge and s(ills o# health 'ersonnel$ 0he National &ental .ealth 9olicy /as a''roved in 1998 and +8 health clinics have been identi#ied to im'lement the 'rogram$ 7ome o# the activities carried o!t areC tal(s, #or!ms and e-hibitions on mental health, #ollo/"!' #or stable mental cases, early detection o# mental disorders, gro!' thera'y, home visits, co!nseling, rehabilitation, screening, setting !' o# day care center at health clinics and training #or health 'ersonnel, develo' and distrib!te ed!cation materials on as'ects o# mental health$ 3ii4 .ealthy li#estyle cam'aign aimed at 'reventing and controlling chronic diseases s!ch as diabetes mellit!s and cardiovasc!lar disease$ 3iii4 7etting !' o# s'ecial health clinics #or the diabetic and 'atients /ith hy'ertension /ithin the health clinics in r!ral areas$ 3iv4 Behabilitative 'rograms Q rehabilitative services s!ch as 'hysiothera'y and occ!'ational thera'y are 'rovided to older 'eo'le as a s!''ortive service to the medical care or in"'atient care in hos'itals$ .o/ever, these services are not available in the r!ral areas$ 3v4 .ealth center or comm!nity"based activities are cond!cted$ 0hey incl!deC home visits, health screening #or high ris( gro!'s, re#erral to geriatricians, co!nseling on e-ercise, n!trition, diabetics and social s!''ort needs, home mobility and rehabilitative #acilities, s'ecial care management s!ch as
incontinence, day care n!rsing, and comm!nity ed!cation on iss!es associated /ith health o# the elderly$ 3vi4 .os'ital"based activitiesC ac!te medical care, long"term care, 'sycho"geriatric care, thera'y, 'atient ed!cation, etc$ are initiated$ 3vii4 9lans #or 1992 to year 2000 incl!de t/o main servicesC hos'ital services and health centers or comm!nity health services, /hich are mainly delivered by the ;e'artment o# 7ocial Wel#are, NF1s, 'rivate and vol!ntary organi)ations$
%t is obvio!s that m!ch needs to be done #or the elderly in terms o# health care and the 'rograms initiated by the government are slo/ing evolving to/ard meeting the needs o# an emerging large gro!' o# v!lnerable 'eo'le Q the elderly$ <!rrently, health services #or the elderly are 'rovided as 'art o# the health care services in a non"s'eciali)ed and non" str!ct!red manner 3Nor Aini 19924, altho!gh indications 'oint to the more s'eci#ic care #or the elderly in the #!t!re$ <are #or the elderly comes !nder the *amily .ealth ;ivision, /hich is set !' to 'rovide health care to the /hole #amily o# all age gro!'s$ %t is im'ortant to dra/ attention to the !neven availability o# health care #or the elderly in the !rban areas as com'ared to the r!ral areas /here e-'ertise and #acilities are lac(ing$ .ealth and health"related services that are made available to the elderly in the !rban areas thro!gh 'rivate organi)ations are not available to the r!ral elderly 3/here '!rchasing 'o/er is lo/4$ .ence, in the r!ral areas, elderly 'eo'le are seen as o!t"'atients in health centers, /ith re#errals made to hos'itals #or cases /ith more serio!s health 'roblems$ While the geogra'hical divide in health care #or the elderly has to be eliminated, the income di##erential bet/een the /ealthy and the 'oor remains another obstacle in achieving accessibility #or all$ 8-actly ho/ the availability o# G!ality health care can be made accessible to all elderly remains a great challenge$
=, SOCIAL SERGICES AND COMMUNITY CARE
%n caring #or elderly 'eo'le, both the #amily and the comm!nity have long been 'erceived to be o# 'rimary im'ortance 3<ho/ 19924$ %n the case o# develo'ing co!ntries s!ch as &alaysia /here com'eting needs are varied and sometimes more !rgent than the lesser 'riority iss!e o# the elderly, #amily and comm!nity care seem to be the most viable alternative than the /el#are state a''roach$ %n addition the dee'ly rooted Asian c!lt!re that stresses the im'ortance o# #ilial 'iety dictates that care by #amily becomes an a!tomatic old age sec!rity$ .o/ever, the erosion o# the e-tended #amily system, decrease n!mber o# available #emale
members o# the #amily d!e to the increase in #emale labor #orce 'artici'ation, and the smaller #amily si)e have created greater 'ress!re on #amily as care givers$ 0his develo'ment has some/hat served as a catalyst #or the develo'ment o# instit!tional care$ As instit!tional care is only accessible to those /ho can a##ord 3in the case o# 'rivate n!rsing homes4, mostly available only in the !rban areas, and the arg!ment #or the elderly to remain /ith the comm!nity herald the emergence o# comm!nity care #or the elderly in the #ast ind!striali)ing society o# &alaysia$ Admission to '!blic old 'ersons= homes !nder the &inistry o# 7ocial Wel#are is the last resort and it is 'rovided to elderly /ho have no heirs and no o/n shelter, or to those /ho are destit!te$ ?et/een those /ho have the means to '!rchase services and those /ho have limited #inancial reso!rces, there e-ists a need ga' by those /ho cannot be classi#ied into either o# these t/o e-tremes$ 0his 'art o# the re'ort disc!sses '!blic sector involvement in 'roviding social services to the elderly$ Bole and activities o# NF1s and #amily /ill be covered in 9art %% o# the Be'ort, !nder long"term care$
Social <el"are Ser$ices
Under the 7ocial Wel#are ;e'artment, services to the elderly are divided into t/o broad ty'esE e-ternal services and instit!tional services, aimed at 'roviding services to the 'oor elderly$ 0he ty'es o# aid given can be classi#ied as #inancial aidE materials aid incl!ding items s!ch as cane and s'ectacles$ %nstit!tional care re#ers to shelter care in old 'eo'le=s home 3-umah Seri =enangan4$ %nstit!tional services are 'rovided #or n!rsing and shelter to those /ho are 'oor and /ho do not have (in to 'rovide care$ 0here are eleven 3t/o in 8ast &alaysia4 old 'eo'le=s homes in the co!ntry administered by the #ederal government$ 0hese homes o##er the #ollo/ing servicesC n!rsing and shelter, co!nseling and g!idance, occ!'ational rehabilitation, devotion #acilities, recreational activities, and medical treatment$ *or the age gro!' o# 60 and above, the n!mber o# occ!'ants has increased #rom 865 to 1,052, re'resenting an increase o# 21$2 'ercent #or the 'eriod o# 199+ Q 1999 30able 1+4$
Ta-l" +=: Num-"% o 3umah 5eri 6enan an Occu'ant! -y Ag"( +33= ? +333
Age Fro!' 18 Q 60 60 Q 50
+33= 68 152
+33: 26 91
+33; 16 86
+33> 18 90
+333 19 68
50 Q +0 +0 Q 60 :* ? ;* ;* ? >* a-o$" >* 0otal
222 569 <>: ):* ++> 1,82+
262 522 =A+ )3< +A* 1,226
256 699 =)< A:> +); 1,266
2+1 688 =)= A:3 +)A 1,265
2+8 680 =A: <** +++ 1,222
NoteC 0he B!mah 7eri Aenangan also ho!ses other gro!'s o# inmates s!ch as the ,!venile, ab!sed cases o# /omen and girls, etc$ 7o!rceC 0he Wel#are 7tatistics ?!lletin 3199+ Q 19994, 8-ternal 7ervices, ;e'artment o# 7ocial Wel#are
%n the r!ral areas, h!ts or >pon!o)? assistance is given to elderly 'eo'le #or b!ilding ne/ h!ts or re'air old ones so that the elderly can contin!e to stay /ithin the comm!nity instead o# having to be admitted to old 'eo'le=s home$ 0here are abo!t 60 h!ts, ho!sing abo!t 600 residents, !nder the &alaysian Wel#are <entres <o!ncil$ Fovernment allocates #inancial aid to more than 2 million elderly 'eo'le, #rom 199+ to 1999 30able 164$ A total o# B&11 million /as allocated to the elderly in 1999$ ?esides 'roviding #inancial aid to the elderly, the elderly also receives aid in terms o# s'ectacles$ .o/ever, over the 'eriod 199+ to 1999, the n!mber o# aid reci'ients has declined #rom 2+8 to 2++ 366 'ercent4$ Ta-l" +:: EB'"n#itu%" an# Num-"% o Financial Ai# R"ci'i"nt! o% t/" El#"%ly un#"% Go$"%nm"nt Allocation( +33= ? +333
Y"a%
Num-"% o El#"%ly Ai# R"ci'i"nt!
EB'"n#itu%" 4RM6 8,692,660 8,558,160 2,898,625 2,159,000 11,050,555
Num-"% o El#"%ly Ai# R"ci'i"nt! o% S'"ctacl"! 2+8 269 +91 506 2++
EB'"n#itu%" 4RM6 12,605 +2,11+ 62,609 25,09+ 20,922
199+ 1996 1992 1998 1999
10,059 10,529 11,296 11,156 16,906
7o!rceC 0he Wel#are 7tatistics ?!lletin 3199+ Q 19994
8-ternal 7ervices, ;e'artment o# 7ocial Wel#are
Beg!lations on <are #or the 8lderly
0he <are <enter Act 1996 sets o!t g!idelines and minim!m standards 3#or e-am'le, s'ace and n!mber o# sta## reG!ired #or a certain n!mber o# 'atients4 #or elder care centers in the co!ntry that 'rovide basic care, /itho!t medical services$ 0hose that 'rovide medical treatment and #acilities, li(e geriatric hos'itals, are governed by the more stringent reg!lations o# the 9rivate .os'ital Act 1921$ Altho!gh small n!rsing homes do 'rovide some #orm o# medical services, they 're#er to register /ith the 7ocial Wel#are ;e'artment as a care center beca!se the reG!irements are easier to meet$ 0he 9rivate .ealthcare *acilities and 7ervices Act 1998 /as 'assed by the 9arliament b!t has yet to be en#orced$ 0his Act contains g!idelines and reg!lation s'eci#ically #or n!rsing homes, /hich /ill '!t in 'lace reg!lations that are essential to 'rotect the /el#are o# the elderly$ 0his /ill event!ally bring more consistency in the G!ality o# service$
.o!sing 9ro,ects #or the 8lderly
0he idea o# com#ortable retirement homes or retirement comm!nities li(e those #o!nd in the West is at its embryonic stage in &alaysia$ %n the mid"1990s, a ho!sing develo'er 'lanned to mar(et its a'artment as a high"end retirement condomini!m #or the elderly, com'lete /ith a''ro'riate #acilities$ .o/ever, the mar(et /as not ready to acce't the conce't$ Another attractive model is that o# grad!ated retirement comm!nity, or assisted care villages$ Besidents can choose to move into an a'artment or a little villa o# their o/n, /here they can live inde'endently b!t /ith easy access to the amenities in the “village $ As their needs increase /ith age, they can begin to 'ay #or more and more services, s!ch as cleaning, meals and n!rsing$ 0his is totally ne/ to &alaysia and the mar(et has yet to be tested$ A revie/ o# the 'olicies o# the &inistry o# .o!sing and @ocal Fovernment reveals that there is c!rrently no s'eci#ic 'rovision to meet the ho!sing needs o# the elderly 3<heah, 199+4$ 0he recent emergence o# n!rsing homes had ca!sed 'roblems and con#!sion #rom the @ocal A!thorities$ 0he @ocal A!thority loo(ed !'on setting !' s!ch homes #or the care o# the
elderly as “b!siness and there#ore had to be carried o!t in designated commercial 'ro'erties$ With the rela-ation o# the r!le in the early 1990s, residential 'ro'erties are 'ermitted to o'erate as homes #or the elderly$ .o/ever, the validity o# their licenses is on a year"to"year basis /ith the condition that the neighbors do not com'lain$ 0he !ncertainty associated /ith licensing a##ects the G!ality o# home and care #or the elderly in that o'erators o# these homes are not /illing to commit investment on !'grading #acilities, ,!st in case that the licenses are revo(ed$
2ommunity 2are 0he role o# comm!nity care and NF1s /ill not be covered in detail in this re'ort$ 1ver the years, comm!nity care has e-'anded both in sco'e and scale$ <omm!nity care is im'ortant, as the ob,ective o# the government is to allo/ the elderly to live as normal a li#e as 'ossible in their o/n homes or in a homely environment in the local comm!nity$ 0he conce't o# the “h!ts or pon!o) /or(s /ell in the r!ral areas since a /indo/ o# o''ort!nity is o'ened to the elderly #or integration into society, th!s overcoming the 'roblem o# de'ression or loneliness that are so common among the elderly$ At this moment, the #amily remains the main caregiver$ %n order to ens!re contin!o!s #amily s!''ort and to enable the #amily to discharge their tas(s more e##ectively, the role o# comm!nity services can hel' to strengthen #amily care$ *riends and neighbors can be im'ortant too in the case o# comm!nity care, altho!gh services as in the case o# long"term care sho!ld not be e-'ected$
:, IMPLICATIONS OF AGEING AND FUTURE DIRECTION
8conomic develo'ment, higher ed!cational attainment, advancement in the medical #ield, accessibility to medical care and (no/ledge abo!t n!trition have s!ccess#!lly '!t more years into li#e, /hile the 'resent and the #!t!re challenges /ill be '!tting G!ality into the e-tra years$ %n tandem /ith all these changes, the e-'ectations o# the 'eo'le /ill also be changing$ 0he #!t!re cohort o# the elderly /ill e-hibit di##erent e-'ectations and needs$ 0hey /ill be more discerning in terms o# their demand #or goods and services$ *or &alaysia, co'ing /ith 'o'!lation ageing can be a great challenge, as there are many com'eting iss!es that a''ear to deserve more !rgent attention than the iss!e o# im'roving the /ell"being o# the elderly$ 0he recently released 8ight &alaysia 9lan, 2001"200+, has no mention abo!t the elderly$ 0his indicates that ageing has yet to become a 'riority area$ Altho!gh &alaysia still has time on its
side, the 'henomenon o# ageing m!st be vie/ed in the right 'ers'ectives that it deserves d!e to the many m!lti'le and com'le- im'lications$ Ageing is both a health and a social"economic iss!e$ 0he im'ortance o# this interrelationshi' #or the elderly is most #!ndamental to the /ell"being o# the elderly$ 0o lead an inde'endent li#e and be able to 'artici'ate in 'rod!ctive ageing, the elderly need some basic s(ills #or day to day living that incl!de the ability to !nderta(e social activities, and 'er#orm domestic and 'ersonal tas(s 3Aro(iasamy 19924$ 0here#ore, the #oc!s o# 'olicies and 'rograms #or the elderly sho!ld ta(e into consideration the relationshi' o# health and socio" economic state$ %m'lications o# Ageing Social Security %n &alaysia, the social sec!rity covers only em'loyees in the #ormal sector$ 9ension scheme 'rovides coverage to civil servants /hile the 89* gives 'rotection to 'rivate sector em'loyees$ 0he 'ercentage o# total em'loyed 'ersons covered by these t/o schemes is 61$8 'er cent leaving the remaining 68$2 'er cent /itho!t (no/n so!rce o# coverage 3@abor *orce 7!rvey Be'ort, 19984$ Altho!gh the government has initiated vol!ntary contrib!tion in 1922 to enco!rage those in the in#ormal sector to contrib!te to 89*, the 'ercentage o# sel#"em'loyed that o'ted #or this vol!ntary contrib!tion /as negligible$ 1# the 2$29 million o# sel#"em'loyed, only 26,602 have registered /ith 89* in 1998 3A!mar 19994$ As this /or(s on a vol!ntary contrib!tion basis, the ta(e"!' rate largely de'ends on #irstly, the a/areness abo!t the im'ortance o# saving #or old age, the #inancial reG!irements o# individ!als, alternative !se o# #inancial reso!rces, as /ell as the availability o# other income so!rces$ 0/o ma,or obstacles that need to be overcome /hen introd!cing social sec!rity in the in#ormal sector areC e-'anding coverage to ma,ority in the in#ormal sector, in 'artic!lar those /hose income are seasonal 3#armers and #ishermen4, and monitoring com'liance among these contrib!tors$ %ncome per se is only 'art o# the eG!ation in 'rotection$ 0he other im'ortant iss!e is adeG!acy$ *or 89*, the re'lacement rate o# slightly more than +0> is considered adeG!ate$ Altho!gh the re'lacement rate o# slightly more than +0> #or 89* is considered adeG!ate, the G!estion remains as to ho/ the l!m' s!m /ithdra/al can be best investedLsaved till the end o# li#e$ .ere, the government has introd!ced the ann!ity scheme #or 89* members, b!t the s!ccess or the lac( o# it can only be assessed in the #!t!re$
Health an! Health ,inancing
%n &alaysia, A National .ealth #or the 8lderly <o!ncil /as established !nder the &inistry o# .ealth in 1992, /hich acts as the main body #or monitoring 'olicies 'ertaining to health o# the elderly$ 0he *amily .ealth ;evelo'ment ;ivision in the 9!blic .ealth ;e'artment o# the &inistry o# .ealth serves as the secretariat o# the <o!ncil$ %n the 9lan o# Action #or .ealth o# the 8lderly as enshrined in the National 9olicy #or the 8lderly, health #acilities #or the o'tim!m care areC D 7trengthening coordination and collaboration bet/een government and non" government agencies incl!ding 'rivate sectors in 'roviding health servicesE D D D D 9lanning and 'roviding 'romotive, c!rative and rehabilitative servicesE 9roviding a''ro'riate 'hysical, man'o/er and #inancial #acilities #or the 'rogramE 8nco!rage comm!nity involvement in the care and rehabilitation o# the elderlyE and 8nco!rage training and research$
Altho!gh there e-ists a 'lan o# action on health care #or the elderly, the delivery o# care remains integrated in the broader system o# 'rovision o# health thro!gh 'rimary care, secondary and tertiary services$ 0here is no s'ecial hos'ital #or the elderly altho!gh there e-ists 'ositive develo'ment to/ard the 'rovision o# s'eci#ic health care, as in geriatric care, #or the elderly, both by the '!blic and 'rivate sector$ Feriatric care 'rovided by the '!blic sector is at the nascent stage in /hich it is available in the 7eremban .os'ital, /ith another in the develo'ment 'rocess$ 0he 'lan is to introd!ce geriatric care in all district hos'itals by year 2020$ .ealth #inancing remains a great challenge /ith rising needs and costs relating to health care$ 1!t"o#"'oc(et is the main mode o# #inancing$ 0he 8ighth &alaysia 9lan 32001" 200+4 has '!t in 'lace a strategy #or a health care #inancing scheme, b!t details are as yet to be made available$
<oncl!sion and *!t!re ;irection
0he National 9olicy #or the 8lderly 199+ and the National 8lderly .ealth <o!ncil established in 1992 re'resent milestones in &alaysia in 'roviding care and services to the elderly$ 0he t/o ministries that are res'onsible #or services to the elderly are the &inistry o# National Unity and 7ocial ;evelo'ment thro!gh the ;e'artment o# Wel#are 7ervices, and the &inistry o# .ealth$ 0he National 9olicy 'rovides the broad #rame/or( #or the develo'ment o#
care and services to the elderly$ 8G!ally im'ortant is the delivery mechanism that m!st ta(e into acco!nt geogra'hical se'aration, and the varying needs o# di##ering gro!'s s!ch as /omen /ho are 'artic!larly v!lnerable and the old"old /ho have more needs com'ared to the yo!ng old /ho are li(ely to be more inde'endent$ Notable 'rogress has been made over the years as is evident in the develo'ment o# care #or the elderly$ &alaysia /as classi#ied together /ith the Be'!blic o# Aorea and F!am, as co!ntries that have more recent initiatives in the develo'ment o# health services 3W.1, 19984$ %t is ho'ed that &alaysia /ill soon advance into a co!ntry that has an established system o# care #or the elderly, not only in terms o# health, b!t also in other areas that a##ect the overall G!ality o# li#e o# the elderly$ %n attem'ting to 'redict the #!t!re direction #or the elderly in &alaysia, it is essential to begin /ith the so!rces or determinants and im'rovements to the G!ality o# li#e #or the elderly$ While searching #or innovative /ays to 'rovide care #or the elderly, the 'otential o# elderly 'eo'le in develo'ment sho!ld not be ignored$ 0he conce't o# 'rod!ctive ageing, /ith health 'romotion and maintenance as the most #!ndamental #actor, sho!ld be em'hasi)ed$ .ealthy ageing enables the 'artici'ation o# the elderly in the develo'ment o# the nation and as a reso!rce to #amily and comm!nity$ 7!ggestions #or im'rovements in areas that co!ld bring abo!t greater /ell"being o# the elderly are as #ollo/sC D <ens!s"ty'e in#ormation /ill have to be gathered to #acilitate the #orm!lation and im'lementation o# 'olicies and 'rograms$ %t is ho'ed that the research s!b"committee o# the Action 9lan #or the National 9olicy on the 8lderly /ill be able to #ill the data ga's$ D <ontin!o!s monitoring o# activities as g!ided by the National 9olicy #or the 8lderly 2 A monitoring system is essential in ens!ring G!ality o# service to the elderly and #or contin!o!s im'rovements in services and care$ D Fovernment intervention at the macro level " 9otential loss o# 'rod!ctivity and higher social costs are associated /ith ageing, b!t many 'oints o# intervention can mitigate these costs 3:oaG!in"Kasay 19964$ 0hese incl!de ad,!stments on the age o# retirement, training and e##ective em'loyment o# older /omen, better ed!cation and training #or yo!ng 'eo'le, and a''ro'riate 'olicies #or reg!lating migration and tem'orary #oreign labor$ 7ome o# these interventions are already in e-istence in &alaysia$ ?etter ed!cation and training #or yo!ng 'eo'le and the a''roach to #oreign labor 'oint to some o# the interventions that have been carried o!t$ 0he government has recently anno!nced the ne/ retirement age, /hich is no/ at +6 years instead o#
the ++ years 'revio!sly$ 0he challenges remain #or the elderly /omen, /ho are less ed!cated, less #inancially inde'endent and are e-'osed to greater health ris($ %nterim meas!res can be ta(en to 'rovide 'rotection to this v!lnerable gro!', as the #!t!re cohort o# elderly /omen can be very di##erent$ 0hey are better ed!cated and en,oy better em'loyment o''ort!nities com'ared to their 'redecessors$ D 7ocial sec!rity Q 0a(ing into acco!nt the economic str!ct!re and the develo'ment in &alaysia, a single a''roach, /hether de#ined bene#its or de#ined contrib!tion, to social sec!rity /ill not be #easible as it /ill not 'rovide coverage to all sectors o# the 'o'!lation$ A combination o# a''roaches is highly essential as it can enhance stability$ 0he in#ormal sector remains a great challenge$ D Access to com'rehensive health care Q these services sho!ld be aimed at minimi)ing the e##ects o# diseases and sho!ld 'romote the achievement o# 'ersonal health 'otential$ .ealth 'romotion and 'reventive care sho!ld be em'hasi)ed$ %n addition, the !neven accessibility o# health care services in the !rban and r!ral areas needs !rgent attention$ D 0raining o# man'o/er in the health sector " it is 'artic!larly im'ortant i# better care is to reach a larger n!mber o# elderly$ 0here are vario!s ty'es o# training 'rogramsC 'ost"basic geriatric n!rsing, in"service training #or 'rimary health care sta##, and in" service training #or carers, /ho are medical assistants and n!rses$ %t is im'ortant to introd!ce geriatric medicine and other gerontology disci'lines in the training o# medical 'ersonnel$ %t is envisaged that training to carers sho!ld incl!de 'artici'ants #rom other agencies and NF1s$ D .ealth <are *inancing Q the cost o# health care can be a ma,or barrier to accessibility o# care$ As s!ch, ens!ring an adeG!ate system o# health #inancing is a ma,or decision$ A national a''roach to develo'ment o# 'olicies #or health #inancing, health ins!rance and medical, 'harmace!tical and health care service 'ayment is essential 3W.1 19984$ 0he strategy o# introd!cing a health care #inancing scheme seems to 'oint to/ard the right direction #or &alaysia 38ighth &alaysia 9lan, 20014$ Whatever a''roach or a''roaches that the national 'olicy is modeled, the basic 'rinci'le sho!ld be that no one is denied basic health care$ D 8d!cation and retraining #or the elderly Q develo'ing 'rograms to retrain the elderly can hel' to reali)e the 'rinci'les o# inde'endence, 'artici'ation and sel#"#!l#illment, /hich are in consonance /ith the Vienna=s World Assembly on Ageing, 1982$ 8d!cation to 're'are the elderly to #ace the challenges o# ageing can be introd!ced as a 're"retirement co!rse$ Betraining sho!ld be introd!ced to 'romote 'rod!ctive ageing$
D
%nnovative em'loyment o''ort!nities #or the elderly " in order to 'romote 'rod!ctivity among the elderly, it is 'robably bene#icial to society and the elderly themselves i# innovative /ays o# em'loyment can be initiated$ Altho!gh 'rotecting em'loyment and /el#are o# the old is im'ortant, generating /or( o''ort!nities #or the yo!ng is eG!ally, i# not more im'ortant$ 0h!s, a #le-ible /age str!ct!re may be considered to allo/ the old to contin!e /or(ing, a#ter the mandatory retirement age$ Alternatively, the old can be rede'loyed in other areas o# /or( that reG!ire less 'hysical strength and less mentally demanding, s!ch as, as care givers$ A 'ilot may be necessary$ 9erha's the yo!ng"old can begin to o##er their services to the old"old, or even to yo!ng children, /hether /ith re/ard or other/ise, so that they can “#ree /or(ing age ad!lts to concentrate on their ,obs$ %n this /ay, altho!gh their contrib!tion is indirect, it hel's to instill sense o# /orth and #!l#illment among the elderly$ .o/ever, the G!estion o# mobili)ing them remains$
D
.o!sing and to/n 'lanning Q in antici'ating the gro/th o# an ageing 'o'!lation, 'lanning #or to/nshi' sho!ld ta(e into acco!nt the #acilities #or the elderly$ %n line /ith the advocacy #or the elderly to remain in the comm!nity, in#rastr!ct!re #or the mobility o# the elderly is im'ortant and sho!ld be incor'orated into to/n 'lanning$
D
Avoid d!'lication o# services Q 1'timi)ing the !tili)ation o# scarce reso!rces is cr!cial, /hile leaving ga's o# needs !n#!l#illed can be a barrier to better G!ality o# li#e #or the elderly$ %n order to avoid d!'lication and “!nder"delivery o# services, 'erha's a ne/ ministry is necessary in order to #orm!late 'olicies that /ill o'timi)e the 'rovision o# care and 'rotection to the elderly instead o# s!b"o'timi)ing di##erent #!nctions and activities$
%n concl!sion, a com'rehensive 'olicy #or 'romoting the /ell"being o# the elderly, that ta(es into consideration health, social sec!rity, ho!sing, environment that incl!des the #amily and comm!nity, sho!ld be in 'lace$ &alaysia is #ort!nate in a /ay as it has time to 're'are itsel# #or the challenges o# ageing 'o'!lation$
R" "%"nc"!
Andre/s, F$B$, 8sterman, A$:$, ?ra!nac("&ayer, A$:$ and B!ngie, <$&$ Aging in the <estern +aci"ic, &anilaC World .ealth 1rgani)ation, Begional 1##ice #or the Western 9aci#ic$
Andre/s, F$B$ 319924 “Besearch ;irections in the BegionC 9ast, 9resent and *!t!re in ;$B$ 9hilli's 3eds4 Ageing in East an! South East Asia5 -esearch Stu!ies in Gerontology5 @ondonC .odder and 7to!ghton$
Aro(iasamy$ :$0$ 319924 “Ageing in &alaysia and %ts 9roblems in Ageing +eople in *ransition5 9a'er 'resented in %nternational 7ym'osi!m on a <om'arative 7t!dy o# 0hree <ases in AsiaC Aorea, 0ai/an and :a'an, Advanced Besearch <entre #or .!man 7ciences, Waseda University 1992$
Aro(iasamy$ :$0$ 319924 “7ocial 9roblems and <are o# the 8lderly , Me!ical @ournal Malaysia, Vol +2, No 6, 7e't 1992$
Aro(iasamy, :$0$ and 0eoh, :$7$0$ 319924 Stu!ies Concerning the El!erly in Malaysia: An ine&hausti$e5 <om'ilation o# 9!blished 7t!dies on the <are o# the 8lderly in &alaysia !' to ;ecember 1992$ 0he <learing .o!se 9ro,ect, ;e'artment o# 7ocial and 9reventive &edicine, University o# &alaya &edical <entre, A!ala @!m'!r$
A/ang, .$7$ 319924 “<!rrent 9rogramme %m'lementation and 8val!ation in 9roceedings o# the National 7eminar on <hallenges o# 7enior <iti)ens 0o/ards Vision 2020, 1 1ctober 1992, A!ala @!m'!r$
?engston, V$, Bosenthal, <$ and ?!rton, @$ 319904 “*amilies and AgeingC ;iversity and .eterogeneity in B$ ?instoc( and @$ Feorge 3eds4 Han!boo) o" Aging an! the Social Sciences, @ondonC Academic 9ress, ''$ 266"82$
?o/ling, A$ 319914 Measuring Health: A -e$ie( o" Auality o" 9i"e Measurement Scales , ?!c(inghamC 1'en University 9ress$
?!tler, B$N$ and Fleason, .$9$ 3198+4 +ro!ucti$e Aging, Ne/ Kor(C 7'ringer 9!blishing <om'any$
<han, A$8$ 319964 “;emogra'hic and 7ocio"economic @in(ages in &alaysiaC 0he <ase o# ;emogra'hic Ageing in *irst 7ym'osi!m on Ferontology 199+C %ss!es and <hallenges o# Ageing &!ltidisci'linary 9ers'ectivesC 9roceedings 3199+4, Ferontology Association o# &alaysia, A!ala @!m'!r$
<heah, &$ 3199+4 “.ealth <are #or the Aged Q <ritical %ss!es and Ne/ 1''ort!nities in Betirement and N!rsing .omes $ 9a'er 'resented at the National <on#erence on the 9rivate .ealthcare %nd!stryC 7ha'ing the *!t!re o# &alaysian .ealthcare 0o/ards the 21st <ent!ry, &arch 199+, 9etaling :aya$
<hen, <$K$9$, Andre/s, F$B$, :ose#, B$, <han, A$8$ and Aro(iasamy, :$0$ 319864 Health an! Ageing in Malaysia, A 7t!dy 7'onsored by the World .ealth 1rgani)ation$ *ac!lty o# &edicine, University o# &alaya$ A!ala @!m'!r$
<hen, A$:$ and :ones, F$ 319894 Ageing in ASEAB 'ts Socio-Economic ConseCuences , %nstit!te o# 7o!theast Asian 7t!dies, %nter"<o!ntry Be'ort o# the A78AN Ageing Be'ort, 7inga'ore$
<hia, K$<$ 319964 “9rimary <are in the 8lderly in *irst 7ym'osi!m on Ferontology 199+C %ss!es and <hallenges o# Ageing &!ltidisci'linary 9ers'ectivesC 9roceedings 3199+4, Ferontology Association o# &alaysia, A!ala @!m'!r$
<ho/, N$ 319924 “ .ong AongC <omm!nity <are #or 8lderly 9eo'le in ;$B$ 9hilli's 3eds4 Ageing in East an! South East Asia5 -esearch Stu!ies in Gerontology5 @ondonC .odder and 7to!ghton$
<lar(, B$@$ and 7'engler, :$:$ 319804 *he Economics o" 'n!i$i!ual an! +opulation Aging , <ambridgeC <ambridge University 9ress$
<legg, :$ 319214 Dictionary o" Social Ser$ices, @ondonC ?ed#ord 7G!are 9ress$
;e'artment o# 7ocial Wel#are 3199+ Q 19994 Annual Statistical #ulletin, 199+E 1996E 1992E 1998E 1999$ 8-ternal 7ervices ;ivision, National 9rinting ;e'artment, A!ala @!m'!r$
;e'artment o# 7ocial Wel#are, Vario!s broch!res$
;e'artment o# 7tatistics 319984 Senior Citizens an! +opulation Ageing in Malaysia , 9o'!lation <ens!s &onogra'h 7eries, No$5, National 9rinting ;e'artment, A!ala @!m'!r$
0he 8dge 31999 Q 20004 +ersonal Money, Vario!s %ss!es$
0he 8dge 320014 “Folden 1ldies in Sur$ey an! Gui!e5 *ebr!ary 19, 2001$
0he 8dge 320014 “7elling to the 7ilver"haired , in Sur$ey an! Gui!e5 *ebr!ary 19, 2001$
31999 EmployeesD +ro$i!ent ,un! :.///; Annual -eport7
8m'loyees= 9rovident *!nd Website 3htt'CLL///$(/s'$gov$my4$
Fovernment o# &alaysia 319924 Bational Health an! Morbi!ity Sur$ey '' .//8 , &inistry o# .ealth, National 9rinting ;e'artment, A!ala @!m'!r$
Fovernment o# &alaysia 31998 Q 19994 9abour ,orce Sur$ey -eport, ;e'artment o# 7tatistics, National 9rinting ;e'artment, A!ala @!m'!r$
Fovernment o# &alaysia 319994, Bational Senior Citizens +olicy Action +lan ./// , ;e'artment o# 7ocial Wel#are, &inistry o# National Unity and 7ocial ;evelo'ment, National 9rinting ;e'artment, A!ala @!m'!r$
Fovernment o# &alaysia 319964 Se$enth Malaysia +lan .//8 2 3444, National 9rinting ;e'artment, A!ala @!m'!r$
.ashimoto, A$ 319924 “Ageing in :a'an in ;$B$ 9hilli's 3eds4 Ageing in East an! South East Asia5 -esearch Stu!ies in Gerontology5 @ondonC .odder and 7to!ghton$
319994 Human De$elopment -eport, United Nations ;evelo'ment 9rogramme 3UN;94, Ne/ Kor(C 1-#ord University 9ress$
%nternational *ederation o# Ageing 319994 %*A &ontreal ;eclarationC 5 th Flobal <on#erence 3htt'CLL///$i#a"#iv$orgLmen!1$htm4$
%nternational @abo!r 1rgani)ation 319924 8arly and 9artial Betirement in 8!ro'e and the United 7tates$ ?rie#ing Noted #or the 7enate 7'ecial <ommittee on Ageing :!ly 2+ 1992 Washington ;$<$
Aarim, .$A$ 319924 “0he 8lderly in &alaysiaC ;emogra'hic 0rends , Me!ical @ournal o" Malaysia5 Vol +2, No 6, 7e't 1992, ''$206"212$
Aing, 7$ 319964 “Bole and *!nctions o# Non"Fovernmental 1rgani)ationsC 9rovision o# <omm!nity"?ased 7ervices #or the 8lderlyE 8nhancing National <a'acity in 'mplications o" AsiaDs +opulation ,uture "or l!er +eople in the ,amily $ Be'ort and selected bac(gro!nd 'a'ers #rom the 8-'ert Fro!' &eeting on the %m'lications o# Asia=s 9o'!lation *!t!re #or *amily and the 8lderly, 2+ Q 28 November 1996, Ne/ Kor(C United Nations 9!blications$
:alal, .$ 319964 “*!t!re 7trategies in .ealth <are #or the 8lderly in &alaysia in *irst 7ym'osi!m on Ferontology 199+C %ss!es and <hallenges o# Ageing &!ltidisci'linary 9ers'ectivesC 9roceedings 3199+4, Ferontology Association o# &alaysia, A!ala @!m'!r$
:ohnson, 9$ and *al(ingham, :$ 319924 Ageing an! Economic <el"are, @ondonC 7age 9!blications$
:oaG!in"Kasay, <$ 319964 “<reating A/areness o# the %ss!es and 9roblems o# the 8lderly Among 9lanners and 9olicy &a(ers in 'mplications o" AsiaDs +opulation ,uture "or l!er +eople in the ,amily $ Be'ort and selected bac(gro!nd 'a'ers #rom the 8-'ert Fro!' &eeting on the %m'lications o# Asia=s 9o'!lation *!t!re #or *amily and the 8lderly, 2+ Q 28 November 1996, Ne/ Kor(C United Nations 9!blications$
Aart, F$7$ 319924 *he -ealities o" Aging: An 'ntro!uction to Gerontology , +th ed$ NeedhamC Allyn and ?acon$
A!mar, B$V$ 319924 “0he Bole o# 8m'loyees 9rovident *!nd 389*4 in *inancing 1ld Age in &alaysia in 9roceedings 1996 <elebrationsC National ;ay #or the 8lderly, 12 Q 22 1ctober 1996, A!ala @!m'!r$
A!mar, B$V$ 319994 “1ld Age *inancial 7ec!rity #or the 7el#"8m'loyed $ 9a'er 'resented at the seminar “*inancial 7ec!rity in 1ld Age , 9 R 10 1ctober 1999, 9etaling :aya$
Avale, :$N$ 319964 “.ealth <are as an 8-'ression o# <!lt!re in *irst 7ym'osi!m on Ferontology 199+C %ss!es and <hallenges o# Ageing &!ltidisci'linary 9ers'ectivesC 9roceedings 3199+4, Ferontology Association o# &alaysia, A!ala @!m'!r$
&a,lis 9!sat Aeba,i(an 7emenan,!ng &alaysia 3&9A7&4 Vario!s Becords$
&ehta, A$ 319924 “7ocial 7ec!rity and 8conomic Well"being o# 1lder 9ersons in A78ANC 0he 7inga'ore 7cenario in 9roceedings 1996 <elebrationsC National ;ay #or the 8lderly, 12 Q 22 1ctober 1996, A!ala @!m'!r$
&inistry o# *inance 3199+4 Economic -eport .//E1/8, A!ala @!m'!rC National 9rinting ;e'artment$
&inistry o# *inance 319964 Economic -eport .//81/F, A!ala @!m'!rC National 9rinting ;e'artment$
&inistry o# *inance 319924 Economic -eport .//F1/0, A!ala @!m'!rC National 9rinting ;e'artment$
&inistry o# *inance 319984 Economic -eport .//01//, A!ala @!m'!rC National 9rinting ;e'artment$
&inistry o# *inance 319994 Economic -eport .///144, A!ala @!m'!rC National 9rinting ;e'artment$
&inistry o# *inance 320004 Economic -eport 344414.5 A!ala @!m'!rC National 9rinting ;e'artment$
&inistry o# .ealth 320004 Vario!s broch!res$
&oroney, B$ 319264 *he ,amily an! State, @ondonC @ongman$
&!r'hy, 8$ 319864 “7ocial *actors in @ate @i#e ;e'ression in 8$ &!r'hy, 3ed$4 A""ecti$e Disor!ers in the El!erly, @ondonC <h!rcill @ivingstone, ''$ 29"96$
Ne/ 7traits 0imes 9ress, 2 :!ly 2000, '$16$
Nor Aini 319964 “.ealth <are o# the 8lderly in &alaysia in 9roceedings 1996 <elebrationsC National ;ay #or the 8lderly, 12 Q 22 1ctober 1996, A!ala @!m'!r$
1ga/a, N$, 0s!ya, N$1, Wongsith, &$ and <hoe, 8 319954 “.ealth 7tat!s o# the 8lderly and their @abor *o!rce 9artici'ation in ;evelo'ing <o!ntries along the Asia"9aci#ic Bim , NU9B% Be'rint 7eries No$ +1, &arch 1995, #rom Human -esources in De$elopment along the Asia-+aci"ic -im 319964, ''$ 659 Q 622$
1ga/a, N$ 319954 “<hanging Needs #or 9!blic 7!''ort to *amilies <aring #or the 8lderly in Ageing an! the ,amily, Ne/ Kor(C United Nations 9!blications$
7idell, &$ 3199+4 Health in University 9ress$
l! Age: Myth5 Mystery an! Management , ?!c(inghamC 1'en
Star1Metro 61 :an!ary 2001, '$6$
7!shama, 9$<$ 319924 “.ealth and Wel#are 7ervices #or 8lderly 9eo'le in &alaysia in ;$B$ 9hilli's 3eds4 Ageing in East an! South East Asia5 -esearch Stu!ies in Gerontology5 @ondonC .odder and 7to!ghton$
Sun!ay Star1Sun!ay +lus 15 :an!ary 2001, '$8$
0an, 9$<$ 319954 “*amily <hanges and the 8lderly in Asia in *he Ageing o" Ageing o" Asian +opulations, 9roceedings o# the United Nations Bo!nd 0able on the Ageing o# Asian 9o'!lations, ?ang(o(, 5 Q 6 &ay 1992, Ne/ Kor(C United Nations 9!blication$
0an, 9$<$, Ng, 7$0$, 0ey, N$9 and .alimah, A$ 319994 E$aluating +rogramme Bee!s o" +ersons in Malaysia$ A!ala @!m'!rC *ac!lty o# 8conomics and Administration, University o# &alaya$
l!er
0ey, N$9$ 319924 “7ocial 8G!ityC 9olicies and 9rogrammes A##ecting 1lder 9eo'le in &alaysia $ 9a'er 'resented at the 22nd *ederation o# A78AN 8conomic Associations 3*A8A4 <on#erence “7o!theast Asian ?eyond 2000C .!man ;imension , A!ala @!m'!r$
0in(er, A$ 319964, @td$
l!er +eople in Mo!ern Society, 5th ed$, @ondonC Addison Wesley @ongman
0o!t, A$ 319894 Ageing in De$eloping Countries, Ne/ Kor(C 1-#ord University 9ress #or .el'Age %nternational$
U$7$ ;e'artment o# <ommerce, 8conomic and 7tatistics Administration, ?!rea! o# <ens!s, ;ecember 1996 3htt'CLL///Li#a"#iv$orgLmen!2Sdemogra'hie Lmen!2S ageingSang$htm4$
United Nations 319964 Stu!ies on ConseCuence o" +opulation Change: Malaysia , Asian 9o'!lation 7t!dies 7eries No, 118, 8conomic and 7ocial <ommission #or Asia and the 9aci#ic, United Nations 9!blications$
United Nations 319954 *he Ageing o" Asian +opulations, Ne/ Kor(C United Nations 9!blications$
United Nations 319964, +opulation Ageing an! De$elopment $ Be'ort o# the Begional 7eminar on 9o'!lation Ageing and ;evelo'ment, ?ang(o(, 11 Q 15 ;ecember 199+, U7AC United Nations 9!blication$
Wenger, F$<$ 319954 Gn!erstan!ing Support Bet(or)s an! Community Care , AldershotC Attenae!m 9ress @td$
Williams, 8$%$ 319964 “<are o# 1lder 9eo'le in the <omm!nity in *irst 7ym'osi!m on Ferontology 199+C %ss!es and <hallenges o# Ageing &!ltidisci'linary 9ers'ectivesC 9roceedings 3199+4, Ferontology Association o# &alaysia, A!ala @!m'!r$
World ?an( 9olicy Besearch Be'ort 319954 A$erting the l! Age Crisis: +olicies to +rotect the l! an! +romote Gro(th, Ne/ Kor(C 1-#ord University 9ress$
World .ealth 1rgani)ation 319984, Gui!elines "or Bational +olicies an! +rogramme De$elopment "or Health o" l!er +ersons on the <estern +aci"ic -egion , FenevaC 1##ice o# 9!blications World .ealth 1rgani)ation$
A''endi- A )"tivities and .ro rams for the -ational 5enior 2iti7ens .oli"y )"tion .lan
0he 7ocial Wel#are ;e'artment o# &alaysia established a National 7enior <iti)ens 9olicy 0echnical <ommittee in :!ly 1996$ 0he 0echnical <ommittee has then #ormed si- s!b" committees to ens!re that the action 'lan is e##ective, integrated and com'rehensive to reali)e the aims o# the National 7enior <iti)ens 9olicy$ 0he activities and 'rograms listed belo/ are already in o'eration and #!t!re 'lans have been made to #!rther im'rove the #acilities 'rovided #or the elderly$ 7ome o# the 'rograms are ne/ly introd!ced s!ch as the 7enior <iti)ens= ;ay 319924 and the 7enior <iti)ens= <om'laint <enter 319994$ 0he #ollo/ing table o!tlines the activities and 'rograms o# the si- s!b"committees$
Su-8committ"" A$ 7ocial and Becreation
Acti$iti"!F'%og%am! 1$ 7enior <iti)ens= ;ay
O-."cti$"! <reate general a/areness to the '!blic on the role o# senior citi)ens in the #amily, comm!nity and co!ntry$ 8nco!rage comm!nities to instill the s'irit o# care and res'ect to/ards the elderly$
2$
Visits to %nstit!tions
6$
7enior <iti)ens= <om'laint 0oll"#ree line #acility allo/ing <entre senior citi)ens to com'lain iss!es to res'ective agencies$ <o!nter services and 7'ecial 7eats Available at government agencies, '!blic trans'ort stations, recreational 'ar(s and sho''ing com'le-es$ 8ns!re trans'ortation is more a##ordable to the elderly i$e$ +0> disco!nt #or air travel by &A7, Air Asia, 9elangi Air and ?er,aya AirE 50> disco!nt #or ++ years and above and +0> #or 6+ years and above by A0&?$ 8ns!re elderly and disabled can travel in com#ort$
5$
+$
*are concession
6$ 2$
7'ecial seats in '!blic trans'ort
<reative Betirement <entres9rovide com#ortable homes and #acilities to the elderly, either
alone or /ith s'o!se$
8$
7'orts *acilities
8stablish s'orts #acilities to 'romote health, as /ell as enable senior citi)ens to interact among themselves$ <arry o!t activities that are interesting and bene#icial to senior citi)ens thro!gh recreational cl!bs$
9$
Becreational <l!bs
10$
7ocial <entres
8nco!rage c!lt!ral, s'irit!al and recreational activities among the elderly #or rela-ation and interaction '!r'oses$ 8ns!re senior citi)ens receive basic necessities inde'endently besides assistance #rom other #amily members or local comm!nities$ 0rain the elderly to be inde'endent so that caregivers can rest$ 9rovide assistance and moral s!''ort to senior citi)ens d!ring times /hen caregivers are o!t /or(ing$ 0o enco!rage vol!ntary organi)ations to 'rovide assistance to elderly living alone or /ith #amily e$g$ meal"on" /heels, res'ite care, etc$ 0a- relie# and ta- rebate #or e-'endit!re on elderly and disabled 'arents :ob 'lacements are arranged #or the elderly sho!ld they be interested in s!itable vacancies$
11$
7enior <iti)ens 7!''ort 7cheme
12$
0em'orary <are <entres
16$
;ay <entre #or 7enior <iti)ens
15$
.ome .el' 7ervices
1+$
*amily %ncentive 7cheme
16$
:ob o''ort!nities
12$
8m'loyers= incentive scheme8nco!rage em'loyers to e-tend
services o# their elderly /or(ers and to create #le-ible /or( sched!les #or them$ 18$ 7enior <iti)ens= ;irectory <om'ilation o# senior citi)ens /ho have the 'otential to contrib!te their services to society$ 7enior <iti)ens= involvement 8nco!rage 'artici'ation o# senior citi)ens in vario!s 'rograms incl!ding social /or( and to 'rovide o''ort!nities to allo/ them to !tili)e their e-'ertise$ 9rimary 7ocial Wel#are ?rigade Activities 8nco!rage 'artici'ation o# senior citi)ens to the needy$
19$
20$
21$ 22$ 26$
7!''ort to NF1s U'grade H!ality o# <are
*acilitate NF1s by assisting in social /or($ 9rovide G!ality #acilities to the homes #or the elderly$
%m'rove H!ality o# 7ervices 9rovide training, establish r!les in %nstit!tions and reg!lations and amenities to ens!re the com#ort o# the elderly in homes$ 25$ 7ocial 7ec!rity 7ystem 0o create a system o# social sec!rity to ens!re senior citi)ens receive stable incomes #or retirement$ ?$ .ealth 1$ .ealth 8d!cation <reate a/areness regarding roles o# elderly in #amilies, society and co!ntry$ 8ns!re senior citi)ens have access to medical and o'eration #acilities /hen reG!ired$ 8ns!re senior citi)ens have access to eG!i'ment s!ch as ortho'edic eG!i'ment, hearing aids, s'ectacles, dent!res, etc$ 8-'and home n!rsing services and training #or the #amily to ta(e care o# the elderly$ %ntrod!ce a com'rehensive health care service to the elderly in the co!ntry in stages /ith the
2$
&edical and 1'eration *acilities 7el#"aid eG!i'ment
6$
5$
*amily %ncentive 7cheme
+$
<om'rehensive .ealth 7ervices
co"o'eration o# government agencies, non"government agencies and 'rivate agencies$ 6$ .ealthy @i#estyle 9ractice 0rain senior citi)ens to ado't a healthy li#estyle and to ta(e care o# themselves$
2$
7'eciali)ed <aring 7ystem <reate s'eciali)ed care centers in .os'itals and <omm!nities by increasing n!mber o# government and 'rivate clinics$ 7!##icient #acilities 1+6 home care n!rsing #acilities are available in r!ral areas #or elderly$ ?y 2020, it is e-'ected that district hos'itals /ill be able to 'rovide geriatric services$
8$
9$
7ta## training
0raining health care sta##, g!ardians and /or(ers in instit!tionsLcomm!nities to handle the elderly #or health '!r'oses$
10$
8nco!rage .ealthy @i#estyle 8nco!rage elderly to ado't a healthy li#estyle thro!gh #or!ms and doc!mentaries$ Ferontology and Feriatric 8d!cation 0o e-'and ed!cation in gerontology and geriatric$ .ealth &inistry o##ers short co!rses, 'ost"grad!ate co!rses, basic and 'ost"basic training to sta##$ &inistry o# .ealth, in collaboration /ith the ;e'artment o# 7ocial Wel#are is to ens!re a balanced health care system #or the elderly$ 8-tend health care services to r!ral areas thro!gh additional training #or sta## /ho are c!rrently based at the district level$ Available in all hos'itals and government clinics$ Feriatric services have been
11$
12$
9rimary .ealth <are
16$
B!ral .ealth 7ervices
15$ 1+$
;ental 7ervices Feriatric 7ervices in
.os'itals
integrated in all hos'itals to senior citi)ens /ho reG!ire s'ecial treatment$ <!rrently, this service is available in the 7eremban hos'ital b!t there are #!t!re 'lans to e-'and geriatric services at district hos'itals$
16$
9harmacies
8ns!re medicines, chemicals and other items reG!ired by the elderly are !sed in a correct manner$
12$
“<entre o# 8-cellence &odel8-tend this model co!ntry"/ide to ens!re all senior citi)ens receive necessary medical services and treatment$ 8n#orcement o# 9rivate .os'itals Act 1921 8ns!re G!ality service and care #or elderly in instit!tions$
18$
19$
Bight to ty'e o# medical treatment
Allo/ senior citi)ens to give their o'inion and agreement to ty'e o# treatment they receive and a''ro'riate care given to them$ 0his is an ethical medical 'ractice$ 8nco!rage the sa#e !se o# traditional or alternative medicine$ 8nco!rage 'rivate clinics in assisting the elderly by charging them a minimal s!m o# 'ayment #or treatment$ %ntrod!ce the role and 'roblems o# ageing thro!gh %slamic ed!cation, moral ed!cation in schools at all levels$ <reate a/areness to comm!nity es'ecially to yo!nger generation on roles and res'onsibilities o#
20$
7a#e traditional medication
21$
&inimal medical 'ayment
<$
8d!cation, Beligion and 0raining
1$
Feneral A/areness 8d!cation
2$
*amily 8d!cation 9rogramme
senior citi)ens$ 6$ 7enior <iti)ens= 8d!cation <reate a/areness abo!t the role o# the elderly in the #amily, comm!nity and co!ntry #rom the 'ers'ective o# religion$ %nstill #eelings o# care, love and res'ect to/ards the elderly$ An ed!cation system in school to ens!re the yo!nger generation is bro!ght !' /ith certain living s(ills$ %m'rove and increase s(ills so that retirees can be 'laced into s!itable ne/ ,obs$ 9re'are /or(ers to/ards retirement or 'ost"retirement /or(, and to ens!re that they are able to ada't to a change in their li#estyle as retirees$ 9re'are elderly #or religio!s '!r'oses in times o# sic(ness and death$
5$ +$
9ro,ects at %nstit!tions @iving 7(ills 9rogramme
6$
Vocational 0raining
2$
9re"retirement co!rses
8$
?asic necessities
9$
7enior <iti)ens= Bights
8ns!re that needy senior citi)ens receive /hat they deserve #airly$ 8ns!re that senior citi)ens /ith ed!cational bac(gro!nd can contrib!te to/ards ed!cating others$ 1''ort!nities to all incl!ding elderly to im'rove their (no/ledge in res'ective #ields$
10$
&aintaining A Becord o# Betirees #rom the 8d!cation 7ervices ;istance learning 'rogram
11$
12$
1''ort!nities to retirees #rom A''oint e-'erienced teachers as ed!cation services advisors or cons!ltants in comm!nity /or( es'ecially in social 'roblems$ 1''ort!nities to serve Allo/ senior citi)ens to contin!e serving the comm!nity by e-tending their /or( services$ 9rovide amenities s!ch as li#ts, ram's, )ebra"crossings, non" s'eed )ones and lo/er side/al( 'avements to accommodate senior citi)ens$
16$
;$
.o!sing
1$
U'grade 9!blic amenities
2$
.ome #acilities
.o!sing 'ro,ects are enco!raged to b!ild bathrooms on the gro!nd #loor o# do!ble" storey home, and 'ole gri' to allo/ easy access o# elderly in the home$ 8nco!rage the 'rivate sector to 'rovide #acilities to the elderly by renting o!t lo/ cost ho!ses or #lats located on gro!nd #loors, at lo/er rates$
6$
<ollaboration /ith the 'rivate sector
5$
1ld *ol(s= .omes s'onsored by 'rivate sector and NF1s 7enior <iti)ens= Activity <enter
8nco!rage 'rivate sector and NF1s to b!ild homes #or the elderly thro!gh grants, advice and s!''ort$ @ocal a!thorities are reG!ired to have #acilities #or the elderly s!ch as activity centers and ho!sing schemes$
+$
6$
F!idelines #or b!yerLtenant ;istrict government de'artments and other related agencies are reG!ired to ta(e into acco!nt the 'resence o# disabled and elderly as the basis #or allocating '!blic lo/"cost ho!sing !nits$ 7election o# b!yerLtenant #or 9rivate ho!sing develo'ers are 'rivate ho!sing develo'ers reG!ested to give 'riority to the aged and disabled in the ho!sing 'ro,ects$ .o!se str!ct!re .o!sing develo'ers are enco!raged to ta(e into acco!nt the needs o# the elderly or disabled in 'lanning the str!ct!re o# ho!ses$ *!t!re ho!se 'lans sho!ld incor'orate arrangements #or the elderly or disabled$ 8n#orce la/s in relation to the needs o# the disabled to ens!re that ne/ b!ildings ma(e 'rovisions to allo/ access #or the disabled$ 8ns!re #acilities 'rovided by ho!sing develo'ers allo/ easy access and 'rovide com#ort o# the elderly$
2$
8$
9$
*!t!re ho!sing #acilities
10$
8n#orcement o# la/s
11$
8n#orce r!les and reg!lations
12$
%ntegrated ho!sing 'ro,ects 8nco!rage ho!sing develo'ers to incor'orate ho!sing #or the elderly and their children in the same location$ ;ata reso!rce center #or the 0o create a database o# the elderly elderly in stages$ ?ibliogra'hy o# elderly Ferontology Association o# &alaysia is to 're'are a bibliogra'hy o# research and re'orts #or the elderly$ Besearch #indings are not #!lly !tili)edLanaly)ed to bene#it the elderly$ Analysis is carried o!t to 'oint o!t iss!es relating to senior citi)ens$ %ncl!des research in retirement, retraining o# retirees, #inancial as'ects o# the elderly, health stat!s o# the elderly, etc$
8$
Besearch
1$ 2$
6$
Analysis o# research #indings
5$
Besearch areas that are given 'riority
*$
9!blicity and 9romotions
0his s!b"committee is still in the <reate a/areness o# the needs 'rocess o# '!blici)ing 'rograms #or o# the senior citi)ens the elderly$
0he main agencies involved in these activities and 'rograms areC D D D D D &inistry o# .ealth &inistry o# National Unity and 7ocial ;evelo'ment &inistry o# 8d!cation ;e'artment o# 7ocial Wel#are ;e'artment o# National Unity
