- 2 days ago
- #considerthis
Living longer does not always mean living well. The latest National Health and Morbidity Survey paints a sobering picture of ageing in Malaysia: More than 85% of older persons are not ageing healthily, with many living with chronic diseases, dementia, and depression. How prepared are we, as a society, to invest in ageing healthily? On this episode of #ConsiderThis Melisa Idris speaks with Professor Dr Tan Maw Pin, Head of the Geriatric Medicine Division, Department of Medicine, UM, and President, Dementia Alliance of Malaysia.
Category
🗞
NewsTranscript
00:10Hello and good evening. I'm Melissa Idris. Welcome to Consider This. This is the show
00:15where we want you to consider and then reconsider what you know of the news of the day.
00:19Living longer does not always mean living well. According to the latest National Health
00:24and Mobility Survey, it paints a sobering picture of what ageing in Malaysia is like.
00:30More than 85% of older persons are not ageing healthily, with many living with chronic diseases,
00:38dementia and depression. Malaysia is expected to become an ageing nation in 10 years, but how
00:44prepared are we to invest in ageing healthily? Joining me on the show to discuss this further,
00:50I have Professor Tan Mopin, who is head of the Geriatric Medicine Division at UM's Faculty
00:58of Medicine. She's also the President of the Dementia Alliance of Malaysia. Welcome to the
01:04show, Professor Tan. Thank you so much for joining me today. I appreciate your time. I'm going to
01:08begin with the National Health and Mobility Survey findings on older persons' health first. And
01:16less than 15% of older Malaysians ageing healthily. Yes. As a geriatrician, I'm wondering how that
01:24figure, what that figure means to you. Is that a concerning figure or is it simply the fact that
01:30we're now detecting a worsening reflection, sorry, worsening health amongst Malaysians? It's not
01:37worsening. It's actually better. It's better. Okay, tell me more. So we do know that Malaysians,
01:42when we evaluated Malaysians aged 60 years and over in 2018, the first National Health and
01:48Mobility Survey for older adults, what we found was that the disability rates were quite high.
01:55But basically what we're seeing is actually a drastic reduction in disability rates in our
01:59older Malaysians. Oh, wow. But so this healthy ageing thing is across the board, you know, because
02:06we have for the longest time been associated with, associating ageing with ill health and disability.
02:13And so people become more and more sedentary as they get older. But sedentary behaviour has reduced
02:19with the National Health and Mobility Survey. So we have got very positive things. And you mentioned
02:23depression, that has also gone down. But what is alarming is the rate of depression is creeping
02:28up a bit. So 8.5% was a was a figure we had in 2018. But it's now 10%.
02:35Okay, so are you encouraged by
02:37these numbers? What explains for this improvement? Okay, so we of course, it's a mixed feeling. It's
02:43okay. Because you know that things can get better, which is very positive. And we know that the things
02:48have got better because of the interventions we have actually put in. So we know that that older
02:53people have now are now striving to be more independent as they go older. Yeah, so for
02:58instance, only one in five older adults are now functionally dependent. So they need help with
03:04activities of daily living, which is much, much better than what it was before. And we also have
03:09mental health interventions that's been put in, particularly over the last few years, no longer
03:15such a stigma to seek help. So depression rates have gone down. But what's alarming is the diabetes
03:20rate, the hypertension rate, the high cholesterol rate, that's gone up. And that has also pushed
03:27we think the rates of dementia up as well, because those are risk factors for developing dementia.
03:33Okay, well, let's talk about the chronic disease burden and the comorbidities, right?
03:39Yes, that's right.
03:40Talk to me about the scale and the implications. So if I'm just going to read some of the figures
03:43here, 73% of seniors have hypertension, 76% have high cholesterol and 39% have diabetes.
03:53Why is comorbidity and multimorbidity such a serious concern? Because apparently, many seniors
03:59have at least two of these conditions, and some even have all three.
04:03Yes, that's right. So and it's basically something that you acquired not in late life, but in midlife,
04:09right, in your 40s, your 50s, and early 60s, even. So when you've got it when you're old doesn't
04:15mean that you didn't have it when you were in midlife. And so it's over the years that you've
04:19accumulated these conditions, and it's affected the brain function due to, you know, thickening
04:24of the arteries and also death of the brain cells. So brains have shrunken. And that has that actually
04:32leads to dementia. So we actually need to prevent people getting these diseases at midlife in order
04:38to prevent them getting dementia at late life.
04:41I didn't know that physical chronic illnesses leads to cognitive decline in later life.
04:48Yes, yes.
04:49I see.
04:49Yeah, well, you get strokes. So with strokes, high tablet pressure, high cholesterol, diabetes
04:55all lead to increased risk of strokes and heart attacks. But the other thing that we find
04:59is even Alzheimer's dementia is linked to these risk factors. So Alzheimer's dementia is a little
05:05bit different from, you know, dementia that you get from strokes, that one we call vascular
05:09dementia. And in Alzheimer's dementia, what you have is accumulation of this substance called
05:15amyloid in the brain. And this amyloid accumulates because of inflammation. And inflammation goes up
05:22when you have a lot of high blood pressure, high cholesterol, high diabetes, because that increases
05:29the, you know, free radicals in the brain and, you know, and that the inflammation leads to
05:35accumulation of amyloid in your brain.
05:37Okay. And you mentioned that these, these chronic disease, the prevalence of it begins
05:43in midlife.
05:44So how, how are we detect, how good are we Malaysians at detecting early? Are these conditions
05:52being controlled primarily at, at the primary care stage? Are we detecting it early in, earlier
05:59in life?
05:59We're getting better at it, but we're still not very good. So a lot of people with high
06:03blood pressure don't know they've got high blood pressure until the more advanced stages
06:07when they start getting the complications. Similarly with diabetes, because people don't normally
06:13go for regular screening, etc. In midlife, they wait until late life before, and they've
06:18already had it for some time. So, and then even when they have it, there is often, because
06:24the thing is that we, the best thing is prevention. So they need to change their lifestyle. So what,
06:29what, what we find is people, the society is not motivated in changing their lifestyle.
06:33And even when they have the condition, the motivation to keep it under control is lacking, because
06:39people can't see the link between these, these conditions and ill health, you know, because we, we
06:44seem to enjoy, you know, good food, what we see as good food, and that exercise is often considered a
06:50bad word, those sort of things, you know, we like to use our cars a lot. Yeah, so that these
06:55are basic
06:56lifestyle interventions that seem so easy, but so hard to achieve.
06:59Okay. I, I, I'm quite surprised that, um, so this is the, the observation that, um, many patients don't see
07:07the, the link between all these, um, chronic diseases with ill health. That's right. And then
07:15is it because it's not immediate? Well, they get heart attacks, right? In their 40s, their 50s,
07:19their 60s, and then we cure their heart attacks, isn't it? We treat their heart attacks, but then they
07:23live long enough then to develop dementia. Yeah. So I suppose one of the things is previously people with
07:29heart attacks might have died of the heart attacks, but now we have a way of actually
07:32maintaining their life and then they continue living until they get the dementia. And it's
07:37always a frustration of a lot of the doctors and family members that these people find it so difficult
07:41to change their lifestyle. Can we talk a little bit about dementia? So the dementia prevalence has
07:47risen from eight and a half percent in 2018 to 9.8 percent 2025. Um, how significant is this increase?
07:55Well, as a, um, as someone in this field, how do you track what the trends are and when does
08:01it raise
08:02red flags for you? Okay. It is slightly worrying, but of course, it's not a huge increase in one
08:07percent, one point something percent isn't the hugest increase, but we wanted it to go down,
08:11you know, like other things. Okay. It's in the wrong trajectory. Yeah. So because we know that
08:15dementia, uh, education is a strong risk factor for dementia, the strongest risk factor.
08:19And we do know that the educational level of our population is going up. So, um, uh, in many
08:25developed countries now, we are seeing the, the, the prevalence of dementia coming down when we
08:31adjust for age. Why? Because of the improved education. But in Malaysia, while education has
08:36gone up, so has all these chronic diseases. Um, so, um, and also of course the population who are the
08:43oldest older have also gone up and that seems to have offset the improvement in education. So that's a
08:49little bit upsetting. I can see the link. Um, higher education, maybe better life circumstances,
08:54economic status, and a better, I guess, affluence. So which leads to a lifestyle that may not be,
09:01may not be, maybe more indulgent lifestyle. Can you go back and talk to me a little bit about what
09:07you mean by education is, uh, the risk factor. So, um, so improve, better education means that your,
09:15your brain cells actually have more branches. So it has more resilience against actually getting
09:20dementia. But at the same time, people who are supposedly better educated are supposed to have
09:26healthier lifestyles. They make healthier life choices. So, um, but, uh, for some reason in a
09:32country, um, the increased economic wealth and the change in the dietary patterns has offset that
09:38benefit. Okay. So let's talk a little bit about that. Um, what are the, um, what's being missed
09:45here in terms of the early signs? Um, cause you talked about early, um, early detection is key.
09:52Can we talk a little bit about dementia and what it's like in Malaysia? What's the reality of this
09:57disease burden in Malaysia? What does it, how does it look like in a Malaysian context?
10:01Okay. So now we have 4 million, uh, adults aged 60 years and over. So 10% means 400,000
10:08people living
10:08with dementia. So now we only have about 80 geriatricians. So the number, we're less than
10:14100 dementia specialists. So dementia specialists tend to be, uh, geriatricians, some neurologists
10:20and also geriatric psychiatrists. For the whole country. For the whole country. So, um, in order
10:25to treat dementia, you actually need access to memory service, memory clinics. And that is really
10:31very, very limited. So our memory clinics now have very, very long waiting lists. Um, and people don't
10:38have access to early memory testing because, um, um, many of our doctors went through medical school
10:43where they never had any training or very, very limited training on dementia. And many of them don't
10:49know how to do memory testing, but even those who know how to do memory testing, you know, for instance,
10:54in health clinics and in GP clinics, they're too busy, it takes time and they're unable to devote
11:00this side of time to test memory so that we can actually detect dementia early. And then so people
11:06who are worried end up having to go on a very long waiting list just to wait for an appointment
11:10in a
11:11memory clinic. Okay. Can you tell me more about memory clinics? I've never been in one or have, um,
11:16seen one, uh, on TV or in a documentary. What does it entail? Okay. So when you come to memory
11:22clinic, what normally happens is someone will test your memory using a assessment tool. And that
11:27usually takes about 20 minutes. And then, so then you get a score, but they also look at your
11:32function, you know, whether you're able to do everything for yourself, et cetera. And then you see a
11:36doctor who takes a very detailed history on, you know, how long has your memory been a problem? What
11:40sort of things, how, how has it affected you, et cetera? You know, you're getting lost, going,
11:45wondering, waking up at night, not sleeping, um, you know, getting, uh, getting a bit moody at
11:50times. Those are the symptoms we tend to see with dementia. So we collect the symptoms, et cetera.
11:55And then based on the symptoms and the memory test, then we decide further on what, what
11:59investigations we need to do. So previously the investigations have been just to rule out what we
12:04call potentially reversible causes, such as thyroid problems, B12 deficiency, so vitamin deficiencies.
12:11Uh, and sometimes you might have an infection that affects your memory a bit and we treat the
12:16infection, it gets better. But then over the years we have evolved to the fact that we can
12:20actually treat, uh, diagnose dementia positively. So we now have scans, uh, MRI scans that we can see
12:27changes linked to dementia and also PET scans. Uh, we can also see changes linked to dementia there.
12:33And we also have lab tests, laboratory tests that actually should, um, we actually diagnose Alzheimer's
12:39disease, which is the most common cause of dementia. So, um, so we are, we've moving on, we've moved a
12:44lot
12:44forward. And then with all these tests, then the, the, um, we meet, uh, once a week, the, um, to
12:50actually
12:50what we call it, make a consensus diagnosis. So you need two experts to agree on a certain diagnosis.
12:56So then we decide, yes, have this, has this person got dementia? So you have to have objective evidence of
13:02memory loss with, um, you know, uh, lab tests as well as the, the scan, uh, showing, uh, evidence of,
13:10um, structural
13:11and also, uh, biochemical changes. And then you also then, um, need to have loss of function. Then that's
13:19dementia. And then which type of dementia is it is. Okay. Because there are different types of dementia and
13:24Alzheimer's being the most common type of dementia. Okay. Um, wow. So, so then what is the treatment? Is there
13:31a treatment for
13:31dementia? Okay. So this is very exciting times. So the, the so-called cure for dementia is basically
13:37arrived. Okay. So cure is an over, overstatement. We're looking at, we're talking about disease
13:43modification. So now we have a drug that can actually stop the progression of dementia or we slow down the
13:50progression of dementia. And it's actually arriving in Malaysian shores. And we've already started using
13:56it in some centers as a, you know, early, so we can have to have to get special license to
14:00bring it in,
14:00but it has started. Um, so, um, and, but we do have only very few people are eligible and, uh,
14:08and
14:08really need this treatment. But there are also other things we can do that cost a lot less, uh, that
14:14will actually halt the, the, the disease progression and also help people with dementia lead a better
14:20quality of life. So, so this, this disease modification drug is being adopted in other countries as well.
14:27So this is becoming standard, uh, dementia care practice. It's already available. And, uh, I think
14:32China is the country that's used the most because China has the most older people in the world. Right.
14:36And so China uses a lot now, but it's actually the, the first, the first, um, country that has actually
14:43really take, it has really taken off is of course, Japan. And also, um, it's used widely in the U
14:49.S.
14:49as well. And we expect that there will be a huge uptake as soon as it becomes available in Malaysia
14:55on a, um, you know, on a proper license basis. And, and is that the trajectory? Are we going to
15:00see
15:01this as part of the, this is only the beginning. This is only the beginning. So the current drug is
15:05expensive. And, uh, we have to be very strict because it can have very serious side effects.
15:10You know, so if you imagine cancer many years ago, initially the treatment, uh, uh, can have serious
15:16side effects, but now people don't even think of cancer as a, you know, uh, um, terminal illness
15:22anymore. It's a chronic disease. And so we're heading the same way, but in a much faster, much,
15:28in a much faster speed because we know what cancer was like and we can follow a lot of the
15:33example.
15:34So, so this will be the start. And there are a lot of what we call pipeline treatments that target
15:38more than just amyloid. So, cause you know, it's not just, not just amyloid we see in the brain of
15:42someone with dementia that we are hopefully going to be adding together. And dementia will also
15:48hopefully be a chronic disease that we can treat or cure. This must be such an exciting time to be
15:54in this field. And also scary because the question is whether Malaysia is ready to deliver this sort of
16:00treatment to people who need it. What do you mean? Tell me more. So memory clinics are not accessible.
16:05And currently, uh, our main problem is congestion. So, um, so because nobody else has had much training
16:13in treating people with dementia. So our memory clinic has very little space for new people to
16:18come in because it's full of patients who are home if we've been following up for years and years
16:22because people with dementia tend to live for a decade or so. So we've been following them up
16:27regularly and we have nowhere to send them to, to actually have less, um, you know, um, to have other
16:33kind of, to have attention, the medical attention because other healthcare professionals and GPs are
16:38not trained up. So we really need to accelerate this sort of process because, because the standard
16:44treatment for dementia, which involves drugs that control the symptoms, you know, lifestyle
16:48management, chronic disease management should actually be now the realm of the general practitioner
16:53because it's so well established. We can train them to do it so that we can free up memory clinic
16:57space
16:57and also multiply the memory clinics throughout the country to actually deliver disease modification
17:04for dementia. Is that part of the plan? Because I understand we have, um, a framework in place. We
17:09have the National Dementia Action Plan in place for the country. Is that, is that part of hopefully
17:15part of this action plan? Yes, entirely. So the National Dementia Action Plan was really, um, was launched two
17:22years ago in the first of October, 2024. Uh, and this was basically based on the Global Dementia Action Plan
17:29that was released by World Health Organization in 2017. One of the aims was, uh, for, um, at least, I
17:36think,
17:3670% of member nations, um, of the United, of the World Health Organization to have a National Dementia Plan.
17:43And Malaysia actually got there before most countries in the world. So we're very, very proud. But now to actually
17:51really implement the plan. And it really has a very good roadmap to actually help Malaysia towards
17:57increasing awareness, early diagnostic, uh, processes, uh, delivery of treatment, um, not just
18:04drugs, but also, uh, care, uh, for people living with dementia, enhancing research, and also a process
18:11by which we can monitor all this. So the plan is there, the roadmap is there. Now is to actually
18:16ensure
18:16that it's all properly implemented. I, I just realized, so, um, our health minister said that
18:22Malaysia's, uh, really projected, uh, in his actual words, he said, Malaysia is experiencing,
18:28quote unquote, compressed aging at one and a half times the rate of Japan. Yes.
18:32I'm not quite sure what that means. Can you tell me what that means in, uh, respect to our health
18:38systems, for instance? Okay. So Malaysia is really advancing very fast, isn't it? Because we are
18:43developing, we are a developing nation and we're going, we cross the line for population aging in
18:482021 and then we will become an aged population probably in 2040, 2044. So we'll do that in a
18:55space of 23 years. So a country like, um, France did it in over 100 years and UK did it
19:03in about 80
19:04years. So we're doing it in 23 years and in a speed faster than Japan, how Japan got there. So,
19:11um, and
19:11the difference between us and those other countries is they got rich before they got old and we're gonna,
19:17we, we might, we, we are struggling to get rich before we get old, but hopefully we will cross the
19:23line for, to become a developed nation before we reach 2024 or an aged nation status, but we're trying
19:30hard. Okay. So, um, that's, so part of the national dementia plan is the, the, the entire ecosystem,
19:38but one of the things that you mentioned a bit earlier was, um, we need to also look at prevention.
19:43Yes. And I think that starts earlier in life. Yes. So if you look, if you're looking at delivering
19:49disease modification to the current numbers, it's not something we can afford. Right. Yeah. And not
19:54everybody presents early enough or they might have contract indications, so they can't get the
19:59treatment anyway. So only a few people are eligible for the treatment right now, but the best treatment
20:04is actually prevention, right? So we're looking at healthy aging, vaccination. Yeah. Because we know that
20:10if you get viral illnesses such as COVID influenza, that increases inflammation in your body and that
20:16increases the risk of dementia. And there's already evidence that if you, uh, if you actually, if for
20:21those people who have had, uh, vaccines against shingles of influenza or pneumonia, the risk of
20:27dementia goes down. So these are things that we can do in order to reduce the risk of dementia. Of
20:32course,
20:32education, chronic disease management, wear your helmet so that you don't have head injury,
20:38um, you know, um, and, uh, hearing loss, you need to correct that properly early. You have to correct
20:44visual loss early, um, and physically being physically active. All these are almost common sense. And in fact,
20:52the Lancet commission, uh, has actually published what we call the, uh, modifiable risk factors for
20:58dementia. And, uh, across the, across the globe, 45% of dementia risk factors are modifiable.
21:04But in countries, we found that in developing countries, Malaysia hasn't quite done that,
21:09that research, but in developing countries, a larger proportion of the risk factors are modifiable.
21:13So we are more, we have a bigger potential of reducing the risk of dementia if we change our
21:19lifestyle. So lifestyle changes. Is that, is that purely just behavioral? So I'm just wondering,
21:25um, at what point can public health be incorporated, public health policy be incorporated to,
21:32for some of these, um, modifiable behaviors? Oh, totally. Okay. But the, I mean, we've done it,
21:38we've done it for years, isn't it? But diabetes is still going up, high blood pressure is still going
21:42up. So something really needs to change in order for us to be fully motivated to actually change our
21:49lifestyle. Yeah. Um, and we have to accept that a lot of this behavior is not so easy to change.
21:55So, um, so, but it, so society has to have a total, it's possible because countries such as
22:00Scandinavia, Japan, uh, and further down South Singapore have really improved the health, uh,
22:07profile of their country and Malaysia can do it. Okay. All right. So in the time that we have left,
22:12can I ask you for two things? One is what would you like, um, Malaysia to prioritize? The one and
22:18a half
22:18times of Japan, the speed of our compressed aging is really quite concerning, isn't it? Yes. So what
22:25would you like Malaysia to prioritize specifically in terms of, um, policy, uh, public health policy?
22:31Secondly, for the audience watching tonight, um, what can we do to invest in ourselves so that we
22:38age more healthily? Yep. So it calls for a lock, stock and barrel lifestyle change. You know,
22:45you can't just deal with one thing and, uh, and, and actually affect everything downstream. So you
22:50actually need to have a lock, stock and barrel lifestyle change. So, uh, long term, lifelong education,
22:57chronic disease management, social participation, we must always maintain our social networks, eat well,
23:03you know, a healthy diet, and of course, keep your brain stimulated and your body up and also always
23:09exercise. Lots of things to do, but it is possible. And the, the, what would you like to see policy
23:15makers
23:15focus on, Professor? Well, um, at the moment, what we really need to see is a change in our policy
23:21towards, uh, treating a lot of older people in the community and not just having specialist-led care,
23:27but actually moving towards, uh, community-based care for older adults, preventive care rather than,
23:34uh, so healthcare, not sick care. I think that's a basic mantra that we would like, we would like to.
23:40When you refer to community care, what are you referring to specifically? So preventive healthcare,
23:44so really, um, things like vaccinations, you know, exercise, um, et cetera, but also screening
23:51to detect early problems. So we're looking at muscle loss, memory loss. If you detect them early
23:58or hearing loss, vision loss, detect them early and address them early, then you're less likely to see
24:03the complications. And that can happen in the, at the community level. Community. Okay. I'm so glad you
24:09mentioned, um, social interaction because we often forget that that's such a key component to aging
24:15well, aging healthily. Well, it's a, as big a risk factor for ill health, social isolation as cigarette
24:21smoking. And we often, we've banged on a lot about cigarette smoking, but in our community now,
24:26we are seeing people, you know, living in, um, in nucleus family, nuclear family. And then a lot of
24:32older adults now, the children have moved, uh, to a different city or even a different country to work.
24:37And because they feel unsafe and they don't have ability to go out, go out and about and the social
24:44circle shrinks with age, then we'll see more and more social isolation. So we really need policies
24:49that will address that and actually engage them in society. May I ask very quickly in the time that
24:53we have, what kind of policies might be able to combat social isolation? I think the biggest thing
24:58is transportation, isn't it? We must make, uh, uh, environment age friendly and transportation age
25:05friendly. So if they can get out, they can meet people. Wonderful. Thank you so much for coming on
25:10the show. There's so much more to talk about, but unfortunately, time is jealous of us today.
25:14I appreciate you coming on and telling us a bit more about this. And thank you for the opportunity.
25:17That's all the time we have for you on this episode of Consider This. I'm Melissa Idris,
25:21signing off for the evening. Thank you so much for watching and good night. Thank you.
Comments