October 31, 2017
Photo credit : thinkhealth.priorityhealth.com
MALAYSIANS are living longer going by figures from the department of statistics. The population is expected to live up to an average of 74.8 years this year compared to 74.3 years in 2011.
To top that, life expectancy is also increasing, where men and women are expected to live another 15.0 and 17.1 years respectively. It is also estimated that the ageing population will increase to 7.2% by the year 2020 and 14.5% 2040.
Malaysia’s growing ageing population also means there is an urgency to address the need for long-term care, especially for those who, in the august of their lives, are affected by illness and become infirmed or disabled.
Long-term care or chronic care refers to a continuum of medical and social services that support the needs of patients living with chronic medical conditions or severe disabilities that affect their ability to go through their daily routines without physical help and support from others.
This refers to a person’s basic daily self-care activities such as toilet hygiene, continence, mobility, dressing, bathing and eating.
It also includes continuous medical monitoring and timely intervention when medical complications are detected early.
Apart from medical services, long-term care also requires skilled nursing and rehabilitation services.
Generally, it can be broadly categorised into:
- Institutionalised care which includes:
a) inpatient admission to hospitals which provides skilled nursing care (also known as skilled nursing facility); and
b) nursing homes;
- Community care. This includes:
a) adult daycare centres; and
b) hospices; and
- Informal care, defined as home care by family and friends, with the support of visiting nurses, visiting physical therapists and visiting doctors. In severe cases, full-time nursing services and domestic workers are employed to help out with home care. This option is gaining popularity as patient care is carried out within the setting of the patient’s home.
Our medical and healthcare services are comprehensive overall and are mainly geared towards acute care services and short-term hospitalisation.
Where long-term care needs are concerned, the estimated demand for them is complicated because it involves extensive data collection on the prevalence of medical diagnoses and the limitations in functional abilities of the patients involved.
But due to the increase in the aging population and growing number of non-communicable diseases, there is a definite need for them.
The following scenario well describes a typical situation ― A 60-year-old man with diabetes and high blood pressure sustains a massive stroke and is admitted to an acute care facility. After a week’s stay in hospital, he is discharged. However, the patient also suffers from physical disabilities as a result of the stroke. He experiences weakness in his arms and legs, and needs assistance in his daily self-care.
It is estimated that 10 per cent of stroke patients succumb immediately to the disease. The remaining 50-60 per cent continue to live with disabilities. This is where long-term care comes in.
Apart from stroke, other chronic diseases in the elderly that typically require long-term care include advanced dementia, advanced Parkinson Disease, severe brain injury, spinal cord injury and other debilitating neurological conditions, terminal cancers (some patients are also channeled to hospices) and pathological fractures.
Younger adults may also seek or require extended care for conditions such as traumatic brain injury, where some of these patients remain in a vegetative state with variable outcomes.
Financial Impact and Cost of Long-Term Care
The cost of long-term care is difficult to estimate because data on it is still scarce. However, in general, the financial charges depend on a few factors, such as:
- Complexity of patient’s illness or disability;
- Cost of certain consumables such as diapers and milk;
- Sudden change in patient’s medical condition or sudden acute illnesses; and
- Use of certain medications for patient.
- However, the future holds promise for a more holistic and integrated view of healthcare delivery. What will affect the demand will be factors like the impact of population increase, changes in medical diagnoses and treatment, healthcare delivery, lifestyle and behaviour patterns of patients.
One could argue then that there will be an increased life span but no change in the onset of illness, requiring longer care as more people live long enough to develop disabling conditions.
The opposite view would be that improved treatment or prevention of disabling conditions would lessen long-term care needs independent of the death rate.
However, even under an optimistic scenario, the overall demand for long-term care will still rise signiﬁcantly because of the steady increase in the elderly population.
Published in Malaymail, 19 October 2017
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