AMSC 2010 - Malaysia - Scientific Paper

Aging With Grace: A Focus On The Quality Of Life Among The Malaysian Elderly

*QOL – Quality of Life; GH - General Health Perception; PF - Physical Functioning; REP - Role

Limitation due to Physical Problems; REE - Role Limitation due to Emotional Problems; SF - Social

Functioning; BP - Bodily Pain; VT – Vitality; MH - Mental Health

AGING WITH GRACE: A FOCUS ON THE QUALITY OF LIFE AMONG THE

MALAYSIAN ELDERLY

Malaysia

ABSTRACT

INTRODUCTION: Developing countries experience the “aging” phenomenon and Malaysia

is no different. In 2000, about 6% of the Malaysian population is aged 60 and above. The

number of elderly citizens is expected to double. Seven states in Malaysia have an elderly

population exceeding 7%, putting it under the category of an aging population. The objective

of our paper is to explore the problems of geriatric care in Malaysia, assess quality of life of

elderly and identify factors associated with their quality of life. With the current Malaysian

trend of more women going to work, there is decrease ability of children to care for elderly

parents, causing nursing homes to become increasingly important. There are currently nine

government supported nursing homes for elderly in Malaysia, a number clearly inadequate to

accommodate the vast 1.6 million elderly in the country. The country also faces a major

problem of having small number of geriatricians and centres providing geriatric care, thus

affecting the quality of life of the elderly. MATERIALS AND METHODS: A comparative

cross sectional study was conducted using SF-36 questionnaire to assess the quality of life of

elderly people under institutional care and in the community. A hundred samples were each

collected in government nursing homes for elderly and the community respectively through

convenient sampling. Association and correlation of quality of life with factors such as

disease burden, education level and ethnicity were tested. Literature review on medical

journals and interviews with administrative staff of nursing homes and the president of The

National Council of Senior Citizens‟ Organisations, Malaysia (NACSCOM) were done.

RESULTS: The emotional health of elderly in old folks homes is better than those living in

the community (p=0.031, t=2.171). The quality of life of elderly in the community is better

than that in old folks homes, although not significant (p=0.461, t=-0.739). Education level of

the elderly correlates with their quality of life (p=0.01, r=0.225). There is correlation between





the physical health and emotional health of elderly (p=.000, r=0.409). In terms of ethnicity,

Malay elderly have better social functioning (p=.000, t=0.014) but poorer mental health

(p=0.011, t=2.554). CONCLUSION: Given the multi factorial nature of quality of life of

elderly, we explore approaches of the government and non-governmental organizations such

as NACSCOM and Gerontology Association of Malaysia (GeM) in meeting the varying

needs of Malaysian elderly, their challenges, future potential approaches and the role of

medical students in this field. In order to counter the aging boom, the Malaysian healthcare

providers have to step up in order to meet the challenges of improving the quality of life of

our elderly.

INTRODUCTION

Malaysia’s Aging Problem

As most developing countries, the Malaysian population inevitably ages. Economic growth

leads to social change such as improvements in women‟s education level, healthcare

facilities, changes in fertility, occupation and family formation patterns resulting in a reduced

birth rate and an increased life expectancy, which eventually contribute to the trend of

Malaysian population towards an aging population.

2000 Census of Malaysia found that Malaysian population is still considered „youthful‟ with

6.3% or 1.4 million of population aged 60 years and above. However, growth rates of the

elderly population increase continuously despite declining growth rates for the total

population in Malaysia causing an aging bloom of Malaysian population in coming years.

The census also recorded that 7 states of Malaysia (Kedah, Kelantan, Melaka, Negeri

Sembilan, Perak, Perlis and Pulau Pinang) has reached above 7% of elderly proportion, which

is recognised as „aging‟ population, with significant increase of elderly component in rural

areas from 1991 to 2000. (Malaysian 2000 Census)





The elderly is further divided into two groups, young-old (aged 60-74 years) and old-old

(aged 75 years and above). The number in the old-old group is projected from 277,000 in

2000 to 651,000 in 2020, which implicates a greater need for health facilities and care catered

for the aged.

Malaysian Healthcare System

Malaysia has comprehensive medical and health care services for the general population, but

special programmes for the aged are lacking, including geriatric services and rehabilitation.

(Arokiasamy J T, 1997) The current health care system which focuses on short term care and

hospitalisation is not addressing the needs of the elderly with chronic problems effectively.

(Poi P J H, 1997) This poses difficulty in providing preventive medicine for the elderly,

adding to the fact that the elderly are less reachable through primary prevention of diseases,

where education is the major preventive measure in Malaysia.

Despite the increasing needs of elderly in Malaysia, there are currently only a handful of

hospitals with a Geriatric Care Unit. While it is recommended to have 1 geriatrician for every

4000 elderly, Malaysia has only nine geriatricians at present, meaning that most elderly are

seen by general practitioners who do not understand their needs fully. Some healthcare

providers are also ignorant to the needs of elderly patients. A comparative study of first and

third year nursing students‟ revealed that only 10% of the third year students and none of the

first year students would choose to nurse the older patient as a first preference. (Poi P J H,

1997).

Psycho-geriatricians are also not readily available in Malaysia. General Practitioners and the

patient's family presently bear the brunt of providing care without having the appropriate

support in the community. Rehabilitation from the diseases to help return the elderly patient

to premorbid function is often lacking in hospitals. (Poi P J H, 1997)

Perception of the Society





Malaysian norm that focuses on the young has lead to marginalisation of the elderly.

Examples include early retirement and non-elderly-friendly infrastructures. Generally,

Malaysians retire at the age of 55. This early retirement has lead to the perception of the

elderly as being dependent and even a burden. The society now focuses more on their career

and no longer takes care of the elderly as the yesteryears. The household and family

structures are also changing rapidly to smaller family units and nuclear family household,

leaving the elderly to live alone. The traditional practice in which married children live with

their parents is declining with years. Together with the effect of population aging, this result

in a neglected aging community emphasising on the increasing importance of nursing homes

in Malaysia.

Perception of the Elderly

Current Malaysian elderly are from a generation where spending money on themselves will

be considered crass. A majority of them also have minimum education. 51% of Malaysian

elderly never receive any formal schooling (Malaysian 2000 Census). Therefore, they lack

awareness and have very low expectation on aging where most elderly think that diseases and

dysfunctions are part of the normal aging process and only seek treatment during a crisis.

This results in the under-reporting of symptoms and progress of disease to later stages,

increasing mortality and morbidity in this group of citizens. Other reasons may be due to a

fear that findings of diseases presence and treatment would produce functional loss and

jeopardize independent living.

Poor life satisfaction and self-esteem correlated with abandoned self-care behaviour among

elderly (Backman and Hentinen, 2008). It is important for elderly to have satisfying quality of

life and an practice active aging as elderly people with high levels of habitual physical

activity live longer and have better general health and higher levels

of wellbeing than do those

who are inactive (Kerse et al., 2008).





Factors Affecting QOL Among Elderly

Physical Illness

Physical changes in the elderly is associated with multiple diseases, especially chronic

diseases such as cardiovascular disease, cerebrovascular disease, urinary and fecal

incontinence, injuries from accidents, visual and hearing losses, dental deficits, psychosocial

problems, depression, dementia, and foot problems. A study done in Sepang, Selangor found

that 60.1% of elderly have chronic illness. (Sidik et al., 2003).

Disability is associated with increasing age (Nget al, 2006; Reyes-Ortiz et al, 2006; Pèréset

al, 2005; Walter-Ginzburg et al, 2004). Prevalence of disability among Malaysian‟s

community-dwelling population was observed at 22.8 percent. (Sidiah Siop, 2008). Disability

increases risk for dependence at home, hospitalization, nursing home admission and

premature death (Quinn, 1999; Fried et al, 1997; Ferruci et al, 1996).

Malnutrition is prevalent among the elderly due to changes in dietary habits, poor dentitions

and types and amount of food consumed (Mafalzi, 2000).

Mental Disorder

A study in Kampung Bahru, Kuala Lumpur, showed the prevalence of psychiatric disorders

in those above 65 as 5% with dementia, 13% with depression (4% major depression) and

12% with anxiety states (7% phobic). A study looking at the elderly in an institution in the

Klang Valley revealed a higher proportion of demented elderly (14.7%) in homes not meant

for them. (Saroja Krishnaswamy, 1997). Alzheimer's disease is an increasingly recognized

problem, being the most common form of dementia affecting possibly at least 5% of the

population over 65 years of age. (Saroja Krishnaswamy,1997) There is a positive relationship

between chronic stress and depression that affects quality of life (Fon and Phillips, 2003).





The onset of depression in the elderly is often preceded by severe life events for example

bereavement, loss of income and illness.

Polypharmacy

With greater drug usage and polypharmacy, the incidence of adverse drug reactions is more

prevalent in the elderly. In the University Hospital elderly study, 50% of the elderly patients

were noted to be on multiple drug therapy on discharge. Physiological changes in the ageing

kidney, memory deficits, altered eating habits, and multiple drug regimens make drug therapy

more difficult in the elderly. (Poi P J H, 1997)

Social Factors

The elderly are a heterogeneous group whose quality of life is affected by both medical and

non-medical factors which include work, retirement and income, housing and

institutionalization, family and the community, lifestyles and leisure activities, and personal

characteristics such as gender, ethnic background, personality and widowhood. (Arokiasamy

J T, 1997)

Socio-economic security is important. Depression occurred eight times more frequently

among the elderly with low family income, (Sidek et al., 2003) due to inadequate diet, poor

housing, poor health and medical care and the combination of family and community

disorganization (Lobo et al., 1995; Ramachandran et al., 1982).

A World Health Organization (WHO) study and ASEAN study revealed that about 70% of

males, 60-64 years of age, felt that the elderly should be active in work, while about 40%

aged 75 years and over desired the same. Continued employment is associated with higher

morale, happiness, better adjustment, longevity, larger social network, and better perceived

health among the elderly (Arokiasamy J T, 1997).

For most elderly, families are the most important source of support. Depression occurred

more frequently among the elderly who lived alone compared to those who lived with their





family. (Sidek et al., 2003) Loneliness is common in the elderly, whether living alone or

otherwise. Isolation can be a serious problem in medical emergencies where late treatment

could lead to disability, handicap and even death.

The elderly prefer to live in their own homes and in their familiar neighbourhood.

Institutionalized elderly often experience excess morbidity and mortality. (Arokiasamy J T,

1997). The lack of adequate contact with family and friends, the tendency for excessive

custodial attention and financial or fiscal disability can result in the institutionalized elderly

being depressed and withdrawn.

OBJECTIVES OF STUDY

Seeing that the importance of nursing homes for elderly is increasing, a research was done to

study the quality of life (QOL) among the elderly and the association factors. A comparison

was done to assess QOL between elderly under institutional care and those in the community.

MATERIALS AND METHODS

A cross sectional survey was conducted on the elderly aged above 60 years old at two

government nursing homes for the elderly, Rumah Sri Kenangan Seremban and Rumah Sri

Kenangan Cheng Melacca and the community of Sabah through convenient sampling. 100

respondents from the nursing homes and 109 respondents from the community participated in

the survey. Both of the nursing homes are under the Social Welfare Department of Malaysia,

catering for elderly who are single or come from families who are unable to care for them.

Socio-demographic and medical characteristics of the patients were recorded and the Malay

language version of SF-36 form was either self-administered or led by an interviewer (face-

to-face). Proxy respondents were not entertained as the validity of SF-36 will be

compromised. All respondents were asked to answer based on what they understood of the

question.





SF-36 assesses quality of life subdivided into eight domains which are General Health

Perception (GH), Physical Functioning (PF), Role Limitation due to Physical Problems

(REP) and Role Limitation due to Emotional Problems (REE) under Physical Component; as

well as Social Functioning (SF), Bodily Pain (BP), Vitality (VT) and Mental Health (MH)

under Emotional Component (Appendix I). Scores were given through a Likert Scale with

higher scores reflecting better quality of life and adjusted to a total of 100 QOL units as

maximum score for each QOL component.

The statistical analyses of the study were done using Statistical Package for the Social

Sciences (SPSS) version 13.0. Correlation and Independent T-tests were used in this study.

The level of significance is set at 0.05.

RESULTS

The study included 100 samples of elderly from the nursing homes and 109 samples from the

community. The proportion of males and females in both settings are similar at around 50%.

In terms of race, two third of respondents in the nursing homes were Malays but more than

90% of respondents in the community were of the indigenous race. All respondents in the

community are married in contrast to only 38.0% of respondents in nursing homes being

married. Young-old and old-old respondents were of nearly equal proportion in both settings

at around 50%. A majority of the respondents did not receive any formal education, a higher

majority found in the community. A higher proportion of respondents in the nursing homes

did not suffer from any disease. (Table 1.1)

The mean overall QOL of elderly in this study is 73.82 QOL units, 25% of respondents

having a score of 81.82 QOL units and above (Table 1.2). There is significant correlation

between the education level of elderly and the number of diseases suffered with components





of QOL of respondents (p<0.05). (Table 1.3) Factors such as being under institutional care,

gender, being married and education level affect QOL components significantly (p<0.05).

(Tables 1.4 to 1.7)

DISCUSSION

Elderly who live in the community have better QOL (Mean=74.43 QOL unit) compared to

those living in nursing homes (Mean=73.13 QOL unit) although this is not significant (Table

1.4). This is similar to a study by J T Arokiasamy. (J T Arokiasamy, 1997) PF (t=-2.115,

p=0.036), VT (t=-2.226, p=0.027) and MH (t=-3.118, p=0.002) are significantly better in the

community. This could be due to the common perception of elderly people that living in

nursing home is less desirable as nursing homes are deemed as a dumpsite for those who are

unwanted. Lack of contact with family members, feelings of resentment and loneliness can

affect the mental health of elderly in nursing homes. However, SF (t=8.417, p=0.000) is

better and BP (t=2.233, p=0.027) is less in nursing homes. This could be because elderly in

nursing homes have the privilege of having their daily needs provided for and face fewer

challenges. They live in a homogenous setting of elderly people and are more accessible to

social connections of their age group that they can relate to better. Those who live in the

community however may lack social contact of people of their age group if they are less

active and prone to stay indoors or if family members passively neglect them due to hectic

lifestyles.

In general, the mean scores for all scales were above 60.0 QOL units, similar to the QOL

score of elderly aged 60 and above (N=253) in a national survey done to assess the QOL

among the Malaysian general population in 2000 (Azman A B, 2003) (Table 1.2). In

comparison, the QOL score in this study is higher than that in the national survey in all

domains except in SF and MH.





There is correlation between physical component and emotional component of QOL of the

elderly (p=.000, r=0.554). It indicates that these two factors are interrelated and are

dependent upon each other in affecting the quality of life of elderly (Table 1.3).

The young-old elderly scored higher quality of life compared to their old-old counterparts.

However, these findings are found to be not significant (Table 1.5). Cumulative health–

related chronic life strains set a constraint on the potential of old-old individuals to

experience the positive side of life (Smith J. et al, 2003).

In terms of gender, the female elderly studied have a higher disease burden (t=-2.564,

p=0.011) (Table 1.5). Male elderly experience less REE compared to females and conversely,

females face less REP although these results are not found to be significant. These findings

are supported by studies done by Harolhanam, Orfilla et al., Suzuki et al., Ahamad and

Norhafiza (Harolhanam, 2009; Orfilla et al., 2006; Suzuki et al., 2002; Ahamad, 2005;

Norhafiza, 2006). It indicates that females are more affected by emotional problems and

males by physical problems. It is suggested that interventions can be tailored to suit different

gender needs. Male elderly have better quality of life than females although this is not

significant (Table 1.6).

QOL is higher among the married elderly compared to those who are single, divorced or

widowed, although not significant. (Table 1.7) This is consistent with studies by Harolhanam,

Tan and Chia (Harolhanam, 2009; Tan, 1992; Chia, 1995). Scores for VT (t=-2.345, p=0.020)

and MH (t=-2.891, p=0.004) are significantly higher for the married elderly. However, SF is

higher among those who are single, divorced or widowed (t=4.404, p=0.000). Marital status

affects many aspects of a person‟s life especially for older persons. Changes in marital status

have bearing on living arrangements, nature of care-giving and financial support of the

individual. (Malaysia 2000 Census)





There is correlation between education level and QOL where those with higher education

level have better QOL (p=0.001, r=0.226). (Table 1.3) This is supported by a study done by

Harolhanam in which those with higher education level have better QOL (Harolhanam,

2009). QOL is better in all aspects except in REE and in disability in a study by Chapman et

al. (Chapman et al., 2007) Education determines the QOL of elderly as it helps them in

continuous education and increases social relationship in community (Usman et al., 2001).

Limitations

The study was done in old folks homes and the community are located in different areas, the

old folks home located in urban areas while the community in villages in Kota Belud and

Kudat resulting in a comparison of QOL of elderly between non homogeneous socio

demographic settings. Sampling was limited to two out of nine nursing homes for elderly in

Malaysia. The findings from our study are limited by small sample size, inadequate time of

study and the use of convenient sampling method. The results of this study therefore may not

represent the actual quality of life of elderly in nursing homes and the Malaysian community.

Nevertheless, it provides a useful insight on the conditions of elderly in Malaysia, enabling us

to identify areas of intervention to improve quality of life among elderly as a whole.

Government Policies and Effort

The National Policy for Older Persons was approved by the government in 1995 with

the objectives to enhance and focus on promotive and preventive health care among elderly,

establishment of specialist geriatric services in regional and state levels, plan of action on

training and research needs in care of elderly, and enhancing quality of life through

community-based approach. (Zaimi, 2007) The latest policy focuses on optimising their self

potential, provide access to all opportunities and have provision for care and protection.”

(National Policy for the Elderly, 2001)





In concordance with policy, the National Advisory and Consultative Council for Older

Persons was established in May 1996 with the Technical Committee of The National Policy

for Older Persons in July 1996, to work on the Plan of Action and ensure the integration and

participation of the elderly in the country‟s development (Zaimi, 2007). The Plan of Action

calls for all parties to work towards implementation of the policy which involve education

and training, employment, participation in the community, facilities, health, social security,

research and development.

Institute of Gerontology was established in 2002 at Putra University of Malaysia for

continuous research and to provide recommendations on the needs of the elderly to the

government and non-governmental agencies. The Eighth Malaysia Plan planned to establish

Geriatric Care Units in all district hospitals by year 2020.

In public sectors, pre-retirement courses have been carried out preparing the

upcoming retiree for the challenges of aging and changing of lifestyle physically,

economically, socially and psychologically. Employees in public sector can take a maximum

of two years leave from work with half-pay to care for ill parents. Government hospitals also

provide free medical treatment for parents of government employees.

Roles of Social Welfare Department

The Social Welfare Department (SWD) provides financial assistance scheme-Aid for

Older Persons (BOT) for the poor elderly especially those without next of Kin, giving a

monthly allowance of RM 200 and other assistance such as artificial or orthopaedic

appliances and spectacles.

At present there are 15 Day Care Centres for older persons and 13 Homes for the

Older Persons directly under SWD throughout the country. (Zaimi, 2007) The Care Centre

Act 1993 under the SWD ensures the standards of care and services in NGO-run and private

nursing homes. However, of the hundreds of nursing homes estimated to be in operation





throughout Malaysia, only 188 are licensed by the Social Welfare Department as qualified

care centres.

Social Security Schemes

Currently, there are two social security schemes that cover only those employed in the

formal sector, namely the Pension and Employees Provident Fund (EPF). Pension is wholly

borne by federal government through annual allocation from federal budget for retired

government employees. A government employee is entitled for a life-long monthly pension

after serving at least 10 years with the amount receivable being half of the last drawn salary

after 25 years of services. EPF is a defined contribution plan based on a prescribed rate of

contributions by employers and employees, accumulated as savings in a personal account

with full withdrawal upon retirement

These two schemes only manage to cover around 60% of the labour force in

Malaysia, leaving another 40% mostly from the informal sector or self employed people

uncovered or without a known source of coverage. (Zaimi, 2007) It is essential for an

approach to be formulated especially for those from the informal sector group. However, the

government cannot guarantee adequate income security as EPF is not inflation indexed. The

popular lump-sum nature of withdrawal posts a risk as well.

Non Government Organizations (NGO)

There are various NGOs that contribute to the field of geriatrics in Malaysia,

including the National Council of Senior Citizens‟ Organisations, Malaysia (NACSCOM),

Gerontology Association of Malaysia (GeM) and Persatuan Usiamas Malaysia.

NACSCOM is an umbrella body for various localised group of elderly in Malaysia

which regularly makes representation to the government on many issues concerning the aged.

NACSCOM aims to advocate the development of policies and services that enhance the

quality of life and well-being of the elderly. It is active in joining or hosting conference

locally and or internationally, such as NACSCOM Biennial Delegates Conference in Kuala





Lumpur and HelpAge International Conference in Melbourne, Australia and summiting

proposals to the government in matters regarding the elderly. It provides day care centres,

home visits and organise events to enlighten elderly on healthy lifestyle.

USIAMAS promotes active living in elements of mental health, physical health and

social involvement. Their activities include 1 Home Help for The Aged which identifies,

trains and develops volunteers to visit poor older persons living alone and provide

motivation, companionship and other services such as basic house-keeping, shopping,

correspondence and running errands. Besides that, it has a Day Centre Programme where

older persons can gather and involve themselves in activities developing their mental,

physical and socio-emotional health.

GeM aims to enhance the well being of the elderly through health promotion,

research, information dissemination and community support services. They produce research

reports, training of informal care-givers for elderly, seminars and talks on love and inter-

generation care.

Role of Medical Students

Medical students have a responsibility to equip themselves with comprehensive

knowledge of geriatric field, become role models in caring for the elderly, disseminate proper

information to the community and in future become front liners of geriatric healthcare by sub

specializing in geriatrics in order to meet geriatric care demands in the country. Conducting

researches and publishing papers on local geriatric issues bring geriatric care to light and

increase its emphasis in the continuous medical education of medical practitioners. This is an

area where medical students can become a channel to voice out the needs of elderly to the

government, parallel with the works of NACSCOM.

Medical students play a role to volunteer and support for carers in nursing homes,

take part in NGO activities and Promotion of healthy aging can be done through primary,

secondary and tertiary prevention of diseases which includes education, active disease





detection and rehabilitation. AMSA Malaysia has organised a Geriatric Awareness Campaign

in July 2010 themed „Love Your Age, Love Your Health‟ with talks by geriatricians and

National Diabetic Association and free health screening. The campaign focuses on family

centric themes where there is pledging on elderly care with follow ups, distribution of

bumper stickers, t-shirts, badges, mural painting, family photo booth and competitions i.e.

Best Hugs and talks on proper elderly care, „Tai-Chi‟ and exercising methods.

CONCLUSION AND SUGGESTIONS

Despite having lesser disease and the readiness of basic need such as accommodation

and food, elderly in nursing homes have lower quality of life. Perception of the society has to

be changed and policies promoting elderly as a valuable resource have to be strengthened.

Malaysia is fortunate to be aware of and prepare for the aging bloom of its population by the

policies which provide the framework of the services for the elderly. However, the delivery

and implementation of the policies have to be emphasised. There is a need for more hospitals

to be equipped with ambulatory, rehabilitative and day care services. The introduction of

retirement homes can promote independence while providing social support and a sense of

security among the elderly. It is recommended that geriatric care be integrated in the

undergraduate medical curriculum such as in Universiti Putra Malaysia. Healthcare

professionals should be aware on the increasing need of the aging population of Malaysia for

a better quality of life of our elderly, helping them to live fulfilling lives.





Acknowledgement

The authors gracefully acknowledge Assoc. Prof. Rahmah Mohd. Amin, Department of

Public Health, National University of Malaysia for the guidance and advice given throughout

this research, Faculty of Medicine of National Universiti of Malaysia for the support, Mr.

Jaya Raman from the Social Welfare Department, staff of Rumah Seri Kenangan Cheng and

Seremban, volunteers from various NGOs and AMSA colleagues for the help in this research.

REFERENCES

Ahamad b. Mahmood (2005) Sokongan Sosial dan Kualiti Hidup pesakit-pesakit schizophrenia

di Hospital Kota Bahru. Tesis Sarjana. Bangi: Universiti Kebangsaan Malaysia.

Albert, S. M., Im, A., Raveis, V. H. (2002). Public health and the second 50 years of life.

American Journal of Public Health, 92 (8) 1214-1216.

Arokiasamy J. T. (1997) Special Global Theme Issue on Aging: Malaysia‟s Aging Issues

Medical Journal of Malaysia Vol 52 (3)

Backman K., Hentinen M. R. N. (2008), Factors associated with the self-care of home-

dwelling elderly; Scandinavian Journal of Caring Sciences Volume 15 Issue 3, Pages 195 –

202

Chapman B., Duberstein P., Lyness JM (2007) Personality traits, education and health related

quality of life among older adult primary care patients. Journal of Gerontology Vol 62 (6)

p.243

http://www3.interscience.wiley.com/journal/120701678/issue





Chia YC. (1995) Primary Care in the Elderly. In: Srinivas P (ed). Proceedings of the First

National Symposium on Gerontology 1995. Kuala Lumpur: University Malaya.

Datuk Lum Kin Tuck, Founder And President Of National Council Of Senior Citizens

Organisations Malaysia (NACSCOM)

Ferruci, L., Guralnik, J. M., Simonsick, E., Salive, M. E., Corti, C., & Langlois, J. (1996).

Progressive versus catastrophic disability: A longitudinal view of the disablement process.

Journal of Gerontology: Medical Sciences, 51A (3), M123-M130.

Fon S. O. and Phillips D. R. (2003) Stress, Resources, And Life Satisfaction Among Older

Adults In Malaysia Hallym International Journal of Aging; Volume 5, Number 2, pp. 111-129

Fried, L.P., & Guralnik, J. M. (1997). Disability in older adults – Evidence regarding

significance, etiology and risk. Journal of American Geriatrics Society, 45, 92-100.

Harolhanam b. Mohamed Wahid (2009) Faktor-faktor yang mempengaruhi Kualiti Hidup

Warga Tua yang Menerima Rawatan Kesihatan Primer di Daerah Hulu Langat Selangor. Tesis

Sarjana. Bangi: Universiti Kebangsaan Malaysia.

Joan Weinryb. Chapter 48: Nursing Homes. Geriatric Secret. Published 2004. Hanley and

Beltus Inc.

Kerse N., Peri K., Robinson E., Wilkinson T., Randow M., Kiata L., Parsons J., Latham N.,

Parsons M., Willingale J., Brown P., Arroll B. (2008) Does a functional activity programme

improve function, quality of life, and falls for residents in long term care? Cluster randomised

controlled trial; BMJ 2008;337:a1445





Lobo A, Saz P, Marcos G, Dia JL, De-La-Camara C. (1995) The prevalence of dementia and

depression in the elderly community in a southern European population. Arch.Gen. Psych.

1995; 52: 497–506

Mafalzi M. (2000) The problems and challenges of the aging population of Malaysia.

Malaysian Journal of Medical Sciences Vol 7 (1) p.1-3

Ng, T.P., Niti, M., Chiam, P.C., & Kua, E.H. (2006). Prevalence and correlates of functional

disability in multiethnic elderly Singaporeans. Journal of the American Geriatrics Society, 54,

21-29.

Nina Pflumm Herndon and Victoria Thorpe. Supporting Clients' Quality of Life: Drawing on

Community, Informal Networks, and Care Manager Creativity. Handbook of Geriatric Care

Management. Second Edition. Published in 2007. Jones and Barlett Publishers Inc.

Norhafiza bt. Ali (2006) Faktor – factor yang mempengaruhi kualiti hidup warga tua di

Hospital Alor Setar Kedah. Tesis Sarjana. Bangi: Universiti Kebangsaan Malaysia.

Ong Fon Sim. A Review Of National Policies And Programmes Chapter 4: Ageing In

Malaysia Ageing And Long-Term Care National Policies In The Asia-Pacific Edited By David

R. Phillips And Alfred C.M. Chan Iseas/Idrc 2002 Isbn 9-81230-173-9 E-Isbn 1-55250-005-5

260 Pp.

Orfilla F., Ferrer N., Lamarcar Tebec (2006) Gender differences in health related quality of life

among elderly. The role of objective functional capability and chronic conditions. Social

Science and Medicine Vol. 63(6) p.2367





Persatuan Kebajikan Usiamas Malaysia.

Website available at http://bsdra.com/Newsletter/p6.pdf

Poi P J H (1997) Geriatric Issue In Malaysia: Issues and Challenges,MED J Malaysia, 52

Pèrés, K., Verret, C., Alioum, A., & Barberger-Gateau, P. (2005). The disablement process:

Factors associated with progression of disability and recovery in the French elderly people.

Disability and Rehabilitation, 27 (5), 263-276.

Ramachandran V, Menon SM, Arunagiri S. (1982) Socio-cultural factors in late onset

depression. Ind. J. Psych.; 24: 268–73

Reyes-Ortiz, C.A., Ostir, G.V., Pelaez, M., & Ottenbacher, K.J. (2006). Cross-national

comparison of disability in Latin American and Caribbean persons aged 75 and older. Archives

of Gerontology and Geriatrics, 42, 21-33.

Ross M. M. and Crook J. (1998) Elderly Recipients of homes nursing services: Pain, disability

and functional competence. Journal of Advanced Nursing Vol 27, p.1117-1126.

Saroja Krishnaswamy (1997) Psuchiatric problems among the elderly in Malaysia. MED J

Malaysia, 52

Sherina M, Sidik Rampal L, Aini M, M Norhidayati H (2005) The prevalence of depression

among elderly in an urban area of Selangor, Malaysia, The International Medical Journal, 2005

Sidik S. M., Zulkefli N. A. M., Azhar S. (2003) Factors associated with Depression among

Elderly Patients in a Primary Health Care Clinic in Malaysia, Asia Pacific Family Medicine, 2;

148-152

http://bsdra.com/Newsletter/p6.pdf





Sidik S. M., Zulkefli N. A. M., Mustaqim A. (2003) Prevalence of depression with chronic

illness among the elderly in a rural community in Malaysia, Asia Pacific Family Medicine, 2,

196-199

Smith J., Borchelt M., Maier H., Jopp D. (2003) Health and Well–Being in the Young Old and

Oldest Old Journal of Social Issues Volume 58 Issue 4, p.715 - 732

Social Welfare Policies And Services For The Elderly: A Country Report (Malaysia) The 5th

Asean & Japan High Level Officials Meeting On Caring Societies:Collaboration Of Social

Welfare And Health Services, And Development Of Human Resources And Community:

Community Services For The Elderly. 27 – 30 August 2007, Tokyo, Japan.

Suzuki M., Ohyama N., Yamada K., Hanamori M. (2002) The relationship between fear of

falling, activities of daily living and quality of life among elderly individuals. Nursing and

Healthcare Sciences Vol 4 p. 155-161

Tan PC. (December 1992) Ageing in Caring Society – The Implication of Changing the Family

Structure in Malaysia. Seminar of Counselling and the Family in Conjunction with „Expo the

Caring Face Technology‟ UTM, Johor Bahru, 18–19

Usman Yaakob (2000) Peranan Keluarga dalam Penjagaan Warga Tua di Malaysia. Dlm.

Abdul Aziz Jemain, Lukman Z. Mohamad dan Wan Norsiah Muhamad (pnyt.) Jaminan Sosial

Warga Tua p.37-49. Bangi: Universiti Kebangsaan Malaysia.

Walter-Ginzburg, A., Blumstein, T., & Guralnik, J.M. (2004). The Israeli kibbutz as a venue

for reduced disability in old age: lessons from the cross-sectional and longitudinal aging study

(CALAS). Social Science & Medicine, 59, 389-403.





Ware J.E. (2003) SF-36 Health Survey Update. Available at http://www.sf-

36.org/tools/sf36.shtml

Wilhelmson K., Andersson C., Waern M. and Allebeck P. (2005) Elderly People's Perspectives

On Quality Of Life Ageing And Society, 25:4:585-600

http://www.sf-36.org/tools/sf36.shtml

http://www.sf-36.org/tools/sf36.shtml

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