Vaccination for all

Thanks to advances in medicine and better lifestyles, more Malaysians are living longer. But how can we improve the quality of life among older adults. Priya Kulasagaran discovers the way we need to change how we talk about growing older

The topic of healthy ageing has gained a lot more interest in recent years, and looking at the numbers, it is not a surprise why. There are currently around 876 million adults aged 60 and above and this number is expected to rise to 901 million in 2035; by 2050, there will be two billion older adults.

However, the discourse around older adults, particularly when it relates to government policy, tends to centre around a rather negative trope. “Governments today don’t say, ‘Fantastic, we’ve got about 600,000 more older people’,” quips Dr Jane Barratt, the secretary general of the International Federation on Ageing. “They tend to say, ‘they’re sick and they’re frail, and they cost too much money’. Don’t you feel so good about growing older to be an ‘economic burden’? So how can we expect older adults to make a contribution when they’re classified as ‘done’?”

Dr Barratt adds that while we should celebrate the fact that Malaysians are living longer, we need to think more about the kind of living we would be doing at a later age. “Life is shallow when you’re not able to feed yourself, if you’re too frail to walk, if you’re alone and marginalised, and if you can’t access your social network… What struck me about Malaysia is that one in four people over 65 are still employed, so we are still making a contribution. And it’s not just contributing through paid work; in the joint-family scenario you have here, grandparents are critical to the family structure as well,” she says.

Dr Barratt was speaking at a talk on healthy ageing and vaccinations during her trip to Kuala Lumpur recently. Organised by Pfizer Malaysia, the session was an interesting discussion on the way we need to change how we talk about growing older.

Function over age

While we tend to define ageing chronologically, as in one is ‘old’ upon reaching a certain age, perhaps we should change the focus to the functionality of an individual. Dr Barratt offers herself as an example: “I ride a motorbike in Canada (where she is from), and you wouldn’t relate that to me being the head of a non-governmental organisation and my age. So we have to take age out of the conversation, and start talking about functional ability.”

This may sound like a semantic issue, but definitions shape the way we think about ageing – and it is something that the World Health Organization has taken note of as well. While it previously defined healthy ageing as a life absence of disease, the latest definition deems healthy ageing to be a process as well as the level of function an older person enjoys.

Aside from your intrinsic health status, your environment can greatly impact your quality of life as well. Numerous studies have shown that poor environmental conditions at a young age, such as a lack of access to healthy nutrition, can affect you for the rest of your life. So, an ideal life would be one where you are healthy and mobile, have sufficient social support (such as remaining with a partner) and are relatively stress-free -– here, your function may not change significantly as you age. An equally common scenario may be that you are diagnosed with a condition like diabetes at mid-life, and perhaps due to a lack of screening, you then have diabetic retinopathy that impacts your vision.

“But say your government funds treatment, so your vision returns to an extent. And because you have good management, you can deal with the vision impairment and diabetes because you have access to good doctors; your treatment is funded, so your function may deteriorate but it doesn’t drop,” adds Dr Barratt. However, there is also an unfortunate alternate trajectory if you are born in a disadvantaged area, or have had addiction problems, or are diagnosed with a number of chronic diseases that have been left untreated. As Dr Barratt puts it, “that trajectory would be vastly different in terms how much you are able to function.”

Looking at this domino effect of how one’s environment can affect your ability to function as a healthy adult, it becomes clear just how vaccinations can make an impact among older adults. It is a fact that one’s immune system gets weaker with age. So an older person is already at greater risk of infections such as pneumococcal pneumonia; add the problem of possibly having another condition such as diabetes or cardiovascular disease and that risk becomes all the more dangerous.

Vaccination throughout life

Non-communicable diseases such as heart disease and stroke tend to get the lion’s share of attention in Malaysia. Although these are serious problems, it may surprise you to know that the leading cause of death among those aged 65 and above in this country is pneumonia. According to a Department of Statistics report in 2016, 17.3% (or 5,730 patients) died from pneumonia in 2014 alone. This is unfortunate as there is a vaccine against pneumococcal pneumonia available for adults.

Commenting on the disparity of access to vaccines between children and adults, Dr Barratt questions if adults then are not as valuable as children. “We need to recognise the contribution of each and every person, and not only think about how many years you have left,” she says. Highlighting statistics from Australia, she points out that 48% of those hospitalised are over the age of 85. Additionally, one in five of those over 65-years-old will be four times more likely to have a heart attack up to 30 days after being hospitalised. “There’s a good reason why we don’t have statistics for Malaysia – we don’t have adequate registers. And to have meaningful dialogue, we need evidence,” she adds.

The few studies we do have however, offer a compelling narrative of why we need to do more in this aspect. Quoting a study of 500 older adults who were impacted by pneumococcal pneumonia, Dr Barratt explains the major challenges faced by them; weakness, having a loss of balance, and facing limitations in self-care. “The loss of three basic daily activities is called a catastrophic disability; if you’re not able to wash and dress yourself, unable to do daily activities, and unable to provide meals for yourself, you are not able to autonomous. This then leads to potential hospitalisation and the need for care services. So it’s a domino effect; a person may already have a non-communicable disease, and cannot afford vaccines, is hospitalised, then has a fall, fractures a bone, and they never get out of hospital. Or they get out of hospital, and the family has to care for them,” she says.

As such, Dr Barratt believes that vaccinations should be promoted and encouraged throughout life, as it is a ‘win-win’ approach. “An older person who is vaccinated has a greater potential to contribute to society and to their family,” she says. “Money is an issue for every government, but if we start having this story of older people contributing and working, then the cost starts to make sense. Regardless of someone’s age, they exist and they are making a contribution — we must never forget that.”

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