Breaking Societal Perceptions: How Care Should Be with Prof. Tan Maw Pin
3:14PM Mar 12, +0000
Speakers:
PC Gan
Prof. Tan
Keywords:
people
older
care
older adults
homage
hospital
obligation
children
parents
malaysians
lose
healthcare system
enable
person
proactive
ageless
society
pay
enforce
feel
Happy New Year. Today we have with us Professor Tan, who specialises in geriatric medicine in UM. She's been with UM for more than 20 over years. She's no longer stranger in this industry. We had a very interesting conversation on the role of a child and a senior as they age. I hope it gives you a lot of enlightenment, as much as it has given me a breath of fresh air. I think early on we were talking about a very interesting topic between where the responsibilities lie on so I think, from your perspective, it's really the parents themselves, or because they're adults themselves so they shouldn't. They - they know what are the repercussion on
Yeah, society - society attitudes needs to change, older people are not to be provided for. They are actually well respected members of our community, and most nearly all the time, they are able to make their own decisions. And so, what society chose to side line them sideline them through what we call an ageist attitude. So a lot of times our children feel guilty because there seems to be a societal obligation to provide for the elderly, their older, older parents. And also, there's a societal obligation to be responsible for their own parents behaviour, and, and when they, when it talks about care it's care that they need to accept. So what we tend to do is we we enforce care on the older person we disable them instead of enabling we disable. Instead of rehabilitate we disable, and we basically force them to actually embrace disability as part of old age. If you stop them doing a lot of the things they can do, they will eventually lose the ability to use it if you don't use it you lose it, and then they become dependent. And, you know, at first, some of them might fight this, because they might feel that I can still do things, why are you making me do it, but some of eventually they will lose their dignity and self respect and just give up. If you want me to pee into my diapers I pee into my diapers. Just because you think old people should pee into the diaper so I pee into the diapers. But actually they can perfectly have gone to the toilet or walked to the toilet themselves. But they come to hospital, and we put them in diapers and make the pee in the diapers.
Okay, but okay so because I also have experienced, where my grandparent at a time, We know that he's - his health is deteriorating and he knows as well so he doesn't want to. I think his perspective is, I don't want to burden my children, or anybody, so they kind of like you know, isolate themselves that way, but then it's - isn't that then, our duty to then tell them that you know it's always good to get early care or early checkup.
Yeah but - obviously, when it gets to that level it's almost like trying to close the binder when the horse has bolted because the older person needs to understand that their health is their responsibility and empowered to actually seek help early. And because they have - the health literacy is not there, they don't understand that actually the best form of healthcare is proactive health care. So they needed to have gone for the regular eye check, the regular dental check, they need to go for the annual vaccination, and they need to embrace a healthy lifestyle, regular exercises, you know, once a year or two years, make sure your blood pressure's check, make sure you actually get screened for diabetes. They, they don't do that.
But could it be also because they don't want to burden the children because to go for a health test, it could mean like, you know, hours of waiting in a hospital and then -
But why does - why does the children have anything to do with it? Why can't they take themselves?
I know
That's the thing, we think that older people need to burden their children to go to hospital. And that's actually a well accepted fallacy. I have lots of older people who bring themselves to hospital, 80, 90 year olds, they bring themselves to hospital. In fact, and because I know they bring themselves to hospital and I know that they can have struggle with the system. Some of them actually have my phone number, they send me a WhatsApp message to tell me, I'm coming. And then they are actually quite capable. And what we do as society is we assume they need someone to bring them. At 80, my mother just turned 80, there's no way I was - she was even going to tell me what the doctors told her. And that's her dignity, her self respect, her ability to actually have privacy. You liase with the older person as the client, not with their children, and you respect the dignity of the older person, and the autonomy of the older person. Give them what they want, not what their children want. I know a lot of times it's the children who pay the bills. That's the big problem. The biggest problem, actually.
But what if we feel that you know whatever savings that you have should be kept for anything else but health because you know, as a child, I need to - I need to give back to you because you know you brought me up, you have nurtured me, you have given me an education. So -
Yeah, I almost- I almost feel that there's no such thing as giving back. It's only paying it forward, because our children - our parents responsibility was to actually bring up us as their children, and our responsibility is to bring up their grandchildren. And that's the way society should work. If that one generation suppose to pay both ways. Then, it almost guarantees them to a life of poverty - of poverty. Yeah. So any part of, you know, expecting to just pay for care without any planning impoverishes, so a lot of this care needs to be paid for through if you like enforced savings for, for the future. Yeah, I mean we can't change what's already been done. And we're very fortunate in that the number of older people who count - who we need to pay care for is actually not huge, because we're still a relatively young population. I just looked up the figures yesterday 2.3 million over the age of 60 but they're not disabled at 60. So the point where they really need care usually is beyond the age of 75. And so we are looking at 742,000 Malaysians over the age of 65 eh, 75, not all of them need care. So something that our nation can still afford to do, but to expect children to actually pay for this care out of pocket, that would be actually potentially beyond the capability of an individual. So the resources need to be pooled in some way. So when it comes to - but when it comes to you, don't do this to your children. Yep. Make sure you plan for your care. Don't do this to your children. It's not fair.
Yeah, but I suppose it's, it's our generation that we feel that we won't do that to our parents
Yeah that's right
But, but for me I feel that there's this obligation I need to fulfil my parents, at least,
I know it's difficult, isn't it? It's difficult and I to be honest, I'm exhausted because while I'm a university professor I've got students to teach. I've got young, I've got younger children I've got children that are still dependents, even though they're quite, they're quite capable, and they've had to learn to be very independent, why, because I also have to provide for my older parents because it's a societal obligation, they expect it. Yeah, and there's lots of things they never, never do for themselves because it's expected of you to do it for them. So it is a struggle, and I would never wish it on my own children. But so it's a plea to the older generation please don't do this to your children as well, and it's not too late it's never too late, they can learn. They can learn. They can learn how to clean the house, all over again, and it's easier nowadays. My mom and I have, because she's bored, so we go - we talk about cleaning products, she never used to clean the house to be honest, we had a maid, but I had to send our, our foreign domestic worker home, because a foreign domestic worker also has her own family in Philippines, and she was very depressed, being separated from her family in the pandemic. So I had to send her home, and mom has to clean her own flat. Am I a bad daughter?
No, I think she's just independent.
I mean, I just don't go in. I said the risk is too high for me to go in, I'm a frontline worker. You clean your own place. Yeah so and they did. And then we had fun shopping for different cleaning products. Yeah and then she says oh cleaning is so easy nowadays, you have all of these microfiber dusters and it's quite fun because she can see how it works and then we buy a cleaning robot and she was so excited, you know. Yeah, so and she said oh robot is very good. You pay -you pay instalments and in 10 months you own the robot and then don't have to pay any more. Maid you have to pay every month.
I suppose that is the change that we are trying to adapt. Then, so -
So, so, I mean I'm fortunate because I am, I suppose, have the skill of knowing how to get the older people to do things. But, you know, what we really need is someone like Homage, to do the same thing. Yeah, so I can train, older people with just writing instructions how to actually access Zoom. So for my mother's - mother's 80th birthday. I got her class of 1957 from her old school, to actually all Zoom in to wish her happy birthday. I wrote, I did written instructions, because there's not much what - just press, just click on the link only, and then, and then they all zoomed in, and I even gave them the option of, if you fail, you will call me and I will just do a video call or just a phone call, but none of them called me, they helped each other and they got there. Yes. Yeah. Yes, so they can do it, it's giving them the confidence because society has always said old no use alredy. Yeah so um so we must give them the confidence to do it and they can do it. Don't feel that you have to do it for them.
Right, so it also starts with the child because if I keep spoonfeeding them and always thinking that they are unable to do this because they're old, then they will keep doing what they're doing.
That's right. So we, we don't want to call you care services, you know. We can't - we want to call you enablement services. You know what I mean. Yeah so you, we, when we employ someone from homage, we expect that that Homage - Homage enabler to enable our older person, not a Homage caregiver to provide for our older person. So you need to figure out how to actually facilitate function, and to maximise function, rather than to replace function.
Okay, yeah, I guess. It's a very good conversation to start off because I think people of, or at least with my thinking we always think that oh must give back, must give back, because you know they provided for us. Yeah, that is a very interesting topic so the responsibility should still lie
On the older person.
On the older person because they're of sound mind.
Oh, because I have so many of my friends who are stressed beyond, beyond anything because the children - the parents will not accept care why because they get this care and they make their parents accept it. And that's not going to work. The parents are actually sound minded citizens, and after the age of 18 nobody makes decisions for them you cannot enforce people, you cannot force people. Some are more compliant, they just give in, oh anything to make it - make you less stress. But the others going, what do you think you're doing, you know, I can still make up my mind. Why do you want to make me do these things. So I mean I always, I find myself mean to my own cousins by saying, I'm sorry, but they've lived so long. You expect me to be the one who take your side and collude to you, to - to actually persuade them to go into a care home. No way! If they don't want to go to a care home, they can stay at home. They understand the consequences, and if they understand - as long as they understand the consequences of living in a house that is messy. If they prefer to live in a house in the mess - that is messy and dirty, rather than hire a maid or live in a care home. It's their choice. But then, because, because it comes constant tussle. Then attention gets taken away there's, there's a loss of dignity, a loss of pride and a loss of self respect. Whereas, if the other person is given, if some of the energy is channelled another way you know someone coming regularly for a dinner party, then they might make an effort to clean up the house, it's like people coming, got to clean up my house. But let's give them a lot more notice because it might take them a bit longer to clean up the house, they know how to pick up the phone and they got, they got jalan one. Their friends will know other people who, who have a little - who can come as a temporary helper, pay 20 ringgit can clean the house for one hour one. They know how to do it. Yeah.
Okay, okay. Wow. Okay, so I wasn't expecting this kind of conversation, I think I was just looking at you know oh when when do we seek treatment early, when do we make sure that you know we are always there to -
It's not about seeking treatment early, it's about finding the problem, even before it occurs. Yeah, so, um, so it's called, we call it proactive healthcare, preventing, vaccination, screening, and not the screening go to laboratory take blood test type of screening, but you actually have your memory screened, you - so we actually want them to screen regularly for deteriorating muscle strength, weight loss, loss of weight consists of signs of what we call frailty and we'll pick them up soon enough we can reverse it, we can reverse it or prevent even prevent it happening. So, so that's what we are aiming for when it comes to providing health for older people. And, honestly, this is a societal perceptions, our healthcare system which is totally just a responsive healthcare system you can see what's happened yesterday with the - with the what do you call that movement control order, we went, we could have done so much more to prevent this happening, but we reacted to what was happening, so he has been very lucky to have a self healthcare system that is able to react. But in order for us to move to the status of developing country - of a developed country, we need a healthcare system that is more proactive, not a reactive healthcare system.
But I think unfortunately in that space, we can only. I'm not sure, collectively as Malaysians, we need to make this movement or do we need like the, you know, the tech is such a hype word but I also feel that you know, we need all this tech to be in there to help us to do early detection. To do the -
Technology.
Yeah.
Yes. And the problem is people have this assumption that older adults and technology, don't go together. So so the pandemic has forced us to do a number of things. So one of it is, We actually run this we actually have this longitudinal study of ageing, which we've merged two existing studies called the Melur study and the Tua was study, and it's now called the ageless study so if you're interested, please go to our Facebook page. It's called ageless research MY. So that's our, that's our, our Facebook page. So, so what we what we what we had to do was to totally change the way we actually connected with our older adults because traditionally what you do is you go on the ground you get big campaign just like you know, your election campaign. So we talked about health instead. And then we have people there multiple stations, doing health checks, I'm sure you're very familiar with that. But we can't do that. So what we then did was actually taught a group of medicals graduates fresh medical graduates waiting for their house jobs, how to interview them using video interviews.
Nice
And some of them preferred to fill in the form themselves to fill in the online form. So, so they can do it. They can do it, they just need the self belief that they can do it because it's not, it's not different from, it's just, it's just a different way of doing it but it's not difficult because the technology is such that it's there -it's user friendly. And then, but the biggest barrier wasn't actually the older adults. The biggest barrier was actually convincing the existing researchers that we need to try and it can be done. And then the second biggest barrier was to actually get a younger generation to communicate on the telephone, because of course they are the short text technology generation, they don't, actually, a lot of them are not so confident in having long telephone conversations.
I suppose because the so called seniors, they already have got this exposure to Facebook so they know how to use Messenger
And all use WhatsApp.
Yeah, correct. Correct.
And then you press on the wrong button, you get a video already. I do that all the time. Yeah, so it's more of a perception thing and both older adult perceive that other older adults can't do it. And so they're very proud if they can do it themselves, and they assume that other older adults can't do it. I was so - I was so amused. Yeah but actually when we get when we, when we give them all confidence, they can all do it because it's also, it doesn't seem to be the push for the older adult to teach each other how to do it you know it's like, it's so funny I can do it, they can't do it so you teach them how to do it. No they just can't do it, it's very difficult, some of them not so tech savvy was like, well, two minutes. Two days ago I taught you how to do it. Before that you couldn't do it, so why can't you teach them how to do it.
Yeah, I suppose it's right. Yeah, I tend to find myself to just spoon feed like okay nevermind I do everything for you that kind of thing so
It's faster, perceived faster because if you do, but then if you have to wait for you to do it every time, then it's not faster anymore, right.
So the best thing to do is to actually get them to do it and the key thing is the incentive. You need to give them a big enough incentive to want to do it.
Because what happens. What happens when they need something done is they call somebody, somebody comes to the house.
Yeah, yeah,
they would not get a visitor otherwise. So we actually rewarding this behaviour
So much truth, but yet it's so difficult to embrace that they are capable on their own.
Yes, they are.
Yeah, yeah, I don't know if it's because you know it's an Asian thing where you know we want
It's a societal obligation.
Yeah
And older people, they like to do that because they don't have to do anything for themselves. They love it. They sit around, other people do everything, and then you have food served. You know that it's terrible for them, it's very bad for them, if they have everything done for that. Yeah, because that will be the ticket to getting dementia, isn't it.
Actually, yeah you're right.
If you truly love your parents, you'll never do that. Yeah, so we need enablement services because older people have an ability to fall ill beyond our ability. So when they fall ill, they might lose function, hopefully temporarily. And this is when organisations like Homage needs to come in. So, what we want is people to have already had connection with these services, even before they fall ill, and already have it. Then we already have the file. It's very easy, then immediately if they're in a time of crisis, do they really need to go to hospital, or can Homage come in and provide the support for them at - in their own homes, and then they can have just, you know, outpatient care, or ambulatory care. That would be the first. Because the minute they go to hospital, they get exposed to all sorts of evils. So, um, so because the hospital disables. If you're confined to a bed, you lose muscle like that. It just melts away. You're, you're in a foreign environment, so they get disoriented. And then there are lots of nasty bugs in hospitals, and then they become more, they become more ill as a result. When you go to a hospital walking, you come back out in a wheelchair, and that's a reality. That's why we need to do everything we can, proactive, if it is something we can't prevent, we seek help, as early as possible, preferably, it can be solved as an outpatient. But if we have to go in we have to go in, we make it fast, we make it quick. Solve the problem, come back out, don't stay there because the other problem is because we haven't been proactive then when they're in hospital, the older person then has issues with coming out of hospital because the care infrastructure outside - at home is not there, so then we have patients relatives because at that time, at that point they've already lost the ability to do things for themselves. So someone has to act as a surrogate, has to. There's an obligation that you can't run from, because there's no one else, you are it. So then you go oh, can you keep them a bit longer because I haven't sortedit out. But one more day means one of those nasty bacteria might come in already. And then you've lost the window of opportunity. This is what we don't want.
So you know, we want snap like that, you know, Yeah, and Malaysia is capable of it and I used to say we have genies. Yeah so, I, of course, being a geriatrician, we basically have - I had basically get first port of call for any of my relatives who fall sick you know, and none of them, none of them would have planned for care. I can guarantee you that they never think it's going to happen to them. And, and then what happens is I can summon up care like that. Ding dong at the door, a few hours later. I've never seen anything like this. I worked in the UK for many years if I wanted care I waited weeks. Yeah so um so it is amazing. We have an amazing infrastructure. And one of the main things is to actually make sure this care goes round, you know, because otherwise people hoard care. Do you know that? People hoard care. I'm sure Homage knows that. Yeah so, because family members feel care is so precious that once they've got the care they hoard it, they don't share it. Yeah, well we need to do is to share it. Yeah, because then it makes it affordable for everybody. Because even if you buy 24 hour care when the older person doesn't even need 24 hour care, it is very expensive. But if many people work together. Many people subscribe to care, then this the care can be - the care costs can be split between many people
Agree, yeah, yeah. agree. Okay, this is such a good conversation I think from the start, where we talk about the responsibility lies on the senior to how technology can actually enable them and they should be - they should be able to do it because it's nothing new. And I think, on the last piece is on the ageless research, I think that one. It's something good that we need to read up on as well. I think this is something that I also wanted to continuously because if I, myself and feeling that you know, I need to fulfil this obligation, this responsibility, I'm sure there are many of
I know and you're constantly guilty, isn't it? It's not funny. I feel that all the time. Yeah, and it shouldn't be like that, isn't it. No, no, you should have the choice whether to cook for your parents or not. Not obligated to cook for your parents. Yeah.
Yeah, because I think when obligation, suddenly becomes a chore, then you know the love kind of diminish, and you just feel that I can't -
Yes, that's right care has to be shared. Not just, husband and wife, not just siblings, but cared - care needs to be shared in the community. Yeah. And, and the need for care needs to be minimised by ensuring our services are enabling not disabling.
Thank you, Professor.
No problem.
It's community, as long as there's one person who tells us that it's not really our duty then you know you're kind of like let it brew for a while and then you go, yeah actually come to think about it and then once this gets out there, then there'll be less -
You have obligations. Yeah, you do have obligations. So like I said you when they if they lose the ability to make decisions, if they lose ability to care, then you are obliged legally to actually -actually, you don't have to provide the care but you have to actually facilitate. You have to look into the care provision. Yeah, so so society don't have to enforce that you give up work to look after your own parents, that is actually short sighted of society, isn't it? And so if we have an increasing older population and people are forcing female members of society to actually stop working to look after the older adults, then we are actually actually dis - disadvantaging ourselves because we have, we already have the shrinking productive work processes. Instead what we need to do is put the older person back into the workforce, isn't it? So if they fall ill we call in care services to - to enable them rehabilitation services not care services, to, to actually enable them and then put them back in the workforce. They continue to contribute.
So maybe the last portion of it is you know apart from this ageless research that you're working on, what other things that you're working on what- what is the other messages that you want to get out there for Malaysians, or at least people you know our generation.
Okay, yeah, it's one of the, one of the. Yeah, so one of the things we really want to do is actually to work on proactive care. So we have got a little spin off company from UM that we basically form to actually realise some of our research output, because otherwise we know that it takes about 30 years for something to be research some research to come out before it actually gets into clinical practice. Now we don't have that kind of time as a developing country with a rapidly ageing population, so we're hoping to actually look at rapid implementation by actually engaging our existing redundant workforce we have so much redundancy in the system, you know, we have these Houseman. These people, these these medical graduates with one year for the housemanship so we try and engage those people and to actually deliver preventive-preventive measures. So we want to pull in people in the community to come in for- for memory screening to come in for risk false risk screening, and then we actually if we detect anything we send them, we put them in either single- individual or group training, training programmes, and then hopefully we can actually prevent some of these things, such as falls and dementia that is of course much more common as you get older. But it's preventive.
Nice, nice. Okay, So then, if so we can actually get this sort of - or equip ourselves with this sort of knowledge. So that's act4health.
Act4health Yes.
Great. So we could just, if we want to so we'll just go on to act for help. And then, all those information is available.
Yes, that's right and you can contact us through our Facebook page, we still use Facebook, we found that the most - we found that that's the most user friendly platform for most people, most of our clients.
Absolutely. So then most of these forums, now you're conducting. Do you use webinars, or it's just like a video recording that you posted up on Facebook.
That's a very interesting question. Yeah, so like, it's like not doing things for them, isn't it, so actually we- we wait to be invited by our senior citizens groups and we give them health talks, and they organise it. Yeah, I know we like- we like things done for us.
Oh, wow.
Yeah so, so those are our public talks, we wait to be invited. So we solicit sometimes. You want me to come and give a talk, then they organise everything. They can even record it, put it up on YouTube to share and everything. Yeah. And then the other thing would be training programmes that we're doing, we are training healthcare professionals, how to engage with older adults, yeah. But we never pretend we include [inaudible] the healthcare workers we find we have to do everything for them. Because healthcare workers [inaudible]. So we organise the training for healthcare workers, the senior citizens organise their own talks.
Wow. Yeah.
We don't fund anything. We don't fund anything, they fund everything themselves.
Yeah, this, this is such a breath of fresh air.
It's like everybody's working in a parallel universe they don't realise that there's a huge group of older people who are self sufficient.
I need to change my mindset. I really need to change.
We are very proud of them. Yes.
Okay. All right, thank, thank you, professor so much for taking the time to talk to me. I really appreciate it. And I think shedding the light. It does make me feel a lot better about you know, what needs to be done. So yeah, thank you very much for your time.
We look forward to a progressive and progressive, and also enabling kind of enablement services rather than care services. So, thank you very much for giving me the opportunity to share.