1. Dr. Farizah Muhd Hairi

Symposium: Symposium: Enhancing quality of life of the Enhancing quality of life of the elderly
elderly
Problems, Policies and Program to Improve Quality of Life of the
Improve Quality of Life of the Warga Emas in Malaysia
Associate Professor Dr Farizah
Associate Professor
Dr Farizah Mohd Hairi
University of Malaya
farizah@ummc edu my
farizah@ummc.edu.my
Outline • I. Challenges • II. Policies
• III. Programs
*Also would like to acknowledge that some slides are shared by Dr Mohmad Bin Salleh, Senior Principal Assistant Director, Sector of Elderly Health, Division of Family Health Development
Division of Family Health Development, Ministry of Health, Malaysia.
Challenges – warga emas
Challenges –
Challenges • Demographic changes
• Health challenges among warga emas
• Implications
Social
Economic
Health
3
Demography
Number
Number of Elderly in the World of Elderly in the World
and % in Developing Countries
Year
Population 60 yr old
and above (million)
% in developing
countries
2000
614
62
2025
1,200
72
2050
2,000
80
Source: United Nations, 2001
 Rate of general population growth
Rate of general population growth ~ 50 %
50 %
BUT growth rate for the elderly ~75 %
Countries with 10 million population or almost (in the year
2002) with the highest number of elderly
2002
2025
Italy
24.5%
Japan
35.1%
Japan
24.3%
Italy
34.0%
Germany
24.0%
Germany
33.2%
Greece
23.9%
Greece
31.6%
Belgium
22.3%
Spain
31.4%
Spain
22.1%
Belgium
31.2%
Portugal
21 1%
21.1%
United Kingdom
29 4%
29.4%
United Kingdom
20.8&
Netherlands
29.4%
Ukraine
20.7%
%
France
28.7%
%
France
20.5%
Canada
27.9%
Source: United Nations,, 2001
Penduduk Warga Emas (60
(60+ tahun
tahun) di Malaysia, 1947
tahun)) di Malaysia, 1947
tahun
) di Malaysia, 1947‐
1947‐2050
22
20
20
17
18
Percentage (%)
P
16
“Negara tua” (aged nation) apabila w. emas > 60 = 15%
jumlah penduduk
16
15
14
12
10
8
6
4
2
0
1947
1957
1970
1980
Total population (60+)
1991
2000
2010
Male (60+)
2020
2030
2035
2040
2050
Female (60+)
Sources:
1. Department of Statistics,2006 & 2011
2. United Nations, 2010 World Population Prospects: The 2010 Revision. Retrieved from web
Population Division, Department of Economic and Social Affairs, http://esa.un.org/unpp/
Number and Percentage of Number and Percentage of Warga
Warga Emas by States, 2010
10.7
320.0
280.0
240 0
240.0
7.9
9.0
8.4
7.6
9.4
12.0
10.1
N
%
10.0
8.6
8.1
7.7
6.6
200.0
6.3
7.7
80
8.0
5.8
5.0
160.0
6.0
120.0
4.0
80.0
40.0
2.0
252.7 167.0 123.9 67.1
85.1 114.2 140.8 252.9 24.4 326.3 71.0 200.0 141.9
0.0
3.5
118.7
0.0
State
High percentage of older persons 60+ / rapidly ageing states
Percentt 60+ (%)
Numberr 60+ ('000)
MALAYSIA, 2010 [60+; N = 2067.0, % = 7.7]
Speed of Population Ageing
(Doubling of 65+ Population from 7% to 14%)
Developed Countries
115
France (1865 - 1980)
85
Sweden (1890 - 1975)
73
Australia (1938 - 2011)
69
United States (1944 - 2013)
53
Hungary (1941 - 1994)
45
United Kingdom (1930 - 1975)
Japan (1970 - 1996)
26
Developing Countries
33
Azerbaijian (2004 - 2037)
26
China (2000 - 2026)
Source: Kinsella and He, 2009; and U.S. Census Bureau,
International Data Base, accessed on October 20, 2010.
Sri Lanka (2002 - 2026)
24
Malaysia (2020 - 2043)
23
Thailand (2002 - 2024)
22
Columbia (2017 - 2036)
19
Singapore (2000 - 2019)
19
South Korea (2000 - 2018)
18
Population
p
Pyramids
y
Slide : Prof. Gary Andrews Aust.
…….factors contribute to
increase ratio of warga
increase ratio of warga emas ……
‐ increase life expectancy ‐ decrease birth rate
‐ decrease death rate
‐ migration
‐ internall
‐ external
Life Expectancy At Birth, Malaysia, 1957 ‐‐ 2012
Life Expectancy At Birth, Malaysia, 1957 Age
Years
Male
Female
1957
55.8
58.2
1985
67.0
72.5
1990
69.0
74.0
199
1997
69
69.5
74.4
44
2000
70.2
75.0
2003
71.0
75.5
2006
71.8
76.3
2007
71.7
76.4
2011
72.2
76.8
2013 *
72.6
77.2
Source: Health Facts 2014, MOH, June 2014
Population aging
• Population aging was first observed in developed countries, but more recently this phenomenon has extensively occurred in developing countries.
countries
• In Malaysia, mortality rates among the elderly group are on the In Malaysia, mortality rates among the elderly group are on the
decrease, which means there will be more elderly group in the coming decades.
Health Challenges Among Warga Emas
B
By 2020
By 2020;
2020
• it is projected that three‐quarters of all deaths
p j
ee qua e s o a dea s
in developing countries could be ageing‐related,
• the largest share of these deaths will be th l
t h
f th
d th ill b
caused by non‐communicable diseases, such as di
diseases of the cardiovascular system, cancers f th
di
l
t
and diabetes,
• the number of people affected by senile dementia in Africa, Asia and Latin America may ,
y
exceed 55 million
‐ Active Ageing: A Policy Framework Active Ageing: A Policy Framework
(WHO/NMH/NPH/02.8)
….. Malaysia…….
•Study by MOH (1995), among rural elderly:‐
‐ 77.1% elderly able to move independently.
‐ 1.3% bedridden.
‐ 16.5% considered themselves as in “good” 16 5%
id d th
l
i “ d”
health condition (Urban ‐ 6% ‐ study by ISIS & LPPKN, 1991).
‐ 69.7% considered themselves as in “fair” health condition (Urban ‐ 65% ‐ study by ISIS & LPPKN, 1991).
(Urban ‐ 29% “poor” health – study by ISIS & LPPKN, 1991).
….. Malaysia…….
Malaysia
•The study also showed:‐
‐ 81.4% suffered from at least from one chronic medical illness. ‐ 12.7% had 3 or more chronic diseases. •The commonest medical illness:‐
Th
t
di l ill
‐ joint paint ‐ eyesight problem i ht
bl
‐ hearing problem ‐ hypertension hypertension
‐ heart diseases ‐ diabetes diabetes
50.1% 40%
21%
26%
16.3%
11 6%
11.6%
….. Malaysia…….
•
Study by ISIS & LPPKN (1991), among urban elderly:‐
•
The commonest medical illness:‐
The commonest medical illness:
‐ weakness in arms and legs
poor vision ‐p
‐ respiratory problem ‐ urinary tract ‐ heart problem ‐ digestive tract ‐ back bone back bone
‐ others 35.8% 19.3%
13.8%
11.9%
11.0%
5.5%
1 8%
1.8%
0.9%
1st Five Morbidities Among Malaysian Five Morbidities Among Malaysian Warga
Warga Emas (Return BPKK)
30
20
Hipertension
p
Diabetes
Joint Problem
Heart Problem
Repiratory Problem
Eye
15
10
2013
2011
2010
2009
2008
2007
2006
0
2005
5
2004
Percentag
ge
25
Year
Morbidities
Morbidities Among Malaysian Warga
Morbidities Among Malaysian Among Malaysian Warga Emas (NHMS III)
(NHMS III)
Prevalence
(%)
95% CI
Lower
Upper
Hypertension
73.7
72.3
75.1
Hypercholesterolemia
37.9
36.3
39.5
Diabetes Mellitus
23 6
23.6
22 3
22.3
24 8
24.8
Asthma Adult
6.2
5.5
6.9
Physical Disability
2.4
2.0
2.9
- Underweight
11.0
10.1
12.0
- Normal
48.4
46.9
49.9
- Overweight
29 8
29.8
28 4
28.4
31 2
31.2
- Obese
10.8
9.9
11.7
Nutritional Status
- BMI
Prevalence of chronic diseases among warga Prevalence
Prevalence of chronic diseases among of chronic diseases among warga warga
emas in Malaysia
emas in Malaysia
• Increasing in life expectancy and number of elderly result in increased cases of chronic diseases.
• The most common prevalence of chronic diseases among elderly in Malaysia were
Malaysia were •
•
•
•
•
cardiovascular diseases (21.1%), neoplasms (16.8%), urinary diseases (13 9%)
urinary diseases (13.9%), respiratory diseases (7.7%) and metabolic diseases (7.1).
Implications/issues due to population ageing
• Social Implication
‐ dependency ratio/aged dependency
‐ labour source ‐ availability of care givers ‐ feminization ageing ‐
g g lebih ramai warga
g emas wanita yyang hidup
g
p
bersendirian (kerana jangka hayat mereka
lebih panjang daripada lelaki).
‐ living arrangements living arrangements – penyediaan tempat kediaman yang sesuai
yang sesuai
untuk warga emas bersesuaian dengan
kebolehan fizikal serta mental mereka.
‐ public facilities –
public facilities kemudahan awam sesuai dengan
warga emas seperti tempat rekreasi/riadah,
pengangkutan awam, keselematan jalanraya, t d lif
tandas, lif, susur
t
tangan
(
(ramps) dan
) d sebagainya.
b
i
• Economic implication
• Health implication
Beban Penduduk Kumpulan Umur Bekerja (I5 ‐‐ 64 Tahun) Menanggung Seorang Warga Emas
(I5 Tahun 2004 = 11 pekerja*
Source: Statistical Department, Malaysia
Dependency Ratio
100
Youth Dependence Ratio (0-14)
90
Old Age Dependency Ratio (65+)
T o t a l D e p e n d e n c y R a t io
80
70
60
50
40
30
20
10
0
1970*
1970
1980
1990
2000
2010
Year
2020
2030
2040
2050
There is a decrease in the youth dependency ratio, but an increase in ,
old age dependency ratio. The falling birth rate results in a lowering total dependency ratio, but as population ageing continues, the overall ratio rises again. Policies
• Malaysia’s Vision 2020
• Health Vision
• Goals of health care system
• National
N ti
l Policy
P li for
f Older
Old Persons,
P
1995 (rev
(
2010)
• National Health Policy for Older Persons, 2008
27
MALAYSIA’S VISION 2020
By The Year 2020, Malaysia Is To Be A United Nation With A Confident Malaysia Society:
a ays a Soc e y
• Infused By Strong Moral & Ethical Values
• Living In Society That Is Democratic, Liberal, Tolerant & Caring
• Economically Just & Equitable, Progressive & Prosperous
Economically Just & Equitable Progressive & Prosperous
• In Full Possession Of An Economy That Is Competitive, Dynamic, Robust And Resilient
b
d
l
HEALTH VISION
Malaysia is to be a nation of
healthy individuals, families and
communities
Characteristics of future
healthcare system
•Equitable
•Affordable
•Efficient
•Technologically appropriate
•Environmentally
y adaptable
p
•Consumer friendly
Emphasis of future healthcare
system
•Quality
•Innovation
Innovation
•Health promotion
•Respect for human dignity
•Promotion of individual
responsibility
•Promotion of community
participation
GOALS
GOALS OF HEALTH CARE SYSTEM
OF HEALTH CARE SYSTEM
• Wellness Focus (tumpuan kepada kesejahteraan)
• Person Focus (tumpuan kepada individu)
Person Focus (tumpuan kepada individu)
• Informed Person (individu berpengetahuan) • Self Help (kendiri)
• Care Provided At Home Or Close To Home
• Seamless, Continuous Care
• Services Tailored To Individual Or Group Need
Services Tailored To Individual Or Group Need
• Effective, Efficient And Affordable Services
GOVERNMENT’S RESPONSE
•
Establishment of National
Policy for Older Persons (1995,
revised 2010) and Action Plan of
National Policy for Older Persons
(1999, revised 2010)
– A unified, holistic, inter-sectoral
national policy.
– Formation of National Advisory and
Consultative Council for the Older
Persons with the Department of Social
Welfare as the national secretariat.
•
•
•
National Plan of Action for
Health Care of Older Persons
(1997) - MOH.
N i
National
lT
Technical
h i lC
Committee
i
ffor
Health of the Older Persons
(1998) - MOH.
National Health Policy for Older
Persons (2008) - MOH.
National Policy for Older Persons
National Policy for Older Persons is a government commitment to create a society of senior citizens who are i t f
i
iti
h
independent, contented and possess a high sense of self‐worth and dignity, by g
g y y
optimizing their potential through healthy, positive, active and productive ageing to improve their well being along
ageing to improve their well‐being along with national development.
Improvement in Improvement
Improvement in National Policy for Older in National Policy for Older National Policy for Older
Persons
 Giving priority for preparation during old age;
 Giving priority on strengthening relationship among the older persons as well as inter‐
generation; and
 Improve mechanism of implementation and I
h i f i l
t ti d monitoring by formation of committee at the national, state at district level.
ti
l t t t di t i t l
l
Majlis Penasihat dan
Perundingan Warga Emas
Negara
PELAKSANAAN DASA
AR
Jawatankuasa Teknikal
g Emas Negara
g
Dasar Warga
Pengerusi: Y.B. Menteri
Urus setia: Jabatan Kebajikan Masyarakat
Pengerusi: Ketua Setiausaha
Urus setia: Bahagian Dasar, KPWKM
7 JAWATANKUASA KECIL
1 Jawatankuasa
1.
J
t k
K il kesihatan
Kecil
k ih t
2. Jawatankuasa Kecil Sosial dan
Rekreasi
3. Jawatankuasa Kecil Pendidikan
d Kerohanian
dan
K
h i
4. Jawatankuasa Kecil Perumahan
dan Persekitaran
5. Jawatankuasa Kecil Ekonomi
6 Jawatankuasa
6.
J
t k
K il Pekerjaan
Kecil
P k j
7. Jawatankuasa Kecil Penyelidikan
dan Pembangunan
NEGERI
Majlis Tindakan Negeri
Majlis Tindakan Daerah/
Pihak Berkuasa Tempatan
Jawatankuasa Pembangunan Warga Emas Negeri
Jawatankuasa Pembangunan Warga
Emas Daerah/ Pihak Berkuasa
Tempatan
Pengerusi: Timbalan SUK
Urus setia: JKM Negeri
Pengerusi: Ketua Penolong
Pegawai Daerah
Urus setia: PKMD
10
National Health Policy for the Older Person (2008)
To ensure healthy, active and productive ageing by
productive ageing by empowering the older persons, family and community with knowledge, skills, an enabling environment; and the provision of optimal health care services at all levels and by all sectors. sectors.
The Rationale of the Policy
• Seven rationales;
• Among it:
 Are not always accorded appropriate attention or treatment A
t l
d d
i t tt ti
t t
t
because their ailments are considered to be the result of age itself.  Financially disadvantaged compared to when they were employed. Principles For Service Provision (stated in the Policy)
• Six principles;
Six principles;
• Among it:
 Recognising the Distinctive Needs of Older Person ‐ Health services should provide older person with choices. This should include choice between types of service methods and quality of service delivery as
between types of service, methods and quality of service delivery as well as the provision of services
 Promoting Healthy Ageing ‐ All services for older person should optimize their opportunities for healthy ageing through the life course perspective on ageing and the encouragement of planning for a healthy old age.
a healthy old age.
 Providing Continuity of Care ‐ Older persons who are ill or who have a disability require continuity of care. Their access to support services and the standard of care available to them should be maintained Goal • to achieve optimal health through to achieve optimal health through
integrated and comprehensive health and health related services.
Objectives
• Four objectives outlined;
• Among it:
 To improve the health status of older persons.  To provide age friendly, affordable, equitable, accessible, cultural acceptable, gender sensitive,
accessible, cultural acceptable, gender sensitive, seamless health care services in a holistic manner at all levels. Strategies:
1. Development of a continuum of health care services
2. Interagency / intersectoral collaboration
Interagency / intersectoral collaboration
3. Research and development
4. Human resource planning and development
5. Health promotion
6. Legislation
7 Information system
7.
I f
i
Plan of Action
 Primary Care  Secondary and Tertiary Care
y
y
 Health education and p
promotion
 R & D
 Inter
Inter‐sectoral
sectoral collaboration
collaboration
 Legislative
Programs
• Services
• Issues / Constraints I
/C t i t
what works and what doesn’t?
42
Ministry Of Health
http://www2.moh.gov.my/images/gallery/carta_org/carta_besar_bm‐100713.png
Public Health Devision
Public Health Devision at Federal Level
45
The Services
The Services
Services
Three main services:
• medical ( hospital )
• health ( health clinic )
• ‘institution’
institution
Health Care Services for Warga
for Warga Emas
Pilot project: Health Care Services for Warga
Pilot project: Health Care Services for Warga Emas
• year 1996
1996
• 4 health clinics:
4 health clinics:
‐ H.C. Kuala Kedah (Kota Setar)
‐ H.C. Parit Baru (Sabak Bernam)
‐ H.C. Sungai Mati (Muar)
‐ H.C. Karak (Bentong)
• 1 hospital – Hospital Seremban
…. medical
…. medical and health services
…. medical
medical and health services…..
and health services…..
services…..
a) Medical ( hospital )
a).
i.
Acute medical cares
ii.
Long term care
iii.
Discharge plan
iv.
Psychogeriatric care
v.
Physiotherapy
vi.
Occupational therapy
vii. Clinical pharmacy
viii. Counselling
ix.
Medico social / welfare
…. medical and health services…..
b). Health services (at health clinics):‐
i.
Health education and promotion.
ii. Screening and assessment ‐ memory status, ADL, IADL, fall, incontinence, etc.
iii. Medical examination, counseling, treatment and referral.
iv. Home visits and home nursing.
v. Rehabilitation.
h bl
vi. Recreation, social and welfare.
…. medical and health services…..
b). health services (at health clinics.):‐
i.
Health education and p
promotion.
…. activities at health clinics ……
ii. Health screening and assessment.
…. activities at health clinics ……
ii. …. health screening and assessment……
…..
…. activities at health clinics ……
iii. Medical examination, treatment and counseling.
…. activities at health clinics ……
iii. …medical examination, ,
treatment and counseling …..
Counseling by trained g y
Ahli Panel Penasihat
for their colleague. …. activities at health clinics ……
iv. Home visiting and home nursing.
…. activities at health clinics ……
v.
Physiotherapy and Occupational Therapy.
…. activities at health clinics ……
v. ….physiotherapy and occupational therapy …..
…. activities at health clinics ……
vi. Social, recreation and welfare.
…. medical and health services…..
c). Institutional Services
i.
Long‐term residential care
ii
ii.
Respite care
Respite care
iii. Day care
• Currently, the Social Welfare Department, Non‐
Government Organisations and private nursing homes
are providing institutional services.
Services for elderly
Services for elderly

emphasize on community participation.
h i
i
i i i

‘‘provide’ physical, mental, social and spiritual well‐
id ’ h i l
t l
i l d i it l ll
being.

caring concept.

involvement of NGOs, private sectors and involvement
of NGOs private sectors and
communities – indicate the success of the programs.

effort to make hospitals and health clinics elderly‐
friendly.
Achievements
- Hospital that provide the services (9)
- Geriatricians (10 MOH – 7 univ. – 6 private)
- Psychogeriatricians
y
g
((8 MOH – 3 univ.))
- No. of health clinics provide the services
• ~ 300 health personals (AMO and nurses) undergone post‐basic training in “Gerontology Nursing” 
upgraded to “Advance
upgraded to Advance Diploma in Gerontology Diploma in Gerontology
Nursing” • > 27k health personals had been trained in “Healthcare for the Elderly” (in‐service training)
• ~ 23k carers had been trained
Trained Overseas
Trained Overseas
• 4 Medical Gerontologists (doctor with master in gerontology)
gerontology).
• 4 did attachment in Australia – Community Geriatric
• 5 attended Short Course in Gerontology (in Singapore) 5 attended Short Course in Gerontology (in Singapore)
organised by International Institute on Ageing, United Nation, Malta and NGO in S’pore.
• 1 attended Short Course in Gerontology in Malta.
• 2 did attachment in Hong Kong in community paticipation
(elderly care)
(elderly care).
• 2 did attachment in Japan (JICA Program ).
2 Dr 2 PPP 2 Nurses 2 OTs 2 PTs did attachment in
• 2 Dr, 2 PPP, 2 Nurses, 2 OTs, 2 PTs did attachment in Australia. • 1 nurses did study visit to England.
Health education materials
1.
Proses Penuaan.
Phamplet
2.
Panduan Pemakanan Untuk Warga Tua.
Phamplet
3.
Panduan Kearah Penjagaan Kesihatan Mulut Warga Tua.
Phamplet
4.
Apakah Masalah Pergigian Yang Dihadapi Oleh Warga Tua?
Phamplet
5
5.
Penjagaan Dentur
Phamplet
6.
Pemeriksaan Kesihatan Untuk Warga Tua.
Phamplet
7.
Osteoporosis (Kerapuhan Tulang).
Phamplet
8.
Insomnia (Kesukaran Tidur).
Phamplet
……bahan
……
bahan‐‐bahan pendidikan kesihatan….
kesihatan….
9.
Arthritis (Sakit Sendi).
Phamplet
10. Keusiaan dan Kasih Sayang
Phamplet
11. Menyesuaikan Diri Anda Di Usia Tua
Phamplet
12 Senaman
12.
S
K
Kearah
h Warga
W
Tua Cergas.
C
Phamplet
h
l
13. Panduan Pemakanan Warga Tua Di Institusi.
Booklet
14. Panduan Untuk Penjaga Warga Tua
Manual
15. Senaman Warga Tua
CD & Tape
16. Teknik Mengangkat dan Mengalih Warga Emas
CD & Buku, booklet
……bahan
……
bahan‐‐bahan pendidikan kesihatan….
kesihatan….
17. Osteoarthritis Lutut.
Phamplet
18. Jatuh.
Phamplet
p
19. Senaman Aerobik Warga Emas.
Phamplet
20 Warga
20.
W
E
Emas
d Senaman.
dan
S
Ph
Phamplet
l t
21. Penuaan Sihat
Phamplet.
22. Dementia
Phamplet
MyHealth @ http://www.myhealth.gov.my
Bahagian Pembangunan Kesihatan Keluarga
http://fh.moh.gov.my
The Elderly
The Elderly …. in
in the Health Clinic
Guideline to
Guideline to Implement p
Healthcare Service for the Elderly
Guideline to Implement Implement
Healthcare Service for the Elderly
• S.O.P
• Activities
• Elderly friendly facilities
• Targets/indicators
• Committees
Issues / Constraints (what works and what doesn’t?)
‐ manpower, manpower, manpower ‐ (money) ???
(
)
‐ lack of interagency collaboration:
lack of interagency collaboration:
e.g. multiple agencies do training
KKM – carers
JKM volunteers
JKM –
other NGOs – carers
‐ Stigma for the older person:
• are not always accorded appropriate attention or treatment because their ailments are considered to be the result of age itself.
‐ Older persons often described in terms of:
cost factors,
• cost factors,
• burden of the future • dependent individuals, d
d t i di id l
• lacking social autonomy, neglected, and a burden to the producing world.
‐ One coordinator for research in elderly heath issues
O
di t f
h i ld l h th i
‐ Issue on old folk home which have nursing g
activities
 Currently two acts
C
tl t
t
‐ Laws to protect elderly (Child Law)
p
y(
)
‐ Power of Attorney, elderly abuse issues, work di i i ti /di i i ti
discrimination/discrimination at work place, t
k l
driving, etc.
Global Commitment
Global Commitment
• Vienna International POA on Ageing 1982
g g
• Health of Elderly Report 1989
• Brasilia Declaration on Ageing and Health 1996
Brasilia Declaration on Ageing and Health 1996
• Madrid International POA on Ageing 2002
• Active Ageing –
A ti A i
A P li F
A Policy Framework 2002
k 2002
• Beijing Declaration
• Asia Pacific International POA on Ageing
• ……………… Note: POA = Plan of Action Having said so ……..
g * * * * *
• Healthy Ageing / Successful Ageing /
*
Active Ageing
*
• Ageing Process and Process Of
*
*
*
Ageing
• Add Years to Life and Add Life
to Years
International Day of Older Persons
International Day of Older Persons
• 1st October 1991
• 2015: Theme
2015 Th
Sustainability and Age Inclusiveness in the Urban Environment
82
WOMAN
When she is 18 ‐ She is a football, 22 men going after her. ,
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When she is 28 ‐ She is a hockey ball, 8 men going after her. When she is 38 ‐ She is a golf ball, 1 man hitting on her. When she is 48 ‐ >She is a pingpong ball, 2 men pushing to each other. At the age of 60?
MAN
At 20 ‐ A man is like a coconut, so much to offer, so little to give. At 30 ‐ He is like a durian, dangerous but delicious. At 30 He is like a durian dangerous but delicious
At 40 ‐ He is like a watermelon, big, round and juicy. At 50 ‐ He is like a mandarin orange, the season comes once in a year. At 60 ‐ He is just like a raisin, dried out, wrinkles and cheap.
At 60 ‐
He is just like a raisin dried out wrinkles and cheap
S h t
So what would you like to be?
ld
lik t b ?
Ageing is a privilege and a societal achievement. It is also a challenge, which will impact on all aspects of 21st century society. It is a challenge that cannot be addressed by the public or private sectors in isolation: it
addressed by the public or private sectors in isolation: it requires joint approaches and strategies.
Take
Take Home Message
Home Message
• If you want to go fast, If you want to go fast, go alone. • If you want to go far, If you want to go far, go together.
If you want to go far, go together.
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f i h@
farizah@ummc.edu.my
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