Pioneering research in long-term aged care facilities in Malaysia

Saraswathy in a hospital setting while at work with an elderly patient

The population of Malaysia is ageing, with those aged 60 and over estimated to increase from the current level of 7.4% to 10% of the population (3.4 million) by 2020. By 2030, Malaysia will be classified as an ‘aged’ nation, when the proportion of older adults is projected to reach 15%. The consequences of this demographic trend are considerable and include the need for more supported accommodation and health care. As Malaysia’s social security provision for older people is modest compared to other middle-income countries, the level of health and welfare investment needed as the population ages will be significant.

Like other countries, population ageing in Malaysia is a result of declining fertility, falling mortality rates and improvements in the health system. Effective prevention of infectious diseases and better nutrition has resulted in more people surviving into old age. Life expectancy among Malaysians has also risen to 72 years for men and 77 years for women. Despite the improvement in life expectancy, poverty, lack of education and poor social support tend to influence the well-being of its older population.

While Malaysia is demographically still relatively ‘young’, it will face many of the same challenges experienced by ‘older’ countries such as Japan, Hong Kong and Australia. Traditionally, Malaysian families have taken on the role of providing care at home for older family members and the use of long-term care facilities such as nursing homes was uncommon. However, such traditional care practices are increasingly being challenged as modern pressures on families increase, the younger population becomes more mobile and more women need to gain full-time employment as a means of providing further support. While many families continue to support their older relatives at home, often with the support of a paid informal carer, the demand for long-term care is increasing and a gradual expansion of the sector is expected.

One of the challenges experienced in the early stages of population ageing is the emergence of a new and largely unregulated aged care sector in response to demand. Currently, long-term care is offered by government welfare homes (public sector), private nursing homes and care centres (for-profit) and voluntary aged care organisations and centres (non-profit, charitable). As the sector grows, little is known about the type or standard of care provided in public, private or voluntary long-term aged care facilities.

Saraswathy Venkataraman, an experienced Occupational Therapist and PhD candidate in her second year at Monash Malaysia, is undertaking a study of these long-term care facilities, specifically an exploration of the physical environment and potential injury risk factors which have an impact on the well-being and quality of life for the older residents. “Understanding how older residents engage with both the physical and the social environment is important in making improvements to the standard of care and quality of life” said Ms Venkataraman.  Her experiences in the US and Singapore have motivated Ms Venkataraman to embark on research that can make a difference to the care of older people in her home country. In these aged care settings, the role of the Occupational Therapist is not well developed.  “My research findings will help inform the development of appropriate long-term care standards and also contribute to the further development of the Occupational Therapy profession in Malaysia” explained Ms Venkataraman.

It is already apparent from the first phase of Ms Venkataraman’s study involving 240 residential long-term care facilities that standards vary significantly across the aged care industry in terms of the level of care services available and the experiences of older people residing in these facilities. “A number of issues are already emerging from my research including physical accessibility, health services available, quality of care, staff understanding of injury prevention, wheelchair utilization, communication and resident engagement” said Ms Venkataraman.

Ms Venkataraman has recently presented her preliminary findings at the Gerontology Society of America Annual Scientific Meeting in New Orleans.  The second phase of her research will involve a more in-depth study to better understand the physical environment and its influence on well-being and quality of life while focusing upon the potential of injury risk(s) currently faced, and then in phase three, she will examine strategies for best practice in other countries.

Ms Venkataraman has just been awarded a prestigious Endeavour Research Fellowship by the Australian Government Department of Education to support phase three of her research. This will enable her to travel to Australia for 6 months in 2014 to undertake a comparative analysis of residential aged care and injury prevention.

Ms Venkataraman’s research is supported by supervisors based in Australia and Malaysia, including Dr Jennifer Oxley and Associate Professor Lesley Day from the Monash Injury Research Institute, Associate Professor Louise Farnworth, Head of the Department of Occupational Therapy, and  Professor Helen Bartlett, President of Monash Malaysia.