By Dr. Alan Ch’ng Swee Hock
Consultant Geriatrician, Positive Healthy Ageing Programme Malaysia
The average life expectancy at birth for Malaysians has reached 73.4 years in 2022. By 2040, 14.5% of Malaysians will be aged 65 or older. Malaysians are living longer thanks to increased income, reduction in poverty, improved employment, increase in urban population, higher per capita income, and better health awareness. While living longer is a significant achievement all of us can be proud of, we certainly also want to spend our golden years in good health, or at least delay some of the diseases that tend to occur more frequently as we age.
Certain chronic diseases are also some of the most common causes of death and disability among older adults in Malaysia. It is important to be informed of these common health conditions so that we are able to identify their symptoms, get medical assistance when needed, and take preventative steps to ameliorate these risk factors.
Cardiovascular diseases (CVDs) & their risk factors
Heart attack and stroke are the leading causes of death among older adults in Malaysia. A heart attack occurs when the supply of blood to the heart is disrupted, usually by a blood clot. Signs of a heart attack include chest pain, pain that is spreading from the chest to the arm/shoulder, jaw, neck, back, shortness of breath; nausea, and light-headedness.
A stroke happens when there is obstruction or rupture of a blood vessel that disrupts the blood flow in one area of the brain. Symptoms of a stroke may include sudden drooping of the face, speech difficulty, limb weakness, visual disturbance, or instability. Leading risk factors for heart disease and stroke are high blood pressure, high low-density lipoprotein (LDL) cholesterol, diabetes, smoking and secondhand smoke exposure, obesity, unhealthy diet, and physical inactivity. Both can cause serious disability and death.
Diabetes Mellitus
Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. High blood sugar is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems. Complications of diabetes mellitus involve damage to large and small blood vessels in the body i.e. cardiovascular disease, stroke, kidney disease, nerve damage, blindness, and foot problem.
The risk is higher as we get older. 1 in 3 older adults in Malaysia has diabetes mellitus. Malaysians are getting diabetes at a younger age. We must be mindful of the early signs of diabetes such as increased thirst, frequent hunger pangs, unexplained weight loss, frequent urination, fatigue, and blurred vision. However, some people may have no symptoms at all and are diagnosed after a complication has occurred. Annual screening is important to detect silent disease and should begin at the age of 30 years old.
High blood pressure
The National Health and Morbidity Survey in 2015 reported that the prevalence of hypertension among Malaysian adults aged 18 years and above was 30.3%. The rate increases to 71.9% among older adults aged 60 years and above. Hypertension is a silent killer as people usually would not even realise it until their blood pressure is measured. When the blood pressure is high, some people may have severe headaches, fatigue, chest pain, nose bleed, and difficulty breathing. High blood pressure can put significant strain and bring serious problems to the heart, kidney,s and blood vessels. Therefore, it is important to have regular check-ups or self-monitoring at home, especially if you are in a high-risk group e.g. obesity, smoking, sedentary lifestyle, having a family history, or eating a diet high in salt.
High cholesterol
You may have heard of good and bad cholesterol; high cholesterol usually refers to too much bad cholesterol in the body. 64% and 56.7% of Malaysian adults had elevated total cholesterol and low-density lipoprotein cholesterol (LDL-c), respectively. Similar to high blood pressure, high cholesterol typically does not cause any symptoms. However, high cholesterol increases the risk of heart disease and stroke.
Cancer
Cancer is the 7th most common cause of death in Malaysia in 2021, accounting for 1.7% of all deaths. The most common cancers in Malaysia are breast cancer, followed by colorectal cancer, lung cancer, nasopharyngeal cancer, and liver cancer, according to the World Health Organization. Breast, colorectal, and lung cancers consist of half of the total cancer cases reported by the Malaysia National Cancer Registry. Both breast cancer and cervical cancer are among the leading causes of death for Malaysian women with cancer. The incidence of cancer increases with age (female: increased risk after the age of 40; male: higher risk after the age of 50-60). Therefore, regular screening is important.
Mild cognitive impairment (MCI) and dementia (including Alzheimer’s Disease)
Mild cognitive impairment is a condition in which the person experiences minor problems with memory and/or other mental abilities. However, the symptoms are not severe enough to interfere significantly with daily life. The incidence rate of MCI in Malaysia was 10.5 per 100 person-years. A community survey amongst Malays aged 60 years and above in Selangor, found that 24% were having cognitive impairment. Older adults with mild cognitive impairment have a significantly increased risk of developing dementia, a condition characterised by a progressive cognitive decline that affects the ability to function independently.
On the other hand, 8.5% of Malaysian older adults are having dementia. It is important to note that dementia becomes increasingly prevalent with older age, but it is not a normal part of aging, a common misconception. Symptoms to watch out for include memory loss that affects daily activity, disorientation to place and time, difficulty doing familiar tasks, difficulty communicating, asking questions repetitively, and getting lost in a familiar environment. 12 modifiable risk factors for dementia include shorter duration of formal education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, low social contact, excessive alcohol consumption, traumatic brain injury, and air pollution.
How to think about age-related diseases?
While aging itself is not a disease, it is a risk factor for these different conditions. That does not mean you will have an age-related disease; it just means you are more likely to experience these conditions as you get older. It is important to watch out for the effects of lifestyle factors like smoking, diet, and fitness levels, as well as simple wear and tear, which can all accelerate the rate of decline in different people. Practising a healthy lifestyle at any age plays a crucial role to help prevent or delay the onset of these common health conditions. We must strive to follow a healthy diet, maintain a healthy weight and body composition, stay active every day, quit smoking if you smoke, and get adequate sleep. Also, maintain a positive mindset and healthy social circle to keep oneself occupied.
In conclusion, good health adds good quality of life to years. It is never too late. Start investing in your health today!