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Monday, July 28, 2008

A healthy elderly

What do you mean when you say 'a healthy elderly"? Does it mean an elderly without any illness? But is it fair to say that an elderly who has hypertension unhealthy? According WHO, health is "a state of complete physical, mental and social well being and not merely the absence of diseases and infirmity". This definition was updated fifty years later with the addition of two words, "Health is a dynamic state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity".

With the addition of the word spiritual, it indicates the influence of values, beliefs, norms and practices. This led to debates on what is health and summarizing the different definitions, we can say that health is a multifaceted phenomenon (Aggleton, 1990). It is a multi-faceted entity.

Another way of looking at it is to look at it as positive or negative approach. Positive meaning health being viewed as a capacity or an asset to be possessed. Negative approach means taking the approach of absence of specific illnesses, diseases or disorders.

Hence, health in my PhD was viewed as, "The capacity and asset to be possessed, which would enable one to function and involve in one's environment in a manner acceptable to himself and or herself and to the community he or she is part, without living in fear of illness and the presence or absence of diseases is only part of life".

Dr Rahmah

Sunday, July 27, 2008

View about ageing by an elderly Malay in London

During an in-depth interview for my PhD thesis, I was making a remark that older Malay people whom I met in England seems to be active and appeared younger than their chronological age.

One of the participants, Mr Jamal Hakim (not his real name) seemed to agree to my statement. Mr Jamal associated it to the cold weather in England. He said, "I think it is the weather and food. Hot weather is not good. If you take two pieces of meat, one you put in a refrigerator and one you put in hot temperature, the one in the fridge will last longer".

Another participant, a 66 years old housewife said, "They [her friend in Malaysia] look worn out. They said the weather here is good, that was why I look young for my age".

When we talk about images of old age, the concern is the various arrays of images perceived by public. This is important as it can lead to negative or positive perception. This further lead to the development of positive and negative attitudes towards older people.

An example of 'negative' connotation to older people is the sign used to tell people to slow down their vehicle in areas where there are many elderly residents. The sign used, be it in England or Malaysia, is the figure of two older person using walking stick. To me this type of sign must not be used as a universal indicator for old age. There are many elderly who do not need to use walking stick at the age of 70s or 80. Perhaps we need to make a competition for the best figure to indicate older people.

Another common association is illness. When ever people talk about elderly, they will say that elderly usually have many illnesses and that they are a burden to the government and community. We must be very careful in making ageism statements such as this. We must not consider older people as homogenous. They are in reality a very heterogenous group with different background.

In order to promote active and healthy living, the images of older people must be very positive.

Dr Rahmah

Friday, July 25, 2008

Do you feel old?

How old is old?
First and foremost I would like to start by throwing out the question of how old is old. Do you consider yourself as old at your current age? I remember very well my feelings when I was in primary school. When I was 10 years old my mother was at her early 30s. To me, then, my mother was relatively old. But now at my mid 40s, I do not even feel old. By the way ageing is actually a progressive state beginning from conception and ending with death. So who is old?
Whether you are old or not could be viewed according to chronological age, physiological changes or based on one’s perception. Globally, chronological age has been used to demarcate whether one is old or young. Imagine, if we do not use chronological age, how do we decide who can register for school, who can have driving licence, when do we retire? World Health Organisation (WHO) considers 60 as the cut off point to consider one is old, whilst 65 was used by the developed countries such as the United States, United Kingdom because they have far too many older people.
Physiologically we can determine the changes that normally occur when one is old. For example by looking at skin turgidity, wrinkles, arcus senilis (whitish ring around the pupil) in the eye, reaching menopausal state, loosen and aching joints and so on. But always remember that ageing is NOT a disease.
The most acceptable determinants especially by sociologist is ageing viewed by perception. You may be 60 or 70, but you may not feel 60 or 70. What should we really feel like when we reach 60 or 70?. There is no hard and fast rule about it. Perhaps even if we are 45, but if we have all the chronic diseases and it’s complication, we do not have to wait until 70 to feel ‘old’. You can be 80 plus, but if you are fit and have no or minimal illness, you may feel younger than your chronological age. I do not know how Tun Dr Mahathir feels, but looking at him now, and how he carries himself, I can bet that he do feel as if he is at his chronological age.
The lesson learned behind this issue of are you old or not is to aim for active and productive ageing as well as to make sure that we take care of ourselves in order to minimise chronic illness and it’s complication. We want to ‘compress morbidity’, meaning that, since death is determined by Allah swt, and it will not be delayed even by one second, what we can try to change is the morbidity prior to the time. We can compress the duration of illness we may suffer before we die by practicing healthy lifestyle as early as possible. As an example one may suffer from the outcome of a stoke secondary to uncontrolled hypertension for many years before he or she dies. But if from very young, we practice healthy lifestyle, we can avoid the hypertension. If the hypertension is because of old age plus familial, we can avoid some complication by making sure that the hypertension is well controlled and hence avoiding or delaying the stroke. When the prophet Muhammad s.a.w went for ‘israk mikraj’ he travel on an animal called ‘buraq’ (animal transport from heaven). On stopping, the angel asked him why did you tie the buraq. Rasulullah said he wanted to make sure that it will not run away. The angel told rasulullah that he do not have to worry, it will not run away since he is the prophet. But rasulullah said, we must be caution in whatever we do, then only we leave it (tawakkal) to God. Therefore we must not say that God has already determined when I will die and what illness I will suffer, hence I just accept whatever will happen to me. We must always try to do the best in our life before we ‘tawakkal’ to Allah swt.
Dr Rahmah Mohd Amin