Continuing life as a widow...

My father passed away on the 25^th of August 2009. It was the first week of Ramadhan. Alhamdulillah he was taken away peacefully in Kuala Terengganu Specialist Hospital.

Now my mother is left alone. She went through the “edah” period [4 months and 10 days] without much problem. During that period, she just stay at home. Went out a few times for some urgent matter. Her time was filled with reading Quran, religious books and having visitors (close relatives and her female friends). She has six children: Two sons and daughter in Selangor, another two daughters in Seremban and Kuantan. Only one daughter lives nearby to her (20 minutes drive) and has volunteered to stay with her.

The above scenario, is not uncommon. With the increasing life expectancy, better health care, people live longer. Women have a longer life expectancy compared to men. That is why the ageing population (especially those 85 and above) is sometimes called a population of the widowed.

The issue of continuing life as a widow is related to matters such as: whether the elderly woman has a good social support, what is her health status, what about her income to support her daily needs, is it save for her to live alone etc.

Some elderly prefer to live alone. Studies have shown that elderly do not want to be a burden to their children. Are they a burden to us?. This is the kind of scenario that we have been facing not only now but for ages. I remember a few cases, when I was working as a houseman in 1987. Parents admitted for stroke. Treated in hospital for several weeks. When stabilised,to be discharged home. The moment doctors or nurses tell the family member that patient can be discharged, a decrease in the number of visitors start to occur untill to the point of no more visitors. Visitors become uncontactable…

Nobody wants to bring them home. The outcome of such situation could be: …they are taken home by a daughter (daughters are commonly taken for granted to be the carer); or nobody turn up and at last sent to the welfare home or just left in the ward.

Some elderly widow rotate to stay with their children. This kind of arrangement is good but depends on how much elderly parents can telorate their children, daughters or son in law, grandchildren and not to forget the maid. Some just stay with one particular child whom she can tolerate most.

Whatever the arrangement is, as children we must NOT FORGET that “one mother can take care of ten children but ten children may not be able to take care of one mother”.

Her mom doesn't recognise her

Today 21st January 2010. I was invited as a guest in a television programme name “Fitrah Kasih”. Two other guests were Premah (ex-RTM Radio DJ) and a motivator Amin Idris. Though I work with UKM Medical Centre, but for this programme I represented GEM (Association of Gerontology Malaysia). The host of the programme were Hanna and Fifi. The title of this week’s programme is “Quran Buruk” (Unused Quran) which refers to elderly with dementia. In the Al-Quran, surah Yaasin Allah swt says "Whoever we permit to live a long time we revert to weakness. Do they not understand?"(36:68). When I talked to the producer over the phone she was asking me the difference between dementia and Alheizmer and what is dementia.

“Dementia or in Malay language “Nyanyuk” is a condition where one’s brain cells are damaged or die. 60 to 80 percent of dementia is due to Alheizmer disease where no specific cause can be identified. The rest could be due to vascular dementia (related to cerebrovascular diseases such as hypertension, heart disease, stroke etc); Lewy Body dementia (presence of certain type of protein in the brain which causes brain cell damage) may also be a s result of hypothyroidism, deficiency of vitamin B12, drug induced, infections or accidents leading to brain injury. Dementia can affect any age but majority the elderly. The older you are the higher the chances for you to get dementia.

During the programme they highlighted a case of a woman who lost her mum. She suddenly disappear (allerged to have gone to her daughter in law’s house in Raub, Pahang but never came back. She disappeared for few years).

Well, this is one of the symptoms a demented person will present. They quite often lost their way. They do not know how to get back to their own house. Among the common feature of dementia are LOST OF RECENT MEMORY – if we talk to someone with dementia, we will find that they will keep on asking the same question. They forget that they have asked the question and also forget that we have given them the answer. Thirdly INABILITY TO USE PROPER LANGUAGE – they find it difficult to use simple word, hence use wrong words in their sentence leading to people cannot understand what they were trying to say. Fourthly, DISORIENTATION TO TIME AND SPACE – they will not be able to differentiate between day and night, morning and evening. They also do not know where they are. Another is INABILITY TO THINK LOGICALLY – they put things in weird places. For example put their watch in the sugar jar, putting iron in a fridge. They also can have MOOD SWING – we do become moody at times but dementia patient’s mood swing very fast. They can be calm, depressed, happy, angry in a short period. They also can LOOSE INTIATIVE – prefer to be alone, don’t like to mix around, just sit in their room. They can also show WEIRD BEHAVIOUR – they can accuse people stealing their property, pass motion anywhere. They can also have HALLUCINATIONS –a relative of mine who had dementia, she always talked to plants and said that the plants are little children. When she looked in the mirror, she saw someone else. They can also loose the ability to CARRY OUT THEIR DAILY ROUTINE – can’t drive, cook, get dress, bathe or eat.

They were also concern as to why demented person can only remember incidents from the past and not recent memory.

In dementia patients, their brain cells become corrupted. So they are not able to store new message. For example if they keep their watch in a cupboard, they cannot store this message, hence they forget. But past stories which have been stored long time ago, still remain with them. However some type of dementia such as vascular dementia can loose both short as well as long term memory.However sad to say the long term memory may be lost as the condition progresses.

They wanted to know if there is any treatment for dementia.

There is no medication yet that can cure dementia. However there are medications that can help to slow down the progress of the disease.

Who are at risk or what are the risk factors for dementia?

There are a few risk factors such as age itself, family history, alcohol intake, smoking (higher risk of atherosclerosis and vascular diseases), diabetes, high level of bad cholesterol, low intake of fruits and vegetables.

Whatever it is, I would like to stress here that family members are the one who will notice the changes in the elderly. If suspicious, please consult a doctor. Screening such as ECAQ (Elderly Cognitive Assessment Questionnaire; MMSE (Mini Mental State Examination) and Drawing the Clock test can be done. Patient need to investigated fully to assess the risk factors, possible causes. Also to properly plan the care for them.

Publications in Journals

1) Noor Azimah Muhammad, Khadijah Shamsuddin, Khairani Omar, Shamsul Azhar Shah & Rahmah Mohd Amin, Validation of the Malay version of the parental bonding instrument among Malaysian youths using exploratory factor analysis Malaysia Journal Medical Science, Sept-Oct 2014, 21(5): 51-59.

 

 2) Zaleha Abdullah Mahdy, Hashimah basri, Zaleha Md Isa, Shuhaila Ahmad, Khadijah Shamsuddin & Rahmah Mohd Amin (2014) Antenatal calcium intake in Malaysia, Journal of Obstetric and Gynaecology Research vol 40 (4): 983-987.

3) Rahmah MA, Aniza A & Che Engku Nor Bahiyah CEM (2013) Do elderly women in Malaysia go for mammogram screening? Malaysia Journal of Public Health Medicine vol 13(2): 20-26

4) Mohammed A. Abdal Qader, Rahmah Mohd Amin, Shamsul Azhar Shah, Zaleha Md Isa & Hasanain Faisal Ghazi (2013), Relationship between Nutritional factors, sports practicing and falls among elderly people in Baghdad city, Iraq, Pakistan Journal of Nutrition 12(5): 491-495

5) NurFatihah O., Rahmah M.A. & Rosnah S. (2013) Informal Social Support and Caregiver Burden of Caregivers of Elderly with Dementia, IOSR Journal of Humanities and Social Science vol 8(5) (Mar – Apr): 68-72.

6) NurFatihah O.A., Rahmah M.A., Rosnah S., Ismail D. Khadijah S. & Sh Ezat (2013) Quality of Life Among Caregivers of Elderly with Dementia and its Associated Factors, IOSR Journal of Nursing and Health Science vol 1(2) (Jan – Feb): 07-13.


7) Minhat HS, Rahmah MA & Khadijah S (2013) Continuity theory of ageing and leisure participation among elderly attending selected health clinics in Selangor The International Medical Journal Malaysia vol 12(2): 51-58

8) Minhat HS, Mohd Amin R & Shamsuddin K (2012) Late-life leisure constraints among Malaysian elderly: A qualitative approach, Malaysian Journal of Public Health Medicine, vol 12(2)

9) Nor Afiah MZ, Rahmah MA, Salmiah MS, Fazilah I & Shamsul Azhar S (2012) Religious personality and smoking among form two students in rural schools in Malacca, Malaysia, The International Medical Journal Malaysia

10) Halimatus Sakdiah Minhat & Rahmah Mohd Amin (2012) Sociodemographic Determinants of Leisure Participation Among Elderly in Malaysia, Journal Community Health, 37: 840-847 doi 10.1007/s10900-011-9518-8


11) Shamsul Azhar Shah, Azura Abdullah, Azimatun Noor Aizuddin, Mohd Rohaizat Hassan, Nazarudin Safian, Rozita Hod & Rahmah Mohd Amin (2012), Psycho-behavioural factor contributing to truancy among Malay secondary school student in Malaysia, ASEAN Journal of Psychiatry, vol 13(2), July - December.

12) H.S. Minhat and R.M. Amin (2012) Social support and Leisure Participation of elderly in Malaysia, The Internet Journal of Geriatrics and Gerontology vol 7(1).

13)  Halimatus Sakdiah Minhat and Rahmah Mohd Amin (2011) Sociodemographic Determinants of Leisure Participation Among Elderly in Malaysia, Journal Community Health -->Online First ^TM , 9 December 2011.

14) Rahmah Mohd Amin and Noraishah Jaafar (2011) Elderly Diabetic Patient’s Perception on family Support and Glucose Control, International Journal of Public Health Research, vol 1(1) www.ijphr.ukm. my

15) Zulfiqar MA, Rohazly I and Rahmah MA (2011) Do the majority of Malaysian women have dense breast on mammogram? Biomedical Imaging and Intervention Journal 7(2):e114.
 
16) AK Rashid and MA Rahmah (2011) Role of family support in older adult defaulting treatment for depression: a case-control study, Asian Journal of Gerontology Geriatrics, 6: 27-34.

17) Bachok Norsa’adah, Krishna G Rampal, Mohd A Rahmah, Nyi N Naing and Biswa M Biswal (2011) Diagnosis delay of breast cancer and its associated factors in Malaysian women, BMC Cancer, 11:141, doi:10.1186/1471-2407-11-141.

18) H.O Basaleem and R.M. Amin (2011) Integrated Management of Childhood Illness in Lahej, Yemen: a qualitative analysis from the perspective of health providers, Eastern Mediterranean Health Journal, 17(2): 101-8.

19) Rahmah Mohd Amin, Zakiah Mohd Said, Rosnah Sutan, Shamsul Azhar Shah, Azlan Darus and Khadijah Shamsuddin (2011) Work related determinants of breastfeeding discontinuation among employed mothers in Malaysia, International Breastfeeding Journal, 6(4) doi:10.1186/1746-4358-6-4

20) Rosidah SS, Roslinah A, Mohd Idris, O, Mohd Azhadi O, Haliza, AM, Leela S, Rahmah MA, Hamidon BB, Rohana J, Evi Diana O, Roslan Johari MJ and Magesiwaran M (2010) Pre-hospital delay and it's associated factors among stroke patients in Klang valley, Journal of Health Management vol 8 (1).

21) Shamsuddin K, Ghofari M, Sharifa Ezat WP, Rahmah MA, and Jannatul Madihah AB (2010) A qualitative study of programme managers` perspective on challenges and issues in providing health services for adolescents, Journal of Community Health, vol 16 (supplement 1): 38

22) Hossein Moshiri, Syed Mohammed Aljunid, Rahmah Mohd Amin and Zafar Ahmad (Oct 2010) Impact of Implementation of Case-mix System on Efficiency of a Teaching Hospital in Malaysia, Global Journal of Health Science, vol 2(2): 91-95.

23) Hossein Moshiri, Syed Mohammed Aljunid and Rahmah Mohd Amin (2010) Hospital efficiency: Concept, Measurement Techniques and Review of Hospital Efficiency Studies, Malaysian Journal of Public Health Medicine vol 10(2): 35-43.

24) SM Aljunid, H Moshiri and R Amin, The impact of introducing case mix on the efficiency or teaching hospitals in Malaysia, BMC Health Services Research 2010, 10(Suppl 2): A9 http:/www.biomedicalcentral.com/1472-6963/10/S2/A9

25) Siti Khatijah A.R., Rosnah S. and Rahmah M.A. (2010) Prevalen anemia semasa mengandung dan faktor-faktor mempengaruhinya di Johor Bharu, Malaysia Journal of Public Health Medicine vol.10(1): 70-83.

26) Rashid A.K. and Rahmah M.A. (2010), Negative perception and poor awareness as risk factors to the default of depression treatment among the elderly- a case control study, The Internet Journal of Geriatrics and Gerontology, Vol 5(2).

27) A.K. Rashid and M.A. Rahmah (2010) Treatment related risk factors associated with the default of depression treatment among the elderly – a case control study, The Open Geriatric Medicine Journal Vol 3: 11-16.

28) Fatimang Ladola, Rahmah Mohd Amin and Fatimah Abdullah (2009) Penjaga wanita bagi wargatua pesakit strok di bandar, Malaysian Jurnal of Social Administration, vol 6: 57-72.

29) B.Zabedah, AS Badrul Hisham and M.A Rahmah (2009) Unheard voices: Women’s inner experiences during the Johor flood. Jurnal Kesihatan Masyarakat 15 (Supplement 1): 98-103

30)Fatimang Ladola & Rahmah Mohd Amin (2009) Sokongan Sosial dan Penggunaan Perkhidmatan Sokongan Dalam Mempengaruhi Beban Jagaan Warga Tua Stroke Malaysian. Journal of Social Policy and Society vol 6: 45-63

31) Rahmah Mohd Amin, Zaimi Abdul Rani, Halim Ismail, Hazlina Miskam & Shamsul Azhar Shah (2009) Kepuasan Warga Tua yang Melanggan Perkhidmatan Bantuan Orang Tua (BOT) di Jabatan Kebajikan Masyarakat Wilayah Persekutuan. Malaysian Journal of Social Policy and Society vol 6: 86-101

32) Teik-Beng Khoo, Aminah Bee Kassim, Mohd Azhadi Omar, Nazirah Hasnan, Rahmah Mohd Amin, Zaliha Omar and Ahmad Faudzi H.J. Yusoff, Prevalence and impact of physical disability on Malaysian school-aged children: A population-based survey. Disability and Rehabilitation: 2009;1-9 iFirst article.

33) Huda O Basaleem and Rahmah M. Amin, (2009). Qualitative study on the community perception of Integrated Management of Childhood Illness (IMCI) implementation in Lahej, Yemen. SQU Medical Journal 9(1): 42-52.

34) M. Jamsiah, I. Zurainatul Irwani, W.P. Sh. Ezat, S.A. Shamsul and M.A. Rahmah (2009) Stres dalam kalangan pesakit diabetes mellitus dengan komplikasi di Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan. Jurnal Kesihatan Masyarakat 15(1): 39-46.

35) M. Jamsiah, M.A. Rahmah, W.P. Sh Ezat and S.A. Shamsul (2009) Amalan perancang keluarga dan factor hubungkait bagi penduduk wanita daerah Hulu Langat, Selangor. Jurnal Kesihatan Masyarakat 15(1): 57-63.

36) O. Salimah, M.A. Rahmah, R. Rosdinom and S. Shamsul Azhar (2008) A Case Control Study on Factors That Influence Depression Among The Elderly In Kuala Lumpur Hospital and University Kebangsaan Malaysia Hospital. Medical Journal of Malaysia 63(5):395-400.

37) Rosila Y, Rahmah MA, Idayu Badilla MI and Shamsul AS (2008) Factors Influencing Husbands of High Risk Mothers to Support Family Planning Practice. Malaysian Journal of Obstetrik and Gynaecology 8(15): 33-48.

38) A.S Shamsul, S.A Abdi Nur, I Halim and M.A. Rahmah (2008) Knowledge, Attitude and Practice of Female Genital Mutilations Among Males and Females Attending Out Patients and MCH Clinic of Elder District Rural Hospital Galgadud Region Somalia. Jurnal Kesihatan Masyarakat 14(1): 45-51.

39) A Gulifeiya and M.A. Rahmah (2008) Nurses Awareness and Attitude Towards HIV/AIDS and Universal Precaution: A Cross-Sectional Study in UKMMC. Jurnal Kesihatan Masyarakat 14(2): 37-46.

40) M.A. Rahmah and B Shahraniza (2008) Risk Taking Behaviour Among Adolescents in Johore Bharu and its Associated factors. Jurnal Kesihatan Masyarakat 14(2): 25-31.

41) M.A. Rahmah, J Rozy, I Halim, M. Jamsiah dan A.S Shamsul (2008) Prevalence of Back Pain Among Nurses Working in Government Health Clinics and Hospital in Port Dickson Malaysia. Jurnal Kesihatan Masyarakat 14(2): 12-19.

42) Khalib, A.L., Syed Al Junid, Muhammad, A.R., Osman A., Rahmah M.A. and Khairul Hazdi. (2007) Lessons learned from health and fitness prescription: a Malaysian experience. Medical Journal of Indonesia 16(1): 39-46 January – March.

43) M. Zailawati, I. Aniza, M.A. Rahmah and M.S. Hanafiah (2007). Tahap kepuasan terhadap perkhidmatan kerja social perubatan di kalangan pesakit kanak-kanak di hospital Raja Perempuan Zainab II, Kota Bharu. Jurnal Kesihatan Masyarakat 13(2): 1-10.

44) Rohani, I., Hanafiah, M.S., Md Idris, M.N., Rahmah, M.A., Shamsuddin, K., Khalib, A.B., Kasmini, K., Suraiyah, H. and Siti Sapor, B. (2002) Status of Islamic Religiousity Among Early Adolescent with High and Low Risk Behaviours in a Secondary School in Gombak District. Malaysia Journal of Public Health Medicine Vol 2 (1): 29