Experts: Ageing In Place Is Best But Not Enough Is Being Done

It was just a day like any other when Associate Prof Rahimah Ibrahim received a call from her mother telling her that her 77-year-old father had fallen and had to be hospitalised.

It was as if a switch had flipped. One day everything seemed normal and the next, the director of the Malaysian Research Institute on Ageing at Universiti Putra Malaysia and her siblings had to face the fact that their parents were becoming more frail. 

With that, came several questions.

Can their parents still live on their own? Would living with one of their children be better for them instead? How about sending them to a care centre? Can they continue to live at home when their house may not be friendly to their aches and pains? 

Not once were her parents willing to entertain the idea of moving elsewhere, even to live with their adult children. Neither were they interested in moving to a new neighbourhood or development where things may be easier for them as they age, from the design of the abode to the environment around them. 

What Rahimah’s parents want, and what research says is healthier for them, is to age in place.

“I asked (my mom), please, let’s move to another place. She said ‘No, I have (friends among the neighbours) here. I built a relationship with (them) for 20 to 30 years’,” Rahimah told Bernama.

That left her and her siblings with the final question: since their parents want to remain at home, they will need some support. The first thing is to make their parents’ house, which was built in the 1970s, as elderly-friendly as possible by incorporating universal design or barrier-free design in their renovations.

Malaysian Research Institute on Ageing director, Associate Professor Dr Rahimah Ibrahim, spoke about ageing in place at the M Resort Hotel, Kuala Lumpur recently. --fotoBERNAMA (2024) COPYRIGHT RESERVED

Like other Malaysians dealing with ageing, be it themselves or their children, they are now having to retrofit their home, one of the challenges of ageing in place. Things like squatting or Asian toilets, as well as narrow stairs and hallways, are common characteristics of houses built before the turn of the century. 

These aspects now pose a problem for the elderly as they grow less mobile and more prone to slips and falls.

AGEING IN PLACE

First off, what is ageing in place? Ageing in place is when people can grow old in the home and community they have spent much of their adult lives, with or without their children living with them. Health organisations and ageing experts support the idea as staying independent and in their homes and their communities has many benefits, including having a positive impact on their mental and physical health.

According to the Department of Statistics, Malaysia hit the ageing nation milestone – where seven percent of the population comprises people aged 65 and above  – in 2021. 

The next step is aged nation status, where the elderly will comprise 14 percent of the population. The World Bank estimates Malaysia will reach that point by 2044.

Research done in Malaysia and elsewhere also found a common trend: people want to remain in their homes as much as possible. A survey published in 2019 titled ‘Growing old at own home: A study among pre-elderly adults in Peninsular Malaysia’ by Shamzaeffa Samsudin of Universiti Utara Malaysia and her colleagues found that about 84 percent of 1,153 respondents wanted to grow old in their own homes.

Few preferred to move into a retirement village or neighbourhood designed for the elderly.

A senior citizen decorating her home for Chinese New Year. Experts say ageing in place is best for seniors' mental and physical health. Illustrative photo. --fotoBERNAMA (2024) COPYRIGHT RESERVED

Former chairman of the subcommittee on Retirement Villages and Aged Care with the Real Estate and Housing Development Association James Tan said the trend is evident worldwide. 

“In Australia, last I checked, only seven percent of their senior citizens move into a retirement village – seven percent out of a mature Australian market,” Tan, who is also the chief executive officer of Suntrack Development Sdn Bhd, told Bernama via a Zoom interview. 

However, the wish to grow old at home likely remains unfulfilled for most of the elderly in Malaysia. Unlike Australia, only about 30 percent of Malaysian elderly are living on their own or with their spouse. The rest are living with their children or in elderly care centres, according to the 2014 Fifth Malaysian Population Family Survey, which is published once a decade. The sixth report is expected this year.

Ageing experts said many elderly end up having to leave their homes and communities. It is either because the house or environment design is not conducive to ageing or because there is a lack of support services to provide them with the care they need. Most of the elderly in this situation require some care, just not a lot of care. 

“We are forcing people out of their homes because there are no services there to enable them to live independently or to get services to where they are living,” said Rahimah, adding moving may still be on the cards for her parents if their care needs increased.  

LACK OF ACTION

Even if her parents had agreed to move as some elderly may want to downsize, there was no guarantee that they would be able to find or afford a place that fits their needs.

Despite the Ministry of Housing and Local Government’s (KPKT) requirements for local councils and builders to employ universal design or barrier-free design in their projects, many buildings in Malaysia can still be hard to access for those with mobility issues.   

Over the years, KPKT sent circulars to several professional organisations and agencies, including those for architects, engineers and surveyors, reminding them to adhere to the Uniform Buildings By-Laws 1984 (UBBL) when planning new projects. This is to make sure new developments are easily accessible to people with disabilities, which can include the elderly.

The ministry also reminded them that local governments could make the UBBL a condition to approve building plans.

The environment surrounding the homes is also important when trying to age in place. Illustrative photo. --fotoBERNAMA (2024) COPYRIGHT RESERVED

But the reality is much different.

Ageing experts say lack of action by authorities is one of the main challenges when it comes to ageing in Malaysia.

“Yes, they may have done some work but it is still on paper. It looks good on paper. When it comes to action or implementation, it is always very slow,” said Cheah Tuck Wing, chairman of the Malaysian Coalition on Ageing. 

While the federal and state governments have produced a game plan for seniors, the Petaling Jaya City Council (MBPJ) is the only one that has publicly released its plans for seniors living within its jurisdiction. While it did not directly deal with ageing in place, it detailed objectives to provide social support, financial advice, an accessible environment and infrastructure.

Bernama reached out to KPKT, a few city councils and professional bodies for comment but was unable to get a response in time.  

LIVING SPACES FROM CRADLE TO GRAVE

While some new buildings may lack universal design for multi-generational living, many developers are specifically incorporating aged nation considerations into their plans. In areas with high concentrations of seniors or soon-to-be seniors, developers are taking ageing in place into consideration.

For them, it is just a smart business move to consider demographic changes.

Boustead Properties Bhd recently demolished the eCurve mall in Mutiara Damansara, Petaling Jaya, to make way for The Lines service apartments. The development offers 14 layouts suitable for people of varying ages and also adaptable for ageing in place.

Its CEO Khairul Azizi Ismail told Bernama market research found residents within a 15-kilometre radius of the property very mature, that is, a high number of them are middle-aged and senior citizens. 

“We foresee they are also one of our target markets that we can approach. Whereby not only for new house buyers, the children but also for the parents and grandparents,” he said.

“(The apartments) are ready to be turned into a senior living space, (such as) the switches are kept low and hallways are wider,” piped in Mutasha Musa, head of Design and Planning at Mutiara Spaces, a subsidiary of Boustead Properties.

CEO Boustead Properties Bhd Khairul Azizi Ismail. --fotoBERNAMA (2024) COPYRIGHT RESERVED

According to Boustead Properties, about 63 percent of the estimated one million people within the 15km radius of the development are aged between 20 and 59. And nine percent or about 100,000 are 65 years old and above.

“This means, moving forward, in five to 10 years coming, we are at least tapping into 30 percent of the senior group,” said Muhd Taufiq Jaapar, chief creative strategy officer at Boustead Properties.

Other developments centering universal design and multi-generational living include Tuai Timur by Suntrack Development in Setia Alam.  

PRESENT REALITY

There is no denying that ageing in place options are available for many retirees and seniors – if they can afford it. But renovation costs may be prohibitive in the end, especially if the house involved is not very adaptable to ageing

“(At my house), the doorways are not big, definitely not (big enough) for wheelchairs. There are no anti-slip floors, no railing here and there. It was never built for ageing in place. It’s just a house,” Cheah said.

The 63-year-old said he and his wife may have to move to a more age-friendly place in the future, even though they preferred to age in place.

While he and his wife can likely afford to move into a more senior-oriented dwelling, he acknowledged many do not have the same option. And considering the senior population is growing by the day, exacerbated by the falling birth rate, he said the government would be well-served to follow Singapore which, he added, implemented its action plan on ageing well. 

Cheah Tuck WIng, chair of the Malaysian Coalition on Ageing. --fotoBERNAMA (2024) COPYRIGHT RESERVED

Singapore attained aged nation status in 2020, with the elderly comprising 16 percent of its 5.6 million population, and is heading quickly to super-aged nation status, with at least 20 percent of the population aged 65 and above.

“We are heading to that road already. We still have a little bit of gap to save ourselves so before that happens, learn quickly and implement those things,” he said.

“Why are we always so reluctant to learn from Singapore? Maybe it’s because of the history behind (our relations),” he added, laughing.