Thursday, October 31, 2019

HOW AGE-FRIENDLY IS OUR CITY?


Sometimes one can't help but wonder whether our city fathers and policy-makers consider the special needs of older people when they make decisions on improving the city's infrastructure and public facilities. Do they study the demographics when they brainstorm at meetings?

Admittedly there have been some improvement over the past few years, but there is still much more that City Hall can do to make Kuala Lumpur an age-friendly city. Taiping has just been picked for the first stage of the Age-Friendly Pilot Project financed with a grant of RM1.1million from UNDP. The project will be based on World Health Organisation (WHO) guidelines. Perhaps KL can take a cue from the project.

Here are some suggestions on how City Hall as well as the private sector (and also city dwellers in general) can make it easier for older people to move around in the city, and enjoy a day out on their own or with friends.

PUBLIC TRANSPORT

I gave up driving about 20 years ago, and have been relying mostly on public transport to get around. So my grouses here are mostly about the state of our public transport system. Thank goodness the days of the pink mini-buses and their wannabe F1 drivers are gone.

SeniorsAloud used to run a weekly facebook post on Fridays to highlight shoddy public works, poor maintenance culture and lack of age-friendly facilities. We took hundreds of photos and posted many of them as evidence. Glad that there has been much improvement since then. 
It took years but public transport has improved tremendously with the introduction of air-conditioned buses and trains that run on schedule most of the time. There are now free shuttle buses serving Kuala Lumpur city centre and Petaling Jaya township. Senior citizens aged 60 and above enjoy 50% off all fares. Kudos to the Ministry of Transport for these improvements. When we make enough noise, they listen. (Click here to read some of our previous complaints).

All kinds of notices and advertisements, but no information on bus routes
However, information about bus routes is not easily available. Many senior commuters have no clue what buses to take to reach their destinations. They are not internet-savvy, so we can't expect them to go online to check for information. The design of buses leave much to be desired for the elderly who find the steps too high for them to board easily. Only a handful of buses offer wheelchair access. No wonder we hardly see any OKU out on their own in the city.

Facilities at LRT/MRT and monorail stations have improved, but stairs like the above can be challenging for the elderly. Not all stations have escalators and lifts, and not all are always in working condition.
Just looking at the stairs is exhausting to an elderly. But how
else to cross the busy road to Ampang LRT station if not by this overhead bridge?

PEDESTRIAN CROSSINGS AND KERBS


A challenge for the elderly to cross busy Jalan Ampang at KLCC. KL drivers and motorcyclists are not known for their patience.
The timing device at pedestrian crossings covering more than three lanes should be calibrated to give enough time for the elderly to make it safely across. An example is the Jalan Ampang crossing at KLCC/AvenueK. Is a 23-second time gap sufficient for the elderly and parents with young children to reach the opposite side safely? The elderly will have to cross busy roads at their own risk.

Evidence of poor planning and poor maintenance. The narrow sidewalk does not allow strollers or wheelchair access.

PUBLIC RESTROOMS 


Only squat toilets at this premier department store, and no grab bars. A challenge for older women with knee problems to use these restrooms. 
Incontinence is a common problem for most senior citizens. Is it any wonder that they prefer to stay at home than go out to crowded places where the public toilets are either in short supply or in a filthy state? There is also the problem of long lines at the ladies restrooms. There is no priority queuing for elderly ladies. And while on the subject of public loos, how is it possible that one of the biggest departmental stores in the country does NOT have seated toilets in their restrooms? Don't they know that the elderly can't squat because of knee problems?

SHOPPING MALLS


No benches to rest tired feet for the elderly while waiting for their e-hailing cabs or while waiting for their family members to finish their shopping.
Seniors enjoy walking around in shopping malls. The sights and sounds are a source of wonder and amazement to them, especially if they are visiting from the smaller towns. Unfortunately, the lack of facilities for wheelchair access, long lines at washrooms, and few rest areas make an outing to the mall an ordeal for the less abled elderly.

Educating the public about respecting the elderly is also important. How many young people will give up their seats on the train for a senior citizen, an OKU or a pregnant woman? Would older people be given priority in boarding buses?

The rush to board the bus. Gets worse during peak evening hours. The elderly get crushed by eager young men who push their way through. 

Credit must be given to govt buildings and banks that have special lanes or counters to serve the warga emas. We are also seeing more outdoor gyms for senior citizens and safer walkways and lanes for pedestrians. Let's hope for more improvements to follow.

The award for the worst design for bus stops goes to KLCC! No bus information boards, and these 'seats' are meant for perching on or leaning against, not for sitting and waiting for the bus. Most age-unfriendly!

For those interested in knowing what constitutes an age-friendly city, here is WHO's checklist of what an age-friendly city should be and should have. How does Kuala Lumpur fare?



Monday, September 30, 2019

WHEN THE SCALES RING A WARNING BELL...


The other day I dug up my favourite pair of jeans from the cupboard. It has been a number of years since I last wore them. To my horror, I had to struggle to zip up. What used to be a snug fit was now a tight fit. I knew I was in trouble when the bathroom scales read 56.4 kg.

My ideal weight is 50kg-52 kg. Anything beyond that means I haven't been physically active enough. Or overeating especially on carbs. Since the surgery to remove a lump in my right thigh, I have been guilty of easing off somewhat on my daily exercise regime. I am still nursing a swollen knee from fluid retention.


I do a lot of walking as I don't drive and rely mostly on public transport to get around. But when I am at home and sitting down at the computer, I tend to get carried away. I have to set the kitchen timer to buzz after an hour to remind myself it's time to get up, stretch and do something else before getting back to work at my computer.

We must admit that many of our daily activities involve sitting down, often for hours on end: working at the pc, reading, watching TV, listening to music, attending meetings/seminars, chatting with friends over tea or meals, sittting in buses, trains, even waiting...  Before we know it, we are several kilos heavier than we would like to be.


Thanks to years of going to the gym, running and yoga exercises back in the 1980s and 90s, I have managed to keep obesity at bay. I was a member of Fitness International in the 1980s before I switched to Fitness First. In total I was a gym regular for close to 15 years. I often put in hours on the treadmill and was crazy about aerobics. My daughter Belle even drew a caricature of me as a fitness fanatic on my t-shirt. I am glad I laid a foundation of regular exercise in my younger days. Never too early (or too late) to build up muscle strength, cardio fitness and joint flexibility. But it is a constant challenge to maintain a healthy weight.


I have always enjoyed running, but not competitive running, as I do not want to stress myself out too much with regular training, dieting and the constant need to improve on my best time. The runs I sign up for are usually short ones between 5km to 8km. As age starts creeping up on me, I have opted more for walkathons and jogging.

Source: Mayo Clinic
Nothing like brisk walking at our age to shed off those extra kilos, and give the heart a good workout at the same time. The good doctor says we should aim for 10,000 steps a day. Some days I fall short. But I tell myself a few thousand steps is better than a few hundred. Brisk walking is the simplest, cheapest and easiest exercise. Some women can spend hours walking the floors in the mall. However, that does not constitute brisk walking. It doesn't do anything for your heart. Nordic walking is arguably the best type of walking as it gives you a total body workout with the aid of the poles.
Ministry of Health, Malaysia
Exercising is one way to reduce the risk of chronic diseases like diabetes, heart diseases and cancers that plague older people. If you loathe going to the gym, and don't fancy jogging, hiking or playing tennis, I highly recommend investing in a set of stretch bands that are colour-coded for different levels of resistance. A complete set costs around RM50 or more depending on the quality of the bands.


If you are the type that abhor the exercises mentioned above, you can do gardening, fixing things around the house, or helping with the housework. Just don't be sedentary. Move those muscles and flex those joints. Muscle loss leads to frailty in old age, and stiff joints limit movement. That is something all of us want to avoid.



(Above): A comparison of three healthy plates. They have a lot in common. Sensible advice about making healthy choices. But knowing is one thing, applying is another. A healthier choice of nasi lemak, for example, is to have brown rice instead of the traditional white rice cooked in coconut milk, and add more kangkong or more slices of cucumber. As far as I know, the Ministry of Health has yet to promote this.


What we eat is as important as exercise. There are 101 diets out there, from the vegan diet to the keto diet and intermittent fasting as well. I have not tried any of them, but based on what I have learned from reading up on the diet of centenarians, almost all share similarities in that they eat in moderation, are vegetarians, and favour whole foods to processed foods. Sounds simple, but could be a tough act for most to follow. By the way, none of these centenarians are obese or even overweight, and they are all still active. It's also very important to cut down on our salt and sugar intake, especially the latter. When I see the long queues of young people at bubble tea outlets, I wonder if they are aware that consuming such sweet drinks will ultimately affect their health, resulting in obesity and diabetes.


Like most mothers and grandmothers, I hate to see waste but I also hate to see my waist expanding. I have a bad habit of finishing off any leftovers on my grandchildren's plates or leftovers in the pantry and fridge.The kilos have started to pile up, and the unwanted flab here and there doesn't make for a pleasant sight. Trying on clothes in the fitting room and seeing the reflection in the mirror is a reality check and a wake-up call.

It's a constant struggle to maintain good health. But we owe it to ourselves and our families to take responsibility for our health, to be aware of what is good for us, and what is not. I am sure none of us want to spend our retirement years struggling with pain and hefty medical bills.

Saturday, August 31, 2019

A TIMELY REMINDER OF OUR SHARED IDENTITY AS MALAYSIANS FIRST


As Malaysia celebrates its 62nd independence day, it is time again to ask ourselves how far have we travelled on the road towards one nation, one people. When my former high school friends and I got together recently, we bemoaned how racially divided our schools have become, and how we wish for those good old days in the 1960s when we studied together, played together and ate together without any issues.

Today I would like to share an article from my blog archives. The message is still relevant today, perhaps even more so.

"Racial prejudice and religious bigotry have always been with us. We find it hard to talk about these topics in a cross cultural environment for fear of our emotions. Some of us would deny these things existed and would rather go into self-denial than grapple with this insidious moral and social disease in our midst. The problem unless we admit it, can balloon out of proportions. It has all the hallmarks of a major mental epidemic. We as a group who have been exposed to global cultures and have experienced first hand of these evils should help contain them from rearing up their ugly heads in our society.

It is convenient to put the blame for this prejudice and bigotry as part of the legacy of the former colonial masters. However, the reality is that much of this prejudice and bigotry is of our own making and enforced by interested parties driven by the fear-based environment. These parties need to perpetuate the prejudice and bigotry to exist, because these whether real, perceived or invented are the reasons that justify the existence of these extreme chauvinistic groups.

As a member of the endangered species, what is of concern to me is to see a more stark polarization of races in our schools and institutions of higher learning. This polarization opens the door to prejudice and bigotry amongst the various races. One group would have a sense of superiority from believing that they are members of some elitist group that is superior to others.



Unfortunately the adults at home and the mass media give support to re-enforce this sort of thinking. It is common amongst certain groups of society to believe that they are the chosen ones over the others. They refuse to recognize the worth and contributions of others.

There are enough examples of an artificial importance being placed on everyday happenings reported in the mass media. With a journalistic twist and inflection it could make it appear racial. When young riders are involved with a fight with another rider, all of the same race, it does not make news. But if one rider is beaten up and happens to be of another race, the media dresses the story up in a way that will sell fear and in so doing perpetuate racism and racial hatred. We are being re-enforced through the media, that the respective colors of the skin are more important than the crime itself.

Religious bigotry may well have been the most common form of bigotry for much of the world’s history. In parts of the world people are being persecuted to no end not just because they are of another ethnic group but of another religion as well. We read about these happenings daily in the papers.

Religious bigotry manifests itself as a holier-than-thou attitude towards others. Religious bigots have in their heads the idea that those belonging to their religious group will be saved and the rest will go to hell. They firmly believe that they and they only have a special connection with the Almighty that others lack. This in turn leads them to think that they only have His special favors and others do not.

In my jagged career path, I had occasions to visit countries where people of different religions live together and in so far as ethnicity goes, there are no physical differences between them. They speak the same language. They share a common origin and one would not be able to tell the difference from a member of one religious group from another on the street outside the mode of dress. The only difference is religion, and due to religious bigotry, they are willing to kill each other.

In the more sophisticated societies there are more subtle means of persecution than physical violence resulting from religious bigotry --- character assassinations, harassment of members of religious minorities and the people associated with them. Other members of religious minorities find themselves in the position of an outsider.



Now let us take the racial prejudices and religious bigotry on to the global scale. To these we add to the mix the concept of political correctness which has been in vogue in the last decade. We then have a new category called the ‘Axis of Evil’ which political correctness has been established to eliminate. In reality political correctness needs the ‘Axis of Evil’ so that the ‘Hate Crime’ Industry can continue to exist. Attempts to artificially combat hate, racism and terrorism have created ‘Hate Industries’ in themselves which focus on an attempt to control others. Those who are highlighting the inequality of discrimination are being called religious extremists, or worst still, terrorists.

In a multi-racial, multi-religious nation like ours, where the practice of the religion and culture of one’s choice is protected by the Constitution, there is no reason for any kind of race prejudice and religious bigotry. All of us wish to achieve the same ends, the enlightenment of the soul and well-being of mankind. These ends can be achieved, all the so much easier if there is mutual understanding, trust, respect and to practice what is universally accepted – kindness to others.

With a multi-cultural, racial and religious mix we have all the ingredients of potential social hotspots in the country. We recognize that social conflicts are inevitable, but there are strategies if we care to sit down and work them out for their resolution or at least minimize or divert them before they become unmanageable. It is important that we recognize potential hotspots as we are dealing with human lives, their jobs and their children.

There are enough hotspot indicators which we should take cognizance of. Every day we open the dailies, our computers or turn on the TV, we get reports of street demonstrations, strong public statements airing disagreements. We see increasing lack of respect for Heads of Institutions. There is open disagreement regardless of issues.




For too long we have backed away from displaying the dark side of our social problems, preferring to sweep them under the carpet. What can we do as a group to offer for avoiding and or resolving conflicts which affect our daily lives and the future of the young generation? Institutions of Higher Learning could be roped in, if they have not yet been harnessed, to help gather and analyze data and information on socio-economic matters so that honest discussions and recommendations could be made for a sound apolitical management decisions on the concerns of the people.

At the same time, acceptance and recognition of our diversity through the use of the mass media are conducive to dialogue among the various races, cultures and beliefs, promoting respect and understanding for each other. Our cultural diversity is an asset. It has intrinsic value for development as well as social cohesion and peace. Harnessing our diversity could be the driving force for development not only in respect of economic growth but also of leading a more fulfilling intellectual, emotional, moral and spiritual life.

Have a re-look at the linguistic dimension for our national development. Should we not encourage our young to be multi-lingual which would give them an edge for an appropriate and harmonious use of language in our society? Furthermore, language is of strategic importance for us. Educators amongst you will agree that acquiring languages offer unique modes of thinking and expression which can be an asset to a multi-racial society such as ours."



~ Excerpt from a keynote address given by the late Tan Sri Ani Arope in 2009 ~

( I first posted the above on SeniorsAloud blog in 2009 with the late Tan Sri Ani Arope's permission. Today, as the nation celebrates its 62nd Hari Merdaka, I am reposting it as a reminder that we are all one people, one nation, with one vision - to work together for the progress and prosperity of our country so that we can all live in peace and harmony.)

2010 - With my students at Wawasan Open University. Diversity in ethnicity enriches the learning experience.

Tuesday, July 30, 2019

AGEING WELL - ARE WE THERE YET?


'Diet, exercise, lifestyle, prevention, mindset...' - these words were repeated over and over at the recently concluded 9th Malaysian Conference on Healthy Ageing (MCHA) organised by Malaysian Healthy Ageing Society (MHAS). So too were the more ominous words 'cancer, diabetes, depression, dementia, death'. A total of 6 plenary sessions, 30 symposiums, 11 workshops and 5 forums. Quite a smorgasbord of topics covered in the three days. I had a tough time deciding which ones to attend. My personal copy of the daily programme was covered with ticks and crosses. I had to skip many e.g. Dr Lim Poh Hin's 'Smart Ageing in the Information Age' and Prof Tan Maw Pin's 'Falls Can Be Fatal'. I missed Dr Tan Hooi Chien's talk on 'Volunteerism' but made up for it with Mr James Lim's sharing of the diasaster relief work carried out by Tzu Chi Foundation. Many are not aware of the health benefits of volunteerism.
(For the full programme, click here.)


When I first received the event brochure (above) a few months ago, I was impressed by the broad coverage of topics. All this in just three days? Wow! Then I remembered the same key people had also organised the highly successful 1st World Congress 2012 at KL Convention Centre. MHAS was just a fledgling NGO then, but they proved more than capable of handling an international event. I had no doubt they would repeat their success with the 9th MCHA. The theme this time was 'Ageing, Health and Community'. Not all the topics listed in the brochure ended up in the conference programme, but kudos to the organisers for giving the delegates so much to take away on how we can make lifestyle changes to enjoy quality of life in old age.

(Above) The organising committee with guest-of-honour Dato Mahadev Shankar (centre) after the opening ceremony. From left: Prof Tan Maw Pin, Prof Philip George, Prof Nathan Vytialingam, Dato Shankar, Ms Ranuga Devy, Dr Wong Teck Wee and Mr Matthew Teo.


Not only were delegates spoilt for choice of which sessions to attend, they were also well-fed. The daily lunch saw long queues patiently waiting to fill their plates and cups. It must have been quite a challenge to stay away from the food tables for those on weight loss programmes, on intermittent fasting or on the keto diet. Chow time was also an opportunity to network and make new contacts. The little tumbler that MHAS included in the goody bag was an excellent idea. It allowed us to replenish our drinking water (thanks, Biolux) as many times as we liked, and did away with single-use plastic bottles of water. 

Most of the delegates were doctors, allied health professonals, nursing home operators, academicians and representatives from NGOs. For folks out there who were unable to attend the conference, here's a brief roundup of some of the sessions I attended. It's simply not possible to cover everything on the programme. 


Dr Ravindran Kanesvaran started Day 1 with a very informative talk on 'Cancer: Prevention is Better Than Cure'. Many cancers are curable if detected early. So, people, go get your medical check-up done if it is long overdue. You will save a ton of money and more importantly, add more healthy years to your life. Dr Ravindran stresses to avoid or reduce intake of red meat if possible as it contributes to a high risk of colorectal cancer.


There was a lot of focus on nutrition and diet, and some confusion arising from conflicting advice on foods to avoid and foods to take. Not surprising. Examples: Egg yolk - good or bad for our health? Diet: Mediterranean, Okinawa or Malaysian? Is diet closely associated with ethnicity, culture, religion and geographic location? Should we follow a diet that is meant for a culture and lifestyle that is vastly different from ours? Our Malaysian diet is generally not healthy - too much sugar, salt and saturated oil. We also need to reduce our daily consumption of white rice as it is high in carbs which the body converts to sugars. Opt for brown rice instead as it is healthier. Keep an eye on our weight as obesity is a leading cause of diabetes, cardio-vascular disease and stroke. Malaysia has the highest obesity rate among countries in Asia. So take heed.


Prof Gerard Bodeker's wealth of knowledge on medicinal plants for disease prevention is truly amazing. Great to know that ulam and pegaga are on his list, and that he advocates nature therapy (e.g. forest bathing) and personalised therapy i.e.what works for you may not work for me as we are physiologically different. Dr Johan Manez had an interesting point to make on whether a plant-based diet is good for us. Based on the type of teeth we have and the way we chew when eating, he believes that humans are meant to eat more vegetables and fruits than meat. He proposed six lifestyle changes for better health: increase physical activities, manage stress, maintain good relationships, get enough sleep, eat healthy and avoid substance abuse.


Prof Tan Maw Pin was next after Prof Bodeker with her talk on 'Do Older People Need Vaccination'? Her answer was an impassioned plea to get ourselves and our elderly parents vaccinated or be at risk of getting pneumonia which can be very bad news for older people. The reason why I was initially hesitant about getting my 93-year old mother vaccinated was her advanced age and my fears of possible side effects. In the end, I caved in. Now after listening to Prof Tan, I am glad I did. My mom is fine and did not show any of the contraindications mentioned after her vaccination. 


I agree absolutely with Dr Wong Teck Wee in his interactive session on 'Healthy Ageing Revolution'. To age well, we have to start early to lay the foundation. Healthy living and financial literacy should be introduced in the school curriculum. This would ensure quality of life in old age. From womb to tomb. Prevention is always better than cure. As Dato Mahadev Shankar so aptly put it: "Money is the 6th sense, for without it you can't enjoy the other five senses". 

Good advice from Dr Rajbans Singh regarding supplements. Check out the above five points before you purchase any supplements. Too often we listen to what our friends tell us, or believe MLM sales pitch. We end up spending huge amounts on expensive supplements that show little results. We should do some research first on the internet and find out what reputable sources say about a particular supplement and whether we really need it. 


Day 2 and 3 began with half an hour of Laughter Yoga conducted by certified LY trainer Debbie Rodrigo. Beginning with some exercises, she soon had the room filled with laughter, releasing all the endorphins and prepping the delegates for the morning sessions. 


We often hear the term 'patient-centred' used to refer to care given to patients receiving treatment in hospital settings. But what happens after they are discharged? How does a post-stroke patient, for example, deal with recovery and rehabilitation? Based on her research, occupational therapist Kim Walder believes if the patient understands and accepts his physical limitations, the journey from initial turmoil to wellbeing can be smoother for himself and his family.  


The lunch symposium on Day 2 raised quite a few eyebrows. Prof Dato Dr Hj Mohd Farouk Abdullah didn't mince words (or images) when he spoke on 'Sex in the Golden Years'. His message was loud and clear - older couples can still enjoy sex, with some creativity and the use of various aids. It was definitely a no-holds barred presentation that probably made many in the audience feel a little uncomfortable. Time for a change in mindset about post-menopausal sex. 


Dr Ainoriza Mohd Aini's talk on 'Ageing in Place: Design and Infrastructure for Healthy Ageing' covered both home renovations and city planning. She shared about providing elder-friendly facilities for ageing safely at home and in the city. It is good to know that housing developers and town planners are now giving importance to designing for a growing ageing population. Take a walk in the city streets or visit a public housing complex, and you will agree that the government has a monumental task ahead to improve public housing and city infrastructure for all ages.


Speaking about the government, do you think it is doing enough to protect the rights of older people? Are there laws to prevent financial abuse? Should we advocate for a Maintenance of Elderly Parents Act similar to what Singapore and India have already implemented? The jury is still out on this. The general conclusion is we have laws and regulations to protect the elderly, but enforcement is poor. We already know that. 


This was one presentation I didn't want to miss as I felt the govt should step up efforts to promote productive ageing now that healthy ageing is firmly on their radar, thanks to the positive image of Tun Dr Mahathir, 94, the world's oldest prime minister. With the cost of living going up, not all senior citizens can afford to retire. I was glad to connect with Dr Amuthaganesh Mathialagan after his talk on 'Entrepreneurship for Older Persons'. He was receptive to my proposal to conduct a training course on entrepreneurial skills for our warga emas.


The above sessions on Intermittent Fasting from Dr Vaikunthan Rajaratnam and Ketogenic Diet from Prof Dr Raghu Vadarajan had me wondering seriously if I should follow their advice to lose weight. Both diets seemed drastic but the doctors were themselves proof that intermittent fasting and the ketogenic diet worked for them. However, it requires mental strength and a huge amount of perseverance to stick to the diet given our love of food.


The most humorous presentation came from Dr Tan Seng Beng on 'The Art of Dying'. If his intention was to remove the social stigma attached to talking about death, he succeeded. His wry sense of humour in dispensing advice filled the room with laughter. This was in contrast to Prof Dr Saw Aik's talk on 'Turn a Loss into a Gift: Silent Mentor Program'. I was quite moved when he shared about the dignity and respect shown by the medical students to the silent mentors and their bereaved families. As should be. 

Dr Lam Chee Loong spoke on 'Resources for End of Life' and provided a list of hospitals that offer palliative care and another list of community hospices. Most useful for families looking for end-of-life care for a loved one. Dr Yau Weng Keong's talk was on 'Decision Making in End-of-Life Care for Older persons'. Unfortunately I did not attend his talk. Kudos to MHAS for including these topics. It is high time society stopped viewing death as a taboo subject. Not only should we live well, we should also leave well, and that includes having a say in how we want to make our final exit. 


The final session saw Prof Dr Nathan Vityalingam explaining the differences between retirement homes, nursing homes and daycare centres. Know what to look for when visiting an aged care facility, and check whether it actually provides the services stated in their promotional materials. 

For the organisers, it was a daunting task to ensure everything went without a hitch, from making sure registration was smooth, technical problems were minimal, food was served on time and speakers turned up as scheduled. If there were hiccups, they were hardly noticeable. To the delegates it was three full days of learning, sharing and networking.

So a round of applause to the organising committee for a very successful conference. Looking forward to the next conference in 2021.