1. Geriatrics medicine (or just
geriatrics) is still rather poorly
understood in Malaysia, despite its
rising prominence in other parts of
the world. We speak to Assoc Prof
Dr Tan Maw Pin, one of the few
specialists of this field in Malaysia,
on what exactly geriatrics is and
how it will contribute to the general
health and well-being of our
increasingly ageing population.
A
ssociate Professor Dr Tan Maw Pin initially
wanted to be a psychiatrist. “I was trained
in the UK, and back when I was a medical
student, geriatric medicine didn’t have the good
reputation it has now. I wasn’t particularly inspired when
I was taught by lecturers in that discipline,” she admits.
Indeed, students would take up geriatrics only when they
could not get into other disciplines, so not much respect
was given to geriatrics back in those days.
It was only when she began her housemanship that Dr
Tan realized that her calling was in geriatrics. “It was
fantastic! I really enjoyed it,” she speaks of those days.
The rest, as they say, is history.
Medicine for the
Elderly
Dr Tan Maw Pin
Associate Professor in Geriatric Medicine
University of Malaya
42 HEALTHTODAY August 2016
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2. Understanding
Geriatrics
So, what is geriatrics, exactly? This is
still a relatively new medical field in
Malaysia.
“Geriatrics is commonly assumed to be
medicine for old people,” explains Dr
Tan. She adds that, while in a way this
is true, we must also remember that a
person’s ageing process is influenced
by many factors, including the person’s
genes.
“What we geriatricians – these are
specialists in geriatrics medicine –
focus on are people with multiple
medical problems, on multiple
medications and whom we consider
frail,” she explains. In this case, ‘frail’
refers to a state in which the patient
is more vulnerable to hospitalization,
disability and death due to reduced
physiological reserve.
While most of the time the patients
may be considered old due to the
natural process of ageing, there are
other circumstances when a patient
may also be considered old, such
as due to a wasting disease. Dr Tan
recalls meeting a patient who had
lymphoma. While the woman was in
her 40s, she was a heavy smoker –
hence, her lymphoma and her smoking
had taken their toll on her body,
making her much older than her actual
age.
“Back then, I was working in an
oncology ward. To me, 40 was young,
so I was doing everything I could for
her, even when it was clear that she
was losing the fight. But she was
already a grandmother, with an eight-
year old grandson, and she felt that
she had done everything she wanted
in this life. Hence, she had made
peace with the fact that she would
have to leave this world soon,” Dr Tan
reminisces.
The patient helped her realize that,
sometimes, maximizing a patient’s
quality of life in their remaining time,
as well as doing all that is possible
ensure that the patient meet a
dignified, good end – all these are just
as important as treating a patient’s
physical symptoms.
Like many medical disciplines,
geriatrics has various sub-
specializations such as dementia,
stroke and more. Dr Tan’s sub-
speciality is geriatric cardiology, which
revolves around treating and caring for
older patients with falls, dizziness and
blackouts heart problems as well as
low blood pressure.
Given that we already have existing
specialists in these fields, how does
a geriatrician fit into the picture? Dr
Tan explains that geriatricians are
trained to have a good understanding
of how to manage the complexity of
multiple medical issues and multiple
medications, and is able to identify
important issues which need to be
prioritized according to urgency.
This opens up some benefits for the
patient.
Better understanding of the elderly.
Dr Tan points out that, as we age,
things can become less clear cut.
Take the common cold, for example. A
younger person will have runny nose
and perhaps a cough, but older people
may instead become sleepy, lose their
appetite and experience difficulty in
walking due to what geriatricians call
off-leg deterioration. A geriatrician
will recognize these symptoms,
but another doctor may not, and
as a result may have a harder time
understanding what is wrong with the
patient.
Geriatricians are also trained to have
a better understanding of how an
elderly person thinks and feels. “If we
have, say, an elderly patient climbing
out of his bed and running around
the ward, trying to find his way out, a
new hospital staff may not know what
to do or even panic,” she says. “To a
geriatrician, however, this is a normal
part of the job. She is emotionally
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August 2016 HEALTHTODAY 43

3. She is optimistic for the future,
however. “Look at Taiwan – things
changed for the better in the blink
of an eye!” she enthuses. “Who says
Malaysia can’t do that? We have the
economic capacity to make changes;
we just need to find the will.”
The geriatricians in Malaysia are slowly
but surely leading the vanguard for
change. The Malaysian Society of
Geriatric Medicine (MSGM), of which
Dr Tan is a member of, is formed with
the objective to increase awareness
of the healthcare needs of older
people in Malaysia, advise appropriate
regulatory bodies on training and
credentialing of geriatricians, and to
advance geriatrics through research,
publication, awareness programmes
and more.
Currently, there are only 27
geriatricians in this country. However,
the seeds have already been sown
to increase this number. MSGM has
developed a training curriculum
for geriatricians. The University of
Malaya has introduced geriatrics in its
curriculum for medical students, and
it is hoped that more medical schools
will follow suit.
Thus, the current geriatricians in
our country are not just specialists
tending to their patients; they are also
teachers, trainers, advocates and
advisers. Networking efforts, support
systems and bonds are formed
within a close-knit community on
WhatsApp, keeping present and future
geriatricians close regardless of the
physical distance separating them.
And best of all, their efforts are
starting to pay off. Dr Tan personally
has experienced greater enthusiasm
and even passion among medical
students to take up geriatrics. “The
future is bright!” she concludes with
relish. HT
prepared for such situations, so she
can calmly make efforts to control and
manage the situation.”
Also, the elderly may be seen as
stubborn in admitting that he or
she has a problem, or become
uncooperative. Fortunately, the
geriatrician is trained to smooth the
ruffles of even the most ‘difficult’
patient, therefore providing a good
degree of relief to the patient as well as
the patient’s family.
Psychological benefits for patients
and their family. “Communication with
older people is a specialist skill, not
everyone can do that,” Dr Tan says.
She explains that the geriatrician is not
just trained in medical matters – she is
also well-versed in family dynamics and
some degree of psychology. Aside of
being a doctor, a geriatrician can also
be a confidante and a shoulder to cry
on. Hence, if the geriatrician becomes
someone patients and their family can
trust, she can become their anchor and
strength through trying times.
Fewer doctors in
the picture. Many
elderly people have
more than one
condition at the
same time. The
geriatrician, therefore, does not
work alone. In Dr Tan’s case, she
often enlists the assistance of her
colleagues from other disciplines – for
example, a surgeon will step in should
the patient need to undergo a surgery.
Additionally, she will be working
closely with a multidisciplinary team
consisting of nurses, social workers,
physiotherapists, occupational
therapists, speech therapists,
dietitians as well as the doctor.
Through all of this, she will be
the specialist who supervises the
necessary treatments and procedures
that will meet her patients’ needs.
She is the main consultant, and as a
result, this cuts down on the number of
specialists they need to see.
The benefit of this is more convenience
for both the patient and the family,
especially if the family has to bring
the patient to the hospital regularly
for check-ups. They may also find it
easier (and less confusing) to keep
track of prescriptions and medical
recommendations if these come from
a single doctor.
Geriatrics in
Malaysia
Undoubtedly, geriatrics is an important
medical discipline, especially in a
country such as ours which has an
increasingly large number of ageing
population.
However, our level of geriatric care
still has a long way to go, compared to
the UK and other countries. “The holy
grail of geriatric care is to minimise
the tertiary or late-stage care as
much as possible. Focus should
be on ‘ground level’ care, treating
conditions when they are at early
stages, through a community-
based model that involves
the family, social workers and
community healthcare services,”
Dr Tan explains.
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44 HEALTHTODAY August 2016