The Ageing Landscape in Malaysia by Dr Christine Clark
On a recent visit to Malaysia I had the privilege of meeting with a number of people concerned with the care available for the rapidly growing aged population.
Malaysia is among the fastest countries in the region to move from an ageing to an aged society. The difference between the two, going from an ageing to an aged population is substantial. According to WHO an
- Ageing Society is when ≥ 7% of the total population is aged 65 years and above. This indicates the country has begun transitioning into an older population structure.
- Aged Society is when ≥ 14% of the total population is aged 65 years and above.This stage reflects a more advanced demographic shift, with a significant proportion of older adults.
- Super-Aged (or Hyper-Aged) Society is when ≥ 20% of the population is aged 65 years and above. Countries at this stage face strong pressures on healthcare, pensions, and social systems.
Malaysia: Became an ageing society around 2021 (7.4% ≥ 65 yrs). Projected to be an aged society by 2044, and a super-aged society by 2057.
Japan: Already a super-aged society (about 29% of population ≥ 65).
Singapore: Entered the aged society stage in 2017 and will be super-aged by 2030.
Along with many similar countries, Malaysia now faces significant challenges. Caring for their aged is severely limited as it is the cultural expectation that families should undertake this, however that often no longer occurs. (Over 79% of elderly rely on their children for financial assistance with only 22% having enough savings to last 20 years post-retirement). As to healthcare this is seriously restricted. As of early 2025 there were on 33 geriatricians (Doctors specialising in aged) with an estimated further 600 to 700 needed. Obviously, there is a huge need for trained Nurses and care givers, people with an understanding of the complexities associated with aged, including that of dementia which is not taught currently. The demand for care homes has far exceeded supply. As of now, there are 393 registered elderly care centres and 26 nursing homes, with perhaps 700 to 1,000 unregistered facilities. Most of these use untrained staff, many of whom are not legally allowed to work in Malaysia.
As well as having insufficient infrastructure and trained carers, the reality that many elderly face is that of isolation and aloneness, especially when their children live overseas, as many do. Those living rurally have difficulty accessing transport and infrastructure that is aged friendly. As elderly retire to their homes and become limited in movement due to aged conditions their isolation and mental ill health increases. The care they might be able to access is not for the aged, it is reactive and focussed on the medical model, not person centred and pro active at all. Some community initiatives are occurring but there are very few and little training nor funding is given.
In saying this the Government is acknowledging the challenges associated with the ageing population. It has a number of policies and plans in place, including the Elderly Healthcare Services Action Plan (2023–2030) and Age-Friendly City (AFC) frameworks. These are aimed at creating supportive urban environments. Signage, improved accessibility to transport and aged friendly spaces are an aspect of this. There are also plans to develop aged villages in every region, housing over 157,000 people. Unfortunately, this will not be enough and the majority of people will not be able to afford it. This is where the proposal for mandatory long-term care insurance as well as tax incentives will be of assistance.
Looking after people in their home environment is an important feature of the planning. Helping aged with financial and digital literacy, programmes in fall prevention as well as training in caring for those with dementia are occurring. Helping with both home and facility care is the introduction of Ai and using smart home systems, all of which are being explored for implementation.
Various community initiatives help support those at home, these include PAWE which is a free nationally based programme that serves as a hub for aged to stay socially, mentally and physically active. There is also Kelab Warga Emas which is more focussed on health/medical initiatives. A free mobile clinic service is also available in Kuala Lumpur and St John Ambulance not only offers courses but also has a rest home in Perak. Unfortunately rest homes a few and far between. These vary in condition, services offered, staffing levels and price. Many are ‘not recognised’ and I was told of homeless older people being picked up off the streets and placed into homes that were described as ‘very bad’.
Actually, being allowed to see in any aged care facility was almost impossible however I did get to walk through one and even talk with the staff. The facility was a converted two storey home and was used predominantly by those who had been discharged from hospital and still required nursing care or a place to die. This place was very clean, well-staffed and even had a physiotherapist onsite however patients had to pay for these services. There was a stair lift to help with getting from the bottom floor and there were a number of single bed rooms although most were two or three beds. Privacy had been acknowledged, and curtains were used, which is quite unusual. At the entrance way there was even a small gym set up and swimming pool that was not used. This facility was very different to the ones I had had described where there are 30 patients to one nurse and two carers and these carers also had to organise meals and laundry. These carers had little or no training and were often illegal workers, earning little pay in a job that has no recognition, no respect.
The Facility - 2 story converted house
The Gym
The Single Room - witn ensuite (very unusual)
Malaysia is trying but I look at these situations and thank God that we live in New Zealand and that Kalandra can help provide the training that is so desperately needed.
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