Malaysia has an ageing problem. Compared to European countries, which took 100 years to double the population of citizens aged 65 and above, Malaysia is expected to take only 23 years to double this age group from 7% in 2020 to 14% in 2043. This is a reflection of longer life expectancy, good public healthcare and lower fertility – all good signs of a developed society. The downside is that this doesn’t give us much time to prepare for a new set of issues that come with ageing.

What are the challenges that an ageing population brings? Firstly care and attention of the elderly will be critical. The old are more prone to chronic diseases, sleep disruption, psychological problems and cognitive decline. Healthcare models will have to be reconfigured to cater for the aged who have spent a lifetime of modern living with all its associated stresses. Housing will another challenge as the elderly will slowly find homes designed for the young and active difficult to live in. Whilst ageing in one’s own place is undeniably the best approach for a greying population, the practicalities of navigating stairs and squat latrines become physically insurmountable as one ages. Moving to aged care homes is a possibility but not everyone can afford the high end comfortable places, instead ending up in homes of a basic nature at prices they – or their offspring – can just manage. There are many other problems; the immediate one that springs to mind is physical and psychological degeneration. Even with the extension of retirement ages, there will eventually come a time when we all cease working and attempt to maintain a level of activity to keep occupied. The converse is rapid deterioration, epitomized by emptiness and boredom. Much of our social stimulation is triggered by human company; deprived of it, it is easy to see how decrepitude becomes synonymous with being abandoned or ignored.

A simple solution to the challenges represented above is to promote more intergenerational living. Houses are expensive at the best of times so an affordable housing model for the young could be to share living quarters with the elderly. This occurs anyway as children age and they cannot afford renting or owning their own homes; so they spend their adulthood living with ageing parents. In Japan, 40% of older people live with their adult offspring and over 17% live with their grandchildren. Contrastingly, in the UK less than 10% of those aged 70 and over live with their adult offspring and around 2% live in multigenerational households with offspring and grandchildren. Does this mean Asian families are more amenable to this idea? Non-familial models also exist. Home sharing is where an older person offers accommodation to a younger person at a reduced rate in exchange for some support with basic services such as shopping or gardening. Co-housing is the development of private households with shared facilities that invoke a sense of community.

Other than those involving families, it would be justified to say that the intergenerational housing model has not taken root in any large measure in Malaysia. This is possibly due to the unpopular notion of having to share facilities with strangers, and elderly ones to boot. But the benefits exist – older people can benefit from a lower sense of loneliness and isolation and increased levels of civic participation; younger generations can also gain in similar ways and through the provision of affordable housing.

In an interesting experiment in Alicante, Spain, using an ingenious blend of subsidized public rental housing, grants and low interest mortgage loans, a government agency set up over 200 affordable, intergenerational housing units in central urban areas. Residents include low-income older persons over the age of 65 and low-income young people under the age of 35 in a ratio of 80:20 respectively. In the selection process, priority was given to those more advanced in age and with the greatest socio-economic disadvantage while young people were chosen based not just on low income but also on motivation, empathy and suitability to work in social programmes. On the basis of a ‘good neighbor agreement’, each young person had responsibility for four older people in the building. Feedback from the elders included an increase in well-being, independence (but not loneliness), a decent home life with a family-like environment and a wide range of activities within reach. For the young people, in addition to accessing high-quality housing at affordable rental rates, they reported knowledge gaining and the opportunity to nurture real relationships of friendship with the older persons they assisted. Key to all this was the application of self-managed activities to promote social integration and the creation of a ‘big family’ environment, which ended up more valued than the accommodation itself.

Applying the intergenerational model to a Malaysian city like Kuala Lumpur can be done but the following challenges must be borne in mind:

  • Establishing a relationship between generations can be fraught if individuals do not want to share.
  • Ability to find the right young people with the appropriate skills and aptitude can be difficult not only due to cultural and religious differences but also social upbringing and behaviour.
  • The right activities must be designed to involve the elderly in a Malaysian context.

Lastly the financing of such housing is complicated due to the lack of government resources (always a challenge) as well as inadequate savings from the elderly to sustain themselves in their twilight years. Some of the latter could be addressed by imposing responsibility on the children of elderly to provide funding through a ‘parent tax’, a sort of inverted responsibility model where children have an obligation for their parents. But for singletons who choose not to have offsprings, this is one more gap in resources to add to the financial challenges already encountered.

A starting point for this new radical thinking would be to test an intergenerational community care centre where grandparents mingle with youths and toddlers. Japan has demonstrated that that this arrangement actually works well with the elders being revitalized by the presence of young people around them. Providing facilities such as IT and urban gardens can form the right platforms for interaction and intergenerational learning. In some cases, reverse mentoring from the young to old can be just as effective as the conventional vice versa transfer of knowledge and experience from the old to young. Such building facilities can further be a show case for assistive technologies, green practices and innovative care models.

The time is right to adopt this model as it tackles the dual problems of affordability and active ageing. This is how to make the golden years our best years.

This short paper was written for Session 4 – Healthcare Forum on 29 March 2016 at the ASLI Healthcare Conference, Kuala Lumpur

Dr Thomas S.K. Tang

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