“At my
age it is thoroughly understandable that all these complications arise; I am
totally aware of that […]”. Elderly patients often say this when seeking my
health advice. This expression acts as a psychological “remedy” for different
conditions such as visual impairment, neurodegenerative disease and other
chronic diseases such as arthritis, hypertension and heart problems. But
embracing their condition often means rejecting curative options.
The curse
of old age does not stop there, as this portion of the community, who have
partially or completely retired and depend on pension benefits, are often
considered a burden on their families and society. They are often marked as
“highly vulnerable” to mental health problems, mainly as a result of loneliness,
low social interaction and untreated depression.
This is
truly alarming given an estimated 36 million older people in Indonesia by the
end of 2025. Such a huge demographic expansion as a result of increased life
expectancy in developing countries such as Indonesia will be a true challenge
for authorities.
The
absence of appropriate geriatric management will amplify healthcare costs,
though Indonesia has gradually laid the stepping stones for securing better
health care for the elderly. A focus on health care for the elderly has been
gaining increased governmental attention since 1998 after the inauguration of
Posyandu Lansia (integrated health service posts for the elderly). In 2004, the
government institutionalized the National Commission on the Elderly (KNLU).
This state institution is responsible for managing cross-sectoral programs
related to the elderly.
These
initiatives aim to provide special healthcare for the elderly at the rural
level. However, several bottlenecks now impede these programs.
Firstly,
inefficient bureaucracy and absence of comprehensive guidelines result in a
disproportionate distribution of patients among local health service centers,
i.e. community health center (puskesmas), posyandu and public hospitals.
Instead
of being properly ministered at smaller level healthcare providers, untreated
patients end up queuing endlessly at hospital receptions.
Unbalanced
allocation of government funds often causes inadequate numbers of paramedics
and medication at community level health providers. Typically, patients face
delayed services, increased waiting times and inadequate treatment quality.
Secondly,
several factors related to the elderly are thought to exacerbate the problems.
Lack of awareness, partly because of ineffective health promotion, insufficient
funds and external factors, i.e. cultural perceptions and stigma, contribute to
restrictions among the elderly on maintaining their health. This contributes to
inefficient early monitoring of health and assessment of preventive and
curative treatments.
Therefore
it is urgent to reform health care for the elderly in Indonesia. Ineffective
bureaucracy is the central problem. This can be remedied by revitalizing
community health centers’ role through healthcare training and education, and
improving remuneration for health professionals.
Reforming
health care for the elderly should also include a comprehensive yet concise set
of guidelines on how health professionals work, interact and address
step-by-step care procedures. This would include early screening and
post-screening treatments by relevant care givers.
Again,
the solution needs to be holistically designed for better geriatric management
in Indonesia,negating pessimistic stereotypes about aging. Older people are an
integral part of the community.
As such,
powerful support from the whole community, as well as the government, for
better participation and post-retirement transition for the elderly is needed.
The wise
say, “Treat others as you want to be treated.”
This
counsel needs to be repeatedly echoed as a moral underpinning to properly
manage health care for the elderly. I hope our good deeds will be paid back
when we our self retire.
Ika
Sudiayem (Medical Doctor)
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