From the recent AFCMA Congress in Taipeh, 2004

Reflections of the Christian Spirit in Caring for the Elderly-Challenges and Perspectives

By Freddie Loh M.D. Family Physician

(This talk was presented by Dr. Freddie Loh at the 13^th AFCMA Congress in Taipei Nov. 2004)

Who are the elderly? The World Health Organisation defines an elderly person as anyone aged 65 years and older. This was decided as the age of benefit in Germany in 1873 and perpetuated in the retirement regulations of other countries which followed. There was never any physiological basis for the decision nor for the cut off of 60 years old which the United Nations demographics adopted.

Ageing has been defined as a progressive loss of adaptability with the passage of time so that the individual is less and less able to react adaptively to the challenges from the internal or external environment. With time the individual becomes progressively more frail and in need of increasing support to maintain her autonomy.

Facts about Ageing. A demographic revolution is underway throughout the world . Today worldwide there are around 600 million person aged 60 years and over. This total will double by 2025 and will reach virtually 2 billion by 2050 – the vast majority (two thirds) of them are in the developing world - See graph . Source: UN 2002

Women outlive men in virtually all societies, Malaysia has a population of 25.6 million, with 850,000 Catholics or 3.5% of the population. We have about 1 million who are aged 65 years or more i.e. 4% of the gross population.

Here is a list of major chronic conditions affecting older people according to source: WHO 1998.

Cardiovascular diseases (such as coronary heart disease)

Hypertension

Stroke

Diabetes

Cancer

Chronic obstructive pulmonary disease

Musculoskeletal conditions such as arthritis and osteoporosis

Mental health conditions (mostly dementia and depression)

Blindness and visual impairment

Unfortunately in Malaysia we do not have any national health insurance schemes unlike the developed countries.

The challenge…

So how can we as Catholic doctors, nurses and other healthcare givers respond to the challenge of looking after the elderly who are not only increasing in numbers but are also continuing to live longer, i.e. grow older. Allow me to share with you my personal experiences in looking after elderly people in a Christian setting .

I have been blessed to have been able to help the Little Sisters of the Poor Old Folks Home in Cheras, Malaysia run their clinic . Together with a few doctors we have been taking turns to treat the sick which include the residents , sisters, priests, helpers, and workers of the Home. During my 18 years at the Home I have learned much from the Little Sisters for the dedication and love that they show towards the elderly.

However after 25 years, it was decided to rebuild a new home as the building was leaking and needed constant expensive repairs.

The new home , on the same site is now called the St. Francis Xavier for the Aged which was declared officially opened on 19 March 2004 by his Grace Most Rev. Murphy Pakiam, Archbishop of Kuala Lumpur. Their home complete with lifts is fully equipped with modern facilities to provide a comfortable, convenient and safe environment for the aged residents .

There are 10 sisters and and 20 full time staff running the home. Volunteers consist of .

Doctors, nurses, dentist, physiotherapist and other general helper from the public. These volunteers are important and they form an integral part of our team in caring for the elderly. They help the residents with the arts and crafts, taking them out to the shopping center or to attend a show, wheeling the infirm out into the garden etc.

Ever since the Little Sisters of the Poor started their work in 1839 in France, they depended entirely on charity from the public to run their Home. So when the new \home was built everybody chipped in including our Catholic Doctors who organised a charity golf competition to raise funds for the building.

Criteria for admission to the Home: In order to gain admission to the Home one must be poor and above 65 years of age. The Home is open to anyone irrespective of race or religion . However a large proportions of the residents who had no religion or other religions do convert to Catholicism after witnessing the great love and care they received from the Sisters. Presently we have 51 residents staying at the Home , and eventually there will be 70 plus 30 day care persons.

Tips on caring for the elderly

In caring for the elderly we must be guided by our church teachings
1) we must show respect for the human dignity of the elderly person even when he is physically or mentally disabled.

2) We must show respect for life by strongly opposing the practice of euthanasia

3) we must be aware that the elderly in the home is lonely and feels insecure and sometimes all he needs is someone to talk to and listen to what he has to say or simply by holding his hand to show him that someone cares for him.

4) We must assure the elderly that they will be cared for in health and in sickness until the very end.

Here it will be helpful for us to remember the Beatitudes from the sermon on the mount Mathew 5: 3-11

Happy are those who are spiritually poor; the Kingdom of Heaven belongs to them!

Happy are those who mourn; God will comfort them!

Happy are those whose greatest desire is to do what God requires;God wil satisfy them fully!

Happy are those who are merciful to others; God will be merciful to them!

Happy are the pure in heart; they will see God!

Happy are those who those who are persecuted because they do what God requires;

The kingdom of Heaven belongs to them!

Other tips…

In caring for the elderly it is not sufficient just to look after their physical needs. We also need to give them the joy of feeling useful and making their life more pleasant. At the home residents are given optional small household task like setting the dining table, sewing, gardening made in charge of something e.g. the store, newspapers, library etc. In doing so we are following Jesus teaching in John 10 :10 Jesus the Good Shepherd who looks after his sheep, with love and care.

“ I came so that they might have life and have it more abundantly”!! He wants us to allow them enjoy life to the fullest.

Now allow me to show you two of the residents of the home which will give you an insight as to how we care for the elderly there-

Case No. 1

This is Mr. Jonathan Koh Boon Nam. He is a 78 year old bachelor who migrated to MalaysiaChina in 1942. Prior to his admission to the Home 8 years ago, he worked as a coffee shop assistant. He suffers from high blood pressure which is readily stablised with tenormin 50mg. He is physically active and represents the healthy aged group. He keeps himself useful by pushing the wheelchair for those who are wheelchair bound for their meals in the dining room. He also helps to look after the garden outside and in the chapel during the liturgy. I remember one year he dressed up as a Chinese warrior with his huge sword at one of the shows put up by the residents of the Home.

from

Case No. 2

This is Mr. Joseph Michael Yap. He was 74 years bachelorand a devout Catholic. from Kuala Pilah. His parents were rubber tappers. When he was 8 years old, a herd of elephants trampled and destroyed his house and killed his entire family, i.e. his parents and 8 other siblings. He survived in spite of his injuries and was saved by a military van which brought him to the Singapore General Hospital. He was eventually adopted by a Eurasian male nurse who educated him. He was working in Malaysia until his retirement. (He applied to join the Home a few years ago but his application was rejected because he had some money in the bank.) However, a few months ago he was diagnosed as having terminal cancer of the colon with secondaries in his lungs and he was no longer able to walk.

Through the BEC Basic Ecclesiastical Community and the Catholic Doctors help, he was accepted by the Mother Superior of the Home on humanitarian grounds so that Mr. Joseph’s final death wish could be granted. This picture was taken on the day he was discharged from University Hospital and transferred to the Home.. Although he was in severe pain, due to cancer, and needed morphine injections repeatedly, he was blissfully happy. 3 days later Mr. Joseph was called to join the Lord and the Sisters shared the night vigil with him till the very end.

Mr. Joseph’s case teaches us that we must show compassion, flexibility and humility especially towards the very ill and not be controlled by rigid man made rules. Instead we should be guided by Jesus teachings in Mathew 25: 35-40 (The Final Judgement)

‘for I was hungry and you gave me food ……..ill and you cared for me ….. whatever you did for one of the least brothers of mine, you did for me’.

Discussion:

2 cases representing how the elderly were cared for in health and in sickness at the Home were briefly described and discussed. As Catholic doctors and nurses and other health care givers, we must be firm in our faith and guided by our Church’s teachings when we are called upon to treat and/ or care for someone especially the aged.

At the Home we have seen cases who have been comatosed and unable to eat for weeks and months due to stroke and cancer etc.. These cases challenge our perceptions as Catholic health care givers. When faced with such challenges, we must remember that Jesus said ‘whatever you do to the least of my brethren, you do to me’ . It is Jesus whom we are caring for!

In March 2004, in his speech to the 400 participants of Life sustaining treatment and vegetative state, scientific advances and ethical dilemmas the Holy Father Pope John Paul 11 said that ‘a man even if he is gravely ill or limited in the exercise of his higher functions, is and will always remain a man. He will never become a vegetable or an animal! Our brothers and sisters , who are in the clinical condition of “vegetative state” preserve all their human dignity. God the father continues to look upon them lovingly, recognizing them as his children, especially in need of assistance. Therefore the sick person in a vegetative state awaiting recovery or his natural end has the right to basic health care and to the prevention of complications to his state. The prolongation of vegetative state cannot justify ethically the abandonment or interruption of the minimal care to the patient including food and water. Death by hunger and thirst is the only possible result should these be suspended. If caused in a conscious and deliberate manner it is genuine euthanasia by omission’ the Pontiff concluded.

In August 2004 thirty bioethics and health care experts gathered at a colloquium hosted by the Canadian Catholic Bioethics Institute to study Pope John Paul 11's speech on life sustaining treatment and the vegetative state. They discussed the implication of the general moral principles that was reaffirmed in the papal speech and applied to artificial nutrition and hydration (ANH) in persistent vegetative state (PVS) or post coma unresponsiveness (PCU) and focused on the most common medical conditions affecting the elderly such as stroke, Alzheimer disease, Parkinson’s disease and end stage cancer.

They pointed out that contrary to some early interpretation presented by the media, the Papal speech did not propose that ANH is always morally obligatory in a patient in a PVS or PCU or in any medical condition for that matter. What the Papal speech stated was that ANH should be considered in principle, ordinary and proportionate and as such morally obligatory.

Nevertheless the Papal speech is consistent with our Catholic moral tradition in which ANH and other life sustaining measures are to be assessed in terms of the benefits and burdens of the intervention to the patient in any medical condition including PVS and the disabled.

Conclusion

So where do we go from here? Some questions still remain unanswered such as what shall ANH be considered? Is it care or medical treatment? Is it beneficial or burdensome to the patient? Who decides to withdraw ANH and when? How to handle ‘advance directives’? etc These will be the challenges faced by our Catholic health givers with no clear cut answers in sight in the near future. I will end by borrowing the prayer that Pope John Paul 11 made to the Little Sisters of the Poor at the 150 anniversary of the foundation ‘May Christ the Redeemer and his blessed Mother help the Catholic Doctors, nurses and other health care givers to bear witness to God’s tenderness towards the elderly’ Amen.