30/09/2025

LYFE TUESDAY | SEPT 30, 2025

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To operate or not to operate?

o Factors involved in making surgical decisions for elderly patients

Role of family and shared decision-making When a condition first arises, the process often begins with conversations that involve both the patient and their caregivers, focusing on understanding their concerns and expectations. Families need to know the possible risks, the outcomes if surgery is avoided and what the road to recovery will look like. Conservative approaches may initially be preferred. For instance, a patient with knee osteoarthritis may manage their condition better with physiotherapy, pain relief, braces or weight loss rather than undergoing immediate surgery. The goal is always to align medical recommendations with the patient’s own values and wishes. Special risks for older adults This dilemma is often seen in neurosurgery, where elderly patients face conditions such as intracranial haemorrhages, brain tumours or degenerative spinal disease. Older patients are more fragile and often have other health problems or are on long-term medication that complicates surgery. Elderly patients do not tolerate complications well, and they also do not cope with long operations or prolonged hospital stays. That is why preparation is key, and operations must be done as safely and efficiently as possible. Age-related conditions like frailty, cognitive decline or sensory impairment can increase the risk of post-surgical complications such as delirium. But knowing these conditions in advance allows doctors to prepare better and tailor both the surgery and recovery plan. Advances in modern surgery The good news is that advances in surgical techniques are expanding the possibilities for older patients. But the term “minimally invasive” is often overused. While access may be small, the surgery itself can still be extensive. What truly matters is having skilled surgeons, careful

A S Malaysia prepares to become an ageing nation by 2030, questions surrounding elderly healthcare are becoming increasingly urgent. By 2060, projections indicate that one in five Malaysians will be over 65 years old, with the number of those aged 80 and above expected to triple. This demographic shift places greater emphasis on healthcare decisions that affect the quality of life in later years, and one of the most challenging questions many families face is to operate, or not to operate? Surgery can be a lifesaving and life-changing option. Yet, many older patients are denied the option of surgery because of outdated perceived notions based solely on age. When surgery becomes question of quality of life About half of people over the age of 65 will require surgery at least once in their lives. The most common cases include fractures from falls, head injuries and operations linked to cancer. However, the decision to proceed with surgery is rarely straightforward. It is not a one-size-fits-all situation. Frailty, physical and mental health, the patient’s priorities and the level of support they will receive after surgery are assessed. What matters most is how the decision affects the person’s quality of life. For example, a frail patient with poor mobility may not benefit from a high-risk procedure that requires a long recovery. In contrast, a relatively active 75-year-old with good functional status may regain many productive years from surgery.

About half of people over the age of 65 will require surgery at least once in their lives. – 123RFPIC

support, healthcare, counselling and pathways to employment, Rumah Ibu Sabah is strengthening the social safety net and ensuring no one is left behind. The partnership underscores how public and private collaboration can translate national aspirations into real, on-the-ground support that uplifts families and contributes to a more resilient and compassionate society. Since its launch in Kazakhstan in 2013, the Mother’s Home initiative has grown into a network of 20 centres across 18 cities, helping more than 10,787 infants remain with their families and preventing thousands of children from entering orphanages. International projects have already been established in Ukraine, Uzbekistan and Kyrgyzstan, with Turkiye scheduled to open its first centre in November 2025. In Malaysia, MHIF aims to support over 100 women and children annually, with plans to expand and open additional homes in other states. to operate is not about age alone. It involves the patient’s life goals, medical condition, risks and the support available to them. Decisions must be individualised and grounded in compassion. Doctors’ role is to help patients and families make informed choices that align with what matters most to them. For families navigating these difficult choices, the message is clear – surgery can be life-changing, but it is never the only option. With the right guidance, support and care, elderly patients can face these decisions with dignity and confidence. This article is contributed by Subang Jaya Medical Centre consultant geriatrician and internal medicine physician Dr Chin Ai-Vyrn and consultant neurosurgeon Dr Vickneswaran Mathaneswaran.

long-term success.

pre-operative preparation and strong support after the operation For patients, this means that while technology provides new opportunities, outcomes are most successful when surgery is part of a coordinated care plan that includes geriatricians, surgeons, nurses, physiotherapists and family support. Rehabilitation: Road back to independence What happens after surgery is as important as the procedure itself. Rehabilitation is critical in helping older patients regain independence. Without proper rehabilitation, even a successful surgery may not translate into a better quality of life. Getting patients out of intensive care and back on their feet quickly is essential. Physiotherapy, early mobilisation and sending them home sooner rather than later make a big difference. A strong, holistic team caring for the patient is what ensures

Looking at bigger picture As Malaysia faces an ageing population, the broader context cannot be ignored. Many elderly people may also lack financial security or family support. Decisions about surgery are therefore not just medical but social, requiring consideration of costs, caregiver availability and access to rehabilitation services. Sometimes, not offering surgery can be a mistake because many older Malaysians today are still active, healthy and can expect to live many more fruitful years. At the same time, pushing ahead with surgery in the wrong context can leave a patient in a more difficult condition. It is about balance and about seeing the whole person, not just the disease. Beyond operating room Ultimately, the question of whether

Malaysia’s first ‘Mother’s Home’ opens in Sabah for vulnerable women MALAYSIA’S first “Mother’s Home” ( rumah ibu ) has opened in Sabah, offering vulnerable women a lifeline of temporary assistance, medical and psychological support, legal counselling and training, and employment. between January and September 2024, compared to 96 cases in the same period in 2023. These figures highlight the urgent need for safe, supportive interventions for mothers in crisis.

“Every mother deserves the chance to raise her child in safety and dignity. When women face an unplanned pregnancy, they are often isolated, judged and left without resources. With Rumah Ibu Sabah, we are creating a support system that helps women in crisis find strength, stability and hope for the future. By giving them access to medical, emotional and social support, we can prevent children from being abandoned and help keep families together,” said MHIF co-founder Arsen Tomsky. “This initiative is about more than protecting mothers and children. It is about giving women a fair chance to rebuild their lives. Too often, mothers in crisis feel they have no choice but to give up their babies. Rumah Ibu is not

The centre operates in partnership with the Sabah Department of Social Welfare and is managed by Mother’s Home International Bhd (MHIB). The Mother’s Home International Foundation (MHIF) is a non-profit organisation dedicated to protecting mothers in crisis, preventing child abandonment and preserving family unity. It was established in 2023 by Aidyn Rakhimbayev, a prominent Kazakh businessman and philanthropist, serving as chairman of BI Group, the largest construction and development company in Kazakhstan and Central Asia. Baby abandonment remains a persistent challenge in Malaysia. According to the Royal Malaysia Police, 75 cases were recorded

From left: MHIF CEO Anar Rakhimbayeva, Sabah Community Development and People’s Wellbeing Ministry Permanent Secretary Datuk Maria Chong and MHIB board director Klyshbayeva Azharkul at the opening of the Rumah Ibu recently.

MHIB director Shahul Hamid. The Malaysian initiative also supports the values of the Madani Economy, which emphasises fairness, inclusivity and long-term prosperity for all Malaysians. By providing vulnerable mothers with access to

just a place of support, but also a tool that helps women move forward. By working together with MHIF, we are strengthening families, empowering women and ensuring that fewer children grow up in orphanages and more grow up in loving homes,” said