“Many people think leg pain and swelling are just part of ageing, so they try to live with it,” says Dr Syaiful Azzam bin Sopandi, Consultant General & Vascular Surgeon at Ara Damansara Medical Centre (ADMC). “But when veins in the legs stop working properly, it can lead to more than just discomfort. If left untreated, the complications can be serious.”

CVI happens when the valves in the leg veins weaken or become damaged. These valves are meant to ensure that blood flows upward to the heart. When they stop working properly, blood pools in the lower limbs, increasing pressure and causing damage to the surrounding tissue.

“Think of your veins as rubber tubes with one-way doors,” explains Dr Syaiful. “As we age, the doors don’t shut completely, and the tube walls stretch. Blood collects in the legs, leading to swelling, skin changes, and eventually, ulcers.”

As the condition progresses, venous pressure builds up, a condition known as venous hypertension. Initially, this causes the veins to leak fluid into the surrounding tissues, leading to swelling under the skin. In more advanced stages, the veins begin to leak red and white blood cells. When red cells break down, they release iron, which gets trapped in the tissue and causes a dark staining effect on the skin. “This is why some patients notice a brownish discolouration on their lower legs,” Dr Syaiful shares. “It is not just a skin issue, but a sign of ongoing inflammation inside the tissue.”

Over time, this inflammation weakens the skin, making it more fragile and prone to ulcers, which are slow to heal, especially in older adults.

A common yet overlooked condition

Despite its seriousness, CVI is often underdiagnosed in older adults. Globally, chronic venous disease (CVD) affects an estimated 20 to 40 percent of the adult population, with prevalence increasing significantly with age. In Malaysia, a 2021 study under the Vein Consult Programme Malaysia found that more than 30 percent of Malaysians over the age of 50 show signs of CVD.

“Among those aged 60 and above, the numbers are likely even higher, possibly up to 40 or 50 percent,” Dr Syaiful says. “This is especially true for people with risk factors like obesity, a history of prolonged standing, previous deep vein thrombosis, or a sedentary lifestyle.”

He adds that as Malaysia’s elderly population continues to grow, vein-related problems will become more common and should not be overlooked as just a part of ageing. Some patients delay care due to fear of hospitals or believing nothing can be done. Others face language barriers, limited mobility, or financial concerns. In some cases, reduced sensitivity in the legs can cause patients to overlook pain altogether.

He recalls the case of a 60-year-old woman who had been living with a chronic leg ulcer for six months. She had been dressing the wound at home with the help of her family, unaware that the root cause was a treatable vein condition. An ultrasound assessment showed that she had bilateral CVI with significant venous reflux and damaged skin. Following a minimally invasive laser treatment, the ulcer healed completely within a month.

Signs that shouldn’t be ignored

The warning signs of CVI can appear gradually. Leg pain that worsens with standing or walking, swelling around the ankles, and visible varicose veins are among the most common early indicators. Skin around the lower leg may become darker or feel tight and itchy. In more advanced cases, ulcers may form, usually near the inner ankle.

“These are more than skin deep,” says Dr Syaiful. “If you notice them, especially after 50, you should speak to a doctor. Early treatment can make a huge difference.”

Ageing veins and slowing circulation

As we grow older, the structure of our veins changes. The valve flaps that once closed firmly may now leak. The vein walls, once elastic, become stiff. The calf muscles, which help pump blood back up to the heart, may lose strength due to reduced physical activity. This combination of factors contributes to slower blood flow and increased risk of vein-related complications.

“Older adults may not walk as much or stay as active as they used to,” Dr Syaiful says. “That loss of movement slows down blood circulation and makes venous disease more likely.”

Simple, effective treatments

When a patient presents with leg swelling, pain, or skin changes, the first step is a quick and painless ultrasound scan. “It is a safe, non-invasive way for us to assess blood flow and valve function in real time,” explains Dr Syaiful. “It gives us a clear picture of what is going on.”

Once diagnosed, modern vein treatments offer a range of minimally invasive options that are suitable even for older patients. The most common approach is endovenous ablation therapy, which has two main forms. Thermal ablation uses heat, through either laser or radiofrequency energy, to seal off the diseased vein. Non-thermal methods include medical-grade glue, mechanical ablation, and sclerotherapy, which involves injecting a chemical solution into the vein.

These procedures are typically performed under local anaesthesia. Recovery is fast and minimally disruptive to daily routines.

Most patients can walk in and walk out the same day and return to their normal routine shortly after,” Dr Syaiful shares.

Debunking common myths

Despite advancements in treatment, myths and misinformation continue to delay care. One of the most persistent beliefs is that varicose veins are purely cosmetic. In reality, they may signal an underlying disease. Another common myth is that older adults are too frail for surgery or that vein removal will disrupt blood flow.

“Age is not a barrier,” says Dr Syaiful. “We tailor our treatments to suit the patient’s condition and needs. And no, removing or sealing a diseased vein won’t harm your circulation, other veins will take over.”

He also warns against relying solely on compression stockings. While helpful in managing symptoms, they do not address the root cause. And without proper treatment, CVI tends to worsen over time.

“Vein disease is progressive,” he says. “The earlier we catch it, the easier it is to manage.”

Caring for your veins at home

While medical treatment is necessary for more advanced cases, adopting good daily habits can help maintain healthy veins and manage early symptoms. Dr Syaiful recommends regular walking to strengthen the calf muscles, elevating the legs a few times a day to reduce swelling, and avoiding long periods of sitting or standing. Wearing compression stockings in the morning, maintaining a healthy weight, eating a fibre-rich diet, and avoiding tight clothing that restricts circulation can also make a difference.

Daily leg care is also important. Moisturising the skin, especially around the ankles, helps prevent cracks, while regular self-checks can catch early signs of swelling, wounds, or discolouration. “Smoking damages blood vessels and worsens circulation,” Dr Syaiful adds, “so quitting is one of the best things you can do for your vascular health.”

Early action saves limbs and lives

Left untreated, CVI can result in open ulcers that take months to heal, frequent infections, and in severe cases, deep vein thrombosis or even limb amputation. This condition may also lead to cellulitis, a painful bacterial skin infection that can require hospitalisation.

“Delaying treatment is like ignoring a leak in your roof,” says Dr Syaiful. “It might seem small initially, but eventually the damage becomes extensive and costly to fix.”

With Malaysia’s ageing population on the rise, awareness of venous disease needs to catch up. Leg pain isn’t always just a sign of ageing. With proper diagnosis and timely care, older Malaysians can enjoy better mobility, reduced pain, and a better quality of life.

“Healthy ageing is not just about living longer. It is about staying active, independent, and pain-free,” Dr Syaiful concludes.

By Ms Lee Yin Lan, Lecturer at the School of Accounting and Finance at Taylor’s Business School, Faculty of Business and Law, and member of the Active Ageing Impact Lab at Taylor’s University

Retirement is a significant period in one’s life that prompts reflection on how to embrace active ageing practices and maximise this phase of life, including continued employment.

The question of what to do after retirement and employment becomes increasingly pertinent, as Malaysia transitions into an ageing society, with an extended average lifespan of 74.8 years according to 2023 data from the Department of Statistics .

However, a retiree aged 60 has to support him or herself for another 14.8 years or more, and this will burden public funds in providing medical and welfare aid to the ageing community.

At a closer look in Malaysia, over the past 10 years, government expenditure on pensions and gratuities averaged about RM14.8 billion , and last year, it was at RM32.01 billion. The amount is anticipated to increase to RM46.36 billion by 2030 and RM120 billion by 2040 .

Faced with this rapidly ageing population, one of the ways to finance older persons is to encourage them to supplement their incomes through active ageing.

Ageing and productivity

Several countries with significant ageing populations, including Japan, Singapore, and Germany, actively support post-retirement employment through tailored programmes and initiatives. They believe that being active in the labour market will bring about benefits such as keeping the seniors in good physical and mental condition, fostering social connections, enhancing individual financial security, and contributing to their overall health and happiness.

According  to studies in various countries, employment in later years has been linked to a reduced risk of dementia and lower mortality rates from strokes and heart disease caused by social isolation .

In 2021, a study published in a top health journal by the University of St Andrews scholars found delaying retirement until the age of 67 or older can reduce cognitive decline by up to 34 %, compared to those who retired earlier, highlighting the importance of extended workforce participation in promoting healthy ageing .

Despite the benefits, retirees may encounter challenges such as age discrimination and skills mismatch when re-entering the workforce. Older workers often face bias from employers who favour younger candidates, viewing them as more adaptable and tech-savvy. Additionally, older employees may be unfairly labelled as stubborn or resistant to change due to their extensive and longstanding experience.

Upskilling; putting an end to ageism

To address these challenges, retirees should proactively update their skills to align with current industry demands and tailor their resumes to highlight relevant experience. Leveraging professional networks can also provide valuable job opportunities.

Employers can further contribute to creating an age-friendly workplace, offering flexible options such as remote work or part-time hours for older employees, while also implementing health programmes like screenings and fitness classes to support their well-being and boost productivity. Additionally, using age-neutral recruitment and promotion practices ensures decisions are based on skills and qualifications, promoting fairness and inclusivity for all employees.

Removing age identifiers from resumes, such as graduation dates, can help combat age discrimination, while adopting a modern resume format enhances competitiveness in the job market.

While ageing has traditionally been associated with declining productivity and viewed as a burden on society, this perception is evolving. With advancements in healthcare and a culture of lifelong learning, it is now recognised that individuals can maintain productivity and contribute to society well into their later years. Therefore, middle-aged and older adults approaching retirement or who already retired may consider exploring opportunities for continued engagement and fulfilment in the latter stages of life.

Sources:
1. https://open.dosm.gov.my/dashboard/life-expectancy
2. https://theedgemalaysia.com/node/700728
3. https://www.nst.com.my/news/nation/2024/03/1025556/zaliha-govt-pension-payout-increases-rm-1-billion-annually
4. https://www.bmj.com/content/374/bmj.n1804
5. https://research-repository.st-andrews.ac.uk/handle/10023/23523

With age, immunity declines, increasing older people’s susceptibility to infectious diseases such as the flu and pneumonia, which can manifest into other health risks and complications. Vaccination remains one of the most cost-effective interventions available to protect against infectious diseases.

However, despite the obvious benefits, Southeast Asia lags the rest of the world when it comes to life-course immunisation – falling significantly short of the 75% immunisation target rate set by the World Health Organisation.

The EU-ASEAN Business Council, KPMG in Singapore, and Sanofi, with the support of the Western Pacific Pharmaceutical Forum (WPPF), has published a new report – “The Decade of Healthy Ageing in ASEAN: Role of Life-Course Immunisation” – unveiling healthy ageing barriers in Southeast Asia and calling for an urgent and greater focus on the implementation of life-course immunisation.

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“While the region focuses on Covid-19, and rightly so, we need to also give attention urgently to another pressing issue – ageing societies. As we age, we are more susceptible to health complications. Many diseases that afflict the elderly can be thwarted by immunisation. Yet, the role and value of life-course vaccination or vaccination at every stage of life beyond childhood is not fully realised,” said John Jackson, President of the WPPF. “Today’s report provides a starting point for governments across the region to implement incremental policy changes that can further empower healthy ageing and economies.” 

The report’s recommendations, contributed to by experts from across the region, include:

·       Recognising life-course immunisation as an important part of healthy ageing and dedicating resources to implementing this as part of healthy-ageing policies

·       Engaging the expertise and knowledge of healthcare providers and leveraging their influence to be advocates for life-course immunisation

·       Supporting grassroots efforts to share relevant narratives around the efficacy and safety of vaccines, as well as to help bridge the digital gap among the elderly to access information and other matters related to vaccination

·       Improving public access to vaccination points, to make sure that people who want to be vaccinated can do so at their convenience – at locations with minimal disruption to their daily routines

·       Private sector support through inclusion of annual vaccination in employee benefit programs and development of insurance products by health insurers that help cover vaccination costs

“While we are living longer, we are not necessarily living healthier,” said Chris Humphrey, Executive Director of the EU-ASEAN Business Council. “This report shows us the dividends that we can harness by better ensuring a healthier, more productive older working population. Southeast Asia needs to start planning now to ensure that we take the right policy action – including preventative care.”

Eric Mansion, General Manager, Asia Zone, Sanofi Pasteur said: “Health is wealth but protecting our older adults goes beyond monetary impact – healthy ageing allows ageing populations to enjoy a good quality of life in their golden years and contribute meaningfully to social situations and beyond. Life-course immunisation should urgently be prioritised as a vital part of healthy ageing policies in Southeast Asia, to lessen the impact of ageing societies and to protect against vaccine-preventable diseases.”

“Although further implementing life-course immunisation programs will be a costly and logistically complex endeavour, but the alternative will be far more expensive and not just in monetary terms,” added Jackson. “Time is running out, and swift, decisive action to address the issues that threaten to undermine having a healthy, ageing population is imperative.”

The report covers six countries in Southeast Asia – Singapore, Malaysia, Thailand, Vietnam, Philippines and Indonesia – with insights and input from 27 experts in these six countries as well as Switzerland and the US.