Tuesday, 10 April 2012
The elderly in Bangladesh: does anybody care for them?
Bangladesh is currently undergoing a demographic transition and the proportion of the population 60 years and older is rapidly increasing. Bangladesh’s elderly population is one of the largest in the world in terms of absolute numbers. Currently, older people account for around 7% of the country’s total population, amounting to roughly 10 million people. By 2050, the 60+ population will account for 20% of the total population—a four-fold increase from the present time. The increase in elderly population in Bangladesh during the period 1990-2025 is projected to be much faster (219%) than that of European countries such as Sweden (33%), UK (45%) or Germany (66%). While changing lifestyles, urbanization, and the decline of traditional family support system have increased the plight of the elderly people, especially the poor and the women, little attention has been given by the policy makers to their health and social needs. In the absence of a comprehensive national policy on ageing, the individual small-scale programmes by the various development actors remain largely without direction and coordinated action.
In old age, high prevalence of morbidity is a common feature and health care expenditure for the elderly persons is much higher compared to the younger adults. There is also disregard for the nutritional needs of older people, as nutritional assessments tend to focus exclusively on the under five-year-olds, without taking representative samples of nutritional status among other age groups. Lack of access to safe water and adequate sanitation facilities contribute to the poor nutrition and health status of older people as well. Public health initiatives in Bangladesh have primarily focussed on the younger population. The special health needs of older people have not been considered a major issue by either the government or the NGOs to a substantial extent. The large majority of the health-care seeking population goes to unqualified practitioners providing various kinds of treatments that are frequently sub-standard, ineffective and harmful. Empirical data from Bangladesh indicates that health services for older persons suffer from a lack of coverage and the inadequacy of existing services to meet older peoples’ needs. In most low-income countries such as Bangladesh services retain a curative bias, and there are few examples of successful nation-wide promotion campaigns for elderly population.
The available research suggests that well targeted PHC interventions have considerable potential to improve the health and quality of life of older people in any country. As well as improving the well-being of elderly people, effective PHC could reduce the burden of demands for health services at the secondary and tertiary levels. Of particular importance are relationships between PHC and informal support for elderly people, health education and the promotion of healthy active life expectancy. Besides, familial and community level social capital are significantly associated with good quality of life in old age.
Poor health need not be inevitable in old age. Health promotion, a key element of PHC, is an important tool to slow down or even prevent ill-health and consequently, improve quality of life (QoL) of the older people. Evidence shows that prevalence of morbidities and health care expenditure may be reduced by interactive and participatory education through community organized groups such as self-help groups of the elderly. In a pilot project “Primary Health Care in later Life (PHILL)” in Chandpur near Dhaka, a total of 22 self-help groups of the elderly were formed during 2003-’05 to improve self-esteem and status of the elderly within the family as well as the community. Each group consisted of 10-25 elderly, men and women forming separate groups. They arranged fortnightly meetings to discuss preventive and curative aspects of common health and emotional problems of the elderly, share experiences and to find solutions within the group. They occasionally organized recreational and social activities such as reading books, singing folk songs etc. for entertainment. They also gathered everyday in some selected places to read newspapers and other health and development magazines provided by the PHILL project. Walking together for a km and swimming in the ponds while bathing were also promoted to instill the habit of regular exercise among them. In addition, a total of 56 elderly volunteers from different groups were trained on managing common elderly health problems (such as arthritis, diet, exercise etc.) so that they (‘young old’) can help their peers (‘old old’) in the group who need it. Beside the self-help groups the project had other interventions to improve health and social awareness, manage common health problems and sensitize the community to the needs of the elderly. In subsequent evaluations, the project was found to increase the Quality of Life (QoL) of the elderly to a substantial degree.