Life is a process during which one initially gets less and less dependent, independent, and then more and more dependent. But in Bangladesh, old age means poor health care service, mistreatment from family members, threats from meeting basic needs, unhygienic living conditions and poor sanitary system, isolation and loneliness, unsuitable transport system and poor recreational facilities. The situation is worsening day by day as the number of elderly people is increasing rapidly in Bangladesh, where around 13 million people are aged over 60, which is equal to almost 8% of the country's total population.
It is mentionable that the country's population is still predominantly young but its ageing population is rising day by day thanks to a higher life expectancy rate. According to the United Nations Population Fund (UNFPA), by 2050, people aged 60 and above in Bangladesh will number 3.6 crore and constitute 22 per cent of the total population. But a sharp increase in the proportion of those over 60 years of age could leave it ill-prepared to provide them with care. It is predicted that in 2025, about 37 million people in Bangladesh will be 60 and above making them 21.0 per cent of its total population. Life expectancy for Bangladeshi males will be 78 years in 2050 (an increase of about 7.6 years from 2019) and for women, it will be 81 years (an increase of about 7.3 years from 2019). The old-age dependency ratio (65+ people to 15-64 people) will grow to 23.5 from 7.7 during that time.
The number of people in the age group in the 2022 census was over 1.53 crore, which is around 9.28 per cent of the total population of 16.51 crore. In the 2011 census, this group constituted 7.48 per cent of the population. The 1.8 rise in percentage points between the two censuses is the sharpest increase between consecutive censuses in the country's history. This is consistent with global trends. According to the World Health Organization, by 2030, one in six people in the world will be aged 60 years or over. This is ringing the alarm bell for all stakeholders including the health care providers, health professionals, policymakers, social welfare system, NGOs, and public health experts to work on proposing ways to take care of this vulnerable demographic segment and meet their healthcare needs. The fact that almost one-fifth of the country's population will be over 60 in the near future should raise alarms for all stakeholders including the health care providers, health professionals, policymakers, social welfare system, NGOs, and public health experts to work on proposing ways to take care of this vulnerable demographic segment and meeting their healthcare needs.
Demographers and economists said the healthcare system and existing facilities are not sufficient at all for the care and support of a growing number of elderly citizens.
Bangladesh must find and develop suitable models to care for its growing ageing population. Old homes have been built here but the complete residential isolation of the older parents and living with strangers have not been well-liked by their family members because of the country's prevailing social, cultural, and religious norms.
Bangladeshi people in general value socialisation with friends and enjoy the company of family members more.
Alternate care delivery models need to be explored that will meet the care needs and will also be accepted by the care recipients and their offspring. The rising older population is intensifying this need and the country is simply not prepared to offer suitable options on how to deal with their needs.
Adult day-care is an option where older adults spend time with similar age groups during the day. Providing care at home (home care) is another realistic option as recent research shows that most people like to live and age in their own homes. The home care services model provides essential health and personal care supportive services that enable people to live in their homes. This may be a preferred approach over receiving care in a nursing home (commonly referred to as an old home in Bangladesh) or other institutional settings.
The demand for home care (HC) is increasing across the world because of the supply of traditional home-based caregivers (female family members), women between 15 and 64 years, who are in school or engaged in the formal paid labour force. As an example, in the USA, 67 per cent of women between 15-64 are now working outside whereas 52 per cent of women globally are working outside. This caregiver gap is growing widespread worldwide including in Bangladesh and has interestingly highlighted the often invisible, ignored, or undervalued care work that women have always done since the dawn of human history.
But the big concern is our society is not ready to take care of the ageing population and the issue is not well integrated into the government's development strategy. It is also not an integral part of our economic planning. Both home care and healthcare facilities are inadequate for the ageing population. We don't have good old-age home facilities. Some issues or questions that Bangladesh needs to consider or ponder about how to deliver care for its ageing, chronically ill population or people with disabilities are: (1) Can home care service be a suitable care delivery model?; (2) Who will pay for these services?; (3) How to develop a workforce with training and skills in delivering home care?; (4) How can accounting for aide and client safety improve HC services?; And (5) how can this model be made popular among the care recipients and family caregivers?
Social scientists say the issues should be viewed from a more strategic viewpoint as the continued rise in life expectancy is one of the reasons behind the ageing population. We have to invest in the care economy. Social protection should be expanded, otherwise the elderly will be a big burden for the state. The ruling Awami League in its election manifesto in 2018 pledged that it would ensure health service free of cost for children less than a year old and citizens over 65. But it is yet to be implemented. The AL government has taken some initiatives like an old-age allowance and a universal pension scheme. However, the government needs a comprehensive approach to address the issue.
( The writer is the Managing editor of THE BANGLADESH EXPRESS)
