Table 1 clearly shows the declining trend in the Crude Death Rates (Except Projected Rate) and Total Fertility Rates with an increase in the life expectancy at birth and the geriatric population worldwide and also makes projections of the trend thus set continuing into the future with a substantial increase in the population aged 60 years and above.

Table 1

Though this demographic shift signifies the triumph of modern medicine and public awareness yet at the same time it throws up a challenge to modern society and demands the health care system to get equipped accordingly to serve the present and the future need of the community. The shifting demographic trend was so far considered a feature only in the industrialized world. But with the benefits of modern medicine and public awareness spreading to the developing nations as well, the changing demographic trend is increasingly becoming a reality in the developing countries too.

Table 2 clearly depicts the same worldwide trend in demographic shift becoming a reality in the least developed countries as well. Bangladesh has no exception to this global trend in demographic shift which is shown in Table 3.

Table 2

Table 3

In Bangladesh many older people spend their lives in poverty and ill health, which is a major risk for the elderly population. After a lifetime of deprivation, old age is likely to mean ill health, social isolation and poverty. Poverty and exclusion are the greatest threats to the well-being of older people. This is especially true for older women, who suffer from multiple disadvantages resulting from biases to gender, widowhood and old age. Women, particularly widows, who are without living sons or who live alone, are considered to be particularly at risk of economic destitution, social isolation, poor health and death. The support system for older men and women differ. The older women's dependency on their families will be higher than that of older men. Marital status is an important determinant of where older persons reside, of their support system, and their individual well-being. A Bangladeshi woman often enjoys power and authority if she happens to be head of the family. If this association is broken, her access to resources for care and sustenance is reduced, making her vulnerable. This risk increases for women who have no assets for survival, such as education, possessions or social status. The vulnerability when compounded by falling health, disability and widowhood makes the elderly women the most defenseless in the Bangladesh context.

In many societies, the tradition of older persons co-residing with their family members is generally the norm. Following the oriental tradition, living with son and being taken care of by his family in old age has been considered as a symbol of prestige. An overwhelming majority of caregivers felt that children/family should be responsible for the elderly. Most of the caregivers also felt that the elderly should be taken care of at home by the members of the family and a hired carer. The community services for the elderly available, and preferred to have available, include free medical services, exercise center, day care, health equipment, service center, occupational training, entertainment and regular health check. The findings of a village study conducted in Manikgonj and Rajshahi areas, especially in rural areas, show that community services available for the elderly, are greatly lacking. The elderly in Bangladesh will face many problems such as insolvency, loss of authority, social insecurity, insufficient recreation facilities, lack of overall physical and mental care, problems associated with the living arrangements etc.

Geriatric health management depends largely on the planning and coordinating the care of the elderly and/or disabled to improve their quality of life and to maintain their independence for as long as possible. Health care and psychological care are integrated with the best possible combination of services such as: housing, home care services, socialization programs, financial and legal planning. The care plan for elderly persons should be tailored for each individual's circumstances and must be prepared after a comprehensive assessment. The care plan needs to be modified when necessary based on the monitoring of the effectiveness of the components of the care plan. Eminence and its professional geriatric care managers accomplish this by combining a working knowledge of health and psychology, human development, family dynamics, public and private resources and funding sources while advocating for their clients throughout the continuum of care.

HELP – Homely Endeavor for Lonely People is an endeavor of Eminence that has been created to provide home based service to the parents of NRBs with the aim to improve their physical, emotional, social, and developmental well being. It focuses on helping people achieve independence in all areas of their living as well as providing with various needs positive and fun activities to improve their cognitive and physical skills. It is a community-based wellness programs that built on the unique strengths and talents of people. For more information please visit HELP.

Courtesy: Md. Ismail Tareque, Lecturer, Dept. of Population Science and Human Resource Development, University of Rajshahi.

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