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Abstract
Bangladesh is a South Asian country with a large,
densely-settled population. In Bangladesh an estimated
7.3 million people are currently 60 years or older,
and it is projected that this number will increase
by 173 percent by 2025 (Help Age International
2000). Around 34 percent of the Bangladeshi population
lives below the national poverty line (UNDP 2003),
and 36 percent of the population earns less then
$1 a day. More than 85 percent of the poor live
in rural areas (BBS 2002, World Bank 2002). It
is one of the poorest countries in the world.
Bangladesh has enjoyed an impressive rate of sustained
economic growth of 6.7 percent. During the last
decade real Gross Domestic Product (GDP) per capita
increased by 52 percent. This study focuses on
various problems and needs of elderly people in
Bangladesh, like health problems, mental problems
and problems of health care services, housing,
security and so on. Finally it gives some recommendations
to eradicate major problems and needs of the elderly
people in Bangladesh.
Key Words:
Problems, Needs, Elderly People, Bangladesh
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INTRODUCTION
The aging of populations
has become an emerging issue both in developed and in
developing countries (Sen, 1993). Over the last decade
or so in Bangladesh the proportion of the elderly population
has been gradually increasing. Currently about 6 percent
of the population is 60 years and above. By 2025 this
proportion will increase to over 9 percent. The population
aging seems to be poised to replace the population growth
as the major demographic issue of public, political
and scientific concern in the twenty first century (Knodel
and Debavalya, 1997).
Traditional support system for the older person in Bangladesh
based on joint family structure and kinship to ensure
older people's care security and respect, has been declining.
With the rapid decline of the joint and extended family
system, the community no longer protects older people's
rights as in the past. As a result, older people have
largely been displaced in the community and are exposed
to vulnerability. The present study would help to assess
the elderly population's basic needs in terms of food,
shelter, health care, income security, socialization
and community support. It would also help to draw feasible
policy oriented strategy given the resource constraints
(Kabir, 1999; Hasina, 2002).
The human life cycle is composed of five main stages
from birth to death. These are infancy, childhood, adolescence,
adulthood and elderly. In each of these stages an individual
finds themself in different situations and faces different
problems. Among these the most vulnerable and problematic
stage is old age (Rao, 2006: 345), because in old age,
physical strength deteriorates, mental stability diminishes,
money power becomes bleak and eyesight suffers a setback.
In our traditional society, families performed various
roles to meet all the problems of elderly people. They
were not neglected and they were considered as respectable
bytheir family members. In present times, due to industrialization
and urbanization the modern nuclear families are increasing
and the care of elderly is becoming questionable. So
the elderly people need support from others. In our
country, the welfare services are provided to the elderly
people through family and on an institution basis.
Who are the Elderly?
Being elderly is an obvious reality and the last stage
of the human life cycle. The term elderly is applied
to those aged 60 and over in conformity with the International
Plan of Action in Ageing adopted by the World Assembly
of Ageing, held in Vienna in 1982 (Kabir, 2003: 64).
There are many words such as 'old' or 'old age' or 'pensioners'
used to denote the later life of all people. In a globalizing
world, the meaning of old age is changing across cultures
and within countries and families (Hardy, 1997; Riley
and Riley, 1994:263). For example, 'old' is not a polite
word for people in western societies. In the English
language there is a move from 'the old' to the hopefully
more polite 'the elderly' (Wilson, 2000:4). In America,
Senior Citizens is thought to be more polite. In Europe
they like to be called 'senior citizen' (Walker, 1993:
73). In Bangladesh, there is no universally accepted
specification of the span of years embraced by old age.
Though there is a lower limit of age for those who have
a formal job in our country. In fact in our society,
people work as long their health permits them to continue.
However, in the formal sector there is a specific age.
For example, the retirement age from government service
is 57 in accordance with the Retirement Act-1974 (Feroj,
2005: 173). We generally use the term of 'elderly' from
the age of sixty years.
AIMS AND OBJECTIVES OF THIS STUDY
This study report can be used-
i. To know what are the problems and needs of elderly
people in Bangladesh;
ii. By Government and civil society organizations to
support advocacy for elderly people in Bangladesh;
iii. As an information source for future development
of Bangladesh's plan of action on ageing.
METHODOLOGY
This study is descriptive
and analytical in nature. It is based on the review
of primary and secondary literature including books,
journals, national and international research articles,
and government documents. Relevant literature was also
collected through internet browsing. Finally personal
ideals and critical views were added as well.
Problems of the Elderly
The elderly people are confronted with various problems
like physical, mental, economic and cultural problems
(Butler and Lewis, 1977: 34) stated concerning problems.
The elderly are confronted by multiple losses, which
many occur simultaneously: death of a partner, older
friends, colleagues, relative; decline of physical health
and coming to personal terms with death; loss of status,
prestige and participation in society and for large
numbers of the older population, additionally of their
physical power, they don't move easily and work properly.
Of the major health problems afflicting the elderly,
heart disease leads all other conditions in both cause
of death and utilization of health care services. The
most common ailment is stomachache and diarrhoea followed
by asthma, peptic ulcer, blood pressure, diabetes, cardiac
problems, dental and eye problems and so on (Kabir,
2003:71). The main leading cause of elderly death is
heart disease, cancer and stroke. Psychological problems
are growing more in the older people. They cannot adjust
to the changing situation of the society. In addition,
old age may be a time of loneliness and bereavement
as brothers, sisters, wives and husbands are lost. Another
problem of elderly is the housing problem. Most of the
elderly people have no special arrangement of living.
They sleep at night with their grandson or granddaughter.
They live in a specially arranged room in a separate
part of homes or on a veranda. In a word, they have
some unmet needs in the family. As a result the elderly
consider themselves as a burden on their family members.
* Only those diseases were shown in the table prevalence
which exceeded 5 percent in the total sample.
Source: Kalam and Khan, BRAC University Journal, vol.
III, no-2, 2006, pp. 78.
Table 1: Percentage distribution of usual health
hazards* of the elderly citizen
What are Needs?
Need is the state of lacking basic necessities such
as food or of requiring help (Concise English Dictionary,
11th Edition, 2004). Needs are such a type of phenomenon
which we think necessary to fulfill and meet our daily
or normal lifestyle. To run or lead a balanced life,
we are to face or meet some practical problems that
must be solved by us. As a human being, we are social
in nature. To live in a society, we have to go a long
way in our present so called modern social system. Needs
are nothing but our extreme felt things. Needs vary
from person to person, place to place, society to society,
culture to culture and country to country. They fully
depend on geographical location and that very place.
So, it can be said in short that needs are really an
abstract concept.
Classification of Needs of Elderly People:
Maslow believed that each of us has five basic needs,
which follow a development sequence; human needs are
arranged in ascending order from physiological to self-actualizing
needs. Maslow thought that the lowest level of unsatisfied
need is always dominant. Only when it is fulfilled do
we turn our attention to the next higher one (Maslow,
1954: 12).
Figure 1: Maslow's hierarchy of human needs
Needs of the
Elderly People in Bangladesh:
The elderly people in Bangladesh have strongly filled
(realized) that their main needs are those-
1. Food
2. Shelter
3. Healthcare
The other important needs of the elderly people in Bangladesh
are as follows-
Needs of Physical Care of Elderly People:
Physical care is very much essential in the case of
the aged. The typical image of care giving and the elderly
is one of an older person who is ill or infirm receiving
care from a younger person. In many instances this image
is correct. However, in Bangladesh older women and men
are not only the recipients of care; in many cases they
caregivers themselves. Historically, when an older person
was in need of care, most often the family provided
it. Therefore, the gender differences in care giving
with the elderly as recipients were examined.
Source: Mostafa
and Streatfield, 2003: 49
Table 2: Percentage
of major providers of physical care by sex and marital
status
Mental Security
Needs of Elderly People:
The elderly people of our country feel different kinds
of mental insecurity. Included in this are inferiority
complex, insecurity, loneliness, insomnia etc. They
think that their mental insecurity should be removed
by eliminating these types of problems which they think
are as follows:
1. To arrange entertainment;
2. To set up a library;
3. To arrange play things;
4. To arrange their income and savings;
5. To arrange the treatment of the mentally disordered
elderly persons on an individual and group level with
a Psychiatrist;
6. To arrange for voluntary work for the elderly people;
7. To evaluate their achievement and labor;
8. To arrange the training system to serve the elderly
people of a family so that they can give proper service;
9. To create awareness among them of various kinds of
social and personal consciousness and
10. To appoint the efficient elderly people;
11. Their respective work (jobs).
Nutritional Needs of
the Elderly People:
As people become old, parts of their body become inactive
gradually. Probably, for people between 50 to 70 years
old, according to their activities, their daily needs
are 1600 to 2400 kilo calories. But in some special
situations, their food taking needs vary. As usual,
for people of 51 to 70, their normal needs are 10% less
than the youth and if the age is over 70, their needs
may decrease 20%.
Source: Probinder Sastha Poricharza (training manual),
1998: 87
Table 3: Food Ingredient Table of Elderly People
The elderly people should be involved in income generating
activities:
The majority of elderly people live their lives in absolute
poverty. Elderly people suffer from the cumulative effects
of a life lived of deprivation, entering old age in
a poor state of health and without savings of material
assets. Because of prevailing systems elderly population
are left out from the micro-credit system due to the
age barrier. Currently NGOs who provide micro-credit
do not include the elderly population. The elderly population
who have ability to participate in the system consistently
lack means to fulfill their most basic needs such as
food, clothes, housing and health care (Hasina and Kabir,
2002).
Needs of Living Arrangement and Support of Elderly
People:
Support in old age is important for the elderly population.
In this paper support of the elderly population is investigated
and information from the person who provide such support
is also obtained. Generally the elderly person is dependent
on their children or other close relatives. In Bangladesh
the family has traditionally been the main source of
support and provider of care for the old; changes in
the structures of the family may not automatically provide
such old age support. Traditionally the elderly live
in extended households and rely on their adult children,
their spouse and other family members for material needs
and personal care. Today, the traditional family support
system is under pressure from demographic, social and
economic change (Cai, 1991, Chang, 1992, Kabir and Zarin
Nahar, 1999).
The needs for the elderly population are also very much
essential. The following table suggests more than a
quarter of the elderly persons need the opportunity
to work to improve their present condition, which is
followed by government support, business and they need
financial support etc.
Source: Hasina and Kabir, 2003: 147
Table 4: Distribution of Elderly People by Type of
Needs to Improve their Condition
Health
Care Needs of the Elderly People:
Disease burden is an important issue and needs consideration
in the context of welfare of the elderly population
in Bangladesh. The elderly people of our country suffer
from more than one health problems at old age. Sound
health status of the elderly is an important issue for
their well being. The following table shows how much
health care is needed for the elderly people in Bangladesh.
Basic Needs of
the Elderly People:
Poor elderly people,
particularly in urban areas, live in even poorer conditions
than in the rural areas. Information on basic needs
reported by the urban males and females are shown below.
The information from the table show that the important
basic needs of urban elderly people included treatment,
food, clothing and social security. Since more elderly
women are widows they are considered to be a marginalized
group in Bangladesh, because they occupy a very low
social class. Consequently they have to face severe
social, economic and cultural deprivation.
Source: Hasina, Haque and Kabir, 2003: 6
Table 6: Distribution
of Elderly People by Sex and Basic Needs
Needs of Housing of
Elderly People:
House is a place where elderly people live. Housing
is one of the important basic needs of the elderly people
in Bangladesh. They expect that to have a sound housing
area. But unfortunately we can say the housing condition
of elderly people in Bangladesh is a measurable concern.
The following table shows how much need their is of
the elderly people in Bangladesh.
Source: Sattar, Milton, Al-Mamoon and Shahina, 2003:
26
Table 7: Distribution of Elderly People According
to the Severity of Housing Needs
Care and Services Needs
for the about to Die Elderly People
In our country every elderly person expects to die in
peace. They think that their care and services of the
last time of their age should be as follows:
i. To arrange a peaceful environment for the elderly
person. They should not be aggregated without any reason
so that they can pass their days with peace, tolerably
and pleasantly;
ii. To arrange such a kind of environment where peace,
silence and problem-free situations are available;
iii. In this connection, primarily the numbers of the
family should be initiated. (Probinder Sastha Paricharza,
Training Manual, 1998: 29)
Some Recommendations regarding the Welfare of the Elderly
People in Bangladesh
1. Increasing access to the old age allowance from age
60 by a minimum of 18 percent by 2012, from 1.7 million
2 million people;
2. Increasing the old Age Allowance from 220 to 500
taka by 2012;
3. Improving the allowance distribution systems to reduce
issuing problems and delays;
4. Increasing access to interest-free micro-credit for
older people;
5. Providing free healthcare and medicine to older people
on presentation of ID card;
6. Increasing the number of doctors with expertise in
geriatric issues;
7. Actively promoting the inclusion of ageing and Geriatrics
issues in school, college and university text books;
8. Introducing a national tax with the revenue dedicated
to the needs of older people;
9. Giving local government the responsibility to register
older people;
10. Collecting of disaggregated data on people 60 and
over;
11. Cultural traditions of older persons can be portrayed
positively in the mass media in the context of educational
and recreational activities for the elderly people;
12. We have to create free distribution of food, clothes,
shelter and treatment for the betterment of the elderly
people;
13. Government and NGOs should focus on involving elderly
people in creating employment for those who wish to
work, and improving their livelihood in rural areas.
CONCLUSION
being elderly is a serious reality and it is the last
step of the life cycle. None can avoid this stage. At
present the global population situation in respect of
age structure has been changing and showing the elderly
60+ as a growing segment. This is because of a declining
trend in fertility and mortality and also increasing
trend of life expectancy exceeding lower age limit of
60 years of the old due to increasing awareness of health
as well as improving healthcare services. According
to the ESCAP more than 80 percent of the elderly population
in the developing world will be in Asia by the beginning
of the twenty first century. The growing population
of old age will have more serious social and economic
implications. It is a time to emphasize the need for
policies and programs to create awareness of ageing
populations both from national and individual family's
concern. With the prevalence of morbidity and disability
the elderly should be provided with both financial and
social securities inside and outside homes with health
care services, medical facilities for better treatment,
housing, food and clothing and with extended facilities
of health care center. There should be voluntary organizations
to support the elderly. Special health care centers
for the old, hospitals for the aged attached to the
running public and private hospitals should be established.
In order to create a positive attitude towards the elderly
and promote awareness and understanding of the younger
to the old, Bangladesh should observe "National
Old Day". Although 1st October in every year "International
Old Day" has been observed since 1991. Finally
we can say government should have to take some positive
initiatives for the betterment of elderly people in
Bangladesh.
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