INTRODUCTION

Old age is a product of history, individual experiences and social forces (Morgan and Kunkel, 2001).Population ageing and extension of life are the consequences of modernization - basic changes in the economy and society associated with industrialization, urbanization and migration. The developments, as a result of modernization, have seen the emergence of changes in values, attitudes, behaviourism, institutions and technology. These changes have generated a decrease in the trend and pattern of fertility and mortality. The outcome of these decreases constitute the framework within which the implication of population ageing and the extension of life are required to be considered. Population ageing will be the most prominent demographic trends of the new millennium. Like most developing countries, in Bangladesh ageing is often viewed as welfare rather than a developmental issue and as such the design of welfare policies and programs for older persons are categorized together with groups of poor, disabled and victims of disasters (UN, 1994). The advancement of medical science and increased awareness among the people has also brought about a sharp decline in mortality and a steady decline in fertility. This has resulted in a worldwide shift in the demographic profile and has lead to a significant increase in the aged population.

Moreover, in 2005 out of the total world population of 6,514,751 thousands, 766,816 thousands were living in the least developed countries and 153,281 thousands are living in Bangladesh (United Nations Population Division. World Population Prospectus. 2006), the present scenario is such that about two thirds of all older people are living in the developing world and by 2025 this figure will be 75% (Aging and Life Course, WHO). The tragedy lies in the fact that though the industrialized nations have a well-equipped service delivery system targeted for the elderly, the scenario remains utterly dismal in the developing nations. This article tries to analyze the present status of geriatric care in Bangladesh and its future relevance, and stresses on the need for an immediate change in the attitude of the government as well as the general community.

Present Demographic Situation of Bangladesh with respect to World and Least Developed Countries

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.

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 1. World

Table 1. Least developed countries

Table 3. Bangladesh

Present Status and Future Appeal of Geriatrics

The traditional norms and values of Bangladesh society stress the importance of showing respect and providing care for the older population. Although traditions and norms are changing over the course of time, there still remains a section of the elderly who have no family or are very poor and are looked after by the community or religious organizations. Sometimes these older people live with little care from the relatives, friends or neighbours (Kabir, 1994b). In Bangladesh, like most developing countries of the Asia and the Pacific Region, care for the elderly is still considered as a family responsibility despite the fact that family structure is steadily changing in some of these countries. Family cohesiveness and filial piety has been the main factor behind this tradition of care from the children to the parents (Kabir, 1996).

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 (Kabir et al., 2005; Abedin, 2003). 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 women 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 (Sattar et al., 2003, Chang, 1992). The vulnerability when compounded by falling health, disability and widowhood makes the elderly women the most defenseless in the Bangladesh context (Sattar, 2003; Audinarayana and Kavitha, 2003, Chen and Dreze, 1995).

In many societies, the tradition of older persons co-residing with their family members is generally the norm (Nizamuddin, 2003). 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 (Samad and Abedin, 1999). 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 (Cheung, 1996). 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 (Samad and Abedin, 1999). 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. (Abedin, 2003; Audinarayana and Kavitha, 2003 and Sattar and Dreze, 2003).

Conclusion

The present scenario and the future appeal of geriatrics in Bangladesh is such that there is need for change in the attitude of not only community and the government but also the people. The elderly should be considered not as a burden to society rather their valuable experience should be utilized fruitfully and it should be the responsibility of the society and the government to impart an improved and effective quality of life to them in return for their lifelong dedicated service towards their children and the nation. It is high time that the Bangladeshi policy makers give due importance to the forthcoming age wave. The government should make an earnest and accelerated attempt to bring about reforms in the living arrangements regarding elder abuse and design a suitable social security system and improve the health care facilities for the elderly. The government should realize the importance of geriatrics and make strong efforts to incorporate it in the curricula of the existing and the future Public Health and Medical Institutions in this country. Although this is a mammoth task to achieve in isolation by the public and private sectors, solvent and effective ways can be found through joint approaches and strategies (Aging and Lifecourse, World Health Organization). A study supports the hypothesis that utilizing existing health care structures and providing training to health care providers, the demand for basic gerontological services can be met successfully (Kabir et al., 2005).

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