Hasnat M Alamgir |
Dec. 29, 2021, 10:28 p.m.
The elderly population (65+) in Bangladesh is believed to represent 16.30 percent (31,413,697) of the estimated total population of 192,690,991 in 2051 – only thirty years from its 2021 share of 5.33 percent ( 8,865,237) out of the current total population of 166,303,494 (Source: United Nations, Department of Economic and Social Affairs, World Population Prospects 2019: https://population-pyramid.net/en/pp/bangladesh). The elderly population will represent one-third of the population of Bangladesh by 2100. This aging of the population will change the landscape of current ways of planning, developing and delivering food, transport, housing and health care.
The increasing prevalence and burden of chronic diseases and health problems and other associated morbid conditions will result in functional impairment (disability) and limitations in daily life (addiction) and, therefore, the need for long-term care (SLD) in Bangladesh will increase tremendously over the coming decades.
In view of the increase in the number of elderly people, Bangladesh needs to give serious thought to preparing, organizing, packaging and providing the social and health services necessary for its aging population, while ensuring the quality of these services. services while respecting the dignity and privacy of all beneficiaries. . When the care recipients themselves pay for these services, they must get the maximum value from the service providers and when the government provides these services free of charge or partially subsidizes them, it must create a responsible system, including setting the standards of care. so that the tax money is not wasted and the satisfaction of the elderly person is assured.
LTC encompasses a multiplicity of services depending on the care recipient and their needs and is provided to meet health or personal care needs. These services help people when they can no longer carry out their daily activities due to illness, disability or simply old age and allow them to live as independently as possible for as long as possible. It is delivered by caregivers with different types of training, skill sets and certification depending on the recipient’s health status, susceptibility and available family support. Although not called that, most LTC in Bangladesh has traditionally been provided at home by unpaid family members and friends. It can also be provided in a facility such as an ‘old house’ as it is commonly called now in Bangladesh or in the community as in ‘adult day care centers’ which do not yet exist nor offer in Bangladesh. But with the rapid and continued growth of the elderly population, the attention of government and non-government policymakers in Bangladesh is eventually drawn to thinking about planning and delivering long-term care in a more structured and formal way.
The most commonly used type of LTC is personal care assistance with daily activities, also referred to as “activities of daily living (ADLs)” in formal literature and professional reports. These activities include dressing, bathing, bathing, using the toilet, eating and traveling. Getting out of bed and sitting down in a chair or on a rug is also a mandatory service for a sufficiently frail person. LTC in other countries also includes services provided in the community, such as delivering prepared or cooked meals and arranging transportation services. These services may be provided free of charge by a government in some countries with socialized health care delivery systems or at a cost in countries where private payment for services is customary.
In addition to the elderly, other members of society may also often need long-term care when they suffer from a serious and continuing illness or develop a disability, for example children with autism, people with a spinal cord or head trauma. The need for LTC can arise unpredictably, such as after a heart attack or stroke. Most often, it develops gradually, as people age and become weaker over time or as a disease or disability worsens.
There have been research attempts to measure functional independence through various quick and easy ways of using tools; for example, one of these tools uses a scale of 0 to 7 to rank different ADLs based on the level of assistance required. While instrumental activities of daily living (IADL) measure fundamental functioning when individuals live independently in a community, these include cleaning the house, preparing meals, shopping for groceries and shopping for groceries. supplies, money management, community travel, taking medication, and using the telephone and other forms of communication.
It is difficult to predict how much or what type of LTC a person may need. However, several characteristics have been identified to increase this need. LTC needs generally increase as people get older and women need it more than men, mainly because they have a longer life expectancy. In Bangladesh, women almost always outlive their spouses because men marry women who are several years younger. Single or divorced people would need more care than married people. Poor diet and poor exercise habits can increase the need for care as well as health and family history. Research also suggests that people with low incomes, who are very old and who live alone need more LTC services.
Home LTC includes health, personal and support services to help people living at home. These home services involve help with bathing, dressing and taking medication. Unpaid family members, friends and neighbors provide most of this type of care in Bangladesh. Home care services can also be provided by paid caregivers and in other countries health professionals such as nurses and therapists can be hired as needed. However, at some point, these supports may not be enough and people may need full-time assistance and need to move to a residential facility. Group homes, continuing care retirement communities, assisted living or nursing homes are residential care facilities where long term care facilities can be organized. Some only have accommodation and housekeeping while others also provide personal care and medical services. Specialized establishments offer care for Alzheimer’s disease and other types of dementia. Physiotherapy, occupational therapy and speech therapy services are also offered as rehabilitation services. Many nursing home residents live there long term due to their persistent physical or mental condition.
Bangladesh must respond to the needs and services of its rapidly growing elderly population; National stakeholder engagement and planning can help formulate appropriate policies and begin to deliver programs to meet needs taking into account the unique socio-cultural context of the country.
Dr Hasnat M Alamgir is professor of public health.