The emerging elderly population in Bangladesh : aspects of their health and social situation

Background: Bangladesh is one of the twenty countries in the world with the largest elderly populations, and by 2025, along with four other Asian countries, will account for 44% of world's total elderly population. This rapidly increasing population is a new and important group in terms of social and health policy in the country.

Aim: This thesis aims to establish a knowledge base about aspects of the health and social situation of elderly people in rural and urban Bangladesh. It also aims to adapt existing instruments assessing health status in terms of gender sensitivity and cultural relevance in the cultural context of Bangladesh.

Material and methods: A multi-stage sampling method was used to select the study sample of elderly men and women aged 60 years and older (N=786) for a multi-dimensional survey. With a nonresponse rate of 10.8% (urban: 17.9%; rural: 2.5%), 701 elderly persons were interviewed. Information about elderly people was collected under the broad categories: i) Socio-demographic information; ii) Household composition; iii) Socio-economic information and family support; iv) Contribution of elderly person in household work; v) Use of health care facilities; vi) Functional ability and sources of assistance for managing activities of daily living and instrumental activities of daily living. Cognitive function was also assessed using a modified version of Mini-Mental State Examination (MMSE) adapted for the study.

Results: Socio-economic and demographic characteristics of elderly persons in Bangladesh indicate: a high proportion of men (app 90%) were married while women were widowed (67%); 98% of all elderly people reported having children; intergenerational co-residence with sons was common; and more than 70% of elderly men reported being in paid work while elderly women reported unpaid work.

The Bangla Adaptation of Mini-mental State Examination, BAMSE, a modified Mini-Mental State Examination (MMSE), adapted for the cultural context of Bangladesh and not requiring literacy as a precondition, demonstrated satisfactory test properties in comparison to MMSE. Association between the two instruments was significant (r=0.57), and the test-retest reliability was good (r=0.70). More importantly, BAMSE was found to be less sensitive to age and education than MMSE.

Modified assessment instruments of activities of daily living (ADL) and instrumental activities of daily living (IADL) indicated differential performance in ADL and IADL tasks by gender and region. Socio- economic status was found to influence IADL tasks only. Empirical data regarding type of help used and reason for not performing a task enables understanding of socio-cultural and structural influence on functional ability. Based on this data, socio-cultural and structural factors are suggested to be strong determinants of task performance.

More than 95% of the elderly people reported experiencing health problems and most reported multiple health problems. More health problems were reported by women compared to men and in the rural region compared to the urban. Socio-economic factors were found to have little influence on reporting of health problems. In terms of provision of support, support from family members in old age was found to be strong in Bangladesh. The role of providers of support, i.e. emotional, practical or material, was primarily shared between spouse, daughter, son and daughter-in-law. While elderly people reported receiving support from their family members, they also reported providing support in the functioning of their own households, both financially and with household activities.

Implications: The importance of adapting research methodologies according to context is highlighted. Given the contribution of elderly people in terms of paid and unpaid work, re-definition of indicators such as dependency ratio is called for. Regional variation in performance of health measures may indicate influence of social and structural factors. Welfare of the elderly people is an issue that concerns both the elderly persons themselves as well as their families in Bangladesh and policymakers need to address the issue in the context of the family and not only the individual. Differences within the elderly population, such as regional and gender, need to be recognised in formulating social and health policies for elderly people in Bangladesh.

List of scientific papers

I. Kabir ZN, Szebehely M, Tishelman C, Chowdhury AMR, Hojer B, Winblad B (1998). "Aging Trends: Making an invisible population visible-The elderly in Bangladesh." Journal of Cross-cultural Gerontology 13(4): 361-78

II. Kabir ZN, Herlitz A (2000). "The Bangla adaptation of Mini-Mental State Examination (BAMSE): an instrument to assess cognitive function in illiterate and literate individuals. " Int J Geriatr Psychiatry 15(5): 441-50
https://pubmed.ncbi.nlm.nih.gov/10822243

III. Kabir ZN, Parker MG, Szebehely M, Tishelman C (2001). "Influence of sociocultural and structural factors on functional ability: The case of elderly people in Bangladesh." Journal of Aging and Health (Accepted)

IV. Kabir ZN, Tishelman C, Aguero-Torres H, Chowdhury AMR, Winblad B, Hojer B (2001). "Self-reported health problems among the elderly people: results of a cross-sectional study in Bangladesh." (Submitted)

V. Kabir ZN; Szebehely M, Tishelman C (2001). "Material, practical and emotional support in old age in Bangladesh." (Submitted)