Elder abuse and health care

The increase in life expectancy offers new opportunities but it also creates challenges for the future. As people live longer, there will be growing demand for elderly care. The trend in the size and growth rate of the elderly population in Bangladesh reveals that aging will become a major social challenge in the future when considerable resources will need to be directed towards the support, care and treatment of the elderly population.

The possible policy options may be the program that enhances traditional support at the household and community levels should be encouraged. Because of the rapid growth of the aging population, the Boisko Bhata scheme will come under pressure for increased coverage with an increased amount.   

In old age, high prevalence of morbidity is a common feature and health care expenditure for the elderly persons is much higher compared to the younger adults. There is also disregard for the nutritional needs of older people. Lack of access to safe water and adequate sanitation facilities contribute to the poor nutrition and health status ofolder people as well. Public health initiatives in Bangladesh have primarily focused on the younger population. The special health needs of older people have not been considered a major issue to a substantial extent.
Health promotion, a key element of PHC, is an important tool to slow down or even prevent ill-health and consequently, improve the quality of life of the older people. Evidence shows that prevalence of morbidities and health care expenditure may be reduced by interactive and participatory education through community organized groups. In future year's older people will be the major users of health services and the burden of ill health will increasingly be deferred to later life.

This means that knowledge about the aging process, planning and delivering health services is essential for those working in, or planning health and social sectors. The current levels and patterns of the prevalence of disability among the elderly need to be assessed for providing care. Elderly people are now living longer, which means that they are more susceptible to chronic health problems, which may demand long term treatment, hospitalization and nursing care.

As people live longer, there will be a growing demand for care related to conditions such as cardiovascular disease, cancer, chronic obstructive pulmonary disease, arthritis, vision impairment and disability. The old are more accident prone because of their slow reaction to dangers resulting in malfunctioning of the sense organs and declining mental abilities, the capacity to work decreases. Eyes and ears are greatly affected. Changes in the nerve center in the brain and retina affect vision and sensitivity to certain colors gradually decreases. Most old people suffer from far sightless because of diminishing eyesight. They get fatigued easily. Due to lack of motivation, they do not take interest in learning new skills and become lethargic. Above all visits to the doctor becomes routine work for them.  

Mental disorders are very much associated with old age. Older people are susceptible to psychotic depressions. The two major psychotic disorders of older people are senile dementia, associated with cerebral atrophy and degeneration and psychosis with cerebral arteriosclerosis. It has been observed that these two disorders account for approximately 80% of the psychotic disorders among older people in civilized societies. Older people suffer from senile dementia.

They develop symptoms like poor memory, intolerance of change, disorientation, rest lessens, insomnia, failure of judgement, a gradual formation of delusion and hallucinations, extreme-mental depression and agitation, severe mental clouding in which the individual becomes restless, combative, resistive and incoherent.  

In extreme cases the patient becomes bed ridden and resistance to disease is lowered resulting in his days being numbered. This is accompanied by physiological symptoms such as acute indigestion, unsteadiness in gait, small strokes resulting in cumulative brain damage and gradual personality change. This is also associated with symptoms such as weakness, fatigue, dizziness, headache, depression, memory defect, periods of confusion, lowered efficiency in work, heightened irritability.

Decline in mental ability makes them dependent. They no longer have trust in their own ability or judgements but still they want to tighten their grip over the younger ones. They want to get involved in all family matters and business issues. Due to the generation gap the youngsters do not pay attention to their suggestions and advice. Instead of developing a sympathetic attitude towards the old, they start asserting their rights and power. This may create a feeling of deprivation of their dignity and importance. Loss of spouse during old age is another hazard. Death of a spouse creates a feeling of loneliness and isolation. The negligence and indifferent attitude of the family members towards the older people creates more emotional problems.

 In Bangladesh, population aging is potentially a more serious matter owing to the limited resources available to support the elderly. The process of development tends to bring rapid change in social behavior and institutions, which may have adverse implications for the care and wellbeing of elderly persons. Therefore, the situation of the elderly population should be examined, taking account of the social and economic context in which population aging is taking place.

In the traditional family system, elderly persons are the main decision-makers, and support and care for old age are automatically provided. Changes in the family structures, however, may not automatically provide for such old age support, and elderly persons may not assume such an important position. The process of population aging may impel considerable increases in expenditures for social security as a share of national income.  

Provident funds are normally paid out in a lump sum upon retirement and are usually inadequate and quickly spent. In the poorer segments of the population, where family members usually pool resources for fulfilling their basic needs of food, shelter and security, the economic and political pressures are contributing to the insecurities to life and socio-psychological state of the elderly. With the inflationary effects reducing the buying power of money, those with little savings and meager earnings, have in many instances to sell their property to meet with their day to day expenses.   

The pensions are often not adjusted correspondingly to cover for the inflationary effects of the currency. Most elderly persons therefore have to work to advanced ages and depend almost entirely upon family support during their later years. The care and the support provided to elderly parents are usually in the form of shared housing, food and other necessities, and less often in the form of direct transfers of income. Such transfers or remittances are, however, more likely from those children who live apart or who have migrated. An important point to note is that living arrangements are not indicative of the care and support that is received by parents.
Dr Zubair Khaled Huq, Family Medicine, Gerontology, Public Health Specialist