Adult daycare largely uncared for in Bangladesh

Getting old is largely a frightening experience for many in Bangladesh as they have to depend ordinarily on family caregiving arrangements and, sadly, socioeconomic support needed at that stage of life does not quite exist or is not yet developed by the government. The quality of life of the elderly is particularly low in many low- and middle-income countries (LMIC) like Bangladesh where old-age pension or benefit programmes are limited to only public-and formal-sector private employees. Moreover, the healthcare-delivery system does not take into account the gerontological issues.

 This fast ageing of the Bangladesh population and the presence of a vast number of older people will greatly increase the demand for a number of social and healthcare services over the next few decades. Older people quite normally suffer from various health conditions, require frequent and high-intensity healthcare services, have no regular or lower earnings, and need special accommodation, nutrition, and transportation. They often have more emotional needs.

Many of them will also develop hearing loss, and visual impairment, will have difficulty in walking, and suffer from incontinence of the bowels and bladder. In that age bracket, osteoporosis, diabetes, high blood pressure, arthritis, Parkinson's, and Alzheimer's diseases are quite prevalent health conditions. Who will look after them? Where will they live in Bangladesh?

The forecast growth in the older adult population in Bangladesh and elsewhere will be associated with increased risk for disease and injury and associated socioeconomic burden. This growth in the size of the aging population over the next few decades will require extensive efforts from all quarters in Bangladesh to look into their wellbeing and quality-of-life issues, catalog and comprehend its variation by common economic and demographic characteristics. With the number of ageing persons increasing so rapidly, their accommodation or living arrangements will continue to be a pressing demand and serious task for all.

Adult daycare programmes are one caregiving option for this population group across the developed world, bar Bangladesh. Here, the aging population is still primarily taken care of by their children, family members, or other close relatives. However, this option will decay over time with the appearance of nuclear families, increased labour-force participation of women, and gradual unavailability of individual, private- level, low-wage domestic helps.

 Keeping the ageing population in residential facilities full-time faces resistance and reluctance in Bangladesh where social, religious, and family influence, value systems, or pressure discourage children from keeping their parents in residential sites commonly known as old homes. Also, putting them in these old homes will interrupt family attachment and bonding and a compromise between keeping them full-time with family and sending them permanently to old homes may be needed for some, if not for the most. Adult daycare centres can meet this need by bridging the two extremes.

Adult daycare programmes offer a much-needed rest or pause for the caregivers from providing nonstop care while the older adults can hang around with same age-group peers. It takes so much time, energy, and effort for the caregivers to take care of the older-age care recipients inside the family. Things get more difficult when the care recipients suffer from a host of chronic diseases. Some may have disabilities, while cognitive decline is also common at that age.

The caregivers need to have personal time for their spouses and children as taking care of one or both older parents can be physically and emotionally exacting. Dropping them at nearby daycare will benefit both the caregivers and care recipients by giving them much deserving break.

Older adults will be together with people of similar socioeconomic classes and can develop, maintain new friendships and spend quality time. At the same time, it will help them get rid of the isolation and loneliness they may encounter when their working and adult children leave them at home for the whole day while their grandchildren attend school.

Research evidence shows that older people who attend these centres enjoy a better quality of life. A review of research on such programmes (published in the journal The Gerontologist) found they provided health, psychological and behavioural benefits for them, mostly those with dementia and other cognitive impairments.

Adult day centres may offer various programmes and services. But, usually, they offer healing exercises, mental activities for participants, and social activities appropriate for the condition. Staffs also help them with personal care such as grooming and using the toilet. These centres may also charge for and provide meals and snacks while planning special diets for those with specific requirements. Door-to-door transportation for participants will be particularly useful in Dhaka and other large cities.

Nonprofit organisations run most of the adult daycare centres in other countries. These centres usually operate on weekdays 8 AM-5 PM though some may offer special weekend or evening services when requested beforehand for an extra charge.

Bangladesh needs to prepare for its growing ageing population and find out ways to create and provide accommodation that is adequate and satisfactory for this population.

Hasnat M Alamgir is Professor of Public Health. [email protected]