THE United Nation* General Assembly has

the International Day for the Elderly to focus the attention of the people of the world on the growing problem of the aged. We tn Bangladesh have joined hand* with the world community In observing this day tn a befitting manner The Bangladesh Association for the Aged in collaboration with the government of Bangladesh and the concerned UN Agencies tn Bangladesh has planned a daylong programme on this occasion.

Old age ts a normal biological process which Is a slow, Imperceptible, progressive degenerative process advancing with age leading to functional deterioration, vulnerability and ultimately culminating to extinction of life. Aging process is often accompanied by impairment of physiological and mental functions and chronic diseases that prevent a person to play the role of normal person in the family and In the community. However, all the old people do not lead a vegetable life. There are innumerable examples of great contributions made by the elderly people In science, literature, leadership, humanitarian service and in mapy other fields which may serve as a source of Inspiration and a guide to the younger generation of the modern society which is at the present time passing through a very difficult transition.

So. instead of trying to write off entirely the elderly people from the nation building activities their expertise and experience may be utilized in an appropriate manner in the national planning and management process at different levels.

Apart from health problems. elderly people have other problems as well. The care to meet their basic needs, such as food and nutrition, shelter and clothing and recreational requirements also deserves attention. A study

conducted by the Bangladesh Association for the Aged has amply demonstrated that a significant proportion (about three fourths) of old people suffer from financial hardship.

Magnitude of the Problem

Due to phenomenal development of science and technology over the last few decades, the age structure of the people ha* been showing a change; this i* more so In the developed countries. In Bangladesh, although the proportion of the people aged 60 years and above to the total population is comparatively low, nevertheless this proportion has been showing a gradual and steady Increase from 4.2 per cent in 1951 to 4.9 per cent In 1961 and 5.1 per cent In 1981.

There are more than six million people In Bangladesh over the age of 60. So. ours being a welfare state, it 1* simply beyond anybody » comprehen slon not to include specific programme for the welfare of this high risk group of the population In national socioeconomic development plan

Possible Approaches to

Address the Issue

The primary health care approach to reach the goal of Health for All (HFA/2OOO), set jointly by the World Health Organization and the member countries. Including Bangladesh, emphasises amongst other things the paramount Importance of active involvement of the community tn Solving their own health problems on a partnership basis with the local health authoritlca. Although the essential elements of. the primary health care (PHC) services do not include any specific service for the elderly, nevertheless the existing component* of PHC. If mobilized properly, can go a long way In ameliorating most of the problems of the elderly

people.

Majority of the health care need* of the community, including those of the older sec tion, can be met at the PHC level which is closest to the people. In Bangladesh, the Upazila Health Complex and Union Health Centres constitute thia level, and are responsible for providing health care to al) segments of the people. Of course the district hospitals, teaching hospitals and specialized hospitals serve as referral institutions for those conditions which can not be tackled at the PHC level.

In the Industrialized and developed countries provisions, such as providing homecare. meals-on-wheels, daycare centres and residential homes for the elderly are provided by the Social Service Department. Long-stay hospitals are also run by the geriatric and psychiatric services for those who are too disabled to live in homes. However, this approach has not been able to tackle the problem adequately, because of the Increasing number of people entering the old age and the phenomenal Increase In health care costs. Moreover, only a relatively small fraction of the health problems of the elderly can be tackled by curative medicine

Bangladesh Case

.In a poor country like Bangladesh. It is futile to think of such ambitions and expensive system because of severe resource constraints. So, the answer lies with the estab lishment of community oriented health care system. In Bangladesh, where the tradl tlonal joint family system still operates, one needs to develop a system which would encour age and support the members of the family to look after the old members. But unfortunately due to change In the value system and complexities of modern civilization, the age

o)d system of joint family may not last long; it has already started showing cracks, par licularly In the urban centres of the country.

PHC system, when fully developed. can offer means of effective disability prevention, early detection and rehablhta tion. as well as providing an effective link with specialists and institutional facilities, social services and all other relevant sectors.

At primary level the attention of the PHC workers should be directed to health promotional activities and for mobilizing the community In support of programmes aimed at educating the elderly in dally self-care activities, early detection and reporting of any Impairment of physiological functions. This early detection can often prevent an impairment from becoming a disability

The family and the community have responsibilities and moral obligation towards helping the disabled elderly people cope with the problems of dally living. Similarly, elderly people too have responsibilities towards their own selves and towards the family and community at large. All of them should, therefore, participate in this programme. Apart from investment on the children and other family members, everybody In the community should make adequate provision for their Journey through the old age.

Elderly people, like ail other age groups and high-risk Eoups. have the rights to alth services that can support their own efforts to maintain their health and prevent disability. Help can take many forms, from giving advice to devising strategies to reduce feelings of worthlessness. Family and friends also require guidance about what to do and how to do to remove/reduce sufferings of the elderly tn the family.

PHC Worker!:

The PHC workers will also be required to assess the state of physical, mental and socio economic status of the ekterfy people in the community in addition to their capacity for self-care. The primary health care worker*. social services workers and community leaders — should ail work as a team to plan and implement appropriate programmes for the elderly. This should take into consideration provision of visual and hearing aids, prosthesis as well as necessary drugs and nutrients. The elderly people should he helped, supported and encouraged with regard to self-care practice*. The NGOs in the country may direct their effort* to this hitherto neglected area.

It Is important that the peripheral health and social workers make the elderly people understand that many conditions and impairments can be reversed or rectified at an early stage by prompt treatment or simple aids. This self-care practice can often change the quality of life. Most Important service should be support for those with whom old persons live. In turn, the •members of the PHC team must also be assured of necessary support and advice from higher echelons of health care services.

A great deal of burden of mental disability in the elderly is carried by the relatives and often by the spouses of a slmi lar age. Their ability can be enhanced if the load is shared through day-care services nnd home visits by Public Health Nursing Services. The rote of Public Health Nurses as a member of primary health care team is vital In the develop menl of PHC concept for the care of the aged It Is essential that the members of PHC team know their goal and fully understand their role. Activities proposed for PHC team should have the strongest support of

the specialist services. In order to shoulder this new responsibilities. necessary training of PHC workers is essential to develop their sensitivity towards the needs of the aged

The Department of Social Welfare has a much wider and meaningful rote to play, particularly for those elderly people who are no longer capable of looking after themselves or have nobody to look after them. Like many developed countries In Bangladesh also the elderly people (i.e. those above 60 years of age) may be granted the status of Senior Citizen' of the country. It would be a good gesture on the part'd the drug stores u> give the senior citizens some discount on the prescriptions they serve or the drugs and medical equipment they sell to them.

To define the extent and the nature of the elderly tn Bangladesh, well-designed and properly conducted *ur-vey/studies need to be undertaken. In addttfon. field operational research projects to test some of the approaches mentioned here and which are sustainable with the scarce resources available should be condueted under the guidance of the Bangladesh Research Council and the institute of Geriatric Medicine For these activities the International and bilateral agencies should come forward with generous assistance.

Like freedom of speech, the attainment of the highest possible level of health Is the fundamental right of every citizen of a democratic and welfare state. The elderly people, being an important segment of the total population have, therefore, every right to seek proper care like any other high risk group. This right Is guaranteed by the Constitution of the republic.

The author fs a former medical officer of the World Health Organisation.