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Journal of Medical Sciences

Volume 6 (2): 131-138, 2006

Research Article

The Elderly Care Services and their


Current Situation in Bangladesh: An
Understanding from Theoretical
Perspective
Md. Ismail Hossain  , Tahmina Akhtar  and Md. Taj Uddin

Abstract
This study examines the aging problem in theoretical perspectives
with their relevance in the case of elderly population in Bangladesh
highlighting the needs and problems encountered by the elderly. At
the same time this study reviews the services for the elderly and
their limitations in Bangladesh. The latest section of this article
recommends some guidelines with the emphasis on social worker`s
roles for the welfare of the elderly in Bangladesh.
INTRODUCTION
A man is borne infant but dies old if he lives up to the expectation
of his life. A man’s life is passed through some predestined stages in
a natural process namely: infant, childhood, adolescent, youth and
old age. So in this case we can say that aging is an evitable
socialization process that starts at birth and ends at death. Now in
the world of modern era aging has become a social problem as with
the change of society due to industrial revolution leading to
capitalist social formation. Ageing is considered to be one of the
social problems as the elderly feel solitary due to multifarious
reasons, one of which is disengagement. Besides, people’s attitude
and behavior towards the elderly people in the society are held so
differently. So, now in today’s world, ageing as a social problem has
got momentum and come into focus as a field of study in social
sciences. Bangladesh is one of the developing countries with
approximately 80% population living rural areas, some of them are
inflicted with absolute poverty, where kinship ties are very strong,
social relations are based on collective interactions. But the
increasing rate of urbanization in Bangladesh has given different out
looks and cultural values with regard towards their lives causing
break in traditional family system, e.g., joint family has been broken
down due to urbanization and industrialization giving birth to
nuclear family. Moreover urban life is bound up with individual and
formal relations condemning elderly people to isolation and
unlimited leisure time. Furthermore, due to innovation of modern
technology and improvement in medical sciences death rates are
controlled in many countries and Bangladesh as well. As a result,
the number of aged people is increasing gradually and substantially
day by day. So in this backdrop, this paper attempts to examine the
elderly problems in theoretical perspectives with especial emphasis
on elderly needs highlighting the limitations of the services in the
context of Bangladesh.
Aging: A conceptual context: The term aging refers simply to the
process of growing older. It is the aggregate result of the decrement
processes at cellular, sub-cellular or organ level that are associated
with the passage of time. It is the end of life cycle. It is of course a
biological reality which (despite medical intervention) has its own
dynamic largely beyond human control (Gorman, 1999). Aging
causes a functional deterioration and vulnerability that also creates
physical changes as well. With the increasing of his age, older
people become incapable to carry out his normal functioning as he
did before. Thus, aging is a social process that involves individual
and population aging, biological and psychological aging, individual
and social change, individual and cultural differences within and
between age cohorts and cross-cultural and sub-cultural differences
in values, beliefs and norms (Mcpherson, 1991). Social thinkers are
mostly concerned about social factors of aging that is termed as
social aging, because they can contribute to the aged in this context.
Social aging is a multidimensional and dynamic force. It includes
the transition into and out of roles, expectations about behavior,
societal allocation of resources and opportunities, negotiation about
the meaning and implications of chronological age and the
experience of individuals’ traveling the life course and negotiating
life stages (Morgan and Kunkel, 2001).
MAJOR THEORETICAL PERSPECTIVES OF SOCIAL
PROBLEMS AND ITS RELEVANCY TO AGING
Sociologists have typically studied social problems from five
perspectives, e.g., social disorganization, social pathology, deviant
behavior, conflict and labeling (Weinberg and Rubington, 1973). As
a field of study, an analysis from theoretical perspectives is
necessary and helpful for complete and comprehensive
understanding of aging in Bangladesh.
Social disorganization perspective : Society is made up of
interrelated parts, social institutions and each institution has a
function or role to play in keeping the society running smoothly and,
together the institutions operate to meet the society’s basic needs
which are referred to functional requisites (Curran and Renzetti,
1996). If there causes any change, society becomes unregulated,
unpredictable and uncoordinated and fails to make corresponding
adjustments and demands of the people go unmet. This situation is
termed as social disorganization. Major theorist of disorganization
perspective, Thomas and Znaniecki (1918) define social
disorganization as a decrease of the influence of existing social rules
of behavior upon individual members of the group. Social
disorganization involves a break down of social structure so that its
various parts no longer work together and norms lose their influence
on particular groups or individuals (Coleman and Cressy, 1990). It
happens especially in situations of rapid social and technological
change.
According to this perspective, aging appears in the society from the
changes in institutional system. This perspective is pertinent to
understand the aging in Bangladesh because modernization causes
great changes institutional system that leads the elderly in to crisis
in meeting their needs, like, breaking down the extended family to
nuclear family, institutional and technological development in
medical and health care system.
Conflict perspective: According to conflict theorists, for example,
Marx and Engels (1965) society is always in conflicting situation
since the group in the society frequently come in to conflict with
other groups pursuing their own interest. When groups have
confronted one another about those conflicting interpretations, the
conditions for the development of a social problem have emerged.
According to this perspective, young and old people are in constant
conflict due to the difference in culture and values. This conflict
leads the older people in to crisis and faces multiple problems in
their later life.
Labeling perspective: Another major perspective of social problem
analysis is labeling. This perspective, developed by Becker (1963)
focuses on social reality that men create. This reality rests rather
heavily and some times shakily on the process of social definition
whereby men such for create and sustain meanings and then live by
them. Here, if men define situations as real, they are real in their
consequences. The groups with greatest power do the job by making
the rules and imposing it to others. According to this perspective,
aging is a social construction because our society labels them as old
that denote unproductive, degenerative and liable though very often
they are free from such myths. Such labeling damages older
people’s self-concepts and may cause them to feel ashamed or
embarrassed. They have to face many difficulties from these
prejudices (Curran and Ranzetti, 1996).
Deviant behavior perspective: Deviance is non-conformity to
social norms. Deviance refers to behavior or characteristics that
violate social norms and expectations and are negatively valued or
stigmatized by large number of people as a result (Weinberg and
Rubington, 1973). Two popular theories in deviant behavior
perspective are Merton’s Anomie Theory (1968) and Sutherland’s
Differential Association Theory (1939). In anomie theory Merton
argues that if a person fails to meet his/her needs (cultural goals) by
structural means, he/she will try to fill the demands by taking
another ways (illegitimate means). Sutherland differs here and says,
it is not possible for man to take a way that is completely unknown
to him. He/she learns it from different associations in which he/she
interacts. According to deviant behavior perspective, when the
existing societal institutions, e.g., family, aged homes, old age
allowance, nursing homes, fail to meet the basic needs of the older
people, he commits deviant behavior, like, suicide, beggary.
ELDERLY PROBLEMS IN BANGLADESH: SOME
GROWING ISSUES AND RECENT TRENDS

In traditional societies, older people are treated as resources and are


respected by all and enjoyed a valued social position in the extended
household. But this situation is changing enormously due to the
break down of traditional family pattern, changes in traditional
norms and values, innovation of modern medical facilities and
increasing rate of older people. For these changes, the elderly face
difficulty to meet their physiological, psychological and social
needs. They are mostly vulnerable in terms of living
arrangement, food consumption and possessions on wealth,
participation in decision making of the family and social attitude
and values. A lot of multi-casual factors are responsible for the
current situation of the elderly in Bangladesh.
Changing trend and disorganization of the society: A threat of
lively living for the elderly: In traditional agro-based societies,
older people live with their near and dear one’s and in most of the
cases dependent on them in meeting their needs. Socially it is the
responsibility of the children to take care of their older parents when
the elderly people are unable to meet up their demands with own
efforts. But it is quite difficult task for our young generation to
perform their traditional responsibility towards their parents in
modern industrialized world due to their job and professional duty.
In the advent of industrialization and urbanization a lot of changes
have been taken place in the world. Modernization has affected our
agro-based society and increased the migration from rural to urban
and country to country affecting the pull factors and push factors.
Older parents in Bangladesh are sending their children abroad for
study job and even for settlement. Some young and adult children
are leaving their older parents behind (despite the fact that their
parents do not like it) and settling down either in the urban center of
Bangladesh or in over-seas countries (Rahman, 1999). So the older
people are living separately from their children and grand children.
A study reports that about 55% are living in their own arrangement
(self), slightly more than 25% with their sons and around 11% with
their daughters (Kabir, 1994).
In poor families, both in rural and urban areas, older people often
unable to meet the demands due to the extreme poverty where food
is the top priority needs. About 77% older people do not have
enough income to meet their basic needs and 71.4% are dependent
on siblings for financial assistance for their livelihood (Kabir,
1994). Living arrangement is an important component for the over
all well-being of the elderly but the elderly people face problem in
getting proper shelter. Most of the poor families can not ensure the
separate living places for their senior citizen as they live in one or
two room houses consisting of more than five member households
(BBS, 2001). For this reasons, the older people sleep and take rest in
a corner of the corridor or a hovel that is mostly unhygienic living
condition characterized by health hazards and intricacies. In urban
well off families, though the elderly have no problem with basic
needs but they feel isolated, lonely and depressed within the family.
At the same time they are to be found on odd situation due to the
lack of proper care. Female participation on the labor force and
extensive pressures on school going children, fewer women and
grand children are now available to be the primary care givers for
the elderly.
Productivity and dependency of the elderly: A dilemma for age
biases: In Bangladesh, the elderly people are discriminated both by
prejudice and means of exploitation. Our society feels that the
elderly people are incapable to carry out their duties and sometimes
compel them to retire from their current positions at the age of fifty
seven though they are capable to serve at that age. They are labeled
as aged and considered as unproductive due to our social
construction for age biases. Though the older people retire at the age
of fifty seven but they remain more fifteen to twenty years after
their retirement. At that time they had to live their life depending on
others. This dependency is made by our society through age biases.
On the other hand a myth prevails on the society that the older
people get much but do nothing is also socially constructed. But
elder people in Bangladeshi family life contribute much by their
active involvement in child care and domestic work Data from
various researches revealed that older people provide valuable
contributions to well-being and livelihood of the family by taking
responsibility for house hold activities, freeing younger family
members to seek work out side the home. Elder people have joking
relationships with their grand children and through this process take
the responsibility of proving children’s sex education and preparing
them for later marriage responsibilities. This relation is always
warm, caring sometime educative in nature (Aziz, 1979). In most of
the family where both father and mother are employed, Grand
parents are the only reliable safeguard for the family who take all
the responsibilities to care and protect their grand children from all
sorts of social evils and also protect the most valuable household
resources. Older people are important advisors in the community;
they help to settle misunderstandings and build peace as Joyce
Mukandkundiye of Rwanda remarks (Hossen, 2005). Older people
can help the community people to solve their problems by giving
direction in the light of their life experiences.
Co-residency and the elderly abuse: the generational gap: In
Bangladeshi context because of traditional norms and religious and
social values most of the elderly are living with their offspring but
at the same time it should be elicited that how easier this co-
residency. Because of wide spread poverty and a socio-economic
change, living together is no guarantee of economic well-being of
the elderly (Kabir, 1994). In general the elderly of Bangladesh are
respected and well cared by their families but in recent time, Elderly
abuse is alarmingly visible in rural poor family. Elder people suffer
from the mistreatment of family members and the society. Our
society holds some myths and prejudices towards the aging, which
include ‘rocking chair syndrome’ where the assumption is that an
old person’s daily routine consists of napping in their rocking
chairs; unproductive, due to lack of participation in the labor
market, sick, dependent and generally useless. Although much of the
early works of social gerontologist was influenced by age bias,
focusing on the physical psychological and social decline in the
aged, most recent research has been instrumental in debunking
prevalent myths about aging and old age (Kart, 1985). Their sons
and daughters, daughter-in-laws, spouses, grand children and others
abuse elderly people. Adult children are the most likely perpetrators
of abuse (30%) as compared with spouses (14.8%) (Boudreau,
1993). In most of the cases, young children make a nuclear family
due to the disagreement of wife with their parents. They rarely
communicate with their parents’ even if they posses wealth or
property. Elderly women particularly the widow dissected and
divorced are the silent victim of this situation as they do not posses
any valuable social and economic wealth like, land or other kind of
property. Boudreau have mentioned some forms of elderly abuse,
like, verbal assault, isolation, threat, reduction of personal freedom,
theft of money or property, hazardous living conditions, lack of
supervision, withholding of food and inducement of fear (Boudreau,
1993). National Aging Resource Center on Elderly Abuse
(NARCEA) reports that most frequent types of elder abuse (37.2%)
are followed by physical abuse (26.3%), financial or material
exploitation (20%) and emotional abuse (11%) (NARCEA, 1990).
Vulnerability of the elderly in later life: the generation of social
maladies: Due to the break down of extended family, poverty,
social alienation and myth and abusive behavior from the family
members, exclusion from income generating activities and lack of
safety network the elderly lead a vulnerable life in their later life. In
Bangladesh, it has traditionally been the responsibility of the family
to provide food and shelter for its elderly members. More
specifically traditional norms in Bangladesh, as in other south Asian
countries demand that sons are responsible for financial provision
while the daughters-in-law are responsible for proving day to day
care (Jefferys, 1996). But about 44.3% people live under absolute
poverty both in rural and urban areas. These poor families are
unable to meet the basic needs of the older people including food,
health care, clothing adequate shelter and access to income or
employment opportunities. Commenting on a seminar paper,
Professor Ali Akbar says, irrespective of whether they resided in
urban or rural areas, a significant portion of the elderly men lived a
solitary life, singly. More than two thirds of the elderly men lived in
nuclear families where they were likely to be the main breadwinners
(CPD, 2000). Find no other alternative to maintain their life
expenses; the elderly people involve them in Beggary and some one
commit suicide though the suicidal act is very insignificant in our
country. From a study, it is found that 43.1% people have no income
source where 86.3% involved in beggary (Rahman, 2000).
Elderly care services in Bangladesh: GO and NGO
initiatives: Aged people are increasing in alarming rate day by day.
If we don’t take initiatives, it would be more complicated and
fatalistic. According to UN, the world is experiencing an age quake.
Every month, one million people turn 60. By the year 2001, one of
every 10 persons will be over 60. By 2030, several industrial
countries will have one third of their population over 60 (UN, 1999).
In Bangladesh, Eighty thousand new elderly people added to the
over 60 age group each year (ESCAP, 1999). Today, People over 60
years make up 6% of the total population of Bangladesh. While this
percentage is small relative to developed countries due to the large
size of the population, it represents approximately 7.3 million
people (Samad and Abedin, 1998). Furthermore, projection indicates
that the number of elder people in Bangladesh by 2025 will reach in
8.5 million and 10.1% of the total population (Rabbaw and Hossain,
1981) (Table 1  and 2 ).
Perceiving this dreadful situation of aging in Bangladesh, a number
of Government and Non-Government organizations have taken some
programs associated by different international organization. After
the independence, Bangladesh Government initiated some programs
like pension, gratuity, welfare fund, group insurance and provident
fund for retired Government officials and employees. Since 83% of
the population in Bangladesh lives in rural areas only a negligible
fraction of the total elderly are covered by formal pensions.

Table 1: Elderly population from 1911 to 2001(Thousand)

Source: Statistical Year Book 2000, BBS, June 2002


Table 2: Projected elderly population from 2000-2025 (Thousand)

Source: Population Projection of Bangladesh (1975-2025) by Rabbani and Hossain (1981)

Considering the rural helpless, disable destitute poor aged people,


Government have introduced elderly allowance (Boisko Bhata)
program in 1998 that covers 10 aged people in each ward and
403110 aged people can be benefited from this program across the
country. This program has largely been praised. Although this is a
meager amount and the recipients are very few in numbers, yet this
is a very good start and pioneer effort by the Government. It has
been highly appreciated by people of all corners (Rahman, 1999). In
addition to this, Government is imparting the services to the aged,
mostly women, through Vulnerable Group Development (VGD) and
Vulnerable Group Feeding (VGF) programs. Very recently
Government has set up six aged homes (Santi Nibas) in six divisions
for rendering shelter, life long health care, medicare and recreational
services for the aged people.
In parallel with government programs, some non-government
organizations are working for the welfare of our senior citizen.
Bangladesh Association for the Aged and Institute of Geriatric
Medicine (BAAIGM) is the pioneer national organization that takes
a comprehensive care services including residential and health care
facilities for the welfare of the elderly people in Bangladesh. Retired
officers Welfare Association (Dhaka), Retired Police Officers
Welfare Association (Dhaka), Rehabilitation Center for Aged and
Child, Service Center for Elderly People (Rajshahi), Elderly
Development Initiative (Manikganj), Senakalyan Sangstha, etc. are
also undertaking some programs towards the elderly people in
Bangladesh. Resource Integration Center (RIC) and Bangladesh
Women Health Coalition (BWHC), two member organizations of
Asia Training Center on Aging (ATCOA, 2000), are implementing a
pilot project for the development of women health and status. Rotary
Club, Lions Club, Girls Guide, Zayeda Dream Care Mothers Home,
Apon Ghor, Nijer Ghor, Antore Apon, etc also are taking part in
aging care services. But all these existing services are unable to
meet the demands of large number of aged people in Bangladesh for
some constraints and limitations.

A social security program has become the backbone of old age economic assistance in the
developed country. But we are far away from that sort of program. At the time of
retirement the older people get an amount from gratuity and provident fund but find
difficulties to invest it somewhere. Sometimes they have to wait more than one year for
bureaucratic complexities to get their pension and other allowances. The retired personnel
get an amount monthly and after death their wife get equal to half of the amount. About
ninety percent people are excluded from this program as they were not involved in service.
Very recent, in 1998, Government has introduced elderly allowance and widower and
destitute women allowance program from where 403110 people can be benefited from
each program but they get only taka 125 each per month certainly the amount is very little.
In 2005-06 fiscal year this amount will increase in taka 185. This amount is also too little
• to change their lives.

• Aged people mostly suffer from various complicated physical diseases and the number is
increasing day to day but the services provided through government hospitals are
inadequate in compared to needs. They have to take the services from the government
hospitals standing on a large queue. The rural poor elderly people do not get proper
medical care services from there for lack of sufficient doctors and nurses, medicine and for
other modern medical equipments. The family members also unwilling to spend money for
the elderly people because they think that the cost for elderly is meaningless, as they live
no more days. Doctors and nurses are also less interested to take their higher studies and
specialization in this field and also be reluctant to care them that also eventually increase
the sufferings of the older people.

Ninety five percent of the elderly and ninety percent of the disabled elderly live at home
and rely entirely on their family members. Institutional services are insufficient here.
Though some institutions have been set up by the government initiative, these institutions
often face a crisis in absence of the elderly. Most of the older people and their family are
not aware about these services. On the contrary, the institutions that are working for them
are most often proprietary that is run for profit, they hold high amount of service charge
that make the people far from these institutions. This institution also experiences the
shortage of skilled manpower to care for the aged. Professional knowledge is mostly
unavailable among them. There is also found lack of motivation and counseling in both of
• the government and non-government agencies.

Suggestive measures for elderly welfare and social worker’s


roles: Aging is not only a concern for the individual and his or her
family; it is also a matter of social concern. The existing services are
quietly inadequate and insufficient. Disorganization in the services,
our social myths and prejudice, social structures and systems,
negative attitude towards the elderly are also intensifying the elderly
problems. In order to make easier the life of the elderly in
Bangladesh some steps should be taken, such as:

• Community care services (service arranged by the community itself) should be expanded
to care for the elderly. To ensure these services, we have to take proper steps to re-arrange
or set up new and alternative institutions that can take care to the aged, such as, aged
homes, nursing homes, health complex, day care center, recreational center and so on. In
doing so, Government can make a dialogue with individual solvent donors and voluntary
organizations and should provide them technical and logistic support in this regard.

Micro and macro level counseling can be a more effective initiative to give up the myths
and prejudices of the community people towards their elderly and to inspire them to initiate
more elderly care services and also the elderly people can be persuaded to take the services
• from the newly introduced institution.

Government should take some programs for making them involvement through using their
inner potentialities and experiences to reduce their mental sufferings resulting from
loneliness and isolation. Meanwhile a large scale social security programs, like, pension,
old age allowance, health insurance can also make them free from anxieties in later life.
The amount of old age allowance and beneficiaries should also be increase at satisfactory
• level VGD (Vulnerable Group Feeding). Programs can also be effective for elderly people.

Elderly people mostly suffer from some physical diseases. At that time; they need
comprehensive medical care services. But in some cases it becomes impossible for them to
stand in a queue to avail the services from general out door services in government
hospitals and to get in to the bus due to their physical inability. In this regard government
should take initiative to devise special free out door service units in government hospitals
• and special free transport services for the elderly.

As the elderly people feel free to stay in their own residence, home-based care can be more
effective service instead of institutional care. In this regard, local self-government can
recruit ‘Paid Home Helper’ who will serve the aged people in their home. Some developed
• country like, Norway, Sweden, Finland, Denmark, have already introduced such programs.

We need to revise our academic curriculum and include such issue that would teach and
direct our new generation to respect our senior citizen and awaken them about their duties
• and responsibilities towards the older people.

In all these fields that have been mentioned earlier, professional


social workers can use professional knowledge and training, as it is
a new challenging issue for social workers in the 21st century.
Social workers can involve themselves in both teaching and
promoting social and case advocacy in changing the attitude of
community people and policy makers and the elderly as well in
service to the elders. They can effectively use their advocacy
strategy among the students to change their attitude towards the
elderly people. In the 21st century, as the number of elders increase,
greater participation will be needed from the private sector with the
formation of an effective public-private partnership. Here, Social
workers can play a coordinating role among corporations,
universities, senior citizen centers and members of the aging
network.
CONCLUSIONS
Aging is an unavoidable and universal process in human life. But a
little has been done to make the life easier for the older generation
who are the progenitors of civilization, the transmitter of culture and
the people who ensure society’s lineal succession. It is our ethical
and moral responsibility to extend our helping hands towards our
senior citizen so that they can pass their ending days of life with
respect, proper care, food security. Poor health care service,
mistreatment from the family members and threat from meeting
basic needs, unhygienic living condition and poor sanitary system,
isolation and loneliness, unsuitable transport system and poor
recreational facilities are very much associated with the life of the
elderly in Bangladesh. Earlier the joint or extended family system
used to take care of the elderly population by family resources but
this situation is now changing rapidly through the eroding of
traditional family pattern. In this context, the need for a social
welfare program for the elderly both from the government as well as
public sector is emerging and requires serious attention in future
years.
 

References
Aziz, K., 1979. Kinship in Bangladesh. International Center for
Diarrhoeal Disease Research, Dhaka.

BBS, 2001. Population census 2001 preliminary report. Bangladesh


Bureau of Statistics.

Becker, S., 1963. Outsiders: Studies in the Sociology of Deviance.


Free Press, New York.

Boudreau, A., 1993. Elder Abuse, Family Violence: Prevention and


Treatment. Beverly Hills, Sage Publication, pp: 145.

Center for Policy Dialogue (CPD), 2002. Aging in Bangladesh:


Issues and Challenges. Report-23, pp: 24.
http://unpan1.un.org/intradoc/groups/public/documents/APCITY/U
NPAN020771.pdf.

Coleman, W. and R. Cressy, 1990. Social Problems. Harper Collins


Publishers, New York, pp: 13.

Curran, J. and M. Renzetti, 1996. Social Problems: Society in Crisis.


4th Edn., Allyn and Bacon, USA., pp: 16.
Gorman, M., 2000. Development and the Rights of Older People. In:
The Aging and Development Report: Poverty, Independence and the
Word's Older People, Randels, J. et al. (Eds.). Earthscan
Publications Ltd., London, pp: 3-21.

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