Population ageing is one of the most important demographic trends in the 21st century. Along with the developed and developing world, Bangladesh is facing such challenges as the elderly population with the high risk of diseases and disability would put urgent demands on healthcare systems while Bangladesh is not well prepared to meet such health care demand. Due to lack of research evidence in this country context, particularly the accessibility of elder care, quality of life and health expectations of elderly citizens, healthcare service utilization, and various factors associated with the healthcare-seeking pattern, such important public health issues are not well addressed in Bangladesh. This study tried to fill up this knowledge gap of these burning issues.  In this regard, a community-based cross-sectional household survey was conducted in Tangail, Bangladesh. A mix-method approach employing both the quantitative and qualitative research technique was applied. A total of 478 households with at least one elder citizen (60 years or more) were surveyed between November 2019 and January 2020. A structured questionnaire was developed to capture the self-reported illness, utilization of healthcare, health-related quality of life among elder citizen at the community level. For breadth of understanding a total of 12 In-depth Interviews (IDIs) have been conducted with elder citizens in the community. The qualitative data have been captured to supplement the data from the structured quantitative interviews. 

 A total of 585 elderly individuals have been enrolled in the study while 49% of the respondents have come from the urban area and the rest were from rural (51%) areas. We found that approximately 93% of elderly people have been suffered from illness in the last 6 months preceding this survey whereas most of them suffered from chronic illness (84%). The most of the elderly citizen was suffered from hypertension (15.6%), gastric or ulcer (14.3%), pain (13.6%), diabetes (8.9%), cardiac disease (7.6%), weakness (6.8%), asthma (5%), flue/cough (3.7%), arthritis (2.9%) as well as eye-related infections (2.7%). Among all the sick elderly people, 95% have taken healthcare services from various facilities. The majority of the elderly people reported that they have taken healthcare services from pharmacies (61%) followed by public facilities (33%) and private facilities (19%). We observed that approximately 9% of the elder citizen in the poorest quintiles did not seek care while in the richest quintiles it was only 2%. The average economic cost of treatment care of elderly people was BDT 7,714 (SD± 32,472) per case from household perspective; where direct cost i.e., out-of-pocket expenditure was 93% of the total cost of illness. Among the out-of-pocket expenditure, about 58% used to purchase the medicines. The study observed that only 7% of total cost was borne due to loss of income or productivity of patients or caregivers during the treatment procedure per case. The cost of acute illness and chronic illness was BDT 4,918 (SD± 9,948) and BDT 7,580 (SD± 31,765). In terms of disease specific illness, we observed that the average economic cost of hypertension and diabetes was BDT 3,018 and BDT 14,118 respectively per case per household in the last six month preceding to this survey. Approximately 59% of the elder citizens reported that they had some or extreme health-related problems. The average health-related quality of life for elderly citizens was only 0.51 (SD± 0.29) out of 1 (‘1’ means full health and ‘0’ means death). The inequality results indicated that the poorest income groups often suffered more from hypertension, pain, and gastric/ulcer related diseases than higher-income groups while the incidence of diabetes was found more among higher income groups than the poorest. Indeed, elder people from higher income groups always seek care from private facilities as the value of the Gini-coefficient is positives which indicated that inequality was still present in terms of accessing private care during illness. From the qualitative study, it was revealed that the health condition for elderly people is very critical and they suffered from several diseases for a longer time. However, elder citizen often felt and suggested that the government should prioritize for affordable elder health-friendly care in public hospitals for the betterment of their health and wellbeing. 

Although the provision of basic health services is a constitutional obligation of the Government of Bangladesh. Providing adequate care of the elderly citizen is often a major challenge in Bangladesh. This study concludes that improvements to elder-friendly health infrastructure are a necessary component for betterment the health of elderly citizen. Indeed, rapid population ageing combined with an increasing demand for healthcare with chronic disabilities have created an emerging research agenda as a means to inform policymaking. These findings can be utilized further for designing financial risk protection schemes targeting elder citizen which is in line with the core objectives of the Healthcare Financing Strategy of Bangladesh to achieve universal health coverage within 2032.

Study Director

Dr. Abdur Razzaque Sarker, PhD

Research Fellow, BIDS