Care for the growing number of elderly people in developing countries needs to be addressed

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7141.1387a (Published 02 May 1998) Cite this as: BMJ 1998;316:1387
  1. Debashis Dutt, Assistant professor
  1. Department of Community Medicine, Kasturba Medical College, Manipal, Karnataka, 576119, India

    EDITOR—I strongly agree with Black and Bowman's call for more attention to be paid to the care of elderly people1; the same need exists in developing countries, not just in Britain. As life expectancy increases so too does the number of elderly people living in developing countries. The World Health Organisation estimates that 200 million of the 355 million people older than 65 years are in the developing world.2

    In addition to the health issues, which are the same as elsewhere, elderly people in developing countries have become especially vulnerable because of the rapid social changes occurring in many of these countries. Until recently, elderly people in developing countries enjoyed considerable status, respect, care, and social and psychological support from their families. Migration, urbanisation, changes in value systems and aspirations, changes in the role of women, and the breakdown of the family system have eroded traditional familial support,3 and elderly people suddenly find themselves poor, uncared for, and without power or influence.4

    There is almost no social support for elderly people outside the family. Except for a tiny minority who have worked in the organised sector and so receive pensions, economic support does not exist. The focus for most developing countries is on maternal and child health; health care for elderly people is neglected. Both facilities and trained personnel are lacking. Health workers that are the first point of contact for elderly people are inadequately trained and equipped to care for them. Few secondary and tertiary care institutions have separate services for elderly people. General outpatient departments and departments of general medicine provide care5 but there are long waiting times, the care is often inadequate, and minimal attention is paid to personal care and counselling. Separate inpatient facilities are rarely designated for elderly patients. Gerontology is not a popular specialty.

    The changing demographic profile in developing countries requires recognition. Systems need to be devised to engage elderly people in suitable vocations so that their wisdom and experience can be effectively utilised; this would also help them to retain their sense of self worth. Social security systems need to be developed for their general welfare. Healthcare support services need improvement. All health personnel should have additional training in caring for elderly people. A three tier health system needs to be developed so that auxiliary health personnel can provide ambulatory care in the community and be supported by a separate referral system for specialised care.


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