Common geriatric diseases and problems: Bangladesh perspective

Biological ageing can be described as the gradual reduction in the homeostatic reserve or the hidden capacity of each organ in the human body to function beyond its normal limits. This decline generally begins around the age of 60 and differs from person to person. Genetic factors play a role, but dietary habits, environment, personal habits, mental and social stress, and certain systemic diseases also contribute to it.

The United Nations recognises the process of ageing and places importance on the mature attitudes and abilities of older people in social, economic, cultural, and spiritual activities. The United Nations has observed the International Year of Older Persons (IYOP) since 1999 and marks the Day of the Welfare of Older Persons as well as World Alzheimer’s Disease Day (September 21) every year. The main goals of these observances are to promote solidarity, respect, intergenerational exchange, and to address the problems of the elderly and their care.

In Bangladesh, about eight percent of the total population are elderly. They are divided into three categories: young elderly (60–70 years), middle-aged elderly (70–80 years), and very old (80+ years).

The Government of Bangladesh gives importance to issues such as independence, participation, healthcare, self-sufficiency, and dignity for these elderly people. As a result of improvements in the standard of living, economic conditions, and healthcare, the mortality rate has decreased and average life expectancy has increased to 72 years. Consequently, the proportion of elderly people is rising. However, due to changes in socio-economic conditions, modernisation, current family customs, and shifts in people’s mentality, many elderly people are not receiving proper care from their families. The traditional joint family system is breaking down because of smaller family sizes, economic pressures, and socio-cultural influences. The rise of broken or single-parent families (centred on only the father or mother) has many disadvantages. This situation is particularly seen in educated and wealthy sections of society, where earning members live outside the home or abroad, leaving very old people in misery or in old-age homes.

Problems of the elderly in Bangladesh

- Lack of care and supervision by someone at home  

- Poor socio-economic status  

- Lack of food and proper nutrition  

- Poor healthcare facilities for the elderly  

- Lack of awareness about health, nutrition, and diseases  

- Mental and financial abuse by family members and society  

- Lack of care from family and society  

- Financial problems in case of serious illness  

- Helplessness or exposure to various risk factors  

Helplessness/Risk factors

1. Lifestyle changes, disruptions in activities of daily living, and ageing itself.  

2. Smoking, alcohol consumption, and unhealthy environment (air, water, and noise pollution).  

3. History of falls, particularly those causing head injuries.  

4. Mental illness such as depression, anxiety, stress, and loneliness.  

5. Neurological illnesses including abnormal gait or imbalance, muscle weakness, and Parkinson’s disease.  

6. Systemic diseases such as hypertension, ischaemic heart disease (IHD), stroke, diabetes mellitus (DM), thyroid disease, cancer, chronic obstructive pulmonary disease (COPD), liver disease, and kidney disease.  

7. Poor socio-economic status and neglect by family members.  

8. Use of psychotropic drugs.

Common diseases and problems of the elderly

Old age is mainly characterised by weak immunity and the high prevalence of non-communicable diseases such as hypertension, ischaemic heart disease, diabetes mellitus, stroke, cancer, chronic obstructive pulmonary disease, and mental disorders. These are often linked with physical and mental instability as well as social and family dysfunction.

The diseases commonly known as geriatric illnesses or old-age-related illnesses are:

1. Dementia: This refers to psychological problems associated with old age that usually increase gradually. It causes permanent loss of cognitive and intellectual functions such as memory, language, emotions, and personality, while perception and consciousness remain unaffected. The most common type is Alzheimer’s disease, which results from the loss, degeneration, and accumulation of proteins in brain cells. This leads to errors in signal transmission within the brain. Patients cannot recognise familiar people or remember events, their ability to think logically is reduced, and they may lose trust in relatives or caregivers. About half of those with Alzheimer’s disease are over 80 years old, and the rate is higher among women. Many have a history of head injury, heart attack or stroke, diabetes, depression, or thyroid disease. The condition causes problems with memory, judgement, decision-making, and can lead to incontinence. It may also be associated with other diseases of ageing, including infections and chronic illnesses.

In Bangladesh, approximately 1.5 million people (one in every 12 people aged 60 and above) suffer from dementia. Early screening and diagnosis are essential for proper management of these patients and for providing support to their caregivers.

2. Depression: Feelings of sadness and guilt, often linked with neurological diseases and delirium. Delirium is a fluctuating disturbance of consciousness associated with changes in cognitive function or perceptual disturbances.

3. Anxiety (Stress or Tension): This not only causes mental illness but can also contribute to dementia. Even people with previously strong intellectual abilities can develop dementia. Anxiety is very common in all societies due to economic, family, professional, and personal reasons.

4. Parkinsonism: A common neurodegenerative disease of the elderly, usually characterised by unilateral resting tremors along with varying degrees of rigidity and slowness of movement.

5. Stroke: This occurs when a blood clot forms in an artery in the brain or a blood vessel ruptures, damaging brain cells and disrupting blood flow. It can result from ischaemia caused by cerebral embolism or thrombosis, or from haemorrhage due to the rupture of a brain artery. It is commonly caused by high blood pressure, ischaemic heart disease, and diabetes, and may also result from atherosclerotic changes linked to hyperlipidaemia. Stroke can lead to dementia, paralysis, unconsciousness, and even death.

6. High Blood Pressure (Hypertension): Persistent high blood pressure, along with hyperlipidaemia and increased atherosclerotic changes, damages brain cells and affects many vital organs. It can occur at any age and is usually associated with obesity, diabetes mellitus, thyroid disease, smoking, and anxiety. Studies show that about half of people aged 60 and above, and 22 percent of the younger population, suffer from high blood pressure.

7. Ischaemic Heart Disease (IHD): This develops when there is an imbalance between oxygen supply and nutrient demand in the heart muscle due to insufficient blood supply. It is mainly seen in patients with hypertension, diabetes mellitus, obesity, smoking, and anxiety. It can cause partial or complete blockage of the coronary arteries.

8. Diabetes mellitus: The prevalence of diabetes is very high in Bangladesh. Morbidity and death from diabetes mainly occur due to undiagnosed disease at a young age, inadequate treatment, and uncontrolled lifestyle. The disease damages important organs (brain, kidneys, eyes, and heart) through thromboembolism and atherosclerotic changes. Major consequences include cardiovascular disease, stroke, kidney failure, eye complications, and infections.

9. Arthritis and osteoporosis: These damage the joints, causing pain and disability. They are mainly caused by infections, autoimmunity, hormonal changes associated with ageing, osteoporosis, and degenerative changes in bones and joints.

10. Bladder incontinence: This increases with age and muscle weakness. It is most common in diabetic patients, men with enlarged prostate, those with recurrent urinary tract infections, and people with mental illness. It affects both sexes. Enlarged prostate is very common in men over 50; it is usually harmless but can sometimes become serious.

11. Constipation and changes in bowel habits: These are digestive problems caused by poor absorption in the colon and reduced gastrointestinal motility.

12. Empty nest syndrome: This refers to feelings of loneliness, depression, sadness, and grief experienced by parents when children leave home. It is more common in women, but it can affect both sexes when the family home becomes empty or a partner is absent.

13. Head injuries and infections: These damage brain cells and reduce blood flow, leading to memory loss and other neurological disorders. They can even cause paralysis and death.

14. Food and nutrition: A good and balanced diet is very important for the elderly. Special dietary advice may be needed for other health conditions. In such cases, consultation with a nutritionist is recommended to ensure a properly balanced diet.

15. Eye, ear, nose, and dental care: Elderly people often suffer from vision impairment, cataracts, hearing problems, and dental diseases such as caries, tooth decay, and loss of tooth roots.

16. Cancer: Cancer is more common in the elderly. In men, common types include lung cancer, bowel cancer, and prostate cancer. In women, breast cancer and cervical cancer are frequent. Because incidence and mortality rates are high, screening and early diagnosis are extremely important for successful treatment.

All the diseases mentioned above should be treated by qualified doctors and specialists. Management often requires a multidisciplinary team. The treatment of serious illnesses is very urgent and requires support from the government.

Prevention of diseases in the elderly

Since elderly people suffer from most of the conditions mentioned, prevention of complications is of utmost importance. They need regular screening, exercise, counselling, advice, and timely medical decisions, especially those related to organ dysfunction.

Assessment and screening: Regular screening and medical check-ups should be carried out at designated service centres for early diagnosis and treatment. People aged 60 and above need routine health check-ups to identify any difficulties in performing daily activities.

Home and family care: Special attention should be given to companionship, caregiving, and providing reliable love, affection, and respect to elderly family members.

Role of the caregiver

- Providing balanced food and nutrition  

- Assistance with toileting, bathing, grooming, and personal hygiene  

- Advice and support for regular physical exercise  

- Respecting the elderly person’s preferences regarding religion, food, reading, watching television, etc.  

- Giving medicines on time and recognising emergency situations  

- Keeping the elderly happy and providing psychological support  

Social Support

- Organising meetings and seminars on the various problems of the elderly  

- Establishing medical centres for screening and first aid  

- Running caregiver training programmes  

- Encouraging communities to support the joint family system  

- Organising laughter and joke sessions, entertainment centres, and creating elderly-friendly environments  

- Promoting respect and dignity for the elderly  

Support and actions by the government of Bangladesh

1. Strengthening and expanding social welfare projects such as Shantinibas and Prabin Hitaishi Sangha, along with mental health policies and programmes for the elderly.  

2. Providing separate healthcare facilities for the elderly in hospitals at all levels.  

3. Emphasising geriatric medicine in the curriculum and training programmes for doctors.  

4. Organising quality caretaker training programmes for the elderly, especially for Alzheimer’s patients, both at home and in nursing homes.  

5. Utilising physically able young and middle-aged elderly people in developmental work.  

6. Providing subsidies for the treatment of serious illnesses for elderly and poor patients in all hospitals.  

7. Ensuring respect and dignity for the elderly in national organisations and important public places.

Management of diseases of the elderly by a multidisciplinary team

Joint consultation and treatment by medical specialists, physiotherapists, psychologists, geriatric specialists, nutritionists, and social welfare workers are necessary. A balanced diet, regular physical exercise, a safe environment, personal hygiene, safety measures, and mental care are also important. Correction of vision and hearing impairments and management of hypothermia are essential for elderly people.

Last but not least, it can be said that an elderly-friendly society and environment can only be created through the sincere, cordial, and respectful efforts of families, society, elderly welfare associations, and the government.

Writer: Dr. Md. Abdur Rahman Khan is retired Director General, Directorate General of Health Services (DGHS)