Though definite national demographic data is unavailable, the longevity of people with intellectual disability has increased in Nepal over the recent decades due to improvements in nutrition, sanitary conditions and health services. This, in turn, has created large demands for service needs in order to support them in their old age. It also adds to need for service provision for the elderly especially at a time when family structures are changing and alternative forms of care for the elderly are not in place.
In the first place, there are a few studies that explore the health needs of the elderly in relation to conditions such as uterine prolapse, cataract services, and parasitic infections. And those studies are not holistic in nature. While one study examines metabolic syndrome amongst inmates of a home for the aged, another study may look at self-reported health problems of the elderly. In general, there is a lack of knowledge with regard to specific health needs of the elderly in Nepal. All this points to a need for further research in the area especially when the number of elderly population is rising and their health needs multiplying.
A number of challenges await elderly people in Nepal. Among them, migration is perhaps one of the most serious ones. They migrate from their birth homes to more urban centres on their children’s pressure though they would much like to live with their friends in their own birth homes. This movement, despite their will, will have negative impacts on them and they develop anxiety, helplessness and loneliness.
Elderly people in Nepal have long been ignored and neglected when it comes to policy-making process.
Plus, elderly people face the stress of social and cultural burdens and isolation.
With the increase in migration and the ‘empty nest syndrome,’ as in the case of Nepal as in many other societies, there are more elderly people living alone and are vulnerable to mental problems like loneliness, depression and other forms physical ailments. In urban areas, the skills and knowledge of the elderly are often underutilized or not utilized at all. This makes them feel being useless and unwanted as a result of which feelings of loneliness and depression rise in them. Hence, the emotional aspects of ageing population and the impact of being displaced from their family homes require urgent attention in Nepal.
To be more specific to gender dimension of elderly migration, women often have to bear the brunt. They are left in rural villages to tend to land, children and dependents. The breakdown of traditional family structures has made the situation even worse for them. But the truth is that it is equally important for older adults to remain active, utilizing their leisure in religious activities among others. Hence, elderly people should be encouraged to remain working and active. The health planners in Nepal must understand the need for the expansion of physical and psychiatric health care systems to accommodate ageing population.
It is equally important to highlight the lack of work in assessing the effectiveness of mental health and psychosocial support in Nepal. Given the post-conflict situation Nepal is undergoing, these needs require urgent attention, not only for the elderly but for all across Nepal. As much of Nepal’s population is clustered around the remote parts of the country, mobile health camps and mobile counselling camps should be conducted to support the rural populations. Practitioners and academics alike are calling for a more detailed examination of the needs of the elderly, one that takes into consideration geographical as well as socio-economic and cultural disparities. These calls should be responded immediately.
It is important that the ageing population is also examined in the context of increasing levels of outward migration and urbanization which is expected to rise in the coming decades. In 2010, the Geriatric Centre for Nepal (GCN) emphasized this lack of research and called for a baseline study in 15 of the 75 districts of varying geographical regions. The objective was to increase the level of understanding of the complexities the ageing population in Nepal often have to deal with. Further recommendations have been made to improve health provision, policy development and socio-economic considerations of the elderly.
The GCN also calls for awareness building and education within society to increase understanding of the challenges Nepal will face with regard to ageing population. The lack of research, from both a scientific and sociological perspective, needs to be urgently addressed and a forum created wherein academics, government agencies and practitioners can share their findings.
Furthermore, there is a need for scientific research into the health situation of the elderly in Nepal alongside research that focuses on experiences and needs of the elderly. It is equally important for research to focus on the socio-economic situation of the elderly and explore the impact of such factors as caste, ethnicity and geographical location. As the ageing population is increasing in the coming decades, it is imperative that services are provided to meet their needs.
As is the case, Nepal will face an extra challenge in the face of challenges to promote political and economic development together with the impacts of climate change. It is essential, therefore, that a holistic and multi-generational approach is taken toward addressing these challenges. It is vital that both the experience and knowledge of the older members of the population are taken into account to meet these challenges. The agencies working in this sector should engage the elderly fully in making policies and developing services to meet their needs. Elderly people in Nepal have long been ignored and neglected when it comes to policy-making process. It is high time we translated the slogan Matri/Pitri Debo Bhabha (parents are like gods) into action and lived up to its true meaning.
The writer, based in the University of Liverpool, was awarded for his research on Ageing by British Academy
bijan.pant@liv.ac.uk
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