“The Need for Geriatric Nursing In the Coming Years in Bangladesh”

Salome A. Rahim, RN, BSN, MPH

Nursing SuperintendentTMSS Medical College and

Rafatullah Community Hospital, Bogra

Introduction

• There will be absolute numbers of elderly people, a larger share of elderly, no longer healthy life expectancies, and relatively fewer numbers of working-age people.

• According to the World Health Association, the world’s population aged 60 and over will more than triple from 600 million to 2 billion in the next forty years. The fastest growing group is those over the age of 80. This increase in population is global.

Global Status of Geriatric Population

• The number of elders will rise in developing countries from 400 million in 2000 to 1.7 billion by 2050, which is about 20% of the total 9.8 billion.

• The annual rate of increase of the elderly population of age 60 + would be 2.5%.

Geriatric Population Status of Bangladesh

• The older section of the population is increasing much faster than the total population.

• In Bangladesh, 6.9% of the population was classified as elderly in 1950, and is projected to increase to 8% in 2020 and 17% by 2050.

• According to 2014 statistics above 65 years of age population is 8,32,0136 and between 55-64 years of age population is 9,834,577.

• Also, the old-age dependency ratio would be almost triple between 2000 and 2050 (WPP, 2008).

• According to UNFPA in 2050 Bangladesh population will be more than 190 million and aging population will be 32.3 million.

COMMON GERIATRIC HEALTH PROBLEMS

• Most common problems are: Diabetes, Arthritis, Gout, Infections, COPD (like Asthma, Bronchitis), Cancer (prostate, breasts, colon, rectum, skin), Indigestion, fatigue, depression, dementia, heart attack, heart failure, hypertension, Benign hyperplasia of prostate, urinary incontinence etc.

Psycho-social problems affecting their health like

• Loneliness from losing a spouse and friends• Inability to independently manage regular

activities of living• Difficulty coping and accepting physical

changes of aging• Frustration with ongoing medical problems

and increasing number of medications

• Social isolation as adult children are engaged in their own lives

• Feeling inadequate from inability to continue to work

• Boredom from retirement and lack of routine activities

• Financial stresses from the loss of regular income

Geriatric Nursing – Present and Future Challenge

• There is a growing demand for a skilled geriatric nursing workforce to provide quality care across a wide range of health care setting. The exponential growth in the health care costs for older adults creates a call greater accountability. There is mounting pressures for health care providers and settings to demonstrate costs effectiveness and safe, quality outcomes. Building nursing expertise in geriatric practice has been embraced by National Nursing Organization around the globe. From expanding geriatric education in school of nursing, to mandating evidence based geriatric practice in accreditation standard for health care, the push is on!

Global Demand of Geriatric Nursing and Outlook

• Geriatric nursing is a fast-growing career, because Americans are living longer. The post WW II “Baby Boomer” generation is just now hitting retirement age. According to the U.S. Census by 2050 more than 20% of Americans will be over age 65. Because of the aging population, there is increasing demand for geriatric nurses, especially in nursing homes and health care facilities that have a higher older patient population. According to the U.S. Bureau of Labor Statistics (BLS), RNs earn an average annual salary of $65,470.00 (BDT. 5,106,660.00). According to National Council of Nurses of US about 13000 Filipino Nurses takes NCLEX (National Council Licensure Examination) annually, so that they

can work as Registered Nurse in the USA.

• In Japan also, the percentage of the elderly population (aged ≥65 years) reached 25% in 2013; it is expected to exceed 30% in 2025 and reach 39.9% in 2060. To accommodate the medical care demand changes, it is necessary to secure a system for providing medical care. They are changing from "hospital-centered medical care" to "community-oriented medical care" in correlation with nursing care and welfare. In this view, last year Japan made an agreement with POEA (Philippine Overseas Employment Authority) to hire 10,000 Filipino nurses (according to POEA Press Release).

Bangladesh Perspective

• The suggested doctor-nurse ratio of 1:3• Bangladesh has a shortage of over 60,000

doctors and 280,000 nurses.• Maldistribution and migration: Over 75% of

the population of Bangladesh live in rural areas, but have less than 20% of the health workforce available to them.

NURSING WORKFORCE IN BANGLADESH

• As of January 2011, 26,644 registered nurses with 17,605 posts in the public nursing services and education

• 15,086 nurses are working in the public sector and 2,513 posts are vacant. Vacancies in public sector posts are higher among nurses of higher qualification, with 96% of class 1 (senior) posts, 68% of class II (junior) posts, and 20% of class III (aide) posts being vacant!

• 3,000 registered nurses are employed in the private sector

• 3000 are working abroad.• Bangladesh has a population-nurse ratio of

5000:1, a bed-nurse ratio of 13:1, and a doctor-nurse ratio of 2.5:1.

• These fall far short of the international standard for bed-nurse ratio of 4:1 and doctor-nurse ratio of 1:3.

• Faculty shortages: There is an acute shortage of teachers, with one-third of all sanctioned posts of nursing instructors in public NIs vacant. The resulting teacher-student ratio is very high at 1:57, where a ratio of 1:20 is considered to be the standard.

Bridging the Nursing Gap

• Govt. initiations• Private Sector initiations

Present Nursing Courses

• Diploma in Nursing• B.Sc in Nursing• Post -Basic (In-service) Education• Diploma in Midwifery.

• Specialized Course: The specialized course on CCU; ICU and Cardiac Nursing is available in the National Heart Foundation, Mirpur. The opportunity is open for 20 nurses only. Rehabilitation Nursing is available in BHPI (CRP), Savar. The scope of having this course is limited for 20 nurses only.

• For other subspecialty nursing courses, Govt. sending few numbers of nurses to other countries for training. Gerontological Nursing Training is still lacking.

Global Employment Opportunity

• There is a huge demand for qualified nurses in Middle East, North America, Europe, Japan and Australia. USA alone needs 1.5 million new nurses. If Bangladesh can send only 200,000 nurses to these countries for an average yearly salary of USD 70,000 and if these nurses send 50% of their salary to Bangladesh, it will amount to USD 8.5 billion foreign remittance per year. Bangladesh will move from a low income country to a middle income country almost overnight.

APPROACH TO A NEW SYSTEM OF HEALTH CARE OR THE ELDERLY

• Community-oriented medical care• Home Health Nursing

Conclusion

• The Bangladesh Govt., the NGO’s, private sector and the Bangladeshi nurses must be ready to take the challenge of growing aging population in the coming years, as the birth rate is decreasing and life expectancy is increasing.

• It is the high time for the policy makers to necessary step to implement diploma and post-graduate courses on geriatric nursing.

• “A test of a people is how it behaves toward the old. It is easy to love children. But the affection and care for old, the incurable, the helpless, are the true gold mines of a culture” Abraham Joshua Heschel, rabbi and civil rights activists