How are older people in Bangladesh coping with the pandemic?

With the onset of the Covid-19 pandemic in early 2020, the general knowledge, as declared by the World Health Organisation and health experts around the world, was that older adults were the most vulnerable segment of the population due to their age and underlying health concerns.

They would experience disproportionately greater adverse effects from the pandemic including more severe complications, higher mortality, concerns about their access to care and medicines, difficulty in adapting to technologies like telemedicine, and fears that isolation would exacerbate existing mental health conditions.

To better understand the impact of mobility restrictions on mental health and well-being of older adults in Bangladesh, a survey was carried out by an international consortium of researchers from Bangladesh and The Netherlands, as part of the project Inclusive Cities through Equitable Access to Urban Mobility. 

The survey was led by Professor Ajay Bailey from Utrecht University, The Netherlands in collaboration with Dr Shanawez Hossain from Brac Institute of Governance and Development (BIGD) and Professor Musleh Uddin Hasan from Bangladesh University of Engineering and Technology (BUET), Dhaka.

A total of 221 participants aged 50 years and above participated in the survey comprising of 72 percent men and 28 percent women. More than 60 percent of the participants was between 50-59 years of age, 25 percent older adults belonged to 60-69 years, and only 2.3 percent above the age of 80. The study was conducted online and participants hailed from different parts of the country, with more than half from Dhaka and Chattogram. 

Over 85 percent older adults reported that they were living with family members and about 15 percent were living alone. Those who claimed to live 'alone' responded to diverse living arrangements such as nursing home, with sister, with nephew, etc. In terms income brackets, one-third of the participants reported monthly income of Tk41,000-80,000; while 20 percent older adults reported monthly income between Tk21,000 - 40,000. 

Using two screening questions of the perceived stress scale (PSS), the survey found, 85 percent of older adults in Bangladesh reported symptoms of moderate to severe stress, of which 70 percent were male compared to 30 percent female. Similarly, men were also more likely to report signs of depression (as per PHQ-2 scale for depression which inquires about the frequency of depressed mood and anhedonia over the past two weeks), and poor Quality of Life (WHO-5 Scale was used to measure Quality of Life) than women.

About one-third of the respondents reported symptoms of depressive disorder and almost 45 percent of the older adults acknowledged that they would 'sometimes' feel 'nervous and stressed' and 'upset over unexpected situations'.

Contrary to assumptions that lockdown-induced unemployment may have triggered anxieties and stress, it was interesting to note that 76 percent of those who reported poor 'Quality of Life' were, in fact, working and employed during lockdown. One can infer that working older adults may have had difficulty navigating work-life balance and may have experienced burnout.

Given the age group of the target participants, it is understood that not everyone had the resources or the digital skills to adapt to the virtual modes of working from home which may have led to poor quality of life indications.

An important reminder is that in Bangladesh, 87 percent of the labour force is employed in the informal economy according to the 2010 ILO Labour Force Survey. This means that many of the participants may not have had the luxury of working from home if they pertained to the informal sector or even worked in banks and other essential service provision, further adding to the nervousness and stressors related to braving the streets in the middle of a pandemic.

Intriguingly, the findings of the survey also revealed older adults who live alone are less likely to suffer from depressive disorders than those who live with families. This underscores the increased stress involved with living with others, where sociocultural ties, expectations and responsibilities takes its toll on mental health.

Seven percent of respondents continued to 'visit other people's houses' or 'have people over' during the lockdown, while 93 percent people adhered to social distancing guidelines and maintained social networks over the phone and social media channels (Facebook, messenger, whatsapp, etc). Over two-thirds of the respondents enjoyed spending time with their family and grandchildren, often a rare occasion in the context of busy urban city lives. 

Reading books (including religious and holy books), watching TV and browsing social media all fared comparably high in keeping people entertained during the pandemic. As such, almost 59 percent of the respondents reported high/good Quality of Life according to the WHO-5 Well-Being index, women marginally more so than men.

A recent study in the global north notes that older adults as a group tend to be more resilient to the anxiety, depression, and stress-related mental health disorders characteristic of younger populations. This resilience may reflect an interaction among internal factors (biological stress response, cognitive capacity, personality traits, physical health) and external resources (social status, financial stability).

The findings of this survey reiterate that older adult's well-being is also linked to whether or not they have the resources required to deal with the stress of the Covid-19 pandemic. This may include material (lack of access to smart technology), social (family members or friends), cognitive or biological (inability to engage in physical exercise or participate in online activities or routines) resources.

We acknowledge that this innovative dataset was restricted to people with internet access and having basic literacy of English or Bangla. Older adults in lower economic groups certainly would have faced much more difficulties but we do not capture this group in our survey. 

Mental health and its impact still remain a taboo topic in the South Asia. Many studies show underreporting of mental health issues. In our study there could have been also some amount of that. Older adults in Bangladesh face multiple health and social inequalities which get exacerbated during a pandemic such as the current one. 

There is thus a greater need to design policies and interventions that take a holistic approach and give due recognition to mental health of older adults. 

Dr Seama Mowri is doctoral researcher at Utrecht University in Netherlands.

Dr Selim Jahangir is a post-doc at the Transdisciplinary Center for Qualitative Methods.

Prof Ajay Bailey is a professor of social urban transitions at Utrecht University, the Netherlands.

Musleh Uddin Hasan is an Associate Professor. Department of Urban and Regional Planning, Bangladesh University of Engineering and Technology.

Dr Md Shanawez Hossain is a development economist of BIGD. 

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.