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Aging, care and dependency in multimorbidity: how do relationships affect older Bangladeshi women’s use of homecare and health services?

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Mohammad Hamiduzzaman at The University of Sydney
Mohammad Hamiduzzaman
Stacy Torres
Stacy Torres
Stacy Torres
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Amber J. Fletcher at University of Regina
Amber J. Fletcher
M. Rezaul Islam at University of Dhaka
M. Rezaul Islam
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Gender issues can create major barriers to healthcare utilization for older women with multimorbidity, especially in developing countries like Bangladesh. Elderly rural women in Bangladesh, are the poorest of the poor, and the women with multimorbidity live in a regulated family atmosphere. This study explored the relationship dimensions of older women with multimorbidity in homecare and their utilization of health services. To gain a deeper understanding of these complex issues, a qualitative case study was conducted. Semi-structured, in-depth interviews were conducted with 11 health staff and 22 older women with multimorbidity, living in three residential communities of the Sylhet District, Bangladesh. Our analysis used critical thematic discourse, a technique developed from Axel Honneth's recognition-and-misrecognition theory. Seven relationship dimensions have been identified, and grouped under three major themes: intimate affairs [marital marginalization and parent-children-in law dynamics]; alienation in community relationships [patriarchal sibling relationships, neighborhood challenges, and gender inequality in interactions]; and legal disconnections [ignorance of rights and missed communication]. Our findings revealed a lack of understanding of the women's multimorbid care needs and patriarchal marginalization in family. This lack of understanding together with poor peer-supports in healthcare is perpetuated by misrecog-nition of needs from service providers, resulting in a lack of quality and poor utilization of homecare and health services. Understanding the high needs of multimorbidity and complexities of older women's relationships can assist in policy decisions. This study deepens our understanding of the ways gender inequality intersects with cultural devaluation to reduce the well-being of older women in developing countries.
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... Thus, the female workforce plays a key role in bringing about changes in local communities. Despite their contribution to the national economy, gender inequity is still prevalent in healthcare services too, which is vastly visible in rural and urban areas (Andaleeb and Millet, 2010;Hamiduzzaman et al., 2021). In fact, social influence impacts how society allows women to avail their healthcare needs from online platforms. ...
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Frailty indexed classification of Bangladeshi older adults' physio-psychosocial health and associated risk factors-a cross- sectional survey study
Article
Full-text available
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  • BMC Geriatr
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Factors associated with health-related quality of life and burden on relatives of older people with multi-morbidity: a dyadic data study
Article
Full-text available
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  • BMC Geriatr
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Self-reported Seasonal Symptoms and Diseases and Primary Healthcare Utilization Among Rural Elderly Women in Sylhet District, Bangladeshバングラデシュのシレット地区農村部の高齢者女性を対象とする季節的症状と疾病の自己評価及びプライマリケアの利用
Article
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Article
Full-text available
  • Nov 2019
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Article
Full-text available
  • Jul 2019
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The world is not mine: Factors and issues of rural elderly women's access to modern healthcare services in Bangladesh
Book
  • Sep 2018
Bangladesh is one of the poorest countries with disparities in accessing modern healthcare services. Rural elderly women are a vulnerable population who face the compounding effects of increasing longevity and comorbidity resulting in a greater requirement for healthcare than other population groups. Despite the recognition of treatment requirements, women’s access to modern healthcare does not feature significantly in government policy or in research literature. This study aims to explore the factors and issues that have an impact on rural elderly women’s access to modern healthcare in Bangladesh. A systematic review of the literature on rural elderly women’s access to healthcare revealed the effects that personal beliefs and behaviours, the healthcare system, socioeconomic factors, and the cultural context have on access in relation to downstream and upstream social determinants. It has been found that downstream determinants, such as the healthcare behaviours of the women and the healthcare system, are influenced by upstream determinants including living conditions, and socioeconomic and cultural circumstances. A blended critical social theoretical framework was developed based on Jurgen Habermas’s ‘Theory of Communicative Action’ and Axel Honneth’s ‘Theory of Recognition & Misrecognition’ to explore the healthcare, social, and individual spheres of the women and their access to modern healthcare. The data collection method used was face-to-face audiotaped semi-structured interviews with both healthcare professionals and rural elderly women. A combined thematic and critical discourse analysis provided an understanding of the healthcare system, the socioeconomic and cultural context, the women’s issues, and social relationships that exist and affect access for these women. Five themes emerged from the views of healthcare professionals relating to the women’s access, including: unequal distribution of healthcare services, marginalisation in the relationships between rural elderly woman and healthcare professionals, an inability to pay for services, negative social responses, and a mistrust of medical treatment. The themes evident from the views of the women themselves included: an exclusionary healthcare system, oppressive social conditions, repressive social relationships, and self-exclusion as a result of the internalisation of sociocultural values. The problematisation of rural elderly women’s access to modern healthcare presented numerous social determinants in the healthcare, social, and individual spheres. Whilist the healthcare sphere as an institution was inadequate, the professionals who provided care lacked gerontological education and training and were not responsible legally or professionally to the women. In the social sphere, the poor socioeconomic status of the women, unemployment, low incomes, and a lack of financial support from family members and the government contributed to poor access. This sphere was further affected by religion, male domination, and socio-political alienation that created repression for the women. The healthcare and social spheres played a role in shaping the women’s knowledge, beliefs, and behaviours resulting in inadequate access, which was also affected by hegemonic family relationships. Access to modern healthcare was subject to healthcare, social, and family support, as well as the women’s personal choices and decisions. The healthcare, socioeconomic, and political implications require significant policy changes in the future to improve the women’s access to modern healthcare in Bangladesh.
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Nutritional vulnerability and associated risk factors estimation of Bangladeshi wetland community people aged 50 years and over
Preprint
  • May 2021
People aged 50 years and over often show nutritional vulnerability in South-Asia including Bangladesh. Consequently, they present physical weakness and illness that escalate overtime. In Bangladesh, community-focused investigations have potentials to inform healthcare interventions, but current studies examine older adults’ nutrition status which are not all-encompassing [e.g., wetland communities]. We, therefore, assessed the malnutrition status among wetland community-dwelling older adults aged ≥50 years in Bangladesh. A cross-sectional survey with 400 older adults was conducted in the north-eastern wetland community of Bangladesh through simple random sampling. Demographic and health information were collected using a structure questionnaire and the Nestle Mini Nutrition Assessment-Short Form criteria was used to assess the nutrition status. Respondent’s socio-demographic and health profiles were assessed, and the Pearson’s Chi-square association test was performed to identify the associated socio-demographic and health factors of older adult’s malnutrition. The prevalence of malnutrition and risk of malnutrition were 59.75 and 39.75 percent respectively. Malnutrition prevalence rate was higher with increasing of age and female were more malnourished than male. The age, gender, educational status, occupation and income were significantly associated with older adults’ malnutrition. The wetland community-dwelling people who are suffering sleeping disorders and poor self-rating health condition were found to be more malnourished. The findings confirm that the prevalence of malnutrition and risk of malnutrition are high among community-dwelling people aged ≥50 years in wetland communities. Our findings suggest the health professionals to implement public health and clinical interventions simultaneously to improve nutritional status of this cohort.
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Article
  • Feb 2021
Hypertension has been increasingly cited mortality cause in developing countries including Bangladesh,[1–4]and generally associated with coronary artery disease, stroke, heart failure, atrial fibrillation, peripheral vascular disease, vision loss and chronic kidney disease.[5,6] The prevalence of hypertension in developing countries is 32.3%, while this rate is 22% worldwide.[7–9] Islam, et al. reveal this prevalence is increased from 26.4% in 2011 to 40.7% in 2017 among Bangladeshi adults.[10] In Bangladesh, people aged 50 years and over tend to be acutely inclined to hypertension than any other age groups, and in more need of treatments.[11] More often, elderly people live in a resource-poor setting with limited access to education, financial assistance, active lifestyles and healthcare services, and this living circumstance resulted in a high risk of chronic hypertension and premature death.[12–15] Several researches indicate that hypertension increases with age, however, little is known about the prevalence of hypertension among elderly people and associated risk factors in Bangladesh.[6,16–18].
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Stakeholders’ perspectives on adapting the World Health Organization iSupport for Dementia in Australia
Article
  • Aug 2020
Background: In Australia, informal caregivers (family, friends and neighbours) play a crucial role in supporting people with dementia to remain at home. Within the community aged care policy, informal caregivers are acknowledged as assisting with managing care. However, they usually receive very limited dementia care education and training to support them in their role. The World Health Organization (WHO) developed iSupport for Dementia, a comprehensive online dementia education and skill training programme, to address the gap in supporting informal caregivers. Aim: The aim of the study was to identify stakeholders' perspectives regarding adapting the WHO iSupport for use by informal caregivers of people with dementia in Australia. Methods: An interpretive description study design was used. Data were collected in focus groups with informal caregivers and care staff of dementia and aged care service providers conducted in May-July 2018. A thematic analysis was utilised to analyse data and identify findings. Results: In total, 16 informal caregivers and 20 care staff participated in the study. Five themes were identified. First, informal caregivers perceived iSupport as an opportunity to provide an online one-stop shop to meet their education needs and their needs to manage care services. Second, both informal caregivers and care staff believed that an integrated caregiver network moderated by a health professional was much needed to enable informal caregivers to share learning experiences and enhance social support. Third, both informal caregivers and care staff strongly suggested that dementia and aged care service providers had a role to play in promoting the iSupport. Fourth, informal caregivers were concerned about the time commitment to participate in the iSupport programme. Finally, informal caregivers expected the iSupport to be user-friendly. Conclusion: Stakeholders perceived the adaptation of the WHO iSupport in Australia would strengthen informal caregiver education and optimise support for informal caregivers.
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