Abstract
Bangladesh is undergoing a significant demographic transition, with the proportion of its elderly population projected to increase dramatically in the coming decades. This shift presents a unique set of challenges and opportunities for the healthcare sector, particularly in the nascent field of geriatric medicine. Historically, elderly care has been rooted in the traditional extended family system, which is now facing strains due to urban migration, nuclear families, and changing social values. The current landscape is marked by limited specialized services, a scarcity of trained professionals, and a gap in comprehensive governmental policy. However, a growing awareness of the need for structured geriatric care, along with a few pioneering initiatives, signals a positive trajectory. This article examines the past and present state of geriatric medicine in Bangladesh, explores global trends, and proposes a future framework for building a robust, accessible, and inclusive healthcare system for the country’s aging population, encompassing policy, infrastructure, and human resources.
Keywords: Geriatric Medicine, Bangladesh, Elderly Care, Gerontology, Healthcare Policy, Aging Population
Introduction
The global demographic landscape is undergoing a profound transformation. For the first time in history, the number of people aged 60 and over is expected to outnumber children under five.1 This phenomenon, often termed the “graying of the globe,” is not limited to developed nations; it is a rapid and defining challenge for developing countries like Bangladesh. As a developing economy, Bangladesh has made remarkable strides in improving life expectancy, which has risen from around 47 years in 1971 to over 72 years today.2 This success, however, has created a new set of health and social challenges, as the nation’s healthcare system now needs to cater to the complex, multi-morbid needs of a growing elderly population.
Past and Present: The Journey of Geriatric Care
For centuries, the care of the elderly in Bangladesh was firmly embedded within the socio-cultural fabric of the extended family. The traditional filial piety and communal support systems ensured that older adults were cared for and respected within their households. Geriatric health issues were largely managed by general physicians or through traditional home remedies, with little to no recognition of geriatrics as a distinct medical specialty. This informal care model, while deeply humane, lacked the scientific rigor and multidisciplinary approach required to manage the unique medical needs of aging.
The erosion of this traditional support system is the single most significant driver for the need for formalized geriatric care today. Rapid urbanization, the rise of nuclear families, and economic migration have left many older adults isolated and vulnerable. While the government has implemented some social safety net programs, such as the Old Age Allowance, these are primarily financial and do not address the complex health needs of this demographic.3
Currently, specialized geriatric services are sparse. While some private initiatives and non-governmental organizations have begun to fill the void, they are often limited to urban centers and are largely unaffordable for the majority of the population. A notable pioneer in this space is the Bangladesh Association of Aged and Institute of Geriatric Medicine (BAAIGM), which provides some dedicated services.4 The BIRDEM General Hospital, renowned for its work in endocrinology and diabetology, has also established a Geriatric Day Care Unit. These services aim to provide comprehensive care, including physical and mental health check-ups, rehabilitation, and social engagement opportunities. However, the services remain limited in scale.
Global Trends and the Future Perspective
The global trend in geriatric medicine emphasizes a shift from a disease-centric model to a holistic, patient-centered approach. Key international developments include the integration of geriatrics into primary care, the promotion of healthy aging, the use of technology to support independent living, and a greater focus on palliative and end-of-life care. Many developed countries have robust national policies and dedicated funding for elderly care, along with specialized training programs for doctors, nurses, and allied health professionals. The global geriatric medicines market is also experiencing significant growth, driven by the increasing prevalence of chronic conditions such as cardiovascular disease, arthritis, and neurological disorders in the elderly.5
A Generalized Snapshot of Geriatric Medicine Policies & Compliant Services in Some Countries
United States:
Policy: Medicare, Medicaid, Age-Friendly Care (the 4Ms: What Matters, Medication, Mobility, Mentation) and new hospital measures to standardize geriatric quality across settings. Payment models and accreditation increasingly require geriatric-friendly pathways (inpatient, ED, post-acute).
- Medicare: This is a federal insurance for people 65+ and some under 65 with disabilities. The funding comes from the taxes paid by all citizens in employment.6
- Medicaid: Joint federal–state program for low-income people, including elderly and disabled, covering medical and long-term care.
Together, they fund most U.S. healthcare for older adults. - The Centers for Medicare & Medicaid Services (CMS) introduced a new Age-Friendly Hospital Measure (effective January 2025) under the Hospital Inpatient Quality Reporting program where hospitals must report how they are doing on delivering age-friendly care for older adults (≥ 65) in hospital wards, emergency rooms, operating rooms.7
- Hospitals must show they deliver “4Ms” care under this Age Friendly program which consists of- What Matters, Medication, Mobility, and Mentation.
- Reporting is mandatory; noncompliance may reduce Medicare payment updates.
- The policy promotes standardized, person-centered geriatric care, transparency, and public reporting through Care Compare.8
Health Service Provider Industry: Medicare-contracted home-health agencies, geriatric primary-care clinics, memory-care/residential providers, post-acute rehabilitation, tele-geriatrics vendors, and health systems adopting the 4Ms/Age-Friendly Hospital standards.7
India
Policy: The National Programme for Health Care of the Elderly (NPHCE) creates dedicated geriatric services (regional/national centres, geriatric OPDs, training, outreach) and supports expanding MD/fellowship training and district-level geriatric care. Implementation gaps remain (workforce, accessibility), but major public investments and new national centres are underway.
Health Service Provider Industry: Government-partnered geriatric units, private geriatric clinics and hospitals, home-care companies, physiotherapy/rehab centers, and NGOs running community outreach and caregiver training aligned with NPHCE standards.9
Thailand
Policy: Universal Coverage + targeted elder benefits (expanded UCS benefits for older adults such as eyeglasses, adult diapers, dentures) and local elderly-policy frameworks that promote community care and preventive/dementia services. Local governments and social-welfare ministries drive integrated aging policies.
Health Service Provider Industry: Public-private partnerships in community day-care, private nursing homes, home health agencies, commercial rehabilitation centers, and social enterprises offering elder products/services that link to UCS referral pathways.10
Vietnam
Policy: National legal framework (Ordinance/Law on Elderly) plus MOH/ministerial circulars promoting healthy ageing, social support, and community self-help clubs; country is rapidly ageing and scaling pilot community-based care and cash/benefit programs. Capacity and workforce remain constrained.
Health Service Provider Industry: Small-scale private care homes, home-care/startups, community social clubs that contract services, and NGOs/CSOs partnering with local government to deliver eldercare and prevention programs. 9
Japan
Policy: Long-Term Care Insurance (LTCI) — a universal, municipality-operated insurance (since 2000) that covers in-home, day-care and residential long-term care with standard eligibility/certification and modest copays; the system funds a large, regulated long-term care industry.
Health Service Provider Industry: Certified long-term care providers (home-help, day-care, group homes), care-management agencies, institutional nursing care facilities, rehab providers, and many tech/robotics companies supplying eldercare innovations under LTCI contracts.11
Policy Goal for Bangladesh:
Currently there is no national geriatric framework addressing preventive, clinical, or long-term care for older adults. The country can adopt a National Geriatric Health Initiative by combining proven models from other countries. Building on successful international models, Bangladesh can establish a phased, scalable geriatric health policy leveraging its strong public–private health network and community structures.
Adaptable Policy Components:
1. District-Based Geriatric Care Model (Adapted from India’s NPHCE)
- Establish geriatric outpatient departments (OPDs) at district and medical college hospitals.
- Integrate basic geriatric screening (blood pressure, diabetes, mental health, fall risk, nutrition) in Upazila Health Complexes and community clinics.
- Train physicians, nurses, and health assistants in geriatric care and palliative management.
- Develop a National Geriatric Clinical Guideline through DGHS and BMDC.
Implementing partners: DGHS, Ministry of Health, medical universities, NGOs.
2. Community-Based Elderly Care Program (Adapted from Thailand)
- Create community day-care centers for social interaction, physiotherapy, and chronic disease monitoring.
- Train community health workers and local volunteers to provide home-based support (medication reminders, basic nursing, nutrition).
- Collaborate with Union Parishads and NGOs for outreach and service delivery.
- Promote intergenerational programs linking schools/youth groups to elderly well-being activities.
Implementing partners: UHCs, Union Parishads, Directorate of Social Services, BRAC, HelpAge Bangladesh.
3. Elder Self-Help and Wellness Clubs (Adapted from Vietnam)
- Form self-help clubs for elderly individuals focusing on physical activity, health education, and peer support.
- Provide small community grants to support club-led micro-projects (gardening, nutrition drives, health camps).
- Integrate these clubs into community clinic catchment areas for regular monitoring and outreach.
Implementing partners: NGOs, local social welfare offices, PKSF, Department of Women and Children Affairs.
4. Long-Term and Home-Based Care Pilots (Adapted from Japan)
- Launch pilot long-term care homes in urban centers through public–private partnerships.
- Develop a home-care certification program for caregivers and domestic aides.
- Offer tax incentives or CSR-linked grants for businesses providing elderly care, assistive devices, or home-health services.
- Explore a national long-term care insurance feasibility study for future implementation.
Implementing partners: Ministry of Social Welfare, private hospitals, CSR wings of corporates, insurance companies.
5. Geriatric-Friendly Health Systems (Adapted from U.S. 4Ms Framework)
- Introduce Age-Friendly Hospital Certification based on the “4Ms” —
What Matters, Medication, Mobility, and Mentation. - Add geriatrics and palliative care modules to MBBS, nursing, and public health curricula.
- Encourage hospitals to establish geriatrics quality indicators in accreditation systems.
- Expand telehealth services for chronic disease follow-up among older adults.
Implementing partners: BMDC, private hospitals, Bangladesh Nursing Council, ICT Division.
A multi-prong strategy for the future of geriatric medicine in Bangladesh promises an overall growth in health system of the country. A framework, timeline, geriatric health service provider licenses, training institutions, and health human resource buildup will create a robust industry tending to this population.
1. Career Opportunities: There is a critical need to build a pipeline of skilled geriatricians, nurses, and caregivers. Currently, there is no formal postgraduate training program in geriatric medicine at the level of FCPS (Fellow of the College of Physicians and Surgeons) or MD. Creating these training pathways is crucial. Additionally, establishing certified caregiver training programs, perhaps in collaboration with international bodies, would create employment opportunities both domestically and abroad, addressing the growing demand for home-based care.12
2. Government Policy and Role: The “National Policy on Older Persons 2013” and the “Parents’ Care Act 2013” were significant steps, but their implementation and scope remain limited. A more comprehensive, integrated national policy is needed that addresses not only financial support but also healthcare access, housing, and social inclusion. This policy must include a plan for integrating geriatric services into the public health system, particularly at the Upazila and community clinic levels. The government could also promote public-private partnerships to scale up geriatric care services.
3. Research and Development: The lack of dedicated research on the specific health challenges of the Bangladeshi elderly is a major gap. Most available research is focused on general health problems and social issues, with limited data on specialized topics like polypharmacy, geriatric syndromes (such as falls and dementia), and the efficacy of specific interventions in the local context.13 A national geriatric research agenda, supported by government grants, is essential to inform evidence-based policy and practice.
Conclusion
The demographic transition in Bangladesh presents both a formidable challenge and a unique opportunity. While the past relied on an informal, family-based system, and the present is characterized by fragmented services, the future of geriatric medicine in Bangladesh holds the promise of a structured and compassionate healthcare model. By learning from global trends, investing in human resources, and enacting a comprehensive and well-funded national policy, Bangladesh can build a system that not only meets the needs of its aging population but also celebrates the valuable contributions of its senior citizens.
Author of this Article:
Dr. Md Ashraf Uddin Ahmed
MBBS, FCPS (Medicine), Trained in geriatric medicine (UK), Fellow, IPM (Kerala), St Christofer Hospice (UK), Associate Professor (Medicine), Geriatrician, Palliative care specialist, BIRDEM general hospital E-mail: ashrafbirdem2022@gmail.com Contact: +8801819272977
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