Nepal has a relatively young population, with 20.8 percent of people aged 16-25 years and 40.68 percent aged between 16-40 years. Meanwhile, the population of the elderly is increasing, according to the Nepal Population and Housing Census 2021. The census demonstrates that in the past 10 years, the population of those over 60 increased from 8.13 to 10.21 percent. The life expectancy of Nepalis has also increased from 55 years in 1990 to 70 years in 2020. This is primarily due to improved healthcare and a declining birth rate. However, older people often face healthcare challenges, including chronic diseases, mobility issues, mental health concerns, cognitive impairment and social isolation, requiring healthcare services dedicated to the elderly, also called geriatric care. Unfortunately, such care has not been seriously addressed in Nepal.

One major reason is the recent demographic shift, with many Nepalis opting for temporary or permanent migration abroad for employment, education or enhanced quality of life. This has resulted in the accumulation of older people, women and children within the country. The early 2000s witnessed a surge in the demand for blue-collar workers seeking temporary employment in the Gulf Cooperation Council countries. This has intensified the frequency and volume of Nepali workers heading to these regions. The United Nations data reveals that nearly 2.7 million people live in the GCC countries; Nepali workers account for about 432,000—a whopping 16 percent of the total population. Most of them are employed at construction sites. Besides this, many Nepalis live and work in Europe, America, Australia and other Western countries.

Migration blues

Foreign employment has radically altered family dynamics in Nepal, presenting more challenges than opportunities. Although the remittance has superficially improved the financial well-being of families, severe emotional, social and health-related complexities within the families and societies have emerged. The youths embark on foreign employment, leaving the older members of the families, women and children alone to cope with the country’s diverse adversities. Foreign employment results in the prolonged separation of people with immediate family members like spouses, elderly parents and children, forcing them to maintain long-distance relationships. This has led to a significant strain on emotional bonds and disrupted effective communication.

Additionally, families in Nepal increasingly rely on the remittances sent by their migrant members, which partially eases their economic hardships but instigates a degree of dependency for financial support on those members. This has concurrently underscored an escalating demand for geriatric care in Nepal.

Geriatric care

There is a pressing need to improve healthcare services dedicated to the elderly population in Nepal. Specialised geriatric clinics, trained geriatricians and a focus on preventive care are needed to address the unique healthcare needs of elderlies. As loneliness and social isolation are shared among the elderly people left behind, community-based programmes, senior centres, and other initiatives to promote social interaction are a must to alleviate these issues.

Several studies report that older adults are frequently at risk of developing mental disorders, such as depression and anxiety, especially when they feel isolated or abandoned. Therefore, accessible, uncomplicated mental health services impart a significant difference in the overall well-being of the elderly.

So far, a specialised and internationally endorsed caregiving service does not exist in Nepal. The elderly are bound to seek assistance from untrained, informal caregivers, many of whom are often exclusively their incompetent family members. Since the caregiver training initiative dedicated to senior citizens is a contemporary requirement in Nepal, a training course syllabus endorsed by certified geriatric institutes should be developed. Aspiring professional caregivers and caregiver family members should be supported by providing tailor-made training and respite services to better care for their ageing loved ones. The Ministry of Health and Population and other concerned authorities should collaborate with national and international geriatric institutes to make this possible.

As the overall health system in Nepal is still fragile, the government should identify the healthcare challenges posed to the elderly population due to brain and muscle drain, and implement steps to address the needs of the ageing population. The Ministry of Health and Population has recently developed a Geriatric Health Service Strategy after recognising the vulnerability and rights of senior citizens to build a state capacity to support healthy ageing and provide quality health care to senior citizens. However, the ten-year plan (2021-2030) is still in its initial phase, and there haven’t been any remarkable results. If implemented optimally, this strategy will be a game-changer in addressing senior citizens’ health and social concerns.

To reiterate, the trend of Nepali citizens seeking opportunities abroad has created a growing need for geriatric care within the country. Adapting to this demographic shift by providing comprehensive healthcare services, social support networks and caregiver assistance, ensuring that the elderly can age with dignity and receive the care they deserve is imperative. By addressing the unique needs of older adults, Nepal can better navigate the challenges posed by the abroad-going trend and ensure the well-being of its ageing population. This will be a fitting tribute to the senior citizens who serve as the guiding force behind our existence.