Demographic distribution of elderly in nepal

INTRODUCTION ABOUT NEPAL AND NEPALI PEOPLE INCLUDING ELDERLY PRESENT IN Nepal

Nepal being the landlocked country is having border with the India from three sides and the China from one side. Nepal is relatively beautiful country with the area of 141, 181 sq. km in the south Asia region, having 885 km in the east-west direction and with the mean north-south width of 193 km. Financially Nepal is not considered strong but culturally, Nepal is rich for its diversity, peculiarity, and uniqueness. Nepal has 101 ethnic groups, 92 languages, 10 religions and 3 geographical regions and a population of 28.6 (2005 census) million people living 157 persons per sq km which was just 40 in 1911. The 2001 census showed that 57.5 % of the population belonged to a caste, 2/3 of them living in the hills and 1/3 in the Tarai. Dalits (untouchables) who make up 13.6% of the population are one of the most disadvantaged and backward groups2. It has five development regions: Eastern, Central, Western, Mid-western and Far-western with 14 zones, 75 districts, 58 municipalities and 3915 village development committees which are further divided into small political units called wards. National standard living survey 2003/4 reports that poverty incidence decreased from 42% in 1995/6 to 31% in 2003/4, however rural urban disparity still exist (rural poverty-35% and urban poverty-10%). A significant increase in remittances, increase in wages, improved connectivity and access to markets, urbanization, and falling birth rates were behind this decline. Household receiving remittances went up to 32% in 2004 from 23% in 1996 (MoF, 2006).

AGE DISTRIBUTION IN NEPAL

Ageing is the ultimate manifestation of the biological, psychological, and demographical activities in the individual human being and population in large. Nepal is having the sum total of population of 28,676,547 (2005 census). Persons of age 60+, is considered as the elderly in the context of the Nepal. The elderly population is 10,61032, a 7.46% of the total population.
Age structure: According to the census 2003
0-14 years: 39.7% (male 5,424,396; female 5,080,171)
15-64 years: 56.7% (male 7,692,134; female 7,320,059)
60 years and over: 7.46% (male 468,697; female 484,112) (2003 est.)
According to the census 2005

Data Size
Population
28,676,547 (2005)
Growth Rate 2.2%
Population below 14 Years old 39%
Population of age 15 to 59 57.3%
Population above 60 7.46%

Pyramid showing the population of Nepal
Age distribution by major age groups, prior and post 1951.
Prior 1951 Post 1951
Age group 1911 1941 1971 2001
0-14 38.68 39.16 39.72 39.31
60+ 4.28 5.33 5.88 7.46
65+ 2.43 3.17 3.17 4.21
75+ 0.45 0.65 0.87 1.30

The above data implies that Nepal is in the state of development, as the youths ranging from 14-59 are in the majority. Nepal is having relatively few numbers of aged people in comparison with the other groups of the people; however, the older population is increasing both in terms of absolute numbers and as a proportion of the total population; unfortunately, traditional family norms and values of supporting the elderly are eroding. There were 1.6 million elderly inhabitants which constitutes 7.46% of the total population in 2001 which will be double by 2017. Persons of 60+ years are known as elderly people in Nepal, the index of ageing has increased from 11.7% in 1911 to 18.89% by 2001. For the aged 65+ years, the increment is from 6.28% in 1911 to 10.69% by 2001. The rate of increasing older people is rapid from 1971 to 2001. During the period 1991–2001, the annual elderly population growth rate was 3.39%, which was higher than the annual population growth rate of 2.1%. Increasing in the ageing population is mainly due to advancement and easily availability in the health services. This increasing number of elderly in Nepal is enforcing government to change the policy towards the helping of the elderly people and building of infrastructure considering elderly people.


Sex ratio:
at birth: 1.05 male(s)/female
under 15 years: 1.07 male(s)/female
15-64 years: 1.05 male(s)/female
65 years and over: 0.97 male(s)/female
total population: 1.05 male(s)/female (2003 est.)

MORTALITY AND MORBIDITY CONDITION OF ELDERLY IN NEPAL
Mortality Rate among Aged Persons
Though starting age of ageing is considered as 60 years in most of the previous discussions, 50 years age is considered for the starting age for high risk mortality among aged persons. It is based on common observation that by a person reaches 50 years, multitude of Physiological and Psychological problems start to show their effects on the physical health of a person accelerating the risk of his/ her death as age advances.
Adjusted death rates among aged persons, Nepal, 2001.
Age Group Male Female Both Sexes
50 – 54 18.70 11.87 14.24
55 – 59 30.04 20.69 23.77
60 – 64 47.59 32.85 37.46
65 – 69 64.39 47.84 52.38
70 – 74 103.10 72.60 82.12
75 – 79 149.89 97.08 114.55
80 + 296.28 211.13 235.35
All Ages 13.89 9.73 11.00
Median Age at death 78.10 81.60 79.52
Source: Present study, based on Census, 2001, CBS

Unadjusted death rates for all ages according to 2001 census report are found only 5.24 per thousand for males, 4.15 per thousand for females and 4.7 per thousand for both sexes. These rates are very low as compared to 11 per thousand reported for both sexes in U.N’s population data sheet for 2002.271. The above table shows that up to age group 50-54 years, the death rates for both sexes are only 3% to 5% higher than for all ages. .But as age advances, the rate substantially increases for both sexes and at age 80 years and above, the rate attaining the levels of 296.28 per thousand for males, 211.13 per thousand for females and 235.35 per thousand for both. From the table, it is clear that among aged persons, death rates for females are much lower than for males. Median age at death for aged 50 + years persons is found as 78.1 years for males, 81.6 years for females and 79.52 years for both sexes.

Deaths occur at old age due to many causes. One cause is the natural processes due to ageing .Others are due to various diseases, accidents and suicides etc. Twenty five specific reasons of deaths are included in Census inquiry of 2001. Data analysis of deaths by specific reasons for 65+ years aged persons by sex shows that highest of 41.33% deaths among males aged 65+ years occurred due to Natural rules followed by 21.66% due to other causes not included for the inquiry. Among females, highest of 26.97% deaths occurred due to causes not included for the inquiry, followed by 16.97% due to Natural rules. Excluding the cases of Non-stated which accounted to 7.45% in case of males and 8.05% in case of females, third specific cause is the Asthma which caused 11.02% of deaths among aged males and 7.68% of deaths among aged females followed by cancer causing 3.11% of death among males and 4.61% of death among females. Next to cancer, tuberculosis and heart diseases are the main causes of deaths among males, but among females, miscarriage and heart disease followed by the Cancer for causing more deaths.

The 85% of elderly people are living in rural areas depending upon their agricultural profession and living under the poverty due to lack of access to resources and income generation activities. They suffer from the cumulative effects of a lifetime of deprivation, lack of education, poor health and nutrition, low social status, discrimination and restriction on mobility, entering old age in a poor state of health and without saving or material assets. They lack means to fulfill their basic needs such as food, clothes, shelter, health care, love and safe drinking water. Gender inequality and discrimination against women continue from before birth to death (NEPAN, 2002).

LITERACY OF ELDERLY PEOPLE
The literacy rate (those who can read and write) for aged 65+ years is found as 27.0% for males and 4.07 % for females and 47.12% are found economically active with sex differential of 59.7% for males and 34.30% for females. For both sexes, the literacy rate for aged 65+ years is found as 15.64 %. But for districts of Katmandu valley, the literacy rates for both sexes are found much higher than those observed for all Nepal. Low elderly literacy rate is due to the political situation of the Nepal. Nepal had been ruled by the Rana’s (one of the caste of Nepal), who tried to suppress the education of the population for their benefit, so that they can rule the country for long time. Government later on tried to increase the elderly literacy with some education program developed mainly for the women and the elderly people and they succeeded to somewhat. Elderly literacy in Nepal is even affected with the ethnic group as well. The Brahaman elderly are more literate than other ethnic group as they have to perform some cultural activities and they occupation which requires education.
Literacy:
definition: age 15 and over can read and write
total population: 62.8%
male: 69.7%
female: 55.9% (2003 est.)
MARITAL STATUS OF THE ELDERLY
The marital status of the elderly is an important indicator of their places of residence, their support systems and, importantly, their individual well-being. The elderly that are still married tend to recover more rapidly from illness, have better mental health, utilize more health promoting services, socialize more and are generally more satisfied with their lives than those elderly without a partner.
In 1961, only 73.17% male and 32.13% females were married, which increased to 88.3% for male and 71.7% for females in 2001. The lower proportion of married elderly women may be due to society’s strict prohibition of widow remarriage. This prohibition is in addition to and exacerbated by the male tendency of marrying a younger woman. In Nepalese culture, widower remarriage is not accepted before centuries, during ruling by Rana’s. One of the Rana Prime Ministers later on bring changes in the policy and allowed the widowers remarriage. Though it’s legally allowed and accepted, widower remarriage is still not in good practice among the Nepalese citizen. Males marrying multiple women are not allowed in the Nepal. The proportion of never married elderly in Nepal is low, possibly due to the prevalent universal marriage system in that society. Many parents in that society believe they are responsible for the marriage of their offspring. Arranged marriages are common in Nepal. Love marriage in proportion to arrange is relatively minimal.
ETHNICITY:
The population in Nepal is made up from diverse ethnic groups. The largest single ethnic group is Chhettri (16%), followed by: Brahman-Hill (13%), Magar (7), Taru (7%), Tamang (6%), Newar (5%), Muslim (4%), Kami (4%), Yadav (4%) and ‘other’ (34%). The number of elderly present in Nepal has great effect due to the ethnicity of Nepal as different ethnic group perform different activities according to the ethnic culture. Chettetri ethnic people have different celebration days than the other group and have different kind of belief followed by different types of eating habits. Chettri, are the people mostly found in the Kathmandu and gives emphasis to the groupism and strength. While as newar are mostly resident of the capital city Kathmandu and gives emphasis to the socialization, sharing and parties. They tend to be more cultural and social than the other ethnic group. They have lots of cultural celebrating days. The elderly people above 75 in this ethnic group are considered to be the god, so they give more emphasis to the elderly people. Newar elderly seem to be little conservative on the matter of health as they believe that sickness is merely the curse from the god than from the disease. The local elderly living in the Kathmandu are very much conscious about their health and will be seen gradually taking part in the health promotional activities and social activities. Gurung, tamang, tharu are found mostly far from capital city and they are very sociable. They believe ancestors are the gods and praise the elderly people.
RELIGION:
Since Nepal is the only official Hindu state in the world, the majority of the population in Nepal practice the Hindu religion (86% of the population), whilst the remaining religions are represented by Buddhists (8%), Muslims (4%) and ‘other’ (2%). Though other religions are negligible in comparison to the others, there are some total of 10 religions can be found in the Nepal. The elderly of Hindu religion are sociable enough but not as the Buddhist, who constantly takes part in the social activities and will be found active in the gumba (religious place). Buddhist religious people tend to have more elderly people according to the religious belief and their eating habit, than the other group. Buddhist religious people are mostly vegetarian and non-violent as their religion is against the violence and eating meat. Buddhist elderly have less common problems with mental health, as they would be relatively taking part in the social activities and would not be lonely. The elderly people in the Buddhist religion are given more value by the younger and give them respect and considered as the teacher. While as in the other religion, this is not so often seen.
OCCUPATION:
Among 65+ years aged persons, 47.12% are found economically active with sex differential of 59.7% for males and 34.30% for females.

Economically active among aged 65+ years , by development regions, 2001 in
%’s.
Region Male Female Both Sexes
Eastern Dev. Region 62.02 35.28 48.74
Central Dev. Region 58.66 29.84 44.20
Western Dev. Region 58.88 36.39 47.86
Mid-Western Dev. Region 5ng the5.04 32.83 44.60
Far-Western Dev. Region 65.31 46.12 55.58
Nepal 59.70 34.30 47.12
Source : Based on Census 2001, CBS.

The table shows that Far Western Region as compared to other development regions has the highest percentage of aged persons among both sexes who are economically active. On the other hand, Central Region as compared to other regions has the least % of females aged 65+ years that are economically active.
Most of the people in the Nepal tend to be dependent on the farming as their occupation and only few percentage are involved with other occupation. So does the elderly people in the Nepal. Elderly people above 65 can be seen working in the field, and enjoying their life. When elderly people will not be able to work in the field, they will be involved with some other occupation such as knitting of the mattress by the males and sweaters and other stuffs by the females. So the elderly population keeps themselves productive most of the time.
LANGUAGES:
In Nepal Nepali is the national languages used all over the Nepal. While as each caste and each ethnic group in the Nepal tend to have their own language. According to governmental record there are around 90 languages in the Nepal. Most of the elderly in the Nepal can speak can understand Nepali very well, while as English is not so common among the elderly people of the Nepal. They tend to speak their own mother tongue, language according to their ethnicity and caste, in their house and with their relatives and Nepali with other visitor from different locality and different ethnicity. Elderly people tend to give emphasis on their mother tongue language then in others. They constantly encourage younger to speak ethnic language. Language does not have great effect on the health and belief of the elderly, but elderly seems to be proud of their own language.
CONCLUSION:
Nepal is the country with vast diversity in the culture and in the ethnic group; where there is different beliefs are prevalent among the elderly people according to their caste and religion. Increasing number of elderly population in Nepal is demanding for changes in the policy for the elderly. Government and local population has to take in consideration in the services provided to the elderly as the number of increasing in elderly is more than the total population increase. More services and facilities are to be given for the elderly people and lots of elderly homes and special hospitals for the elderly are to be made considering the elderly number increasing. The numbers of elderly people are increasing in the Nepal, which shows that Nepal is in state of development. The present ageing index 65+ years of 10.69% is expected to increase to 12.65% by 2031. Elderly people tend to me more sociable in the Nepal, so youth should encourage them to be more sociable by supporting them and giving opportunities for them as it might decrease the morbidity, mortality and mental health problem in elder people. Youths support to the elderly people would be greatest help for the elderly people than the governments support as elderly in Nepal love to be sociable and be with people around them.
Elderly people should be given increase access to the information regarding their rights at home and in the society including their rights to governmental services provision as most of the elderly literacy percentage is relatively low. More of the elderly literate program to be run in the county, so to increase the literacy rate among the elderly and women.

community health nursing

Community health nursing is the nursing care given to the people living in the community, which referrers to the certain area where people are living. Community health nurses have to provide the care of the community as if they are providing care to the patient in the hospital. Community health nurses has to visit the individual homes and the people living in the home and assess the problems of the people, not only that much, they have to find out the people who might need the special care and who has been hidden by the family members due to some problem and report those people to right place. Community health nursing is the new trend of the nursing evolved in the nursing faculty and community health nurses has to meet some standards of practice.
Standards of Community health Nursing Practice
1. Theory
The nurse applies theoretical concepts as a basis for decision in practice.
2. Data collection
The nurse systematically collects data that are comprehensive and accurate.
3. Diagnosis:
The nurse analyses data collected about the community family and individual to determine diagnoses.
4. planning
At each level of prevention, the nurse develops plans that specify nursing actions unique to client needs.
5. Intervention
The nurse guided by the plan intervenes to promote, maintain, or restore health to prevent illness, and to effect rehabilitation.
6. Evaluation
The nurse evaluates response of the community, family and individual to interventions to determine progress toward goal achievement and to revise the data base, diagnoses, and plan.
7. Quality assurance and professional development
The nurse participates in peer review and other means of evaluation to assure quality of nursing practice. The nurse assumes responsibility for professional development and contributes to professional growth of others.
8. Interdisciplinary collaboration
The nurse collaborates with other health care providers, professional and community representatives in assessing planning implementing and evaluation programs for community health.
9. Research
The nurse contributes to theory and practice in community health nursing through research.

Mentioned above are the standards that the community health nurses have to meet in their practices. Below are the some activities that community health nurses have to accomplish while in their practice.
1. Takes preventive or corrective action individually or in partnership to protect individuals and communities from unsafe or unethical circumstances.
2. Advocates for societal change in support of health for all.
3. Uses nursing informatics (including information and communication technology) to generate, manage and process relevant data to support nursing practice.
4. Identifies and takes action on factors which affect autonomy of practice and quality of care.
5. Participates in the advancement of community health nursing by mentoring students and new practitioners.
6. Participates in research and professional activities.
7. Makes decisions using ethical standards and principles, taking into consideration the tension between individual versus societal good and the responsibility to uphold the greater good of all people or the population as a whole.
8. Seeks help with problem solving as needed to determine the best course of action in response to ethical dilemmas, risks to human rights and freedoms, new situations and new knowledge.
9. Identifies and works proactively—through personal advocacy and participation in relevant professional associations—to address nursing issues that will affect the population.
10. Contributes proactively to the quality of the work environment by identifying needs, issues and solutions, mobilizing colleagues and actively participating in team and organizational structures and mechanisms.
11. Provides constructive feedback to peers as appropriate to enhance community health nursing practice.
12. Documents community health nursing activities in a timely and thorough manner, including telephone advice and work with communities and groups.
13. Advocates for effective and efficient use of community health nursing resources.
14. Uses reflective practice to continually assess and improve personal community health nursing practice.
15. Seeks professional development experiences that are consistent with current community health nursing practice, new and emerging issues, the changing needs of the population, the evolving impact of the determinants of health and emerging research.
16. Acts upon legal obligations to report to appropriate authorities any situations of unsafe or unethical care provided by family, friends or other individuals to children or vulnerable adults.
17. Uses available resources to systematically evaluate the availability, acceptability, quality, efficiency and effectiveness of community health nursing practice.