BMC Geriatrics · 9 authors, 9 centres
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This cross-sectional study of 864 older adults (≥60 years) in the Rohingya refugee camp in Bangladesh found that 26.5% had limited self-reported functional ability, with the highest difficulties in grooming (33.2%) and bathing (31.8%). Key determinants included age ≥80 years, female sex, low memory/concentration, loneliness, and living on aid alone. The findings highlight an urgent need for targeted interventions addressing functional limitations in this vulnerable refugee population.
{"Background": "The global population of older adults is growing rapidly, and functional limitations become increasingly prevalent with age. Rohingya refugees in Bangladesh live in the world's largest refugee camp, with extreme overcrowding (~40,000 people per km\u00b2), poor access to clean water, sanitation, and hygiene (WASH) services, and limited healthcare. These conditions may disproportionately affect older adults' functional ability. While prior studies have documented functional limitations in other refugee populations (e.g., 60% of Syrian older refugees faced ADL difficulties), no study had specifically examined functional status among older Rohingya adults. This study aimed to determine the prevalence and determinants of self-reported functional status among older adults (\u226560 years) in the Rohingya refugee camp.", "Methods": "A cross-sectional study was conducted between November and December 2021 in five selected sub-camps of the Rohingya refugee camp in Cox's Bazar, Bangladesh. A sample of 973 older adults was calculated assuming 50% prevalence, 5% margin of error, 95% confidence level, 80% power, and 25% non-response rate; 864 participants consented (response rate 88.8%). Simple random sampling was used from a list of all eligible individuals (verified by UNHCR SMART cards). Functional status was measured using the Barthel Index (score 0\u2013100; \u226460 = limited functional ability). Data on sociodemographics, self-reported chronic diseases, and lifestyle factors were collected via face-to-face interviews using a pre-tested semi-structured questionnaire in the Rakhine language, administered electronically via SurveyCTO. Loneliness was measured using the 3-item UCLA Loneliness scale. Multiple logistic regression with backward elimination (AIC criterion) was used to identify factors associated with limited functional ability. Model fit was assessed via Hosmer-Lemeshow test, AUROC, and VIF.", "Key Results": "Overall, 26.5% of participants had limited self-reported functional ability (male: 22.6%, female: 31.5%). The most common functional difficulties were grooming (33.2% inability), bathing (31.8%), stair use (13.2%), and mobility (10.7%). In the final adjusted logistic regression model, factors significantly associated with limited functional ability included: age \u226580 years (aOR = 2.01, 95% CI: 1.08\u20133.75, p = 0.027) compared to age 60\u201369 years; female sex (aOR = 1.44, 95% CI: 1.04\u20132.00, p = 0.027); low memory or concentration (aOR = 1.83, 95% CI: 1.30\u20132.56, p < 0.001); feeling of loneliness (aOR = 2.89, 95% CI: 1.74\u20134.80, p < 0.001); and living on aid alone (aOR = 2.30, 95% CI: 1.09\u20134.85, p = 0.029) compared to monthly family income \u22655000 BDT. The model showed good fit (Hosmer-Lemeshow p = 0.355) and moderate discrimination (AUROC reported in supplementary file); no serious multicollinearity was detected (VIF < 5).", "Clinical Implications": "This is the first study to examine functional status specifically among older adults in the Rohingya refugee camp. The 26.5% prevalence of limited functional ability is substantial and comparable to rates in other refugee and rural settings (e.g., 24.7% in rural Malaysia, 28.3% in rural Nigeria). The strong associations with modifiable factors\u2014loneliness, low memory/concentration, and economic dependency on aid alone\u2014suggest actionable targets for intervention. The authors recommend comprehensive interventions including family/caregiver support, social and physical activities, nutritional support, and income-generating activities. Currently, only a few organizations (e.g., YPSA, HelpAge International) provide limited services for older adults in the camp. The findings underscore the need for policymakers and humanitarian agencies to prioritize age-friendly infrastructure (e.g., accessible latrines, WASH facilities), mental health support, and economic empowerment for older Rohingya refugees. Limitations include the cross-sectional design (causality cannot be established), purposive selection of sub-camps (potential generalizability concerns), self-reported data (possible recall bias), and lack of qualitative data on social context."}