Prevalence and determinants of quality of life among Rohingya older adults residing in the refugee camp in Bangladesh

Abstract

Background

Ensuring a good quality of life (QOL) among older refugees is a critical yet underexplored aspect of humanitarian support. Older adults in refugee settings often face unmet basic and healthcare needs, which adversely impact their QOL. This study examines the level of QOL and its determinants among older adults residing in Rohingya refugee camp in Bangladesh.

Methods

A cross-sectional study was conducted in five sub-camps of Rohingya refugee camp in Cox’s Bazar, Bangladesh, between November and December 2021. The study participants were older adults (≥ 60 years), and data were collected using face-to-face interviews. QOL was assessed using the Older People’s Quality of Life (OPQOL-brief) tool, and data on socio-demographics, self-reported diseases, and lifestyle factors were collected via a pre-tested questionnaire. Multivariate logistic regression identified factors associated with QOL.

Results

Among 864 participants, the majority were male (56.3%), aged 60–69 years (72.3%), and married (79.1%). Approximately three-quarters (71.6%) of participants reported having good QOL. Females (aOR = 0.69, 95% CI: 0.49–0.98), married participants (aOR = 0.48, 95% CI: 0.31–0.74) and those with non-communicable diseases (NCDs) (aOR = 0.54, 95% CI: 0.39–0.75) had significantly lower odds of good QOL than their respective counterparts. Conversely, individuals who were employed (aOR = 3.67, 95% CI: 1.77–7.62), and those living with families (aOR = 1.85, 95% CI: 1.12–3.04) had higher odds of good QOL than their counterparts.

Conclusion

The study found that more than one quarter of the Rohingya older adults did not exhibit a good quality of life, and females, unemployed, married participants, and those who were not living with families and suffering from NCDs were at risk. Targeted interventions are needed particularly for subgroups such as older females and those with chronic conditions. Policymakers and humanitarian organizations should prioritize strengthening social support, particularly for those living alone, to improve self-sufficiency, emotional well-being, and overall QOL.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-025-06227-7.

Introduction

The Rohingya people, an ethnic minority group displaced from Myanmar [1], are among the largest stateless populations globally. Forced to flee widespread military violence, many sought refuge in the overcrowded and under-resourced refugee camp of Cox’s Bazar, Bangladesh [2]. As of 2023, approximately one million Rohingya refugees resided in the camp, including over 38,000 older adults aged 60 and above [3]. With a staggering population density of 40,000 per square kilometer [4], far exceeding international humanitarian standards for refugee housing [5], Rohingya camp face severe shortages in clean water, sanitation, hygiene (WASH), and essential healthcare services [4, 6]. Older adults residing in the camp contend with compounded challenges: the trauma of displacement, a lack of basic facilities, and overwhelming mental health burdens—all of which can reduce their quality of life (QOL) [7].

QOL, as defined by the World Health Organization (WHO), encompasses individuals’ perceptions of their well-being in relation to their goals, standards, and societal context [8]. Refugees endure pre-migration stressors such as torture, war, and loss [9–11], alongside post-migration stressors including social exclusion, loneliness, hardship and diminished support [12, 13], which collectively contribute to mental health problems like post-traumatic stress disorder (PTSD), depression, and anxiety [14–16]. These issues, along with weak social integration and fragile social networks [17, 18], often undermine their QOL [19, 20], particularly among vulnerable subgroups like older adults, who face additional risks from non-communicable diseases (NCDs) [21], functional immobility [22], and inadequate social support [23].

Humanitarian organizations, constrained by limited resources and prioritizing younger age groups, often overlook the basic needs of older adults in refugee settings. Essential services such as healthcare, nutrition, and WASH remain inadequate, compounded by poor infrastructure, limited access to care, and insufficient healthcare facilities, leaving older refugees particularly vulnerable [24, 25]. Although programs by organizations like HelpAge International [26] and Young Power in Social Action (YPSA) [27] offer some support to older population in Rohingya camp in Bangladesh, significant gaps including limited program coverage and tailored humanitarian support such as food aid suitable for older adults, access to aid centres, health care and WASH support, old age allowance and livelihood opportunities persist, and efforts remain fragmented, failing to fully address their unique challenges. Moreover, a critical lack of evidence on specific needs, target populations, and factors influencing QOL among older refugees hinders implementation of effective interventions.

Despite the significant number of Rohingya older adults residing in refugee camp in Bangladesh, limited research has specifically focused on their QOL, leaving substantial gaps in the literature. Existing studies have provided insufficient insights into their unique challenges and needs. For instance, Hossain and colleagues [28] conducted a study prior to the COVID-19 pandemic to examine the correlation between depression and health-related QOL among Rohingya camp residents. This study, involving 150 participants, with 10% of them being older adults, found an inverse relationship between depression and health-related QOL. Similarly, another study [29] showing the negative impact of COVID-19 on QOL among Rohingya adults in the camp only had 4% of the participants being older. While the abovementioned studies focused on exploring QOL for Rohingya adults, they did not focus on older adults exclusively. So, the unique challenges faced by Rohingya older adults, such as high prevalence of chronic illness [30], limited access to health care services [31] and risk of loneliness [32] that impact the quality of life of older adults were not explored in depth. Consequently, the current evidence base is limited in terms of overall QOL and associated factors among Rohingya older adults in the camp. There is an urgent need to address this research gap to inform policy and practice.

The present study aimed to address the gaps in the QOL of older refugees by systematically examining its prevalence and associated individual, health, and social determinants among Rohingya older adults residing in refugee camp in Bangladesh.

Methods

Study aim, design, setting of the study

This cross-sectional study was conducted between November and December 2021 among older adults aged 60 years and above living in the Rohingya refugee camp to explore their QOL. To estimate the required sample size for detecting a meaningful difference in the proportion of individuals reporting good versus poor quality of life (QOL), a power analysis was conducted using a one-sample proportion test (Wald test) [33]. Assuming a baseline proportion p0 = 0.50 and aiming to detect an increase to p1 = 0.55, with 80% power (1 − β = 0.80) and a 5% significance level (α = 0.05), the sample size was estimated using the following formula:

Where:

• is the average of the two proportions,

• ​ is the critical value for a two-tailed test at the 5% level (≈ 1.96),

• ​ is the critical value corresponding to 80% power (≈ 0.84).

Using this method, the required sample size was calculated to be 778. To account for an anticipated 20% nonresponse or attrition rate, the target sample size was inflated to approximately (778/0.80=) 973 participants.

According to the sample calculation, we approached 973 randomly selected individuals, however, 864 consented to participate, resulting in a response rate of 88.8. The study was conducted in collaboration with a local NGO, which provided a comprehensive list of all Rohingya older adults (aged ≥ 60 years) residing in five sub-camps within the camp (where the participating NGO was working), which served as the sampling frame for the study. A member of the research team used computer-generated simple random numbers to randomly select the required number of participants from the sampling frame.

Inclusion criteria for participation were being aged 60 years or older and currently residing in the Rohingya refugee camp for at least one year. Participants’ ages were verified using smart cards issued by the United Nations High Commissioner for Refugees (UNHCR), which served as identification. Individuals were excluded if they self-reported any clinically diagnosed mental health conditions, such as schizophrenia, bipolar mood disorder, or dementia/cognitive impairment, or if they were unable to communicate effectively.

Measures

Outcome variable

The outcome variable was the quality of life, assessed using the brief version of the Older People’s Quality of Life (OPQOL-brief) scale [34] translated into Bengali. The OPQOL-brief is a reliable and valid tool, developed based on the perspectives of older adults [34]. It has been widely used, translated into multiple languages, and validated in various populations, making it an effective instrument for assessing QOL in older age across diverse cultural contexts [35–37]. The OPQOL-brief comprises 13 questions addressing key aspects of life, including health, social relationships, independence, psychological well-being, and financial circumstances. Participants rate their agreement on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The total score ranges from 13 to 65, with higher scores indicating a better QOL. In line with prior studies [38, 39], the total score was dichotomized, with a median score of 45 (70% or above) representing good QOL, while scores below 45 indicated poor QOL. The scale’s reliability among the study participants was confirmed to be highly acceptable (Cronbach’s α = 0.93).

Explanatory variables

Explanatory variables for the study were carefully selected based on a comprehensive review of relevant literature [39–42] to capture a wide range of demographic, social, and health-related factors that could influence the QOL among older adults. These variables included age categorized as young old [30, 43–51], middle old [52–61], and very old (≥ 80 years) [62], sex (male/female), marital status (currently married/without a partner), and literacy (unable to read and write/able to read and write). Socioeconomic variables such as family size (≤ 4 or > 4 members), household monthly income source (aid only/aid plus other income sources), and current occupation (employed/unemployed) were also included. Living arrangements (living alone or with family) and health-related variables like the presence of NCDs were also considered.

Self-reported data on pre-existing NCDs—including arthritis, hypertension, heart disease, stroke, hypercholesterolemia, diabetes, chronic respiratory diseases, chronic kidney disease, and cancer—were gathered by asking participants whether they had ever been diagnosed with any of these conditions by a healthcare provider. Based on their responses, participants were categorized as either having at least one NCD or not (yes/no).

Data collection tools and techniques

The English version of the questionnaire including OPQOL items and background variables (supplementary file 1) was translated into the Bengali language and then back-translated into English by two staff members of a participating local NGO to ensure accuracy. The Bengali version was pre-tested with a small sample (n = 10) of Rohingya older adults to refine its content, language and structure, though no modifications were deemed necessary. The participants participating in the pre-test of the questionnaire were not included in the final sample. Data were collected using this final Bengali questionnaire using the SurveyCTO mobile app (https://www.surveycto.com/) by twenty-two trained enumerators. All enumerators were local residents with prior experience administering health surveys on electronic platforms. Before data collection, the research team conducted a three-day intensive training program on the tools and techniques of the study. Face-to-face interviews with participants were conducted using the final questionnaire, with each interview lasting approximately 30 min.

Statistical analyses

To summarize the demographic, social, and health characteristics of the participants, descriptive statistics were presented as frequencies and percentages. A bivariate analysis, specifically the chi-square test, was performed to assess the associations between explanatory variables and QOL.

To identify the factors associated with QOL, both unadjusted and adjusted logistic regression analyses were conducted. A backward elimination approach, guided by the Akaike Information Criterion (AIC), was employed to refine the model by selecting the most relevant variables. Initially, the regression model included all potential predictors listed in Table 1, which were selected based on a comprehensive review of the literature [39–42]. Variables were sequentially removed from the model based on their statistical significance and impact on the AIC value to achieve a parsimonious model. The final model retained only significant variables and included age, sex, marital status, literacy, household monthly income source, current occupation, living arrangements, and non-communicable disease status. For each variable in the final model, crude odds ratios (CORs), adjusted odds ratios (AORs), p-values, and 95% confidence intervals (95% CIs) were reported to quantify associations and assess statistical significance.

Table 1.

Characteristics participants by overall and quality of life status (N = 864)

Characteristics	Overall		Quality of life		1P-value
	n	%	Good (%)	Poor (%)
Overall			71.6	28.4
Age groups (year)
Young old (60–69)	625	72.3	72.8	27.2	0.471
Middle old (70–79)	190	22.0	68.4	31.6
Very old (≥ 80)	49	5.7	69.4	30.6
Sex
Male	486	56.3	74.5	25.5	0.036
Female	378	43.8	68.0	32.0
Marital status
Married	683	79.1	70.6	29.4	0.174
2Without partner	181	21.0	75.7	24.3
Literacy
Unable to read and write	769	89.0	70.5	29.5	0.031
Able to read and write	95	11.0	81.1	19.0
Family size
≤ 4	372	43.1	70.7	29.3	0.592
> 4	492	56.9	72.4	27.6
Household monthly income source
Aid only	580	67.1	71.7	28.3	0.940
Aid plus other income	284	32.9	71.5	28.5
Current occupation
Employed	94	10.9	89.4	10.6
Unemployed	770	89.1	69.5	30.5
Living arrangements
With family	782	90.5	72.9	27.1	0.012
Alone	82	9.5	59.8	40.2
Non-communicable disease status
None	431	49.9	78.9	21.1
Has one or more diseases	433	50.1	64.4	35.6

¹P-values were derived from chi-square tests. ²The “Without partner” category includes individuals who are never married, single, widowed, or divorced

Model diagnostics were performed to ensure the robustness of the analysis. The area under the receiver operating characteristic (AUROC) curve was calculated to evaluate the model’s discriminative ability, where AUROC values range from 0.5 (no discrimination) to 1.0 (perfect discrimination), with higher values indicating better model performance. The variance inflation factor (VIF) was calculated to detect multicollinearity among explanatory variables, with a VIF value greater than 10 indicating significant multicollinearity. All statistical analyses were performed using Stata software (Version 17.0), and statistical significance was set at p < 0.05. In the diagnostics for binary logistic regression, the absence of multicollinearity was confirmed by a Variance Inflation Factor (VIF) value of less than 10 for each included variable (Supplementary file 2). Additionally, the AUROC value of 0.67 indicates a good discriminative ability of the logistic regression model to distinguish between the categories of the dependant variable (Supplementary file 3).

Results

Characteristics of the participants

The sociodemographic characteristics of the 864 participants are summarized in Table 1. The majority were young old (72.3%), with smaller proportions middle old (22%) and very old (5.7%), and lived with family members (90.5%). Males constituted 56.3% of the sample, while most participants were married (79.1%) and lived in households with four or more members (56.9%). Literacy was notably low, with 89% of participants were unable to read and write, and a significant majority (89.1%) were unemployed. Additionally, two-thirds of the participants (67.1%) relied solely on aid for their livelihood. Health-related data revealed that half of the participants (50.1%) reported having one or more NCDs (Table 1).

Quality of life among the participants

Approximately, three-quarters (71.6%) of participants reported good QOL, while 28.4% reported not having good QOL (Table 1). In bivariate analyses, several factors were significantly associated with QOL among participants. Females and those who were unable to read and write were more likely to report poor QOL compared to males (32.0% vs. 25.5%, p = 0.036) and those with formal schooling (29.5% vs. 19.0%, p = 0.031). Employment emerged as a critical factor, with employed participants reporting better QOL than those unemployed (89.4% vs. 69.5%, p < 0.001).

Living arrangements also played a significant role, as participants living with family reported better QOL than those living alone (p = 0.012). Health status emerged as a major determinant of QOL, with participants who were suffering from NCDs were significantly more likely to report poor QOL (35.6% vs. 21.1%, p < 0.001).

Factors associated with quality of life

Table 2 presents the factors associated with QOL among the participants. In the adjusted analysis, female participants had 31% lower odds of reporting good QOL compared to males (aOR = 0.69, 95% CI: 0.49–0.98). Participants who were married had 52% lower odds of reporting good QOL compared to their counterparts (aOR = 0.48, 95% CI: 0.31–0.74). Additionally, individuals suffering from NCDs had 46% lower odds of reporting good QOL compared to those without such conditions (aOR = 0.54, 95% CI: 0.39–0.75).

Table 2.

Factors associated with good quality of life among participants (N = 864)

Characteristics	1cOR	95% CI	P	2aOR	95% CI	P
Age groups (year)
Young old (60–69)	Ref			Ref
Middle old (70–79)	0.78	0	0.185	0.78	0.54–1.13	0.185
Very old (≥ 80)	0.76	0.39–1.46	0.404	0.76	0.39–1.45	0.404
Sex
Male	Ref			Ref
Female	0.69	0.54–0.98	0.037	0.70	0.50–0.98	0.037
Marital status
3Without partner	Ref			Ref
Married	0.77	0.53–1.12	0.175	0.48	0.32–0.74	0.001
Household monthly income source
Aid only	Ref			Ref
Aid plus other income	0.99	0.72–1.35	0.940	0.70	0.49–1.01	0.054
Current occupation
Unemployed	Ref			Ref
Employed	3.69	1.88–7.23		3.91	1.89–8.09
Living arrangements
Alone	Ref			Ref
With family	1.81	1.13–2.89	0.013	1.83	1.11-3.00	0.017
Non-communicable disease status
None	Ref			Ref
Has one or more diseases	0.49	0.36–0.66		0.51	0.37–0.70

¹Crude Odds Ratio, ²Adjusted Odds Ratio, ³The “Without partner” category includes individuals who are never married, single, widowed, or divorced

Conversely, participants who were employed during the survey were nearly four times more likely to report a good QOL compared to those who were unemployed (aOR = 3.67, 95% CI: 1.77–7.62). Furthermore, those living with family had 85% higher odds of reporting good QOL compared to individuals living alone (aOR = 1.85, 95% CI: 1.12–3.04).

Discussion

This study explored the prevalence and factors associated with QOL among Rohingya older adults residing in the refugee camp in Cox’s Bazar, Bangladesh. Despite having a higher proportion of participants (nearly three-quarters) reported having good QOL, over a quarter reported poor QOL. Positive associations were observed for employment and living with family, while poor QOL was more common among women, married individuals, and those with NCDs.

A notable finding of this study is that more than one-quarter of the participants reported having a poor QOL. Our findings align with previous studies that indicate older adults in refugee settings experience a poor QOL [63, 64]. Older refugees are particularly vulnerable due to a convergence of challenges associated with both aging and the unique adversities of forced displacement. Aging itself is often accompanied by a lifetime of cumulative stress and exposure to significant adverse events, such as risk of Alzheimer’s disease and other related disorders, dementia and frailty [65], and an increased burden of health issues, including chronic illnesses, injuries, and disabilities. For older refugees, these age-related vulnerabilities are compounded by the trauma and hardships of displacement. Many endure violence, loss, instability, and malnutrition during the process of displacement [66]. The experience of forced displacement introduces profound changes in familial, social, and economic aspects of life. Refugees frequently face the disruption of their social networks, including separation from or loss of family and friends, which can lead to feelings of isolation and loneliness [12, 13]. Economic difficulties, such as the loss of possessions, income, and opportunities for meaningful engagement, further compound these stressors [67]. Additionally, the psychological toll of being uprooted from their homeland, often described as “aging in the wrong place [68],” brings emotional distress and a sense of disconnection that undermines their ability to adapt and thrive in a new environment [63, 69]. These cumulative stressors—ranging from physical health challenges to psychological and social disruptions—create a complex web of vulnerabilities, which significantly impair their overall QOL [70].

Female participants report a poorer QOL compared to their male counterparts, a disparity supported by existing studies, including research on older Syrian refugees, where women were more likely to report a poor QOL [64]. Several studies have reported that women are more vulnerable to poor physical and mental health, nutrition, and functioning in both humanitarian and non-humanitarian settings [71–73]. All these factors are often exacerbated by displacement, and they tend to bear a disproportionate burden of household and caregiving responsibilities, significantly impacting their physical and mental well-being [72]. Among Rohingya women, these challenges are further magnified by entrenched gender norms and customs, limited access to education, lack of awareness about rights and resources, and constrained employment opportunities post-displacement [74]. Additionally, the intersection of these factors with the trauma of forced migration compounds their vulnerability, leaving older women particularly susceptible to poor QOL.

Our study found that married individuals reported poorer QOL than those without partners, a finding that contradicts previous studies, suggesting that refugees with partners tend to have better QOL than those without [75, 76]. This discrepancy also challenges the broader theory that marriage generally benefits health and well-being [77]. Married individuals in the context of refugee camp and older study population may experience poorer QOL due to several compounding factors. In resource-constrained settings like Rohingya refugee camp, marriage often comes with additional responsibilities, including caring for spouses, children, or extended family members, which can place significant physical, emotional, and financial burdens on older adults [43]. The challenges of supporting family amid limited resources, coupled with inadequate access to basic needs such as healthcare, food, and shelter, can exacerbate stress and strain. In many cases, the lack of privacy and personal space in overcrowded living conditions within camp can amplify interpersonal conflicts, further reducing QOL. Additionally, married individuals may face heightened anxiety over the well-being and future of their family members in the uncertain and unstable environment of a refugee camp, contributing to mental health challenges such as anxiety and depression [44]. These multidimensional stressors exacerbate their overall well-being and QOL.

Rohingya older adults with NCDs reported a poorer QOL compared to those without such conditions. This aligns with findings from studies on Rohingya populations, which show a strong link between chronic illness and diminished QOL [30]. People living with NCDs often face a diminished QOL due to a combination of physical limitations, chronic pain, increased dependence on caregivers, and the emotional burden of managing a long-term illness. NCDs, such as diabetes, cardiovascular diseases, and respiratory conditions, often require prolonged and costly treatment, imposing a significant financial burden and potentially leading to severe complications or premature death if inadequately managed [45]. For forcibly displaced individuals, the risk of developing NCDs is heightened due to a combination of unhealthy living conditions, high levels of psychological stress, and limited access to timely healthcare, all of which are common in migration and refuge contexts [46, 47]. Managing NCDs is particularly challenging for older refugees who often face barriers to basic needs such as food, clean water, shelter, and protection [48, 49]. Additional aggravating factors—such as poor healthcare access, language barriers, low health literacy, and persistent food insecurity—further complicate disease management. Older Rohingya refugees are especially vulnerable as they face a dual burden of NCDs and infectious diseases compounded by unhygienic living conditions and pre-existing health challenges [50]. The combination of these factors places immense strain on their physical and mental health, leading to a significant decline in QOL.

Our study found that older Rohingya refugees who were employed reported a better QOL than those who were unemployed, a finding consistent with research conducted among Rohingya adults living in Bangladesh [30]. Prior research also supports the idea that employment in later life promotes a better QOL among older adults [51]. While employment is traditionally associated with working-age populations, its benefits extend well into post-retirement years, especially for older refugees. Employment provides financial security, enabling access to healthcare, nutritious food, and other necessities that support physical and mental health [52]. Beyond these economic benefits, work offers an invaluable sense of purpose and accomplishment, countering the isolation and inactivity often experienced in retirement. It fosters social connections, strengthens community ties, and enhances self-worth, all of which are critical for maintaining psychological well-being [53]. For older refugees, employment or similar structured activities such as volunteering are not just about economic sustenance but also about reclaiming dignity and integrating into their new environment. However, many, such as Rohingya refugees in Bangladesh, face significant barriers to employment due to legal and mobility restrictions in the refugee camps, leaving few avenues for formal or informal work [54]. Addressing these challenges and creating tailored opportunities for post-retirement age employment or volunteering is essential to improving the overall QOL for older refugee populations.

Our study found that Rohingya older refugees living with family reported a better QOL compared to those living alone, which aligns with prior research [43]. Living alone poses significant challenges for older adults, increasing their risk of psychological distress and poor QOL [43]. Isolation is a key factor, as older adults without strong family connections often experience profound loneliness, which is closely linked to adverse health outcomes [55, 56]. In contrast, living with family offers numerous advantages. Economically, families can pool resources, share income, and divide unpaid domestic responsibilities such as cooking, cleaning, and caregiving, which eases the burden on older individuals. Additionally, family members provide instrumental support with activities of daily living during times of declining health [57, 58], in addition to offering emotional comfort, and access to healthcare services. For Rohingya older adults living alone in refugee camp, the difficulties are even more pronounced. Geographical restrictions and mobility issues hinder their ability to secure daily necessities, complete essential chores, and access healthcare. Aid collection presents additional barriers due to the distant locations of distribution points and the cumbersome size of aid packets, which are not tailored to the specific needs of older adults [59]. These challenges exacerbate their vulnerability, leading to poorer mental health outcomes, as evidenced by previous studies on Rohingya refugees. Living with family mitigates many of these hardships, providing practical support, emotional stability, and a sense of belonging, all of which are crucial for maintaining a better QOL.

Implications for policy and practice

Understanding the QOL and its associated factors among Rohingya older adults is critical for identifying their unique needs and designing effective programs to improve their well-being. Currently, only a few organizations, such as Young Power in Social Action (YPSA) and HelpAge International, focus on older adults in limited sub-camps. These organizations provide age-friendly spaces, home-based care, primary health services, psychological and family counseling, awareness sessions, referral services, and income-generating opportunities [60, 61]. However, the scale and scope of these efforts remain insufficient to meet the vast needs of this population. To address the gaps, older adults must be prioritized in every step of humanitarian response, from needs assessment to program design, implementation, and evaluation. This requires collaboration between government authorities, funding agencies, and implementing partners.

Livelihood programs such as kitchen gardening, homestead gardening, and poultry rearing should be strengthened to improve earning and engagement opportunities for older adults. Supplementary credits for purchasing items from general food distribution and e-voucher centers could also provide financial relief. Additionally, manageable employment opportunities tailored to the physical capabilities of older adults can help enhance their economic security and sense of purpose. Comprehensive care approaches that include family members and other support providers [53] can improve the living conditions, social connections, and physical health outcomes of older adults. Expanding age-friendly spaces across camp can help increase social networks and reduce isolation. Furthermore, peer support groups [78] targeting older adults, particularly those living alone, can be instrumental in fostering a sense of community and mutual assistance.

Within the existing strategy for NCD management in Rohingya camp [79], periodic mass screening campaigns, along with dedicated referral and treatment services, can address the high burden of NCDs. Reserving specific hours or days at health facilities for older adults on a weekly or biweekly basis can further strengthen accessibility and tailored care for this population. Older women, being among the most disadvantaged within the population, require targeted interventions. Community-based rehabilitation programs [80] that provide safe spaces, resilience-building initiatives, and extra support should be prioritized. Modifications to existing programs are needed to ensure their participation and inclusion, thereby addressing the significant gaps in programs aimed at improving their QOL.

Strengths and limitations

This study provides important evidence on the QOL among older forcibly displaced individuals living in low-resource settings. The findings offer valuable insights for policymakers and practitioners working with displaced communities in low- and middle-income countries. Given the long-standing exclusion and stigmatization of older refugees in humanitarian responses, these results call for an urgent need to prioritize the well-being of older adults and allocate resources to improve their QOL. One notable strength of this study is the use of local surveyors who were familiar with the study settings, ensuring cultural sensitivity and fostering trust with participants. Additionally, the study employed validated tools, which enhanced the accuracy and reliability of the data collected. The large sample size further bolsters the robustness of the findings.

There are some limitations of the current study. Firstly, it is a cross-sectional study that precludes delineation of causal and temporal relationships between QOL and its predictors. Future research should include longitudinal studies to examine the evolving dynamics of QOL and its relationship with conflict and post-displacement stressors. We also could not draw a sample from all the sub-camps within the camp, which limits the generalizability of our findings for the whole camp. Moreover, qualitative studies are needed to gain deeper insights into the lived experiences of older displaced individuals, exploring their challenges, resilience, and coping mechanisms in greater detail.

Conclusion

This study sheds light on the QOL among older forcibly displaced individuals living in resource-constrained settings, a population often overlooked in humanitarian efforts. Our findings found significant positive association of employment and family support on the QOL among this study population. Conversely, factors such as being female, married, and living with NCDs were associated with poor QOL, highlighting critical areas for intervention. By addressing gaps, identified in this study, we call for a study that provides a foundation for more inclusive and equitable responses from various stakeholders, though developing and delivering a comprehensive program that could address the unmet needs of older forcibly displaced individuals, crucial for improving QOL.

Authors’ contributions

SKM, AMA and UNY conceived and designed the study. SKM carried out the data analysis and interpretation of the result. AA, GK, PKM, AAMR and SDS contributed to writing the first draft of the manuscript. SKM, UNY, MNH, SG, SB, AMA and AA commented extensively on the draft of the manuscript to finalize it. All authors read and approved the final version of the manuscript.

Funding

This research did not receive any external funding.

Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to the organizational policy of the institution conducting the research. However, they are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

The study protocol was approved by the Institutional Review Committee of Jashore University of Science and Technology (Ref: ERC/FBST/JUST/2020–61). All methods were conducted in accordance with the guidelines set forth in the Declaration of Helsinki. Written permission to enter the camp and conduct the survey was obtained from the Office of the Refugee Relief and Repatriation Commissioner (RRRC). Informed consent was obtained from participants both verbally and in writing before the survey was administered. For participants unable to read or write, thumbprints were collected after obtaining informed consent from their legal guardians.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.