A field study assessing the health care needs of senior citizens in Upper Mustang, Nepal

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This research offers an innovative approach to enhancing the quality of life of Nepal’s elderly population. The study’s primary goal is to assess the health care status of senior citizens through a personal interview. This will later be used to determine elderly care needs. A field study was implemented in Lomanthang R.M., Upper Mustang. The main focus of this study was the visit to all i.e. 188 senior citizens, conducted through face-to-face interviews guided by a comprehensive questionnaire. Special attention was paid to the issue of quality of life, with targeted questions on the socio-emotional well-being. The field study gave us significant insight into the daily life of senior citizens in Lomanthang. All items were evaluated according to frequency and severity. The majority of seniors complained that they missed their children. Our survey reveals that a great number of seniors (38%, n = 72) consume alcohol, some to a considerable extent. It was found that alcohol was consumed to forget one’s own worries/family-related memories. The vast majority of our participants attested that their greatest happiness lies in their relationship with family and good friends or going out in sun and chatting with neighbors. Introduction The total population of Nepal is 29,164,578, including 14,253,551 males (48.87%) and 14,911,027 females (51.13%). The senior population (aged 65 years and above) included 2,021,714 individuals, comprising 977,945 males (48.4%) and 1,043,769 females (51.6%). Senior citizens now represent 6.9% of Nepal’s total population (Nepal Population and Housing Census, 2021). The data underscores the potential demand for elderly care. Mustang in Nepal is a remote region, divided in five rural municipalities, one of which is Lomanthang R.M., situated at an altitude of 3800 meters above sea level, further subdivided into five wards, each encompassing one to three villages. It consists of approximately 500 households, with a total of 1’450 residents. Here the elderly population is as high as 13%, comprising 188 senior citizens (Table.1). For the whole area of Mustang, there is only one district hospital in Jomosom, located approximately 90 miles down the valley (half-day travel by Jeep). Table 1: Senior Population Nepal Census 2021 Age NEPAL LOMANTHANG Total Male Female Total Male Female All ages 29,164,578 14,253,551 14,911,027 1,430 643 787 65 + 2,021,714 977,945 1,043,769 188 87 101 Age ratio* 10.6 % 17.1 % Prevalence* 6.9 % 13.1 % *Age ratio: number of seniors in relation to the group of working people (15-64 y) *Prevalence: number of seniors in relation to the total population Compared to other regions, the need for elderly care is more pronounced in rural areas such as Lomanthang R.M. (Kalasha Foundation, 2024). This region appears to be almost abandoned due to geographical and environmental difficulties despite its stunning beauty and a few other religious and cultural significance (Darnal, 2017). The global population is growing, and the senior population is rising in high- and middle-income countries and low-income countries (World Health Organization, 2016). The demographic change is visible not only in Europe or specific regions like Switzerland or Australia but also in South Asia, including Nepal (Chalise, 2022). However, Nepal’s situation is becoming increasingly skewed since social and health infrastructure are insufficient to accomodate the elderly. Numerous articles have urged policymakers to enact proper policies and regulations so that the life of elderly citizens can be enhanced (Joshi et al., 2018). The World Health Organization’ Global Strategy and Action Plan on Ageing and Health (2016–2020) states that the problem is not aging per se but rather the accelerated risk of chronic disease and functional impairment that occur simultaneously. Nepal’s life expectancy is 71,1 years, which has considerably increased in recent decades (World Bank, 2023). It is still lower than in most developed countries, e.g., in Switzerland, currently 81.6 years for men and 85.4 years for women. (Kalasha Foundation, 2024). In comparison, other close-by developing countries like Sri Lanka (77.0 years), Bangladesh (73.6 years), and India (70.9 years) capture similar trends, both tracking the regional progress and the dominating inequalities in global health measures. Residents in rural areas primarily depend on income from traditional farming and remittances from their children (Acharya et al., 2023; Shrestha et al., 2021). To increase the quality of life and social security of the aging population, further research is needed before sustainable policies can be developed (Joshi and et.al., 2018; Acharya et al., 2023). Such challenges require a thorough scientific study of the current situation, finding problems and implementing resources. For this practical solution the project senior citizen care (SCC) has been developed. In its first part, it included the field study in Lomanthang in summer 2025, where we organized visits to all senior residents. A questionnaire was used to record general living conditions and determine the health status and social well-being of senior citizens. We intend to report on the data we collected by this study, which underscores the immediate need to address the quality of life of the elderly population. However, we discovered a gap between the stunning beauty of the place and the complete lack of quality of life, relating to health, transportation, family members, and a few other physical and psychological needs of the senior citizens at the place. Background Many articles and research studies have discussed and evaluated health status and aging challenges among senior citizens in Nepal in terms of their quality of life, activity of daily living (ADL), nutritional status, and health system (Acharya, et al., 2023; Aging Nepal, 2022; Shrestha, 2021; Ghimire, 2021; Chalise, 2020). Quality of Life (QOL) : Evaluating quality of life (QOL) is a central focus of aging research. In a cross-sectional study in Nepal, QOL was assessed on the basis of subjective perceptions (Joshi, 2018). Living arrangements significantly influenced QOL outcomes. A vast majority (85%) of those residing with their son or daughter reported their QOL as either good or neutral. Conversely, among the 3% of respondents living alone, two-thirds reported poor QOL. In a general context, some prefer daughters to sons in regard to spending time with their children (Acharya et al. 2023 ). However, it is a crucial fact that quality of life has no clear definition, it is based solely on subjective assessment. Activity of Daily Living (ADL) : Several reports discuss general health and the severity of disabilities in Nepal (Chalise, 2020; Ghimire, 2021). In ADL it is defined as difficulty performing activities of daily living, which are necessary for their independence. This index differentiates five levels of dysfunction to determine whether seniors can perform the activity alone: 1) eat 2) get up and move 3) get dressed 4) go to the toilet 5) grooming. People in need of care have functional limitations on at least one level of dysfunction. Evaluations of activities of daily living (ADLs) have revealed alarmingly high rates of functional limitations. Unfortunately, field studies in rural areas remain limited (Kalasha Foundation, 2024 ). Nutritional Status : It has a profound effect on the quality of life of older adults. A systematic review and meta-analysis of studies revealed a significant positive correlation between nutritional status and QOL (Tucker et al., 2022 ). A study in Lomanthang R.M. highlighted the poor nutritional status of the elderly population. Of the total 210 elderly participants (age > 60 y), 28.6% were malnourished, and 44.3% were at risk of malnutrition (Gurung, 2021 ). Even in general study, seniors lacked a balanced diet (Acharya et al., 2023 ). As a substitute for weight, we chose to measure upper arm circumference (cm). Senior Citizen Act : In 2006, Nepal introduced the Senior Citizen Act, which outlines principles for the care and welfare of elderly individuals. It mandates that social, economic, and human rights of elderly citizens should be ensured by local governments. In addition, it shall be the duty of each family member to maintain and care for the senior generation, based on their economic state. Traditional Nepali culture has long upheld the belief that caring for one’s parents is a sacred duty, often seen as a divine blessing and a way to accrue good karma (Gurung, 2021 ). However, traditional living arrangements for older people in Nepal face challenges because of the migration of younger generations. Demographic statistics for the Mustang region reveal an alarming trend: out of 5,692 households 1,261 (22%) reported that second-generation members are absent within Nepal, whereas in 757 households (13%) family members live abroad (National Census, 2021). Health System of Nepal : Nepal’s healthcare system remains frail, with insufficient public welfare and social security structures (Shrestha, 2023; Acharya et al., 2023 ). The organizational chart of the National Health System in Nepal is quite vast and complex (Nepal Health Facility Registry, 2023). In most rural areas general medical care is provided by the local Health Post (HP). There are 3778 HP in the whole country; only 3 HP in Lomanthang R.M. In general, medical conditions are rather precarious; in Nepal, only 61.8% of the population can find a health post within 30 minutes of walking. The health post serves as the primary contact point for basic health services and acts as a referral center. In Nepal, most doctors and health workers are concentrated in larger cities and central areas, despite offering higher salaries aimed at encouraging work in rural regions (Kalasha Foundation, 2024 ). Many health workers in these areas report feelings of isolation, frequently citing a lack of support or opportunities for professional development. Methods and Analysis We report on the field study, a collaborative effort between the Kalasha Foundation and the Nexus Institute of Research and Innovation (NIRI), Nepal. The field study was conducted through face-to-face interviews guided by a questionnaire. A health expert, under the responsibility coordinated the data collection plan. Data acquisition : the data were collected in Nepali, but the questionnaire was available in both English and Nepali; later all answers were translated into English by an expert in both languages. The data sharing and preservation strategy adhered to the NHRC policy. They were stored on a computer at NIRI and accessible only to those involved in the project, mainly the authors of this article. The principal investigator and program coordinator oversaw the SCC research project. Questionnaire : We developed a standardized, detailed questionnaire for the study. Already published questionnaires were not used. Our questionnaires are available on appendix section. We developed a questionnaire encompassing the following criteria in five sections: 1. demographic and living arrangements, 2. quality of life and activities of daily living (ADL), 3. Disabilities and chronic illness, 4. Nutrition including alcohol consumption. 5. Emotional world, joys and complaints. We tried to capture their feelings and state of mind with key questions. Overall, it included both qualitative components and quantitative measures, in total fifty-six parameters to be evaluated. The main goal of this assessment was to determine the overall well-being and satisfaction of the seniors to understand all needs. We aimed to identify the seniors most affected to assign them to the group labelled “need for care”, who should receive professional support (Kalasha Foundation, 2024 ). Research staff : two research staff members with nursing degrees, residents from Lomanthang, were engaged for three months. They managed fluently both English and Nepali, even more they could communicate in the local dialect (Tibetan). They were given precise instructions on how to use the questionnaire. We asked them to visit all households in Lomanthang between May and August 2025, to interview all the senior citizens individually. All participants gave informed consent by signature or fingerprint. The data were registered on paper and recorded in a file the same day. Female Community Health Volunteers (FCHVs) : These females are an exceptional group of lay care staff integrated into the National Health System in Nepal. The community program was started in 1988 and is active in all districts with 52’000 women in Nepal. Worldwide, this is a unique unit of medically trained lay-women caregivers. For Lomanthang R.M. 27 members have been registered since 1994. They commit themselves to a code of conduct to work honestly and with absolute confidentiality. Their major role is to act as the mediator between the public health institutions and residents; they collaborate in health programs, family planning, safer motherhood and health education. The volunteers never receive a regular salary (Kandel 2019 ). The designated group of volunteer women aligns perfectly with the objectives of the SCC project. It allows us to integrate the existing healthcare infrastructure while introducing new responsibilities for elderly care (Shrestha,S. et al, 2021) Data collection In the first phase, we went to Lomanthang to launch the project SCC. We met local stakeholders for collaboration to ensure community support. In a two-day workshop our medical team trained the research staff in handling the questionnaire. We also convened all the 27 FCHVs to attend the refresher training course according to legal requirements. This program has been expanded by a module specifically focused on elderly care under the title “senior caregiver”. The primary interest was providing information about their involvement in the project SCC and asking for their consent. In the second phase of the project FCHVs will go to visit seniors in need for care every two weeks next summer 2026. In the training session we conveyed knowledge on the needs and common problems in the elderly population (e.g. heart insufficiency, respiratory illnesses, stomach pain, rheumatic disorders, severe infections etc.). Additionally, the course addresses cognitive and mental health concerns such as dementia, psychotic disorders and chronic alcoholism. We even trained the females on basic life support, especially cardio-pulmonary resuscitation, to the great interest of all involved. Data collection with the questionnaire has been carried out from May to September 2025. Data Analysis The data was collected in Nepali, but the questionnaires were available in both English and Nepali. Later the date collected in Nepali were translated into English by a translator expert in both Nepali and English. Our questions focused on the senior citizens’ way of living, form of disability, and type of disease. We also registered blood pressure, upper arm circumference and classification of daily activities by our trained volunteers. We analyzed the quantitative data through MS Excel 2016 program. We described senior citizen’s living arrangements, and their basic physical health indicators. We used NVivo pro 15 software to analyze data that helped us to code and generate themes and categories to discuss the current conditions of the senior citizens and the needs they have. Findings The research staff visited all the households in Lomanthang R.M. It completed the questionnaire with 188 senior citizens. Amazingly this corresponds exactly to the expected number of seniors from the National Census 2021. Obviously, there is an occult shift of people who died or moved away to the moving up of younger generation. Living conditions : Out of 188 seniors we surveyed 45% males and 55% females. They comprise the age groups 65–89 years. The mean age was 75.5 years. 87.2% of senior citizens were found to be illiterate, while the rest of them were literate but only with informal education (lama). As the living conditions are very harsh during winter administrative offices and hotels are often closed; and the majority of residents move to the lowland. We were astonished to find that 52% (n = 98) of the senior citizens stayed in the village; they remaining citizens take care of all houses and cattle. Many houses lack commodities, 17% (n = 33) have no toilet, but they all have light facilities and electricity. Family structure : 62% (n = 117) of the surveyed population are living with family members, mostly with daughters and sons-in-law, as many males migrate for employment or education. 38% (n = 71) of senior citizens were living without all family members, because their children had moved to the cities or gone abroad. 29% (n = 55) live together with their spouse. All share the wish to spend the rest of their life in their birthplace together with their children. On the other hand, 16 (8%) seniors (9 men, 7 women) are living all alone. There are differences in the impact, 5 seniors are self-sufficient and happy, however 3 show evident alcohol abuse and the remaining 8 belong to the group with label need for care due to various disabilities. Nutrition and Alcohol consumption : Our survey reveals that a great number of seniors (38%, n = 72) consume alcohol, some to a considerable extent. 35% (n = 67) state that they have quit, due to health problems and medical advice; 26% (n = 49) never drink alcohol. Relying on all parameters we could separate 8 individuals (7 males, 1 female) heavily addicted to alcohol. Generally, there is enough food available, most are self-suppliers. In heavy contrast three seniors directly complained to be hungry (urgently we supplied them with food). Rather a lot of seniors mentioned that they have impaired swallowing, a rather unexpected finding for us. In some cases we suspect problems of chewing, only a few have documented paralysis. Many mentioned difficulties in breathing and suffering from cough. Blood pressure and body weight : We found 16 (8%) seniors with significantly elevated blood pressure (> 150/100 mm Hg), most of them were not aware of this problem before. Out in the fields it was not possible to measure body weight with a scale. Instead, we decided to measure the circumference (cm) of the upper arm. The values fluctuated between 19 and 31 cm. We divided into four groups: first < 21 cm (n = 11), second 21–25 (n = 146), third 26–28 cm (n = 28), fourth 29–31 cm (n = 3). One lady (26 cm) assessed herself as obese. We could find 11 seniors with measures below 21 cm, in whom we suspect malnutrition. Activity of Daily Living (ADL) : We found that 7.5% (n = 14) of senior citizens depended on their family members for their daily activities. Their age ranged from 65 to 86 years. They were disabled on different levels, single or combined. 4 seniors had lack of activity on all levels. The most serious malfunctions were caused by paresis after stroke and / or state of dementia. All others showed symptoms that led to general frailty, due to the combination of weakness, pain, short of breath, blindness, and forgetfulness. Fortunately, 92.5% (n = 174) still have full range in ADL. Dementia : We recognized 11 (6%) seniors presenting full dementia. Overlapping with the ADL deficient group is evident. Most are embedded in their family, only 2 seniors live alone with their spouse. The burden on relatives to take care of them is extremely high. Socio-emotional well-being : This section examines the perception of senior citizens regarding their personal emotions. We asked three guiding questions: what makes you happy / what makes you sad / what do you miss the most. We tried to categorize the answers into four distinct domains: family/friends, recreation/social activities, health conditions, and income related factors. We used NVivo 15 software to generate the groups. Happy : The vast majority of our participants attested that their greatest happiness lies in their relationship with family and good friends or going out in sun and chatting with neighbors. As well they find recreation in spiritual engagement. Praying (including pilgrimage) is a great source of happiness and contentment. Good health and ability to work even in old age are important, valued primarily to avoid becoming a burden to others. Economic aspects play a marginally supportive role. 6/8 men addicted to alcohol only feel happy with drinking. A minority claims never to be happy even without any reason. Sad : Being separated from their children and relatives is the dominant factor of sadness. This is entirely consistent with the most common response in the next group. Being dependent on others due to disability (the whole group ADL) is most depressing. Conversely, sadness is frequently linked to conflict within families and loss of close relatives. Financial insecurity is blamed as source of sadness to a smaller extent. On the other hand, suffering from frequent pains and other disabilities is not often cited as the main cause of distress. Unfortunately, some seniors are afraid of dying all alone at home. Missing : To miss the children is the most frequent answer in the spectrum. Many parents confirm that they are really reviving by videocalls with their children, seeing their faces and hearing their voices. Also important is the wish to be respected in personal interests and retaining autonomy. They feel hurt being blamed and suffer missing a peaceful setting. Discussion Within the project of senior citizens care the main goal was to assess the number of seniors who should receive professional support for their well-being. Evaluating all parameters, relying both on external and physical factors as well as socio-emotional findings, we have selected seniors into the group with the label “need for care”. Even though the Citizen Act would secure livelihoods of older generation the reality is quite different. More than one third of senior residents live without their children. Emigration has a severe impact on the stability of family support in Nepal. There is a small group of seniors living all alone. Their personal situation varies greatly: those with relevant disabilities should be cared for. Rather unexpectedly, quite a few are satisfied on their own, they emphasize the advantage of a quiet self-determined living. Seniors with deficiency in activity of daily living (ADL) and/or dementia demand our special attention. They can only survive dependent on their families; it is humiliating with all its implications. Overall, we selected 38 seniors for the group with need for care, and we define this group as the care rate (ca. 20%) of senior citizens in the relevant municipality. In a field study of this scope we believe it is mandatory to measure the blood pressure of all participants. Hypertension is such an important characteristic in health, with life-threatening consequences. To our surprise, we found 17 (9%) seniors with unusually high blood pressure readings. Only three knew about the problem, obviously their medical treatment was insufficient. We will inform them and give advice to get consultation again at the health post as soon as possible. The results of the arm circumference measurements raise suspicions of relevant proportion of malnourished seniors. Our study reveals that alcohol abuse is a major problem in this population. We assume that eight seniors are heavily addicted to alcohol, a rather alarming finding. Our questionnaire included registration of various diseases but we put little emphasis on classification. Of course, those affected feel disabled and her quality of life is impaired, but they accept it silently. Indeed, we were surprised to learn how patient they are and grateful for the empathy they received. We devoted particular attention to the emotional dimensions of ageing. Family and social relationships emerged as the most influental determinant of happiness, underscoring the central role of social connectedness in old age. Likewise, leisure activities and spiritual engagement highlighted the importance of recreation and purpose for well-being. In stark contrast, the absence of happiness revealed a deeply troubling reality. The most frequent statement was the longing for children. Despite prolonged separation, nearly all seniors continue to hope for support from their children living overseas. Those who have succeeded abroad are revered as heroes within the village – yet this admiration stand in painful contrast to the emotional and practical abandonment experienced by the ageing parents left behind. This represents a sobering and distressing realization for all of us engaged in development and humanitarian work. Conclusions and way forward The field study gave us significant insight into the daily life of senior citizens. It is important to draw the right conclusions and find a sensible solution to provide living support for the elderly in Lomanthang. We need people, possibly with some basic experience, who will go to see seniors at home supporting the family in overcoming obstacles. In the second phase of the project, FCHVs will act as caregivers assigned to a small group of seniors in need for care. The females bear responsibility and deliver personalized support based on common sense. The decisive factor in arranging care for the elderly is human assistance in the spirit of charity. With dedicated caregivers, marginalized seniors can regain activities crucial for preventing frailty. The existing structure of the FCHV should definitely be retained. A holistic treatment addressing social needs alongside medical concern should be the first and foremost aim in the care of elderly individuals. The SCC model could be replicated in other remote Nepalese communities. The reliance on existing health structures and low financial requirements makes it profitable. The data collected from this specific location may not represent senior citizens from other areas. Nevertheless, we believe that the conclusions can also apply to other groups. We aim to propose a viable approach to improving the qualtiy of life of older people in Nepal. With the engagement of national health authorities, this initiative has the potentiel to become a meaningful step toward addressing the unmet needs of a rapidly ageing and vulnerable pouplation. Declarations Ethical approval Ethical approval was obtained from the Nepal Health Research Council (NHRC), Government of Nepal. The IRB approval reference no. is 1956. Written Permissions to conduct a study was obtained by Lomanthang Rural Municipality. Signed informed consent for the questionnaire was provided by all participants. Consent for Publication Not Applicable Conflict of Interest Statement The Senior Citizen Care (SCC) project was initiated by Dr. Serena Hartmann, MD, President of the Kalasha Foundation, Switzerland. The founders of Kalasha have knowledge of the history of Mustang, including documents of Tibetan refugees immigrating in Mustang after the invasion of China into Tibet in 1961. Based on personal experience of the living conditions in this remote area and general references Kalasha has started the project Senior Citizen Care (SCC) in collaboration with Nexus Institute of Research and Innovations (NIRI) Nepal. The study received funding from the Kalasha Foundation. The funder supported the implementation of the project in Upper Mustang, Nepal, beginning with a field study in Lomanthang R.M. Clinical Trial Number Not Applicable Funding Declaration: This project was supported by Kalasha Foundation, Switzerland. Author Contribution The primary objective of this research project, including the field study was to assess the living conditions of the elderly population and to draw conclusions on how to contribute to the well-being of senior citizens in daily life, with a particular focus on improving health outcomes. All authors made substantial contributions on the conception and design of the study, data collection, analysis, and interpretation of the data. Acknowledgement We express our gratitude Mr. Tenzing Gurung, Public Health Coordinator at Lomantang RM, Mr. Norbu Gurung, Chairperson of the Lomanthang R.M., and the whole municipality for their incredible support in data collection. We are grateful to Dr. Rajendra Pangeni and Dr. Tara Sigdel for their continuous guidance and mentorship. We are grateful to our research assistants Ms. Karsang Gurung and Ms. Nima Choedon Gurung. We thank all the participants of this study. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Acharya T, et al. Senior citizens in Nepal: Policy gaps and recommendations. Gerontol Geriatric Med. 2023;9:1–10. Ageing Nepal. (2022). Proud to be old . https://ageingnepal.org Central Bureau of Statistics. (2021). Nepal population and housing census 2021: National report . National Statistics Office, Kathmandu. ISBN: 978-9937-1-3221-3. Chalise HN, et al. Functional disability in instrumental activities of daily living among rural older people in Nepal. J Kathmandu Med Coll. 2020;9(3):105–10. Chalise HN et al. (2022). Older people and social security system in Nepal. Gerontol Geriatr, 8(2). Chang J, Wray L, Lin Y. Social Relationships, Leisure Activity, and Health in Older Adults. Health Psychology: Official J Div Health Psychol Am Psychol Association. 2014;33(6):516. https://doi.org/10.1037/hea0000051 . Darnal P. (2017). Significant heritages of Upper Mustang and issue of conservation. Dhaulagiri Journal of Sociology and Anthropology, 11(0) , 1–23. https://doi.org/11.3126/dsaj.v11i0.18820. FCHV Basic Training - English. pptx - Google Drive https://drive.google.com/file/d/1AhdLgNKA9NLgFgKAvKoLMlNii4tRRvOv/view Ghimire S, et al. Functional status and its associated factors among community-dwelling older adults in rural Nepal. BMC Geriatr. 2021;21:335. Gurung TW. (2021). Dietary practices and nutritional status of senior citizens in Lomanthang Rural Municipality of Mustang district (BPH thesis). Faculty of Health Sciences, Pokhara University. Joshi MR, et al. Quality of life of Nepalese elderly individuals living in rural Nepal. Gerontol Geriatr Med. 2018;7(5):1–6. Kalasha Foundation. ). Study in Lomanthang Rural Municipality, Nepal. [Brochure]. Georges and Serena Hartmann. Switzerland; 2024. Kandel N, Lamichhane J. Female health volunteers of Nepal: The backbone of health care. Lancet. 2019;393(10171):e19–20. Lomanthang Rural Municipality. (2025). गाउँपालिकाको संक्षिप्त परिचय. Retrieved from https://lomanthangmun.gov.np/ Nepal Health Facility Registry, 2023. Senior Citizen Act. (2006). An act was enacted to provide protection and social security for senior citizens . Shrestha S, et al. Elderly care in Nepal: Are existing health and community support systems enough? SAGE Open Med. 2021;9:1–5. Tucker E, et al. Nutritional status and quality of life of older adults in aged care: A systematic review and meta-analysis. Exp Gerontol. 2022;162:111764. https://doi.org/10.1016/j.exger.2022.111764 . Additional Declarations No competing interests reported. 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The senior population (aged 65 years and above) included 2,021,714 individuals, comprising 977,945 males (48.4%) and 1,043,769 females (51.6%). Senior citizens now represent 6.9% of Nepal\u0026rsquo;s total population (Nepal Population and Housing Census, 2021). The data underscores the potential demand for elderly care.\u003c/p\u003e\n\u003cp\u003eMustang in Nepal is a remote region, divided in five rural municipalities, one of which is Lomanthang R.M., situated at an altitude of 3800 meters above sea level, further subdivided into five wards, each encompassing one to three villages. It consists of approximately 500 households, with a total of 1\u0026rsquo;450 residents. Here the elderly population is as high as 13%, comprising 188 senior citizens (Table.1). For the whole area of Mustang, there is only one district hospital in Jomosom, located approximately 90 miles down the valley (half-day travel by Jeep).\u003c/p\u003e\n\u003cp\u003eTable 1: Senior Population Nepal Census 2021\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNEPAL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLOMANTHANG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eAll ages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e29,164,578\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e14,253,551\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e14,911,027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1,430\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e787\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e65 +\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2,021,714\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e977,945\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1,043,769\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e188\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e87\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e101\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eAge ratio*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10.6 %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e17.1 %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003ePrevalence*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.9 %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13.1 %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u0026nbsp;*Age ratio: number of seniors in relation to the group of working people (15-64 y)\u003c/p\u003e\n\u003cp\u003e*Prevalence: number of seniors in relation to the total population\u003c/p\u003e\n\u003cp\u003eCompared to other regions, the need for elderly care is more pronounced in rural areas such as Lomanthang R.M. (Kalasha Foundation, 2024). This region appears to be almost abandoned due to geographical and environmental difficulties despite its stunning beauty and a few other religious and cultural significance (Darnal, 2017).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe global population is growing, and the senior population is rising in high- and middle-income countries and low-income countries (World Health Organization, 2016). The demographic change is visible not only in Europe or specific regions like Switzerland or Australia but also in South Asia, including Nepal (Chalise, 2022). However, Nepal\u0026rsquo;s situation is becoming increasingly skewed since social and health infrastructure are insufficient to accomodate the elderly. Numerous articles have urged policymakers to enact proper policies and regulations so that the life of elderly citizens can be enhanced (Joshi et al., 2018). The World Health Organization\u0026rsquo; Global Strategy and Action Plan on Ageing and Health (2016\u0026ndash;2020) states that the problem is not aging per se but rather the accelerated risk of chronic disease and functional impairment that occur simultaneously.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNepal\u0026rsquo;s life expectancy is 71,1 years, which has considerably increased in recent decades (World Bank, 2023). It is still lower than in most developed countries, e.g., in Switzerland, currently 81.6 years for men and 85.4 years for women. (Kalasha Foundation, 2024). In comparison, other close-by developing countries like Sri Lanka (77.0 years), Bangladesh (73.6 years), and India (70.9 years) capture similar trends, both tracking the regional progress and the dominating inequalities in global health measures. Residents in rural areas primarily depend on income from traditional farming and remittances from their children (Acharya et al., 2023; Shrestha et al., 2021). To increase the quality of life and social security of the aging population, further research is needed before\u0026nbsp;sustainable\u0026nbsp;policies can be developed (Joshi and et.al., 2018; Acharya et al., 2023).\u003c/p\u003e\n\u003cp\u003eSuch challenges require a thorough scientific study of the current situation, finding problems and implementing resources. For this practical solution the project senior citizen care (SCC) has been developed. In its first part, it included the field study in Lomanthang in summer 2025, where we organized visits to all senior residents. \u0026nbsp;A questionnaire was used to record general living conditions and determine the health status and social well-being of senior citizens. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe intend to report on the data we collected by this study, which underscores the immediate need to address the quality of life of the elderly population. However, we discovered a gap between the stunning beauty of the place and the complete lack of quality of life, relating to health, transportation, family members, and a few other physical and psychological needs of the senior citizens at the place.\u0026nbsp;\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eMany articles and research studies have discussed and evaluated health status and aging challenges among senior citizens in Nepal in terms of their quality of life, activity of daily living (ADL), nutritional status, and health system (Acharya, et al., 2023; Aging Nepal, 2022; Shrestha, 2021; Ghimire, 2021; Chalise, 2020).\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eQuality of Life (QOL)\u003c/span\u003e: Evaluating quality of life (QOL) is a central focus of aging research. In a cross-sectional study in Nepal, QOL was assessed on the basis of subjective perceptions (Joshi, 2018). Living arrangements significantly influenced QOL outcomes. A vast majority (85%) of those residing with their son or daughter reported their QOL as either good or neutral. Conversely, among the 3% of respondents living alone, two-thirds reported poor QOL. In a general context, some prefer daughters to sons in regard to spending time with their children (Acharya et al. \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). However, it is a crucial fact that quality of life has no clear definition, it is based solely on subjective assessment.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eActivity of Daily Living (ADL)\u003c/span\u003e: Several reports discuss general health and the severity of disabilities in Nepal (Chalise, 2020; Ghimire, 2021). In ADL it is defined as difficulty performing activities of daily living, which are necessary for their independence. This index differentiates five levels of dysfunction to determine whether seniors can perform the activity alone: 1) eat 2) get up and move 3) get dressed 4) go to the toilet 5) grooming. People in need of care have functional limitations on at least one level of dysfunction. Evaluations of activities of daily living (ADLs) have revealed alarmingly high rates of functional limitations. Unfortunately, field studies in rural areas remain limited (Kalasha Foundation, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eNutritional Status\u003c/span\u003e: It has a profound effect on the quality of life of older adults. A systematic review and meta-analysis of studies revealed a significant positive correlation between nutritional status and QOL (Tucker et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). A study in Lomanthang R.M. highlighted the poor nutritional status of the elderly population. Of the total 210 elderly participants (age\u0026thinsp;\u0026gt;\u0026thinsp;60 y), 28.6% were malnourished, and 44.3% were at risk of malnutrition (Gurung, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Even in general study, seniors lacked a balanced diet (Acharya et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). As a substitute for weight, we chose to measure upper arm circumference (cm).\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSenior Citizen Act\u003c/span\u003e: In 2006, Nepal introduced the Senior Citizen Act, which outlines principles for the care and welfare of elderly individuals. It mandates that social, economic, and human rights of elderly citizens should be ensured by local governments. In addition, it shall be the duty of each family member to maintain and care for the senior generation, based on their economic state. Traditional Nepali culture has long upheld the belief that caring for one\u0026rsquo;s parents is a sacred duty, often seen as a divine blessing and a way to accrue good karma (Gurung, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). However, traditional living arrangements for older people in Nepal face challenges because of the migration of younger generations. Demographic statistics for the Mustang region reveal an alarming trend: out of 5,692 households 1,261 (22%) reported that second-generation members are absent within Nepal, whereas in 757 households (13%) family members live abroad (National Census, 2021).\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eHealth System of Nepal\u003c/span\u003e: Nepal\u0026rsquo;s healthcare system remains frail, with insufficient public welfare and social security structures (Shrestha, 2023; Acharya et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The organizational chart of the National Health System in Nepal is quite vast and complex (Nepal Health Facility Registry, 2023). In most rural areas general medical care is provided by the local Health Post (HP). There are 3778 HP in the whole country; only 3 HP in Lomanthang R.M. In general, medical conditions are rather precarious; in Nepal, only 61.8% of the population can find a health post within 30 minutes of walking.\u003c/p\u003e \u003cp\u003eThe health post serves as the primary contact point for basic health services and acts as a referral center. In Nepal, most doctors and health workers are concentrated in larger cities and central areas, despite offering higher salaries aimed at encouraging work in rural regions (Kalasha Foundation, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Many health workers in these areas report feelings of isolation, frequently citing a lack of support or opportunities for professional development.\u003c/p\u003e"},{"header":"Methods and Analysis","content":"\u003cp\u003eWe report on the field study, a collaborative effort between the Kalasha Foundation and the Nexus Institute of Research and Innovation (NIRI), Nepal. The field study was conducted through face-to-face interviews guided by a questionnaire. A health expert, under the responsibility coordinated the data collection plan.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eData acquisition\u003c/span\u003e: the data were collected in Nepali, but the questionnaire was available in both English and Nepali; later all answers were translated into English by an expert in both languages. The data sharing and preservation strategy adhered to the NHRC policy. They were stored on a computer at NIRI and accessible only to those involved in the project, mainly the authors of this article. The principal investigator and program coordinator oversaw the SCC research project.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eQuestionnaire\u003c/span\u003e: We developed a standardized, detailed questionnaire for the study. Already published questionnaires were not used. Our questionnaires are available on appendix section. We developed a questionnaire encompassing the following criteria in five sections: 1. demographic and living arrangements, 2. quality of life and activities of daily living (ADL), 3. Disabilities and chronic illness, 4. Nutrition including alcohol consumption. 5. Emotional world, joys and complaints. We tried to capture their feelings and state of mind with key questions. Overall, it included both qualitative components and quantitative measures, in total fifty-six parameters to be evaluated. The main goal of this assessment was to determine the overall well-being and satisfaction of the seniors to understand all needs. We aimed to identify the seniors most affected to assign them to the group labelled \u0026ldquo;need for care\u0026rdquo;, who should receive professional support (Kalasha Foundation, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eResearch staff\u003c/span\u003e: two research staff members with nursing degrees, residents from Lomanthang, were engaged for three months. They managed fluently both English and Nepali, even more they could communicate in the local dialect (Tibetan). They were given precise instructions on how to use the questionnaire. We asked them to visit all households in Lomanthang between May and August 2025, to interview all the senior citizens individually. All participants gave informed consent by signature or fingerprint. The data were registered on paper and recorded in a file the same day.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eFemale Community Health Volunteers (FCHVs)\u003c/span\u003e: These females are an exceptional group of lay care staff integrated into the National Health System in Nepal. The community program was started in 1988 and is active in all districts with 52\u0026rsquo;000 women in Nepal. Worldwide, this is a unique unit of medically trained lay-women caregivers. For Lomanthang R.M. 27 members have been registered since 1994. They commit themselves to a code of conduct to work honestly and with absolute confidentiality. Their major role is to act as the mediator between the public health institutions and residents; they collaborate in health programs, family planning, safer motherhood and health education. The volunteers never receive a regular salary (Kandel \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The designated group of volunteer women aligns perfectly with the objectives of the SCC project. It allows us to integrate the existing healthcare infrastructure while introducing new responsibilities for elderly care (Shrestha,S. et al, 2021)\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData collection\u003c/strong\u003e \u003cp\u003eIn the first phase, we went to Lomanthang to launch the project SCC. We met local stakeholders for collaboration to ensure community support. In a two-day workshop our medical team trained the research staff in handling the questionnaire. We also convened all the 27 FCHVs to attend the refresher training course according to legal requirements. This program has been expanded by a module specifically focused on elderly care under the title \u0026ldquo;senior caregiver\u0026rdquo;. The primary interest was providing information about their involvement in the project SCC and asking for their consent. In the second phase of the project FCHVs will go to visit seniors in need for care every two weeks next summer 2026. In the training session we conveyed knowledge on the needs and common problems in the elderly population (e.g. heart insufficiency, respiratory illnesses, stomach pain, rheumatic disorders, severe infections etc.). Additionally, the course addresses cognitive and mental health concerns such as dementia, psychotic disorders and chronic alcoholism. We even trained the females on basic life support, especially cardio-pulmonary resuscitation, to the great interest of all involved. Data collection with the questionnaire has been carried out from May to September 2025.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData Analysis\u003c/strong\u003e \u003cp\u003eThe data was collected in Nepali, but the questionnaires were available in both English and Nepali. Later the date collected in Nepali were translated into English by a translator expert in both Nepali and English. Our questions focused on the senior citizens\u0026rsquo; way of living, form of disability, and type of disease. We also registered blood pressure, upper arm circumference and classification of daily activities by our trained volunteers. We analyzed the quantitative data through MS Excel 2016 program. We described senior citizen\u0026rsquo;s living arrangements, and their basic physical health indicators. We used NVivo pro 15 software to analyze data that helped us to code and generate themes and categories to discuss the current conditions of the senior citizens and the needs they have.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eFindings\u003c/h2\u003e \u003cp\u003eThe research staff visited all the households in Lomanthang R.M. It completed the questionnaire with 188 senior citizens. Amazingly this corresponds exactly to the expected number of seniors from the National Census 2021. Obviously, there is an occult shift of people who died or moved away to the moving up of younger generation.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eLiving conditions\u003c/span\u003e: Out of 188 seniors we surveyed 45% males and 55% females. They comprise the age groups 65\u0026ndash;89 years. The mean age was 75.5 years. 87.2% of senior citizens were found to be illiterate, while the rest of them were literate but only with informal education (lama). As the living conditions are very harsh during winter administrative offices and hotels are often closed; and the majority of residents move to the lowland. We were astonished to find that 52% (n\u0026thinsp;=\u0026thinsp;98) of the senior citizens stayed in the village; they remaining citizens take care of all houses and cattle. Many houses lack commodities, 17% (n\u0026thinsp;=\u0026thinsp;33) have no toilet, but they all have light facilities and electricity.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eFamily structure\u003c/span\u003e: 62% (n\u0026thinsp;=\u0026thinsp;117) of the surveyed population are living with family members, mostly with daughters and sons-in-law, as many males migrate for employment or education. 38% (n\u0026thinsp;=\u0026thinsp;71) of senior citizens were living without all family members, because their children had moved to the cities or gone abroad. 29% (n\u0026thinsp;=\u0026thinsp;55) live together with their spouse. All share the wish to spend the rest of their life in their birthplace together with their children. On the other hand, 16 (8%) seniors (9 men, 7 women) are living all alone. There are differences in the impact, 5 seniors are self-sufficient and happy, however 3 show evident alcohol abuse and the remaining 8 belong to the group with label need for care due to various disabilities.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eNutrition and Alcohol consumption\u003c/span\u003e: Our survey reveals that a great number of seniors (38%, n\u0026thinsp;=\u0026thinsp;72) consume alcohol, some to a considerable extent. 35% (n\u0026thinsp;=\u0026thinsp;67) state that they have quit, due to health problems and medical advice; 26% (n\u0026thinsp;=\u0026thinsp;49) never drink alcohol. Relying on all parameters we could separate 8 individuals (7 males, 1 female) heavily addicted to alcohol. Generally, there is enough food available, most are self-suppliers. In heavy contrast three seniors directly complained to be hungry (urgently we supplied them with food). Rather a lot of seniors mentioned that they have impaired swallowing, a rather unexpected finding for us. In some cases we suspect problems of chewing, only a few have documented paralysis. Many mentioned difficulties in breathing and suffering from cough.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eBlood pressure and body weight\u003c/span\u003e: We found 16 (8%) seniors with significantly elevated blood pressure (\u0026gt;\u0026thinsp;150/100 mm Hg), most of them were not aware of this problem before. Out in the fields it was not possible to measure body weight with a scale. Instead, we decided to measure the circumference (cm) of the upper arm. The values fluctuated between 19 and 31 cm. We divided into four groups: first\u0026thinsp;\u0026lt;\u0026thinsp;21 cm (n\u0026thinsp;=\u0026thinsp;11), second 21\u0026ndash;25 (n\u0026thinsp;=\u0026thinsp;146), third 26\u0026ndash;28 cm (n\u0026thinsp;=\u0026thinsp;28), fourth 29\u0026ndash;31 cm (n\u0026thinsp;=\u0026thinsp;3). One lady (26 cm) assessed herself as obese. We could find 11 seniors with measures below 21 cm, in whom we suspect malnutrition.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eActivity of Daily Living (ADL)\u003c/span\u003e: We found that 7.5% (n\u0026thinsp;=\u0026thinsp;14) of senior citizens depended on their family members for their daily activities. Their age ranged from 65 to 86 years. They were disabled on different levels, single or combined. 4 seniors had lack of activity on all levels. The most serious malfunctions were caused by paresis after stroke and / or state of dementia. All others showed symptoms that led to general frailty, due to the combination of weakness, pain, short of breath, blindness, and forgetfulness. Fortunately, 92.5% (n\u0026thinsp;=\u0026thinsp;174) still have full range in ADL.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eDementia\u003c/span\u003e: We recognized 11 (6%) seniors presenting full dementia. Overlapping with the ADL deficient group is evident. Most are embedded in their family, only 2 seniors live alone with their spouse. The burden on relatives to take care of them is extremely high.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSocio-emotional well-being\u003c/span\u003e: This section examines the perception of senior citizens regarding their personal emotions. We asked three guiding questions: what makes you happy / what makes you sad / what do you miss the most. We tried to categorize the answers into four distinct domains: family/friends, recreation/social activities, health conditions, and income related factors. We used NVivo 15 software to generate the groups.\u003c/p\u003e \u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eHappy\u003c/span\u003e: The vast majority of our participants attested that their greatest happiness lies in their relationship with family and good friends or going out in sun and chatting with neighbors. As well they find recreation in spiritual engagement. Praying (including pilgrimage) is a great source of happiness and contentment. Good health and ability to work even in old age are important, valued primarily to avoid becoming a burden to others. Economic aspects play a marginally supportive role. 6/8 men addicted to alcohol only feel happy with drinking. A minority claims never to be happy even without any reason.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSad\u003c/span\u003e: Being separated from their children and relatives is the dominant factor of sadness. This is entirely consistent with the most common response in the next group. Being dependent on others due to disability (the whole group ADL) is most depressing. Conversely, sadness is frequently linked to conflict within families and loss of close relatives. Financial insecurity is blamed as source of sadness to a smaller extent. On the other hand, suffering from frequent pains and other disabilities is not often cited as the main cause of distress. Unfortunately, some seniors are afraid of dying all alone at home.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eMissing\u003c/span\u003e: To miss the children is the most frequent answer in the spectrum. Many parents confirm that they are really reviving by videocalls with their children, seeing their faces and hearing their voices. Also important is the wish to be respected in personal interests and retaining autonomy. They feel hurt being blamed and suffer missing a peaceful setting.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWithin the project of senior citizens care the main goal was to assess the number of seniors who should receive professional support for their well-being. Evaluating all parameters, relying both on external and physical factors as well as socio-emotional findings, we have selected seniors into the group with the label \u0026ldquo;need for care\u0026rdquo;. Even though the Citizen Act would secure livelihoods of older generation the reality is quite different. More than one third of senior residents live without their children. Emigration has a severe impact on the stability of family support in Nepal. There is a small group of seniors living all alone. Their personal situation varies greatly: those with relevant disabilities should be cared for. Rather unexpectedly, quite a few are satisfied on their own, they emphasize the advantage of a quiet self-determined living. Seniors with deficiency in activity of daily living (ADL) and/or dementia demand our special attention. They can only survive dependent on their families; it is humiliating with all its implications. Overall, we selected 38 seniors for the group with need for care, and we define this group as the care rate (ca. 20%) of senior citizens in the relevant municipality.\u003c/p\u003e \u003cp\u003eIn a field study of this scope we believe it is mandatory to measure the blood pressure of all participants. Hypertension is such an important characteristic in health, with life-threatening consequences. To our surprise, we found 17 (9%) seniors with unusually high blood pressure readings. Only three knew about the problem, obviously their medical treatment was insufficient. We will inform them and give advice to get consultation again at the health post as soon as possible. The results of the arm circumference measurements raise suspicions of relevant proportion of malnourished seniors. Our study reveals that alcohol abuse is a major problem in this population. We assume that eight seniors are heavily addicted to alcohol, a rather alarming finding.\u003c/p\u003e \u003cp\u003eOur questionnaire included registration of various diseases but we put little emphasis on classification. Of course, those affected feel disabled and her quality of life is impaired, but they accept it silently. Indeed, we were surprised to learn how patient they are and grateful for the empathy they received.\u003c/p\u003e \u003cp\u003eWe devoted particular attention to the emotional dimensions of ageing. Family and social relationships emerged as the most influental determinant of happiness, underscoring the central role of social connectedness in old age. Likewise, leisure activities and spiritual engagement highlighted the importance of recreation and purpose for well-being. In stark contrast, the absence of happiness revealed a deeply troubling reality. The most frequent statement was the longing for children. Despite prolonged separation, nearly all seniors continue to hope for support from their children living overseas. Those who have succeeded abroad are revered as heroes within the village \u0026ndash; yet this admiration stand in painful contrast to the emotional and practical abandonment experienced by the ageing parents left behind. This represents a sobering and distressing realization for all of us engaged in development and humanitarian work.\u003c/p\u003e"},{"header":"Conclusions and way forward","content":"\u003cp\u003eThe field study gave us significant insight into the daily life of senior citizens. It is important to draw the right conclusions and find a sensible solution to provide living support for the elderly in Lomanthang. We need people, possibly with some basic experience, who will go to see seniors at home supporting the family in overcoming obstacles.\u003c/p\u003e \u003cp\u003eIn the second phase of the project, FCHVs will act as caregivers assigned to a small group of seniors in need for care. The females bear responsibility and deliver personalized support based on common sense. The decisive factor in arranging care for the elderly is human assistance in the spirit of charity. With dedicated caregivers, marginalized seniors can regain activities crucial for preventing frailty. The existing structure of the FCHV should definitely be retained.\u003c/p\u003e \u003cp\u003eA holistic treatment addressing social needs alongside medical concern should be the first and foremost aim in the care of elderly individuals.\u003c/p\u003e \u003cp\u003eThe SCC model could be replicated in other remote Nepalese communities. The reliance on existing health structures and low financial requirements makes it profitable. The data collected from this specific location may not represent senior citizens from other areas. Nevertheless, we believe that the conclusions can also apply to other groups.\u003c/p\u003e \u003cp\u003eWe aim to propose a viable approach to improving the qualtiy of life of older people in Nepal. With the engagement of national health authorities, this initiative has the potentiel to become a meaningful step toward addressing the unmet needs of a rapidly ageing and vulnerable pouplation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthical approval\u003c/h2\u003e \u003cp\u003e Ethical approval was obtained from the Nepal Health Research Council (NHRC), Government of Nepal. The IRB approval reference no. is 1956. Written Permissions to conduct a study was obtained by Lomanthang Rural Municipality. Signed informed consent for the questionnaire was provided by all participants.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for Publication\u003c/strong\u003e \u003cp\u003eNot Applicable\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eConflict of Interest Statement\u003c/h2\u003e \u003cp\u003e The Senior Citizen Care (SCC) project was initiated by Dr. Serena Hartmann, MD, President of the Kalasha Foundation, Switzerland. The founders of Kalasha have knowledge of the history of Mustang, including documents of Tibetan refugees immigrating in Mustang after the invasion of China into Tibet in 1961. Based on personal experience of the living conditions in this remote area and general references Kalasha has started the project Senior Citizen Care (SCC) in collaboration with Nexus Institute of Research and Innovations (NIRI) Nepal. The study received funding from the Kalasha Foundation. The funder supported the implementation of the project in Upper Mustang, Nepal, beginning with a field study in Lomanthang R.M.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eClinical Trial Number\u003c/h2\u003e \u003cp\u003eNot Applicable\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eDeclaration:\u003c/p\u003e \u003cp\u003eThis project was supported by Kalasha Foundation, Switzerland.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThe primary objective of this research project, including the field study was to assess the living conditions of the elderly population and to draw conclusions on how to contribute to the well-being of senior citizens in daily life, with a particular focus on improving health outcomes. All authors made substantial contributions on the conception and design of the study, data collection, analysis, and interpretation of the data.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe express our gratitude Mr. Tenzing Gurung, Public Health Coordinator at Lomantang RM, Mr. Norbu Gurung, Chairperson of the Lomanthang R.M., and the whole municipality for their incredible support in data collection. We are grateful to Dr. Rajendra Pangeni and Dr. Tara Sigdel for their continuous guidance and mentorship. We are grateful to our research assistants Ms. Karsang Gurung and Ms. Nima Choedon Gurung. We thank all the participants of this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAcharya T, et al. Senior citizens in Nepal: Policy gaps and recommendations. Gerontol Geriatric Med. 2023;9:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgeing Nepal. (2022). \u003cem\u003eProud to be old\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ageingnepal.org\u003c/span\u003e\u003cspan address=\"https://ageingnepal.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCentral Bureau of Statistics. (2021). \u003cem\u003eNepal population and housing census 2021: National report\u003c/em\u003e. National Statistics Office, Kathmandu. ISBN: 978-9937-1-3221-3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChalise HN, et al. Functional disability in instrumental activities of daily living among rural older people in Nepal. J Kathmandu Med Coll. 2020;9(3):105\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChalise HN et al. (2022). Older people and social security system in Nepal. Gerontol Geriatr, 8(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChang J, Wray L, Lin Y. Social Relationships, Leisure Activity, and Health in Older Adults. Health Psychology: Official J Div Health Psychol Am Psychol Association. 2014;33(6):516. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/hea0000051\u003c/span\u003e\u003cspan address=\"10.1037/hea0000051\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDarnal P. (2017). Significant heritages of Upper Mustang and issue of conservation. \u003cem\u003eDhaulagiri Journal of Sociology and Anthropology, 11(0)\u003c/em\u003e, 1\u0026ndash;23. https://doi.org/11.3126/dsaj.v11i0.18820.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFCHV Basic Training - English. pptx - Google Drive \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://drive.google.com/file/d/1AhdLgNKA9NLgFgKAvKoLMlNii4tRRvOv/view\u003c/span\u003e\u003cspan address=\"https://drive.google.com/file/d/1AhdLgNKA9NLgFgKAvKoLMlNii4tRRvOv/view\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhimire S, et al. Functional status and its associated factors among community-dwelling older adults in rural Nepal. BMC Geriatr. 2021;21:335.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGurung TW. (2021). Dietary practices and nutritional status of senior citizens in Lomanthang Rural Municipality of Mustang district (BPH thesis). Faculty of Health Sciences, Pokhara University.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoshi MR, et al. Quality of life of Nepalese elderly individuals living in rural Nepal. Gerontol Geriatr Med. 2018;7(5):1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKalasha Foundation. ). Study in Lomanthang Rural Municipality, Nepal. [Brochure]. Georges and Serena Hartmann. Switzerland; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKandel N, Lamichhane J. Female health volunteers of Nepal: The backbone of health care. Lancet. 2019;393(10171):e19\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLomanthang Rural Municipality. (2025). गाउँपालिकाको संक्षिप्त परिचय. Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://lomanthangmun.gov.np/\u003c/span\u003e\u003cspan address=\"https://lomanthangmun.gov.np/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNepal Health Facility Registry, 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSenior Citizen Act. (2006). \u003cem\u003eAn act was enacted to provide protection and social security for senior citizens\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShrestha S, et al. Elderly care in Nepal: Are existing health and community support systems enough? SAGE Open Med. 2021;9:1\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTucker E, et al. Nutritional status and quality of life of older adults in aged care: A systematic review and meta-analysis. Exp Gerontol. 2022;162:111764. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.exger.2022.111764\u003c/span\u003e\u003cspan address=\"10.1016/j.exger.2022.111764\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8818362/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8818362/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eA review of the literature highlights the growing challenges posed by Nepal\u0026rsquo;s aging population, which now comprises 6.9% of the nation\u0026rsquo;s total population. This research offers an innovative approach to enhancing the quality of life of Nepal\u0026rsquo;s elderly population. The study\u0026rsquo;s primary goal is to assess the health care status of senior citizens through a personal interview. This will later be used to determine elderly care needs. A field study was implemented in Lomanthang R.M., Upper Mustang. The main focus of this study was the visit to all i.e. 188 senior citizens, conducted through face-to-face interviews guided by a comprehensive questionnaire. Special attention was paid to the issue of quality of life, with targeted questions on the socio-emotional well-being. The field study gave us significant insight into the daily life of senior citizens in Lomanthang. All items were evaluated according to frequency and severity. The majority of seniors complained that they missed their children. Our survey reveals that a great number of seniors (38%, n\u0026thinsp;=\u0026thinsp;72) consume alcohol, some to a considerable extent. It was found that alcohol was consumed to forget one\u0026rsquo;s own worries/family-related memories. The vast majority of our participants attested that their greatest happiness lies in their relationship with family and good friends or going out in sun and chatting with neighbors.\u003c/p\u003e","manuscriptTitle":"A field study assessing the health care needs of senior citizens in Upper Mustang, Nepal","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-23 09:50:25","doi":"10.21203/rs.3.rs-8818362/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-01T07:58:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T18:22:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-28T23:36:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"194467102834454391437302964999318907520","date":"2026-04-16T16:41:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"136142441865858849659237711195331391855","date":"2026-04-16T16:10:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T09:48:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"57917663634351951481895514048979511256","date":"2026-02-24T05:49:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250988563834050927231691749873401539898","date":"2026-02-24T04:25:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-19T08:34:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"314701676725005483131459566331592023368","date":"2026-02-18T07:45:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"81642244697828704036936099916407750633","date":"2026-02-17T14:16:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-17T13:45:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-16T14:27:58+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-13T19:43:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-12T19:32:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2026-02-12T19:27:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"38653ac1-30f1-4f68-bfa5-d4ce8e065f06","owner":[],"postedDate":"February 23rd, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-01T07:58:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T18:22:03+00:00","index":63,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-01T08:10:13+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-23 09:50:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8818362","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8818362","identity":"rs-8818362","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}