old age problems in agra

8/13/2019 Old Age Problems in Agra

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Old Age Problems in Agra

Contents

Background

Methodology

Findings


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Introduction

In India, around 2/3rd of the population is below or close to 30, so does

talking about old age problems (which exist) sound awkward?

Consider this, out of every 10 elderly couples in India, more than 6 are

forced by their children to leave their homes. With no place to go and all

hopes lost, the elderly have to resort to old age homes, which do not

guarantee first class treatment. In India, unlike USA, parents do not

leave their children on their own after they turn 18 (of course there are

exceptions), but children find it hard to accept the fact that there are

times when parents want to feel the love that they once shared with

them. There are times when parents just want to relax and want their

children to reciprocate their care. Every parents wants to see their child

grow and be successful but no parent wants their child to treat them like

an unnecessary load on their responsibilities.


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Every other day, we see news of parents being beaten up by their

children, parents and in laws being forced to do the house hold chores,

being made to live in small dungeon like rooms, their property being

forcefully taken over by over ambitious children.

There are 81million older people in India-11 lakh in Delhi itself.

According to an estimate nearly 40% of senior citizens living with their

families are reportedly facing abuse of one kind or another, but only 1 in

6 cases actually comes to light. Although the President has given her

assent to the Maintenance and Welfare of Parents and Senior Citizens

Act which punishes children who abandon parents with a prison term of

three months or a fine, situation is grim for elderly people in India.


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According to NGOs incidences of elderly couples being forced to sell

their houses are very high. Some elderly people have also complained

that in case of a property dispute they feel more helpless when their

wives side with their children. Many of them suffer in silence as they

fear humiliation or are too scared to speak up. According to them a

phenomenon called grand dumping is becoming common in urban

areas these days as children are being increasingly intolerant of their

parents health problems.

After a certain age health problems begin to crop up leading to losing

control over ones body, even not recognizing own family owing to

Alzheimer are common in old age. It is then children began to see their

parents as burden. It is these parents who at times wander out of their

homes or are thrown out. Some dump their old parents or grand parents

in old-age homes and dont even come to visit them anymore. Delhi has

nearly 11 lakh senior citizens but there are only 4 governments run


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homes for them and 31 by NGOs, private agencies and charitable trusts.

The facilities are lacking in government run homes.

Forget the rights that the elderly enjoy in India. Just forget about the

action that they can take. Think on moral grounds. Why do we tend to

forget that the reason we are in this world is our parents, the reason we

studied is our parents, the reason we were alive all this while is our

parents, the reason we survived all the diseases is our mothers care. The

hands who made us walk is our parents. When we were kids we never

thought of it but we knew that no matter what, our parents will be by our

side. But when our time came to show our respect, to reciprocate the

love, to show our gratitude, we back out.

But the truth is that even when they are counting their last breath, they

are still thinking of us!


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Is the youth too insensitive to the elder? Passing comments at an old

man walking slowly on the road and disturbing the flow of the traffic are

our ethics? Come on youth, stand up against such injustice.

Given the trend of population ageing in India, the elderly face a number

of problems and adjust to them in varying degrees. These problems

range from absence of ensured and sufficient income to support

themselves and their dependents, to ill-health, absence of social security,

loss of social role and recognition, and the non-availability of

opportunities for creative use of free time. For a developing country like

India, the rapid growth in the number of older population present issues,

barely perceived as yet, that must be addressed if social and economic

development is to proceed effectively. Gore (1993) opined that in

developed countries population ageing has resulted in a substantial shift

in emphasis between social programmes causing a significant change in

the share of social programmes going to older age groups. But in

developing society these transfers will take place informally and will be


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accompanied by high social and psychological costs by way of intra-

familial misunderstanding and strife. Among the problems of elderly,

health problems and medical care are the major concern among a large

majority of the elderly. The present paper focuses on the health of the

elderly in India. This is based on a comprehensive review of the studies

conducted on the elderly in India and also suggests measures to improve

their health status.

Health Conditions of the Elderly

It is obvious that people become more and more susceptible to chronic

diseases, physical disabilities and mental incapacities in their old age. As

age advances, due to deteriorating physiological conditions, the body

becomes more prone to illness. The illness of the elderly are multiple

and chronic in nature. In the later years of life, arthritis, rheumatism,

heart problems and high blood pressure are the most prevalent chronic

diseases affecting the people. Some of the health problems of the elderly

can be attributed to social values also. The idea that old age is an age of

ailments and physical infirmities is deeply rooted in the Indian mind,


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and many of the sufferings and physical troubles within curable

limitations are accepted as natural and inevitable by the elderly.

Regarding the health problems of the elderly, having different socio-

economic status, it was found (Siva Raju, 2002) that while the poor

elderly largely attribute their health problems, on the basis of easily

identifiable symptoms, like chest pain, shortness of breath, prolonged

cough, breathlessness / asthma, eye problems, difficulty in movements,

tiredness and teeth problems; the upper class elderly, in view of their

greater knowledge of illnesses, mentioned blood pressure, heart attacks,

and diabetes which are largely diagnosed through clinical examination.

Gore (1990), by analyzing the social factors affecting the health of the

elderly, concluded that, while there were no data showing direct

relationship between income level and health of elderly individuals, it

could be assumed that the nutritional and clinical care needs of the

elderly were better met with adequate income than without it. If so, the

poor countries and the poorer


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Professor, Unit for Urban Studies, Tata institute of Social Sciences,

Deonar, Mumbai-400088, India segments of the elderly population

within each country would experience problems of health and well

being.

The idea that old age is an age of ailments and physical infirmities is

deeply rooted in the Indian mind, and many of the sufferings and

physical troubles within curable limitations are accepted as natural and

inevitable by the elderly Some clinical studies have found that

multiplicity of diseases was normal among the elderly and that a

majority of the old were often ill with chronic bronchitis, anemia,

hypertension, digestive troubles, rheumatism, scabies and fever. Some of

the cases of disability among the elderly, as reported by a few medical

studies, were difficulty in walking and standing, partial or complete

blindness, partial deafness and difficulty in moving some joints,

indigestion and mild breathlessness. Joshi (1971), through his clinical

study of the elderly, opined that the differential ageing phenomena, both

physical and mental, appear to depend on environmental and social


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factors such as diet, type of education, adjustment to family and

professional life, and consumption of tobacco and alcohol. Purohit and

Sharma (1972), in their clinical study, observed that males werereported

to have more ailments (average: 4.07) than females (average: 3.85).

Further, they also found that the older patients had under-reported the

incidents of diseases during the survey and that some of the serious and

significant ailments were revealed only on closer examination. Desai

and Naik (1972) by comparing the pre-and postretirement situation of

health of the retired persons in Greater Bombay, inferred that if a retired

person keeps himself/herself fit before and immediately after his/ her

retirement, he/she continues to be free from illness during the post-

retirement period; but once an illness starts, before or just after the

retirement period, he / she continues to face it during the post-retirement

period too. The study of the Medical Research Centre of the Bombay

Hospital Trust (Pathak, 1975), based on the post-treatment analysis of

the records of 1,678 patients admitted in the Bombay Trust Hospital

during the years of 1970 and 1971, revealed that a good number of

patients had gone through more than one major illness in the past. The


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author expected that there was a higher incidence of disease in the

subjects than mentioned in the records since the patients mentioned only

such symptoms that they considered serious. In another study of the

hospital data, Pathak (1982) found that 62.6 per cent of the elderly

patients had cardiovascular ailments, 42.4 per cent had gastrointestinal

problems, 32.5 per cent had urogenital problems, 19.8 per cent had

nervous breakdowns, 19.2 per cent had respiratory problems, 11.6 per

cent had lymphatic problems, 7 per cent had high or low blood pressure,

11.2 per cent had ear and eye problems. 4.8 per cent had orthopedic, 5.7

per cent had surgical problems while 37.3 per cent of the elderly had

problems with all their systems.

Darshan et. al (1987) carried out a study of older persons in various

slums scattered in and around the city of Hissar. Among the 85 subjects

interviewed by them, 67.1 per cent were sick at the time of the survey.

Out of these, 73.7 per cent were suffering from chronic illness. Gupta

and Vohra (1987) observed that only a few elderly with psychiatric

disorders were being cared for in the inpatient-wards in hospitals or as


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residents of homes. A more recently conducted medico-social study of

the urban elderly in Mumbai (Siva Raju, 1997) has revealed that the

influence of the factors like, educational status, economic status, age,

marital status, perception on living status, addictions, degree of feeling

idle, anxieties and worries, type of health centre visited and whether or

not taking medicines, on both the perceived and actual health status of

the elderly is found to be significant and vary considerably across

different classes and sexes of the elderly. Such a wide sex difference in

this stratum is probably due to greater prevalence of health problems;

compulsions to continue in labour force, and the resultant stress; and

worries about unfinished tasks, which the male elderly mostly face.

At an advanced age, due to restricted physical activity, a majority of

elderly change their living habits, especially their dietary intake and

duration of sleep. There is a general perception in the community that

since the old lead a sedentary life, they should eat less food, have more

rest and develop more religious interest to occupy them. Several factors

like lack of physical movement, absence of a work routine, ill-health,


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etc. are observed to be responsible for irregularity in the sleeping

schedule of the elderly (Siva Raju, 1997). The allocation of less time to

sleep among the lower strata of the elderly, probably indicate the

compulsions for them to work. Besides, inadequate facilities in the

household go against resting or sleeping during the day. Mental health of

the elderly is another important area in understanding their overall health

situation. It is generally expected that the elderly should be free from

mental worries since they have already completed their share of tasks

and should lead a peaceful life. But, often, the unfinished familial tasks

like education of children, marriage of daughter(s), etc, becomes a

source of worry over a period of time. It is noticed (Siva Raju, 1997)

that the worries among the poor are probably about inadequate economic

support, poor health, inadequate living space, loss of respect, unfinished

familial tasks, lack of recreational facilities and the problem of spending

time.

Some of the earlier research works (Purohit and Sharma, 1972; Pathak,

1975; Mishra, 1987; Sati, 1988) had reported that there was a


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considerable difference in the perception of old people of their health

status and the reality. It was presumed that such differences narrow

down as socio-economic status of elderly increases, because with higher

education and income they would have greater access to health/ medical

information and services. There is a general perception among the

elderly that they are prone to illnesses mainly due to their advanced age

and that it is natural to suffer from such health problems at that age.

However, in reality, most of their diseases are minor in nature and

curable at the initial stage itself. Most of them neglect the illnesses and

postpone seeking medical aid. In some cases, due to neglect of timely

medication, the health problems become aggravated and sometimes lead

to death. Although the retired persons enjoy pension benefits, a large

number of the elderly in India, who do not belong to the 'employed',

category, do not enjoy any social security benefits. During the service

period, certain medical facilities such as free treatment and supply of

medicines from the government hospitals / dispensaries are provided to

the employees. But these facilities may not be available after retirement

when the old people are really in need of such subsidies. Thus retired


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government servants face a hard time after retirement if they are the

victims of any serious illness.

There appears to be a significant difference in the health situation of the

elderly living in rural areas when compared to urban areas. The elderly

people living in rural areas appear to be much healthier as compared to

those residing in urban areas. Interestingly the prevalence of chronic

disease among females is higher than among males in the case of urban

areas while reverse is the case in rural areas (CSO, 2000). Further,

prevalence of various types of physical disabilities was found to be quite

high among the elderly. All types of disabilities were also found to be

more prevalent in rural areas as compared to those in urban areas.

Utilization of Health Care Services by the Elderly

As the physiological condition deteriorates and responds only slowly to

medication, the elderly need medical advice and treatment regularly to

minimize their health problems.


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However, seeking medical aid is a costly affair, unless it is from a public

hospital. But most of the public health care centres are plagued with

many problems like improper hygiene, overcrowding and inadequate

infrastructure in terms of health, human power, medicines and the

necessary medical equipment. Further, generally the elderly are the last

segment in a household to seek or to demand the medical aid, in view of

the general perception in society that not much can be done about the

health problems of old age.

Health care system at various levels in our country is designed for the

general population and no special provision preferences are so far

provided in the system to take care of the elderly in our society. At

present, the old have to compete with the other segments of our

population in getting the public health care facilities. The poor strata

utilize public health centres mainly because of free treatment facilities

and its nearness to their residences. Majority of the well- to-do and to a

certain extent the MIG elderly utilize mostly the private health care

facilities. The advantages cited by those who utilize private source(s) of


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medical care mainly include: good treatment, quick relief, less waiting

time to see a doctor, cleanliness of the hospital premises, adequate

interest shown by doctor, convenient time and nearness of its location

(Siva Raju, 1997).

India's health system, though rests on a well-conceived infrastructure to

make health available to its people, the paradox, however, is that inspite

of the availability of the facilities, their utilization is very meager hardly

10 to 20 per cent (Griffith, 1963; John Hopkins University, 1976). The

problem is more acute in the remote areas, where, whatever meager

facilities have been made available, they are not optimally utilized by

the people. Instead, people go to practitioners of indigenous methods,

who are not qualified, such as traditional birth attendants, faith healers

and other private practitioners who live and work among them (Siva

Raju, 1986). Majority of studies conducted so far, on the utilization of

existing health care services in India have revealed the very poor image

the government health centres have among the people.


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Among the small proportion of villagers who use the facilities, a

majority are dissatisfied with the services, mainly because of the non-

availability of medicines and the impersonal behaviour of the health

functionaries.

Health care system at various levels in our country is designed for the

general population and no special provision preferences are so far

provided in the system to take care of the elderly in our society.

A fact that has been found universally valid is the relationship between

poverty and ill health. Many of the communicable diseases, especially

debilitating diseases like fever and diarrhoea, take a heavy toll on the

poor. In the case of both acute and chronic diseases the lower socio-

economic status groups fare very badly compared to the higher

socioeconomic status groups. The same trend is seen in case of

disabilities and handicaps too. It is seen that in both cases morbidity

shows a steady pattern; whatever be the illness its prevalence increases

as socio-economic status goes down. These indications from the above

facts clearly indicate that poor people are more vulnerable than the rich;


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women; and those who stay in villages have a higher incidence of

diseases than men and urban people. Also poor people spend larger

proportion of their income on medical bills than the rich. Since

medicines and consultations are very expensive, they take medicines

only until the symptoms go away, and as a result, most of the leading

ailments become chronic in nature. Getting proper medical aid was

found to be beyond the reach of the elderly, which may have been due to

their poverty, illiteracy, general backwardness and adherence to

superstitious beliefs for curing illnesses and diseases.

Upadhyay as early as in 1960, expressed his doubts as to whether India

would be able to afford health services for the elderly population. Sahni

(1982) is of the view that the health policy should be included as an

integral part of health services of the elderly population. Bose (1988)

suggested creating mobile geriatric units and special counters or days in

the general hospitals for attending to the elderly population. Bakshi

(1987) was of the view that geriatric wards, outpatient units and special

counters need to be setup in hospitals. Pathak (1982) suggested that aids


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such as dentistry, spectacles and hearing aids need to be given to the

needy old. Darshan et.al. (1987) stressed the need for frequent medical

camps for the benefit of the rural old population. Mehta (1987) has

suggested a three pronged approach for care of the elderly being: (a)

provision of curative services; (b) legal protection and (c) health

education to take care of medical and health problems of the aged. It is

clear from the above review of earlier studies on health of the elderly

that the health and well-being of the elderly are affected by many

interwoven aspects of their social and physical environment. These

range from their lifestyle and family structure to social and economic

support systems, to the organization and provision of health care. The

pattern of various inputs for developing the appropriate social policy for

the welfare of the elderly may have to be suitably modified in view of

the diversity of the factors and their differential influence on the living

conditions of the elderly.


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Conclusion

The trend in the size and growth rate of the elderly population in the

country reveals that aging will become a major social challenge in the

future when vast resources will need to be directed towards the support,

care and treatment of the old. Therefore, it is high time suitable policy

measures to minimize the problems of elderly in the country were

adopted. The following are some of the measures suggested to improve

the health status of the elderly in India:

health care so that they could learn certain do's and don'ts related to the

different diseases and inculcate these in their behavioral patterns through

constant practice so as to prevent the occurrence of diseases or reduce

the effects of illnesses.

thic doctors to

handle the specific illnesses associated with aging.


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special units in hospitals and with free or highly subsidized medicines.

Subsidized health care would also represent an indirect transfer of

resources to the family.

special counters and geriatric out-patients units in existing hospitals will

greatly help the elderly.

form a part of the syllabus for medical

professionals and paraprofessionals so that they could integrate health

education along with the health care provided to the elderly persons.

needs to be attempted for that would be most cost effective as well as

more efficient.

on full time basis, irrespective of their health status, mainly to earn a

living. There is a necessity to introduce community based income

generating schemes for the benefit of the poor elderly.


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-availability of food may be

a major factor responsible for reduced in-take and consequent poor

health. In view of this, supplementary nutrition programmes targeting

needy elderly in the poor localities may be considered on a priority

basis, which ultimately helps them in improving their health status.

medicines among the poor elderly is almost absent, in spite of their

requirement from health point of view. Therefore, local NGOs working

even on other issues of society may regularly interact with the elderly of

their community and see that the benefits reach them in time.

elderly so that a greater commitment and involvement could be ensured

in order to include "care for the elderly" within the purview of Primary

Health Care.

Main problems as faced by elderly men and women Older Peoples roles

within their communities Perception of what elder abuse is and what are

the different kinds Perceptions of the contexts in which elder abuse


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occurs, and its perceived causes Situations where different acts of

violence and/or abuse are acceptable or unacceptable Situations where it

is appropriate for family members, neighbours or friend to intervene

Whether abuse in common in the area or not Seasonal influences of

abuse Perceptions of elder abuse as a health issue and an issue of

concern for health care workers Identify existing/needed health and

social services and community support in relation to violence and abuse

Define the gaps, the needs and views for future responses to abuse, care

and prevention.

Why people do not approach help Discussion Conclusion Elder Abuse in

India

Background:

India is growing old! The stark reality of the ageing scenario in India is

that there are 77 million older persons in India today, and the number is

growing to grow to 177 million in another 25 years. With life

expectancy having increased from 40 years in 1951 to 64 years today, a


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person today has 20 years more to live than he would have 50 years

back.

However, this is not without problems. With this kind of an ageing

scenario, there is pressure on all aspects of care for the older persons

be it financial, health or shelter. As the twenty first century arrives, the

growing security of older persons in India is very visible. With more

older people living longer, the households are getting smaller and

congested, causing stress in joint and extended families. Even where

they are co residing marginalization, isolation and insecurity is felt

among the older persons due to the generation gap and change in

lifestyles. Increase in lifespan also results in chronic functional

disabilities creating a need for assistance required by the older person to

manage chores as simple as the activities of daily living. With the

traditional system of the lady of the house looking after the older family

members at home is slowly getting changed as the women at home are

also participating in activities outside home and have their own career


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ambitions. There is growing realisation among older persons that they

are more often than not being perceived by their children as a burden.

Old Age has never been a problem for India where a value based, joint

family system is supposed to prevail. Indian culture is automatically

respectful and supportive of elders. With that background, elder abuse

has never been considered as a problem in India and has always been

thought of as a western problem. However, the coping capacities of the

younger and older family members are now being challenged and more

often than not there is unwanted behaviour by the younger family

members, which is experienced as abnormal by the older family member

but cannot however be labelled.

The aim of the study was to (1) define and identify the symptoms of

elder abuse, (2) create awareness about its existence to the primary

health care workers and (3) develop a strategy for its prevention.


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Methodology:

Focus group discussions were held to gather data from the participants

of the study. This is a technique widely used to gather data especially on

sensitive issues wherein the subjects involved in the study cannot or for

some reasonreserve their comments and one to one interviews do not

seem to work.

Interaction within a group helps the participants to be able to define a

problem without making an effort to measure its scope.

Sample:

The sample was taken from urban society, residing in Agra. Two major

groups were addressed: the older persons and the primary health care

workers who interact with these persons when they approach as patients.

Older Persons:

Six focus groups were convened with the help of the author and an

assistant facilitator in six different areas in Delhi. These groups


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comprised of members of senior citizens associations in local of

residential areas of Delhi. The details of the groups are given as under:

Group number Constitution No. of participants Socio-economic status

1 Male 10 Middle

2 Male 08 Upper middle

3 Mixed 12 Low

4 Mixed 10 Upper Middle

5 Female 08 Low

6 Female 10 High

The socio economic status was examined from the last income,

occupation and education of the participants of the group.

Health care workers:

Two groups of health care workers involved as primary health care

workers in urban settings were also involved in focus group discussions

regarding their perceptions of what elder abuse is, how rampant it is


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within the Indian context and how they feel that it can be tackled. Both

the groups constituted of male and female doctors, female nurse and

nursing attendents (both male as well as females).Registration clerks

were also included in the groups as they are the first contact of a patient

in a health care setting. Total number of participants in both these groups

was 8.Findings:

During the introduction, in the focus groups with the older persons, care

was taken about avoiding the word Abuse.

Main problems as faced by elderly men and women

MALES

Discussions with male groups indicated that the middle income group

listed economic problems on priority. The second male group from

the upper middle class prioritised mental health problems focusing

more on lack of work, lack of facilities for utilisation of leisure time and

a general feeling of loneliness talking to walls. The problem here did

not seem to be lack of money but lack of time by the others for the

older persons Second to economic problem came lack of emotional


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support from familymembers and both the groups felt that they felt a

need to talk to their family who did not seem to have time for them The

Words were manyranging from neglect from family, experience of

loneliness in everything, a sense of insecurity and feeling of

burden, and Old Age itself was a disease

A glaring problem faced by the males group was older couple being

asked to live separately when they had more than one child i.e. the older

woman to stay with one child and the man to stay with another

according to the convenience of their support in whatever housework

/outside work they could contribute to Health problems however took a

back seat coming in at the third position and linked with lack of mobility

and economic problems Lack of accommodation was also a problem

identified by the older persons who had houses of their own and were

not staying in apartments, where there is only a specified area.

Case study 1

Dr. Singh, 70, is a qualified medico trained in Homeopathic medicine.

He superannuated from Government service about 10 years back. He has


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been living in this apartment, owned by him with his only son, daughter

inlaw and two grandchildren for many years now. His wife died two

years back.

He waits endlessly for the meals to be served. He is an early riser and

goes to bed early. At times, he has to eat whatever is available. The

timing of the meals and the items prepared do not suit his age and taste.

If at all he complains, it creates an unpleasant situation in the house and

nothing improves.If he offers any suggestions about the ways of keeping

the house(which is his own), or for that matter looking after the needs of

the grandchildren, he is told in no uncertain terms to mind his own

business.

He has asked his son and his family to leave as he is the owner and he

can no longer live with them. He has even suggested that would like to

remarry for the sake of a companion and so they must be leaving the

apartment. They do not go anywhere, and continue to neglect him.

MIXED


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Health problems surfaced as being the most common problems faced by

the older persons in the mixed group both in the lower and upper middle

strata of society followed by financial problems. The views were similar

in both the focus groups. They stressed on the physical disabilities and

problems of mobility, as well as problems of living alone with

disabilities.

In the lower group, the problem of women surfaced as the next major

issue wherein there was a general consensus was women were the worst

sufferers with no income of their own and dependent on spouses for

everything. They also tended to underplay their health problems for the

sole reason of causing inconvenience to the other family members by

way of escorting them to the doctor and/or spending money by way of

consultation fee and medicines.

They further voiced that if the women were widows, the situation was

even worse because the finances then came from children for their

welfare and it was the sole discretion of children to decide whether she


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needed medical assistance or not even if she said she did. This problem

however did not get priority in the upper middle level group.

Daughters-in-law was the next problem in both the groups. While

both the groups stressed on the lack of caring attitude by the daughters in

law, women of the lower socio-economic class got very vocal about the

fact that daughters in law were misusing the law, by reporting

harassment by in-laws to the police, leading to maltreatment by the

police to the in-laws. (Indian Penal Code sec.498(a), is designed to

tackle dowry deaths)

While the lower income group faced a very obvious problem of lack of

space within the existing housing structure, causing the older persons to

be moving to smaller rooms, or open spaces covered now for the sake of

the elderly,the upper middle group complained of lack of adjustment

from the younger generation causing a great deal of turmoil among the

older generation. They felt neglected by the family members and also

felt a sense of resentment against their own children at times.

FEMALES


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Economic Hardships became very prominent in the women of the lower

socioeconomic group while the higher socio economic category put

loneliness as the primary problem affecting the older persons today. The

lower socio economic group felt that if the woman has money, she had

power or else she had to be dependent on children for financial support

and also illtreatment, humiliation and complete neglect from family

members. This mental agony also led to various mental health problems

some of which could not even be described.

Case Study 2


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Mrs. SHANTI, 75, widowed for 50 years (at least), mother of two sons.

The younger of the two sons was 3 months old when the husband died,

with no finances or pension to fall back upon. The lady survived by

sitting outside a temple and serving water to the devotees and earned

Rs.35/- per month (less than 1 US$) and some other income generation

activities to make both ends meet. Her sons grew up, got married, and

generally did well in life. One ofthem did better than the other and

moved away from the mother and brothers family and stopped all

contact with them. She stays with the second son and his family, who

continue to support her.

Her first son (staying separately) decided to open a community water

cooler in his locality, in the memory of his father. On the pursuance of

his friends and other members of the community, he invited his mother

to inaugurate it. After the inauguration, when refreshments were being

served, the mother was totally ignored to the extent that the two guests

on her either side were served while she just looked!


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The higher socio-economic strata focus group prioritised health and

mobility as the second major problem following loneliness and stressed

on other issues like lack of utilisation of productive potential of older

persons as well as lack of recreation facilities within the community.

Some in the group also felt that there was economic exploitation by the

hands of the children who wanted their share in the property before the

older parents death and expressedconcern because they felt that parents

gave in to such demands as they did not want conflict.

Case Study 3

Mrs Kamlesh Gupta, 65, belonged to an extremely rich family. For

fifteen long years she took care of her bedridden husband single

handedly. She is mother of 5 well educated and well earning children.

Some of them live in the vicinity.

They all were willing to contribute monetarily towards her welfare but

could/did not provide emotional/moral support that she required the

most. During the course of discussion, she appeared agitated, angry and

practically furious with the callous attitude of the younger generation.


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She had also suffered bouts of severe mental depression. To keep herself

occupied she had started teaching adolescent girls in the neighbouhood.

However, she still felt lonely and neglected.She wanted to get quick

solution to her complicated problems. When the discussion was halfway,

she promptly got up and walked out saying that the focus group was

incapable of arriving at a solution for her problems.

Older peoples role within their communitiesSince we are dealing with

people who have largely been professionals, (both male and female)

there is a definite age of retirement from the professional life. Earlier,

these people could use their energy/potential in taking care of household

activities e.g. buying provisions, looking after grandchildren etc.

With the change in the perception of family, these roles are now played

by domestic helps.

There are no clearly defined roles of older persons with in their families.

Women in the lower middle class who largely had been housewives all

their lives faced a different problem of being marginalized from the kind

of housekeeping that they were used to. This work was now being


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performed by the daughter in law who felt that the household chores be

done according to her style of functioning.

Perceptions of what abuse is and what are different kinds. The groups

linked the word Abuse to extreme behaviour of violence.

Neglect/ abandonment that was clearly felt by the majority in all the

three groups was not defined as abuse.

Disrespect was another acknowledged form of maltreatment meted to

the older persons Lack of dignified living was also cited as a form of

maltreatment

On explaining different types of abuse through vignettes, there was a

general uneasiness among the groups and a genuine attempt was made to

evade the issue. On being forceful about the specific issues of physical

abuse and seasonal abuse, the groups denied the existence of such

happenings in the community.

Verbal abuse seemed to exist however, the older people were not very

vocal about it. There seemed to be some talk about some daughters-in-


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law speaking very rudely to their old in-laws. No major details were

provided but a glaring fact was of a woman who talked about someone

she knew whowas constantly called a bloody bitch by her daughter

in law, even while crossing her bed, or wherever the she used to be

sitting. The narrator had tears in her eyes, and within a matter of a few

minutes after this was frankly crying.Economic abuse was

acknowledged, especially by way of dispossession of property. This

seemed also to be linked to neglect. Cases were cited by the groups

themselves wherein the children took over the property while the older

parent was alive and then confined them/him to one corner of the house.

Disrespect was yet another form of abuse that got acknowledged (refer

to the case study 2 of Mrs. Shanti Gupta)

Old parents staying separately became yet another perception of what

maltreatment was. One parent was made to stay with one child while the

other stayed with the other child. This adjustment was made as one child

could not take the burden of looking after both the parents. There were

also cases of rotation wherein the parents stayed with one child for a


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particular period of time and then moved over to the other child to stay

with him for the same period of time.

In women especially, by way of financial dependency and no access to

money whenever required especially for health problems and buying of

medicines.

Even among the health care workers, physical cases of violence were the

only ones that got acknowledged as abuse but they did not report

physical violence as being seen by them. They however, did

acknowledge symptoms of mental illness and frank pathological mental

illness in older men and women who reported to have family problems

Perceptions of the contexts in which elder abuse occurs, and its

perceived causes Virtually the entire community in all the focus groups

believed that lack of value system and negative attitude of the younger

generation was the most obvious cause of maltreatment in the present

day scenario.

Lack of adequate housing leading to a lack of physical and emotional

space or basic necessities, that make the older parent shift to one corner


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of the house was also perceived as another major cause Dependence of

the older parent due to extreme physical and mental impairments,

requiring a constant support of a caregiver. The burden was perceived

both in the capacity of time and money. Caregivers became non caring

or not caring enough for the older parents and subjecting them to neglect

Lack of adjustment from the side of older persons. This point was

emphasized by majority of groups pointing to the fact the growing

realisation that, to survive, they shall have to adjust with the younger

generation.Situations where different acts of violence and/or abuse are

acceptable or unacceptable According to the focus groups, violence did

not exist in their communities. It was only in abnormal cases that it was

heard but by and large this did not exist.

There was however a passive acceptance of abuse by way of disrespect,

neglect, and economic by women of the lower strata.

The older persons in the groups considered neglect acceptable and a

genuine effort was made to justify this within the existing family

structures. The point was made that this neglect to a large extent was not


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wilful, on the contrary, it was something that the younger generation

could not help!

Economic abuse was unacceptable.

Situations where it is appropriate for family members, neighbours or

friend to intervene

The major problem here was sharing of the fact that they were being

abused.

They were afraid that if this complaint reached their children, they

would subject them to further abuse.

There was also another view that if older people themselves came and

talked about the way they were being harassed by their own children,

there might be a sense of shame among their children and the end result

may be a better life for the older parents.

Intervention was sought by nearly all however, they were scared to take

the initiative.


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Whether elder abuse is common in the area and why

Emotional/psychological, disrespect and neglect existed in all the areas

and while one part of the group blamed it on westernisation of society

and lack of value system in the once traditional family system in India,

there were others in the group who somehow seemed to be blaming the

older parents for the actions by the younger generation.

Economic dependence was considered a major reason for abuse.

Physical weakness due to age was also another reason why abuse existed

and they could not fight it.Seasonal influences of abuse Did not appear

to exist.

Perceptions of elder abuse as a health issue and an issue of concern for

health care workers Concern was shown by the health care workers of

both the focus groups as a mental health problem rather than a physical

problem. Somehow as thehealth care workers also perceived, they did

not seem to have come across violence towards the elderly in the

communities where they had worked.


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Physical symptoms that prevailed in the older persons were of epi gastric

pain, reflux, sleeplessness, anxiety, and depression. These were largely

psychosomatic in nature and could not be labelled as a specific physical

illness.

The medical doctors in the groups explained that they had tried to

convince patients about the fact their illness was more in their minds and

that thepresent diseased state was because they were probably thinking

too much.

Identify existing/needed health and social services and community

support in relation to violence and abuse A health care worker at the

primary health care level did not have the time to listen to the tales of

older persons. There were no facilities for the special geriatric services

that could be availed at the primary or secondary health care set up.

Need for a counsellor was suggested by both the focus groups of health

care workers. The groups felt that the older people needed to talk to the

doctors and other health workers rather than just get their illnesses

diagnosed.


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The groups felt that the older persons needed to be first screened by a

trained counsellor for their physical ailments that largely seemed to be

psychosomatic in nature. Almost all problems of the older patients

would get sorted with the introduction of a counsellor and also lead to

lesser workload for the doctors.

A need for a social worker was also felt by a few in the focus groups to

handle cases of frank/existing abuse that the patients were willing to talk

about.

However, the health care workers were themselves not sure if that would

work out because the older patients immediately tended to withdraw

whenever there was talk about intervention by way of someone going

from the community to talk to the children about the kind of emotional

trauma that the older parents were being subjected to by them.Define the

gaps, the needs and views for future responses to abuse, care and

prevention.

Sensitisation of younger persons through creative use of media

Recreation centre Utilisation of productive potential of older persons


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through utilisation in community services Counselling of older people to

adjust to the needs and changed circumstances of the younger generation

Why people do not approach help.

Most people in the group felt ashamed of the fact that they are being ill

treated by family members. They were also afraid of retaliation by the

family members if the agencies come to help.

A large majority also felt that the social agencies could hardly do

anything to help them and the major fact was that it was emotionally

satisfying to at leastbe able to see their children.

Discussion

As compared to the abundance of systematic data on population ageing

and statistics, there is complete lack of research, or published data on

elder abuse in India. Occasional articles in newspapers hear of elder

abuse but that is about all. This is a problem that largely gets swept

under the carpet, and is within the four walls of a home. It is grossly

underreported and un-discussed as the older people themselves do not


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want to discuss it, and the relatives and neighbours who are aware of this

do not want to get involved.

Concept of elder abuse as relevant to the developed world is alien to the

Indian society. The Indian scenario is not individualistic but a traditional

family based society where the older persons still seem to be considered

a respected lot. Due to technical advances and migration from rural to

urban areas, the roles of older people have become ill defined and too

insignificant for the family.

The six focus groups selected varied from lower to higher strata of

society and largely service sector people who had superannuated at the

age of 58 or 60 years. The participants of all the focus groups initially

talked about emotional problems, lack of emotional support,

neglect by the family members, feeling of insecurity, loss of

dignity, maltreatment, disrespect by the family. However, not a

single person was willing to label it as abuse. They linked abuse to

very severe acts of violence, which they all seemed to agree was

abnormal and did not happen in our societies. Defining abuse was a


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problem.Even encouraging a discussion on abuse with the help of

vignettes did not spark a discussion on the subject. In fact there was a

general uneasiness among the groups and a genuine attempt was made to

evade the issue. On being forceful about the specific issues of physical

abuse and seasonal abuse, the groups denied the existence of such

happenings in the community, at least within their own. One example at

this point would be of Mrs. Kamlesh Gupta (case study 3) who walked

out of the group. The avoidance of the issue, is very very evident which

also points to the fact that whatever exists the older people are not

willing to discuss it.

Another major factor was the fact that the older parents themselves were

trying to justify neglect in the existing circumstances, blaming it on

the changing scenario, changing value system that existed everywhere

in society, and not just their homes. Whatever be the cause, they were

sympathetic towards their own children. The reason could either be

emotional bonding with the children, especially the sons who

traditionally co-reside with their parents and in the traditional Indian


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scenario, are supposed to be the heir and carry the name of the family

into the next generation.

A major cause that is usually considered to lead to elder abuse is the

disability factor in the older persons that creates a need for a caregiver

who cannot/does not care enough or is tired of caring for much too long

that he/she (usually she) starts to neglect the older person.

Even though physical abuse was not sighted, the mental health problems

encountered in these older persons were far too many to ignore the

aspect that the psychological abuse did not hit the older parents as hard

as the physical abuse. In fact this was even worse to quite an extent

because since they felt the abuse but did not share it, talk about it, and

get it out of their system, it manifested in all kinds of psychosomatic

problems that to a large extent did not get cured by medicines. A

previous study done by the facilitator in an outpatients department of a

tertiary care hospital had revealed that about 85% of the older persons

has felt loved and wanted by their familymembers while only about

10% felt that they were being tolerated, 4% hadfelt the need to go to


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an old age home while 1% had no comments on theissue. This reveals

the differences between a one to one interview and a focus group

discussion where largely they were talking about others rather than

their own selves.

Financial abuse was linked largely with people of the lower middle

income group especially women. An older woman in the present day

India scenario has traditional role given to her as a care giver in a largely

patriarchal society, with no financial independence and if she happens to

be a widow that is the case of 55% of the women above the age of 60

years in India, then the world may not be a very nice place to live.

Verbal abuse seemed to exist however, the older people were not very

vocal about it. Sporadic research into the issue has shown that women

have beenfound to be complaining more about abuse especially verbal

and physical.

Here, while women were definitely more vocal than men, incidence of

physical abuse however was not cited. Another glaring aspect seen in the

study was use of crime as a weapon for elder abuse. There is a special


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cell for crime against women where cases of domestic violence and

dowry deaths are handled on priority. These are now being grossly

misused by the younger daughtersin - law against the parentsin-law.

Discussions with primary health care workers revealed that they do not

look for elder abuse in older patients. They do not consider this a health

issue and neither do they feel the need to intervene and try to reduce

elder abuse as they consider it more as a social problem, and not a health

care issue.

Facilities need to be provided to older people to meet like minded people

and spend their time doing some constructive social work. Need for

professional caregivers is also essential, so that the members of the

family who can help monetarily but not with time, and energy could get

help and therefore some extent of abuse in that direction could be

solved.

Counselling needs have emerged as yet another major component of

solving the problem of elder abuse. Counselling could prove to be an


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important component of family therapy and the end result could be

beneficial for both the younger as well as the older generation.

Conclusion:

This study was designed with the overall aims of defining and

identifying the symptoms of elder abuse, spreading of awareness about

its existence among the primary health care workers and also develop a

strategy for its prevention.

Eight focus groups with roughly 10 people in each were the participants

in the discussion that comprised 2 elderly male groups, 2 elderly female

groups, 2 elderly male and female groups mixed and 2 groups of primary

health care workers comprising of doctors, nurses and nursing

attendants. The older persons in the focus groups were staying with their

families in the community.

Elder abuse was linked to violence and was not acknowledged by the

participants of the study as something that happened in their community.


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They however did acknowledge the existence of maltreatment,

neglect, and disrespect within their society and community.

However, a large part of the acknowledged maltreatment was accepted

and efforts were made to justify the behaviour by the younger

generation.

No cases of physical abuse were brought to the notice of health care

workers in these settings. However, they felt that the problems of abuse

among older persons were more mental than physical. It was even more

difficult to first, identify and then tackle as the older persons were not

willing to talk aboutthem. These were instead presented to the doctors as

major psychosomatic complaints that did not get cured with medicines.

The introduction of an issue such as this was disturbing to most of the

participants in the groups. There were very few who initially were

willing to talk about this objectively. They were of the view that cases of

abuse reported in the press were only aberrations and abuse did not exist

in society in general.


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Media was blamed for sensationalising the issue. Acceptance of the fact

that neglect, in any case would occur because of pressures of modern life

styles and changes in the value pattern.

The solutions cited to handle the problems of older persons were in

the form of a recreation centre/day care centre that the older participants

felt could solve a lot of problems of the elderly. The primary health care

workers felt the need of introduction of counselling services for the

elderly as a major problem solving method.

Elder abuse could not be conceived to exist in the typical scenario. There

has been an attempt to accept negligence as apart of the changing social

norm.

Primary Health Care workers are neither aware of their role in

diagnosing elder abuse nor are they considering initiating intervention in

this direction.

Problems

of the


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Elderly

FACTS ABOUT

ELDERLY IN

INDIAMISSION &

VISIONPROBLEMS

OF THE

ELDERLYPROGRA

MMES AT

GLANCE

S.

No.Problem Need

1 Failing Health Health

2 Economic insecurity Economic security

3 Isolation Inclusion

4 Neglect Care

5 Abuse Protection

6 Fear Reassurance

7 Boredom (idleness) Be usefully occupied

8 Lowered self-esteem Self Confidence

9 Loss of control Respect

10Lack of Preparedness

for old age

Preparedness for old

age

Equity Issues are relevant to all the above

Failing Health

It has been said that we start dying the day we are born.

The aging process is synonymous with failing health.

While death in young people in countries such as India is
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mainly due to infectious diseases, older people are

mostly vulnerable to non-communicable diseases. Failing

health due to advancing age is complicated by non-

availability to good quality, age-sensitive, health care for

a large proportion of older persons in the country. In

addition, poor accessibility and reach, lack of information

and knowledge and/or high costs of disease

management make reasonable elder care beyond the

reach of older persons, especially those who are poor

and disadvantaged.

To address the issue of failing health, it is of prime

importance that good quality health care be made

available and accessible to the elderly in an age-sensitive

manner. Health services should address preventive

measures keeping in mind the diseases that affect or

are likely to affect the communities in a particular

geographical region. In addition, effective care and

support is required for those elderly suffering from

various diseases through primary, secondary and tertiary


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health care systems. The cost (to the affected elderly

individual or family) of health has to be addressed so that

no person is denied necessary health care for financial

reasons. Rehabilitation, community or home based

disability support and end-of-life care should also be

provided where needed, in a holistic manner, to

effectively address the issue to failing health among the

elderly.

Economic Insecurity

The problem of economic insecurity is faced by the

elderly when they are unable to sustain themselves

financially. Many older persons either lack the opportunity

and/or the capacity to be as productive as they were.

Increasing competition from younger people, individual,

family and societal mind sets, chronic malnutrition and

slowing physical and mental faculties, limited access to

resources and lack of awareness of their rights and

entitlements play significant roles in reducing the ability of


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the elderly to remain financially productive, and thereby,

independent.

Economic security is as relevant for the elderly as it is for

those of any other age group. Those who are unable to

generate an adequate income should be facilitated to do

so. As far as possible, elderly who are capable, should be

encouraged, and if necessary, supported to be engaged

in some economically productive manner. Others who are

incapable of supporting themselves should be provided

with partial or full social welfare grants that at least

provide for their basic needs. Families and communities

may be encouraged to support the elderly living with

them through counseling and local self-governance.

Isolation

Isolation, or a deep sense of loneliness, is a common

complaint of many elderly is the feeling of being isolated.

While there are a few who impose it on themselves,

isolation is most often imposed purposefully or


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inadvertently by the families and/or communities where

the elderly live. Isolation is a terrible feeling that, if not

addressed, leads to tragic deterioration of the quality of

life.

It is important that the elderly feel included in the goings-

on around them, both in the family as well as in society.

Those involved in elder care, especially NGOs in the

field, can play a significant role in facilitating this through

counseling of the individual, of families, sensitization of

community leaders and group awareness or group

counseling sessions. Activities centered on older persons

that involve their time and skills help to inculcate a feeling

of inclusion. Some of these could also be directly useful

for the families and the communities.

Neglect

The elderly, especially those who are weak and/or

dependent, require physical, mental and emotional care

and support. When this is not provided, they suffer from


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neglect, a problem that occurs when a person is left

uncared for and that is often linked with isolation.

Changing lifestyles and values, demanding jobs,

distractions such as television, a shift to nuclear family

structures and redefined priorities have led to increased

neglect of the elderly by families and communities. This is

worsened as the elderly are less likely to demand

attention than those of other age groups.

The best way to address neglect of the elderly is to

counsel families, sensitise community leaders and

address the issue at all levels in different forums,

including the print and audio-visual media. Schools and

work places offer opportunities where younger

generations can be addressed in groups. Government

and non-government agencies need to take this issue up

seriously at all these levels. In extreme situations, legal

action and rehabilitation may be required to reduce or

prevent the serious consequences of the problem.


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Abuse

The elderly are highly vulnerable to abuse, where a

person is willfully or inadvertently harmed, usually by

someone who is part of the family or otherwise close to

the victim. It is very important that steps be taken,

whenever and wherever possible, to protect people from

abuse. Being relatively weak, elderly are vulnerable to

physical abuse. Their resources, including finances ones

are also often misused. In addition, the elderly may suffer

from emotional and mental abuse for various reasons

and in different ways.

The best form of protection from abuse is to prevent it.

This should be carried out through awareness generation

in families and in the communities. In most cases, abuse

is carried out as a result of some frustration and the felt

need to inflict pain and misery on others. It is also done to

emphasize authority. Information and education of groups

of people from younger generations is necessary to help

prevent abuse. The elderly should also be made aware of


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their rights in this regard.

Where necessary, legal action needs be taken against

those who willfully abuse elders, combined with

counseling of such persons so as to rehabilitate them.

Elderly who are abused also require to be counseled, and

if necessary rehabilitated to ensure that they are able to

recover with minimum negative impact.

Fear

Many older persons live in fear. Whether rational or

irrational, this is a relevant problem face by the elderly

that needs to be carefully and effectively addressed.

Elderly who suffer from fear need to be reassured. Those

for whom the fear is considered to be irrational need to

be counseled and, if necessary, may be treated as per

their needs. In the case of those with real or rational fear,

the cause and its preventive measures needs to be

identified followed by appropriate action where and when


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possible.

Boredom (Idleness)

Boredom is a result of being poorly motivated to be useful

or productive and occurs when a person is unwilling or

unable to do something meaningful with his/her time. The

problem occurs due to forced inactivity, withdrawal from

responsibilities and lack of personal goals. A person who

is not usefully occupied tends to physically and mentally

decline and this in turn has a negative emotional impact.

Most people who have reached the age of 60 years or

more have previously led productive lives and would

have gained several skills during their life-time.

Identifying these skills would be a relatively easy task.

Motivating them and enabling them to use these skills is

a far more challenging process that requires

determination and consistent effort by dedicated people

working in the same environment as the affected elders.

Many elderly can be trained to carry out productive


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activities that would be useful to them or benefit their

families, communities or environment; activities that

others would often be unable or unwilling to do. Being

meaningfully occupied, many of the elderly can be taught

to keep boredom away. For others, recreational activities

can be devised and encouraged at little or no additional

cost.

Lowered Self-esteem

Lowered self-esteem among older persons has a

complex etiology that includes isolation, neglect, reduced

responsibilities and decrease in value or worth by one-

self, family and/or the society.

To restore self-confidence, one needs to identify and

address the cause and remove it. While isolation and

neglect have been discussed above, self-worth and value

can be improved by encouraging the elderly to take part

in family and community activities, learning to use their

skills, developing new ones or otherwise keeping

themselves productively occupied. In serious situations,


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individualsand their families may require counseling

and/or treatment.

Loss of Control

This problem of older persons has many facets. While

self-realization and the reality of the situation is

acceptable to some, there are others for whom life

becomes insecure when they begin to lose control of their

resources physical strength, body systems, finances

(income), social or designated status and decision

making powers.

Early intervention, through education and awareness

generation, is needed to prevent a negative feeling to

inevitable loss of control. It is also important for society

and individualsto learn to respect people for what they

are instead of who they are and how much they are

worth. When the feeling is severe, individuals and their

families may be counseled to deal with this. Improving

the health of the elderly through various levels of health

care can also help to improve control. Finally, motivating


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the elderly to use their skills and training them to be

productive will help gain respect and appreciation.

Lack of Preparedness for Old Age

A large number of people enter old age with little, or no,

awareness of what this entails. While demographically,

we acknowledge that a person is considered to be old

when (s)he attains the age of 60 years, there is no such

clear indicator available to the individual. For each

person, there is a turning point after which (s)he feels

physiologically or functionally old. This event could take

place at any age before or after the age of 60.

Unfortunately, in India, there is almost no formal

awareness programeven at higher level institutions or

organizationsfor people to prepare for old age. For the

vast majority of people, old age sets in quietly, but

suddenly, and few are prepared to deal with its issues.

Most people living busy lives during the young and

middle age periods may prefer to turn away from, and not

consider, the possible realities of their own impending old


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age.

The majority of Indians are unaware of the rights and

entitlements of older persons.

The problem of not being prepared for old age can only

be prevented. Awareness generation through the work

place is a good beginning with HR departments taking an

active role in preparing employees to face retirement and

facing old age issues. For the majority who have

unregulated occupations and for those who are self-

employed, including farmers, awareness can be

generated through the media and also through

government offices and by NGOs in the field. Older

people who have faced and addressed these issues can

be recruited to address groups at various forums to help

people prepare for, or cope with, old age.


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Economic Issue of Elderly in India

Introduction

The traditional norms and values of Indian society laid stress on showing

respect and providing care for the elderly. Consequently, the older

members of the family were normally taken care of in the family itself.

The family, commonly the joint family type, and social networks

provided an appropriate environment in which the elderly spent their

lives. The advent of modernization, industrialization, urbanization,

occupational differentiation, education, and growth of individual

philosophy have eroded the traditional values that vested authority with

elderly. These have led to defiance and decline of respect for elders

among members of younger generation. Although family support and


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care of the elderly are unlikely to disappear in the near future, family

care of the elderly seems likely to decrease as the nation develop

economically -and modernize in other respects. For a developing

country like India, the rapid growth in the number of older population

presents issues, barely perceived as yet, that must be addressed if social

and economic development is to proceed effectively. Unlike in the

western countries, where there is dominant negative effect of

modernization and urbanization of family, the situation in the

developing countries like India is in favour of continuing the family as a

unit for performing various activities (Siva Raju, 2000,2002, 2004). In

spite of several economic and social problems, the younger generation

generally looks after their elderly relatives. Though the young

generation takes care of their elders in traditional societies, it is their

living conditions and the quality of care, which widely differs from

society to society.


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Population Aging in India

The reduction in fertility level, reinforced by steady increase in the life

expectancy has produced fundamental changes in the age structure of the

population, which in turn leads to the aging population. The analysis of

historical patterns of mortality and fertility decline in India indicates that

the process of population aging intensified only in the 1990's. The older

population of India, which was 56.7 million in 1991, is 72 million in

2001 and is expected to grow to 137 million by 2021. Today India is

home to one out of every ten senior citizens of the world. Both the

absolute and relative size of the population of the elderly in India will

gain in strength in future. Among the total elderly population, those who

live in rural areas constitute 78 percent. Sex ratio in elderly population,

which was 928 as compared to 927 in total population in the year 1996,

is projected to become 1031 by the year 2016 as compared to 935 in the

total population. The data on old age dependency ratio is slowly

increasing in both rural and urban areas. Both for men and women, this


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figure is quite higher in rural areas when compared with that of urban

areas. More than half of the elderly populations were married and among

those who were widowed, 64 percent were women as compared to 19

percent of men. Among the old-old (70 years and above), 80 percent

were widows compared to 27 percent widowers. Men compared to

women are found to be economically more active. In 1991, 60 percent of

the males were main workers whereas only 11 percent of the females

were main workers. Out of the main workers in the 60+ age group, 78

percent of the males and 84 percent of the females were in the

agricultural sector. Since women's economic position depends largely on

marital status, women who are widowed and living alone are found to be

the worst among the poor and vulnerable.

Problems of Older Persons


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Given the trend of population aging in the country, the older population

faces a number of problems and adjusts to them in varying degrees.

These problems range from absence of ensured and sufficient income to

support themselves and their dependents to ill health, absence of social

security, loss of social role and recognition and to the non-availability of

opportunities for creative use of free time. The needs and problems of

the elderly vary significantly according to their age, socio-economic

status, health, living status and other such background characteristics. As

people live longer and into much advanced age (say 75 years and over),

they need more intensive and long term care, which in turn may increase

financial stress in the family.

Among the several problems of the elderly in our society, economic

problems occupy an important position. Mass poverty is the Indian

reality and the vast majority of the families have income far below the

level, which would ensure a reasonable standard of living. The Ministry

of Social Justice and Empowerment, Government of India (1999) in its


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document on the National Policy for Older Persons, has relied on the

figure of 33 percent of the general population below poverty line and has

concluded that one-third of the population in 60 plus age group is also

below that level. Though this figure may be understated from the older

persons point of view, still accepting this figure, the number of poor

older persons comes to about 23 millions. As people live longer and into

much advanced age (say 75 years and over), they need more intensive

and long term care, which in turn may increase financial stress in the

family. Inadequate income is a major problem of elderly in India (Siva

Raju, 2002). The most vulnerable are those who do not own productive

assets, have little or no savings or income from investments made

earlier, have no pension or retirement benefits, and are not taken care of

by their children; or they live in families that have low and uncertain

incomes and a large number of dependents

Nearly half of the elderly are fully dependent on others, while another 20

percent are partially so (NSSO, 1998). For elders living with their


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families-still the dominant living arrangement-their economic security

and well being are largely contingent on the economic capacity of the

family unit. Particularly in rural areas, families suffer from economic

crisis, as their occupations do not produce income throughout the year.

Nearly 90 percent of the total workforces are employed in the

unorganised sector. They retire from their gainful employment without

any financial security like pension and other post retirement benefits.

The organized sector workforce who includes the employees of the

Central and State governments, of local government bodies, and of

major enterprises in basic industries (e.g. manufacturing, mining etc.)

constitute approximately 30 million workers and nearly one in every 10

members of the total Indian workforce of 314 million (Vijay Kumar,

2000). The work participation rate among the elderly was around 40

percent. More elderly men participate in the economic activities

compared to women. The participation is high in rural areas compared to

urban areas. The bulk of the 60 plus workers were engaged in


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agriculture. Nearly half of the elderly are fully dependent on others,

while another 20% are partially so (NSSO, 1998). Women are more

likely to dependent on others, given lower literacy and higher incidence

of widowhood among them. The most vulnerable are those who do not

own productive assets have little or no savings or income from

investments made earlier, have no pension or retirement benefits, and

are not taken care of by their children; or they live in families that have

low and uncertain incomes and a large number of dependents (Bose,

1996). Vulnerable groups like the disabled, fragile older persons, and

those who work outside the organized sector of employment like

landless agricultural workers, small and marginal farmers, artisans in the

informal sector, unskilled labourers on daily, casual or contract basis,

migrant labourers, informal self-employed or wage workers in the urban

sector, and domestic workers deserve mention here.

Economic Security Schemes for Elderly


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Government under standardized economic security policy is covering

retirement benefits for those in the organized sector, economic security

benefits for those in the unorganised sector and old age pension for rural

elderly. The government pension bill in 2001 was more than 1 percent of

GDP or 15 percent of the revenues. The employees provident funds,

though gradually extended from 5 to 179 industries, the increase in the

labour force coverage has barely risen from 1 percent to 5 percent.

Though little evidence is available on poverty among the elderly and the

impact of cash transfers, several studies have raised concerns about

target population, administrative efficiency and other such issues. Given

high growth rate among the elderly and also high longevity, there needs

serious thinking on the part of planners to evolve suitable programmes

and schemes and bring reforms in the existing pension programmes.

As per the National Policy on Aging (1999), one-third of the elderly

population (1993-94) is below the poverty line and about one-third are


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above it, but belonging to lower income group. The policy document

also states that the coverage under the Old Age Pension Scheme for poor

persons, which is 2.76 million (as on January 1997) will be significantly

expanded with the ultimate objective of covering all older persons below

the poverty line. NOAP scheme (National Old Age Pension Scheme)

which is initiated by the Central Government provides for a pension of

Rs.75/- per month to the old people living in the conditions of

destitution. The budgetary allocation for NOAP scheme, which was

Rs.450 crores in 1999, has been increased to Rs.465 crores in 2002. The

NOAP scheme is in operation all over India and the reports indicate that

the most vulnerable sections of Indian society like, women, and lower

caste individuals have been benefited from this scheme.

All State Government and U

old age problems in agra

Documents