Rapid ageing of the population may pose some challenges to India’s celebrated demographic dividend in the coming years. It may act as a countervailing force offsetting some of the gains from having a relatively young population.

Why policymakers should worry about this?

• This is a cause of deep concern for policymakers as India already has the world’s second largest population of the elderly, defined as those above 60 years of age.
• As this 104-million-strong cohort continues to expand at an accelerating pace, it will generate enormous socio-economic pressures as the demand for healthcare services and tailored accommodation spikes to historically unprecedented levels.
• It is projected that approximately 20% of Indians will be elderly by 2050, marking a dramatic jump from the current 8%.
• Experts also caution that as the proportional size of the elderly population expands, there is likely to be a shift in the disease patterns from communicable to non-communicable, which itself calls for re-gearing the health-care system toward “preventive, promotive, curative and rehabilitative aspects of health”.

Challenges faced by the elderly:

Elder abuse: They are common across social classes and cities, although there are differences between cities. 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. 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.

Economic dependency: This is identified by many as the major reason for abuse. 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 the elderly to remain financially productive, and thereby, independent.

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 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.

Emotional dependence: In today’s globalized world, people are always on the move in search of jobs. Younger people often move to cities leaving behind their elderly parents. This makes them isolated. 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 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.

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 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.

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.

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.

What needs to be done?

1. 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 health care systems.
2. The cost 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.
3. 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 counselling and local self-governance.
4. 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 counselling of the individual, of families, sensitization of community leaders and group awareness or group counselling 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.
5. 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.
6. 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 their rights in this regard. Where necessary, legal action needs be taken against those who wilfully abuse elders, combined with counselling of such persons so as to rehabilitate them. Elderly who are abused also require to be counselled, and if necessary rehabilitated to ensure that they are able to recover with minimum negative impact.
7. 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 possible.
8. 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 individuals – to 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 the elderly to use their skills and training them to be productive will help gain respect and appreciation.

Way ahead:

So far, efforts to develop a regime of health and social care that is attuned to the shifting needs of the population have been insufficient. While more mature economies have created multiple models for elder care, such as universal or widely accessible health insurance, networks of nursing homes, and palliative care specialisations, it is hard to find such systemic developments in India.

Conclusion:

The elderly should be seen as a blessing, not a burden. The elderly are becoming the fastest growing, but underutilized resource available to humanity. Rather than putting them aside, physically (and mentally), to be cared for separately, they should be integrated into the lives of communities where they can make a substantial contribution to improving social conditions. The benefits of turning the ‘problem’ of the elderly into a ‘solution’ for other social problems is being demonstrated in several countries.