Dr Kasturi Lal
According to estimates Indiahas second largest global population of ageing citizens which probably will increase to 240 million by 2050. Two third of elderly population resides in rural areas. The sex ratio is depicted 1060 women to 1000 men by 2026. The population of 80 plus people would show a tremendous rise with a predominance of women by 2050. Nearly half of the elderly living in the villages are of poor socio-economic status. They are prominently women who are widow, divorced or separated and are dependent upon their families. Many surveys have been conducted to determine the factors which are affecting the care of the elderly in India. Though a plethora of factors have been taken into account, the ultimate results of these surveys which have been conducted point to three main factors: Lack of financial support, Health care cost and seclusion which affects care of the elderly.Added to this is lack of dignity of care which elderly deserve in final phases of their life.
The rapid transformation due to industrialization, urbanization, technology, education and globalization has led to erosion of traditional values. Intergenerational ties that were the hall mark of the traditional family, have weakened. The Immense experience of elderly is not being utilized for better future. The link which they provided for transferring moral values to the younger generation has vanished. Their insight and understanding are not being accepted to ease out tension in society. The changing economy has adversely affected the care of elderly in the society while poor socioeconomic status does not allow an individual to maintain personality because he/she is deprived of means of attaining a well-balanced personality as well as physical and mental exhilaration which is important for better health. Lack of sleep, poor nutrition and stressful life lead to weak immune response and vulnerability to sickness.The better economic gains include more nuclear families and busy adult children are making elders care management difficult.
The children’s personal interest has started shaping the quality of care of ageing parents. Migration of children to other places for green pastures have led to a state of crisis. An inappropriate influence is affecting care of elderly. A conflict of interest is arising because children are overemphasizing on personal gain and neglect of less profitable personal care of the elderlies. Psychological trauma caused to elderly due to isolation is immense.There is no one to listen to their silent grief and misfortune.The feeling of left alone to fend themselves which stems from the thought of non-presence of their off springs at the terminal stage of their life is unsurmountable.
Access to mental health services in the medical sector are limited and thus more care is provided adhoc, informally and in the family. Consequently, dependency anxiety is a common phenomenon among the elderly. The stigma of widowhood leads to profound social ostracism that impinges not only on access to health care but also a broader range of fundamental human rights such as right to shelter, food property and information. Senior citizen is ill developed to get medical support. One of the biggest fears for most senior citizens living alone is how to access an emergency facility if required especially at night.Lack of companionship basically can result in gradual depression and other mental disorders.Studies have revealed that a strong bond with older parents would be beneficial to remain in touch with them by visiting them on holidays, call them and send them surprise gifts. This creates a feeling that their children think about them.
The other underlying reason is that care of elderly is increasingly suffering because of nuclear families. This is a practice of advertant neglect. Many a couple who are working are at dis-ease to meet the challenge of keeping up with care of elderly in the family. In pursuit of earning more money, they have lost the significance of humanity, Devotion to duty, tolerance sensitivity, gratitude and integrity.Unfortunately, the couples in a nuclear family have lost ability to differentiate between right or wrong. Elderly is confronted with problem of isolation and emotions. Their emotions are suppressed until the feeling of independence dignity and respect is fragmented. The nuclear family expect self-abrogation of parents for them without the wish or desire of their own. They are victims of oppression by family. There have been increasing reports of material exploitation, financial deprivation, property grabbing, abandonment, verbal humiliation, emotional and psychological torment in India, all of which compromise the mental and physical health of the elderly.
Elderly citizens will need better access to physical infrastructure in the coming years because increasing longevity is associated with rise in non- communicable diseases particularly cardiovascular metabolic and degenerative disorders.Elderly commonly face geriatric disease such as dementia, depression, Alzheimer’s, incontinence or widowhood which are other social barriers to access of health which manifest in Indian culture. Pathological progression to family nuclearization and dependency from reduction in earning potential and pre-existing inequities in the area of gender caste and region constitute a big number of barriers.
Health of elderly in India suffers because of reduced mobility, declining engagements and the limited reach of the health system. Health affordability constrains include limitations in income, employment and in assets as well as the limitations of financial protection offered for health expenditure in Indian health system.The need of elderly care is higher in rural areas.The lack of availability of infrastructure and health services in rural areas is worrisome. There is an acute need for expanding access to geriatric care beyond the tertiary level in rural areas and in service of the female elderly. Govt has to look at elder friendly policies and develops a better social infrastructure to reduce private cost.
Unlike other countries, in our country emergency response infrastructure for senior citizens is not developed. Elder citizens will need better access to physical infrastructure in the coming years because increasing longevity is associated with debilitating chronic disease while health cost keeps on rising There is very little public or private financial support for elderly. Eligibility for pension and senior care health insurance has very low penetration and has an extremely poor payout history. Indian have no population wide mechanism of social security. Indian has to work as long as possible in order to support themselves.
Employers’ insurance and pension schemes are available only to as low as 9% of rural males and 41.9% of urban males who are in formal sector. Among the females the figures are still low. The rest of the work force who are not entitled to formal retirement benefits in order to afford healthcare in their early years, face the paradoxical challenges of remaining both healthy and employed in old age.
Increasing monthly pension, housing for aged, assisted living facilities for indigent elderly particularly those with age related issues like dementia, more tax benefits, enhancing the geriatric care health infrastructure in rural area, allocation of special budget for elderly population, provision of clubs and libraries at panchayat level and appreciation of elderly for their contribution at village level are the measures which have been suggested for better care of elderly in India. All these measures are incomparable to the protection of already existing social support, traditional social institution such as family and kinship, neighbourhood bonding, community bonding and community participation. Sensitivity shown by kins revives dignity.
(The author is Director UKL Medical Centre Opposite Greater Kailash, Jammu)
Dr Kasturi Lal