Demographic changes are unprecedented. Fertility is falling, longevity is increasing, and rise in elderly population is dramatic both in absolute and relative terms. The first investigation of health, economic, and social well-being of India’s elderly has now revealed their precarious condition. Their terror stricken, shocked, and vacant eyes that most of us may have witnessed during the pandemic can now be explained and understood better in the light of the survey results picturing their conditions in 2017-18.
The Longitudinal Ageing Study in India (LASI) Wave–I India Report 2020 by National Programme for Health Care of Elderly (NPHCE) & International Institute for Population Sciences (IIPS) in association with Harvard TH Chan School of Public Health (HSPH) and the University of Southern California (USC) covered all the States and Union Territories of the country excluding Sikkim.
Individuals aged 45-60 years and above and their spouses formed the youngest of the old, elders between 60-75 formed the elderly, and the and the people above 75 years of age were grouped in the oldest-old persons. About 1.07 lakh people were surveyed. It was part of the world’s largest ever survey providing longitudinal database for designing policies and programmes for older population in the broad domains of social, health, and economic well being.
It has special significance for India because as per the census 2011, we had 8.6 per cent elderly people (60+) accounting 103 million (around 20 per cent of the population) in absolute term, growing at around 3 per cent annually, will to 319 million (over 40 per cent) by 2050. If persons in pre-retiring ageing phase (45+) are included the number will rise to over 650 million.
The report has come when there are currently no comprehensive and internationally comparable national data in India covering the fullrange oftopics necessary to understand all the aspects of the ageing process including the psychological state of an ageing person.
It is already known that the demographic and epidemiological transition in India has shifted a major share of the country’s burden of disease to the older population. The dramatic and wide spread nature of recent and ongoing demographic shifts indicate that the challenges of population-ageing that India will soon be facing are both inevitable and on an enormous scale. These demographic changes present complex health, social, and economic challenges to which our country must rapidly adapt.
Despite several policy and programme initiatives, there is still a considerable policy vacuum. Moreover, with present population of 1.39 billion, India is projected to become the world’s most populous country in the next few years, and major share of the country’s burden of disease will shift from children to older population. The situation may gain alarming dimension additionally due to fast changing family structures.
The ageing transition has farreaching social implications related to family and social networks, psycho-social behaviour, living arrangements, life satisfaction, and overall well-being. The family has traditionally been the prime source of support for ageing people, but evidence shows that this supportsystem has been declining due to factors such as increasing urbanisation and mobility.
Elderly living alone and without spouses is an increasing phenomenon. The reasons for living without children are mainly having no children and having children who reside away due to education, work, or marriage. It has been pointed out that the Maintenance of Welfare of Parents and Senior Citizens Act 2007 that has enabled the elderly above 60 ‘unable to maintain themselves’ to take legal action against adult children or grandchildren who fail to provide them with basic necessities such as housing, food, clothing, and medical care is failing.
While this Act codifies the basic rights of older adults and provides a legal backbone to a faltering social order, the act is also particularly germane to vulnerable sub-populations such as widows, low-income individuals, and other adults who may be subjected to elder abuse, neglect, or ill treatment.
Moreover, the law is difficult to enforce, contains no assurances for childless adults, and does not d dress what, if any, are the responsibilities of the Indian Government towards its ageing citizen. It has been recommended that such family-centred social welfare measures must be supported by appropriate Government initiatives such as a robust pension system and healthcare delivery programme. There are 19 policies and programmes in India which include 11 in health and 8 in social sectors.
However, the result of the report reveals that they have altogether been unable to remove the precarious situation of our elders. About 75 million of 60+ people were suffering from some chronic disease during the period under survey.
While 27 per cent have multi-morbidities, 40 per cent have disabilities and 20 per cent have issues related to mental health. Among the elders diagnosed with chronic conditions, more than three-fourth, about 77 percent, have been treated for hypertension, 74 per cent for chronic heart diseases, 83 per cent for diabetes mellitus, 72 per cent for chronic lung diseases, and 75 per cent for cancer.
Elderly treated for stroke were over 58 per cent while 56percent were for bone or joint diseases. The dismal treatment rate is further noticed for neurological and psychiatric diseases which was only 41 per cent. The conditions in urban areas are little better compared to the rural areas, but it is disheartening to know that over all hospital is at ionrate was only 7 per cent for adults aged above 45. Financial conditions of our elders were also very bad. Most of them have no regular source of income which is reflected in the fact that 78 per cent of our elderly were neither receiving nor expected to receive pension.
Among those who were receiving pension, only 4 per cent of the elderly having less than 10 years of education were receiving pension. One can just imagine their distress when we consider their dried source of income coupled with increase burden of their disease.
Obviously, they require social security coverage, which is almost negligible in most of the States, and where it is, it is insufficient to cater to their needs. India, is thus, in need of a paradigm shift in its policies and laws relating to all aspects of ageing, health, economy, well-being, and the psychological distress of the people. (IPA)