Old Age Problems in Agra

Contents
Background Methodology Findings

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.

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.

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

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!

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 intrafamilial 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 socioeconomic 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

 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

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 postretirement 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 nonavailability 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 socioeconomic 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 family members 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 many ranging 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 in law 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 expressed concern 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 communities Since 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 -in38

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 who was 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.

42

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.

43

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 the present 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.
44

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
45

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 least be 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
46

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
47

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

48

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 family members while only about 10% felt that they were being tolerated, 4% had felt the need to go to
49

an old age home while 1% had no comments on the issue. 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
50

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 daughters in - law against the parents in-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

51

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.

52

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.

53

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

54

Elderly

FACTS ABOUT ELDERLY IN INDIAMISSION & VISIONPROBLEMS OF THE ELDERLYPROGRA MMES AT GLANCE

S. Problem No. Need

1 2 3 4 5 6 7 8 9

Failing Health Economic insecurity Isolation Neglect Abuse Fear Boredom (idleness) Lowered self-esteem Loss of control Lack of Preparedness

Health Economic security Inclusion Care Protection Reassurance Be usefully occupied Self Confidence Respect Preparedness age for old

10 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

55

mainly due to infectious diseases, older people are mostly vulnerable to non-communicable diseases. Failing health due to advancing age is complicated by nonavailability 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

56

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

57

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
58

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. It is important that the elderly feel included in the goingson 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
59

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.

60

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

61

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

62

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

63

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 oneself, 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,

64

individuals and 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 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

65

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 program even at higher level institutions or organizations for 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

66

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 selfemployed, generated including through farmers, the media awareness and also can be

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.

67

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
68

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.

69

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
70

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

71

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
72

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
73

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
74

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

75

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
76

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 Union Territories have their own schemes for old age pension and the criterion of eligibility and the quantum of pension amount vary among these States. The average old age pension which is nearly Rs.150 per month was below the average per capita
77

income per Indian. The percent of elderly who benefited from the old age pension scheme varies across states, with the minimum of 0.3 percent to 68 percent. As on 1999, a total amount of Rs.227 millions were spent to benefit 49 lakh beneficiaries among the elderly.

The combined national budget allocation for the NOAPS comes to 0.6 percent only as compared to 6 percent of Central Government revenue expended on pension for its employees (Irudaya Rajan, 2001). The Central government has announced in the year 1999 another social security programme called 'Annapurna Programme'for the elderly destitutes. Under the programme, all older persons who are eligible for the NOAPS are given 10 kg. rice / wheat monthly, free of cost, through the existing public distribution system and the expected beneficiaries for the programme are estimated to be 6.6 millions. The total number of beneficiaries during 2000-2001 for National Old Age Pension Scheme in the country is worked out as approximately 68.81 lakh. This would imply that 13.76 lakh beneficiaries would be eligible for coverage under
78

the "Annapurna" Scheme. An amount of Rs.100 crores has been provided in the budget for 2000-2001 for the Scheme.

The Ministry realizes that poverty alleviation programmes directed at the aged alone cannot provide a solution to the income and social security problems of the elderly and has so commissioned the National Project tilted OASIS (Old Age Social & Income Security) as a result of growing concern for old age social & income security; especially for the 330 million young workers in the unorganized sector (including farmers, shopkeepers, professional, taxi-drivers, casual/ contract labourers etc.) out of the total 370 million workers in India. According to this project, every young worker can build up enough savings during his/her working life, which would serve as a shield against poverty in old age. The need for this arose because of lack of adequate instrument to enable workers in the unorganized sector to provide for their future old age.

79

Conclusions

The beneficiaries among the older persons for various schemes and programmes initiated by the government are very insignificant when compared to the very high size of their population and the growth rate among them. Further, given the level of urbanization and

industrialization of India, economic factors and diminishing value system are likely to make welfare of the elderly as the most critical area for intervention. In Indian context, social security has to be integrated with anti-poverty programmes. This will involve an optimal combination of promotional and protective policies with the latter being based on an appropriate blend of social insurance, social assistance and social welfare effort. There is need to protect and strengthen the institution of the family and provide such support services as would enable the family to cope with its responsibilities of taking care of the elderly. Along with proper and effective professional welfare services that need to be evolved to provide counseling services both to the elderly and their
80

family members, it is also important to provide financial support to low income family groups having one or more elderly persons. The rapid population ageing will necessarily bring social change and economic transformation. In view of this, a holistic approach to population ageing taking social, economic and cultural changes into consideration is needed to effectively solve the emerging problems of the elderly. Based on the existing diversities in the ageing process, it may be stated that there is a need to pay greater attention to the increasing awareness on the ageing issues and its socio-economic effects and to promote the development of policies and programmes for dealing with an ageing society.

References
Bakshi. H,.S.1987 An Approach to Support Services for the Elderly. In M.L. Sharma and

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T.M, Dak (Eds.) Ageing in India: Challenge to the Society. Delhi: Ajanta Publications, 228-231. Bose. A.B. 1988 Policies and Programmes for the Ageing in India. In A.B.Bose and K. D. Gangrade (Eds.) The Ageing in India:Problems and Potentialities, New Delhi:Abhinav Publications. Central Statistical Organisation. 2000 Elderly in India: Profile and Programmes, Ministry of Statistics and Programme Implementation, New Delhi, Government of India. Darshan, S., Sharma, M.L and Singh, S.P. 1987 Health Needs of Senior Citizens. In M.L.Sharma and T.M.Dak (Eds.) Ageing in India: Challenge Jar the Society. Delhi: Ajanta, 207-213. Desai, KG. and Naik. R.D. 1972 Problems of Retired People in Greater Bombay. Bombay: Tata Institute of Social Sciences.

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http://pib.nic.in/infonug/infyr2000/infoaug2000/i010820001.html

For publication in the Harmony Magazine,Mumbai 2004

**Professor, Unit for Urban Studies, Tata Institute of Social Sciences, Deonar, Mumbai - 400 088

S. Siva Raju**
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