The Challenges of Being an Older Adult in India

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“Longer life can be both a penalty and a prize” – The World Health Organisation

Population aging, which is touted as humanities greatest triumph, is also one of our greatest challenges. Prolongation of life span does not imply that the extra years bring continued health and prosperity. Aging, marked by these aforementioned trends, is said to put an increased burden on the social, economic, and health care demands of all counties, especially in developing countries such as India (United Nations, 2002b). The rapid population aging will contribute to dramatic changes in the social fabric and in the structure of nations. Quality of life, level of familial support, and income generation are all major concerns of an aging society. Demographic trends, such as the increasing number of elderly, the decreasing number of children available to give support, and the stagnant economic infrastructure, coalesce to create further challenges to the aging population that must be met with appropriate policy and action.

A challenge to ensuring the quality of life of the aging population is the double burden of diseases and disability, especially in developing countries, which still struggle with infectious diseases and malnutrition as well as the recent,rapid growth of non-communicable diseases such as diabetes, cardiovascular diseases, and hypertension. In later years, Non-Communicable Diseases (NCDs) become the main harbinger of death and disability. In 1998, NCDs were the cause of almost 60% of deaths in the world, 77% of those deaths occurred in developing countries (World Health Organization, 2000). Statistical trends indicate that we can expect an increase in NCD deaths to 73% in 2020. In addition, osteoporosis which is a debilitating bone disease associated with progressive decline in bone mass and increased susceptibility to fragility fracture is common among older individuals. In the last few years, the World Health Organisation (WHO) and world health experts have been cautuioning the impending osteoporosis epidemic in the developing world (Johnson, Rajan, McLeod, 2003). Yet, in many developing countries including India, osteoporosis is not recognised as a source of concern.

Another layer of health concern is disability caused by age-related changes in physical health, including mobility and ability to perform activities of daily living (Manton, Stallard and Corder, 1998). In India, 75% of aged individuals are afflicted by a physical disability (vision, hearing, locomotor, speech and senility) (National Sample Survey Organisation, 1998).The most common chronic conditions reported by India’s elderly are joint problems (72.4%), cough (38.2%) and hyper/hypotension (33.2%) (National Sample Survey Organisation, 1998).The physical health concerns are often compounded by increasing psychosocial problems as the traditional extended family structure experiences breakdown and the elderly find themselves isolated and experiencing loneliness and depression. The mental and emotional challenges of aging have yet to receive proper acknowledgement and support. Prakash (2001b) writes that, “Mental health issues receive little attention in India”. The Mental Health Policy (MHP) of Kerala, states that “[it is a] common misconception that prevalence of mental illness is low in India particularly as compared to the West” (Praveenlal, Shaji, and Mohandas, 1998). The MHP also recognises that Kerala lacks understanding of the mental health situation “because of lack of epidemiological data”. As a result of the double burden of diseases and increasing psychosocial problems, only 6% of the elderly reported “good health”; 69% had “moderate health”, while 20% had “poor health” and 5% had “very poor health” (Nayar, 2000).

Yet another challenge involves the traditional paradigm that old age is associated with disability and diseases, loss of autonomy and productivity. This has remained a barrier in the allocation of limited resources to improve the health and well-being of the population. A major portion of the funding allocation has concentrated on children and women in their reporductive years. The Government of Kerala is repeatedly reported to have “limited financial resources.”  Despite this status, however, the state does provide some social security for the aged. A study conducted in Trivandrum found that 60% of the elderly get subsistence from past or current work. Twenty five percent rely on children who live elsewhere for income, and 20% live on past savings and pensions (Rajan, Mishra and Tamil Nadu, 2002). It is also important to note that a significant portion of elderly men and women (68%) are illiterate or have five or fewer years of schooling. They are not participating in the work sector and over 75% have a monthly income of Rs. 1,500 which represents two lower socio-economic classifications (Nayar, 2000).

While the population of elderly is rising steadily, the number of people who can provide physical, emotional and financial support in their later years is declining. While-inter-familial support used to be the norm for caring for elderly persons, this social safety net no longer functions as it should due to increasing levels of out-migration and a growing trend towards nuclear rather than extended family systems. The highest proportion of migrants (44%) fall into the age group of 25 to 34 (Devi and Sukuman, 2001). Furthermore, of all the Indian states, Kerala has the most old age institutions. The migration of young workers to Gulf countries has been suggested as a major factor in the institutionalisation of older adults in Kerala.

In India, women are especially inclined to feel the burden of aging. They experience poor nutrition, dangerous working conditions, violence, and lifestyle related diseases (Bagchi and Puri, 1999). The depletion of hormones at menopause is also a cause of gender and age specific morbidity and mortality. Older women are vulnerable to health problems for socio-cultural reasons as they are less likely to be financially independent and less likely to have power and status compared to old men (Prakash, 2001a). Given the feminisation of aging and lack of inter-familial support, higher proportions of women find themselves economically vulnerable in old age as they are largely mothers and wives, and not workers in the formal sector.