There are 87.6 million people in India aged above 60, a fact that deserves the attention of a nation almost obsessed with its ‘demographic dividend’. Considering that the country is expected to be home to 300 million elderly people by 2050, it is time to reflect on the problems of those who are as old, or even older, than the independent nation itself. Otherwise, the country will be confronted with an increasing incidence of degenerative diseases, accompanied with serious gaps in the geriatric medical ecosystem, a changing joint family structure, the lack of ‘grey-friendliness’ in public spaces, transport, housing, and a virtually non-existent policy framework to tackle these issues.
With nearly 50 per cent of the elderly being financially dependent on others, it is affordable housing, healthcare, and the psychological and social manifestations of ageing that will call for a response not least because there is little or no social security. Facilities for old-age care are woefully inadequate. What could the combined impact of this trend be on small, nuclear families, given the improvement in lifestyles and an increase in degenerative diseases and life-spans, especially for women? Where are we going to live as we grow old and who is going to take care of us?
Clearly Parliament had some of these issues in mind when it passed the Maintenance and Welfare of Parents and Senior Citizens Act in 2007. The model Act makes it obligatory for children or relatives to provide maintenance to senior citizens and parents. It also provides for the setting up of old age homes by state governments. Despite this, however, it is a fact that most people in India would rather suffer than have the family name tarnished by taking their own children to court for not taking care of them. The need to maintain a façade is combined with a lack of knowledge of rights, the inherent inability of the elderly to approach a tribunal for recourse under the law, and poor implementation of the Act by various State governments.
So what happens to those who have been turned out from their homes, or have lost their spouse, or just can’t manage to live on their own any more, especially since the number of old-age homes the Centre supports under the Integrated Programme for Older Persons (IPOP) has declined from 269 in 2012-13 to a dismal 137 in 2014-15? The Centre has asked State governments to ensure that there are old-age homes whose functioning can be supported under IPOP, but since it is optional for the State governments to do so, the total number of old-age homes remains abysmally low.
While we hope that the Indian family continues to be stronger than in most countries and provides a caring environment for the elderly, it can’t be the basis for our ability to support the elderly. India needs to take a serious look at the needs of the elderly in a more pragmatic and holistic manner. For starters it could focus on the three key aspects of health, housing, and dignity.
Each of these is a large issue on its own, but it is important to first strengthen the health-care system. If 18 per cent of the population is going to be over 60 years of age by 2050, then it becomes almost crucial to encourage research in geriatric diseases, and push for building capacity in the geriatric departments across the primary and tertiary health-care systems. There also seems to be a growing informal industry of home care providers, which urgently needs regulation and mandated guidelines so that a large pool of certified and affordable trained home care givers can help provide basic support, prevent unnecessary hospital admissions, and keep the elderly in the familiar environs of their homes as far as possible.
There has to be a network of old-age homes, both in the private and public sectors. While the private sector has taken the lead in setting up some state-of-the-art facilities, most of these are priced well out of the reach of ordinary citizens. The State governments must be mandated to set up quality, affordable homes.
As traditionally supportive social structures are changing and the elderly are increasingly losing their ‘status’ as the family patriarchs, it is time that we did our bit to help address the indignities and loneliness that this change is bringing about. Business enterprises can consider harnessing the talent of elders by retaining or hiring older workers and offering flexible working hours for those who want to continue working after retirement.
Industry will benefit by retaining their knowledge and experience and the elderly will continue to be financially independent and retain their sense of self-worth. At the community level we also need to increase the avenues for older people to participate in local issues, in resident associations, set up and manage spaces for community interaction, to leverage their experience as a resource, give them an opportunity to share their concerns, and help them feel that they contribute socially and have a purpose in life.
One major issue that doesn’t get enough attention today is that old people deserve dignity. Apart from ensuring appropriate medical help, there needs to be greater awareness about common degenerative diseases like dementia so that family members, care-givers, and society at large are sensitised to incontinence, the momentary lack of comprehension, the hallucinations. These are the painful behavioural, physical, emotional and mental struggles of those who suffer from these diseases.
We seldom give much thought, at last when we are young, to growing old but it may be surprising to learn that of the many physiological effects of ageing occur much earlier than you might imagine. However, at some point we begin to see and feel the effects of changes, such as wrinkles and grey hair, and some degree of physical decline, for example, aches and pains, issues pertaining to weight, diabetes, high blood pressure and cardio-vascular problems. Indeed, old-age can affect every aspect of our lives ~ physical, physiological, mental and emotional.
Ageing is a life-long process and taking proper care of ourselves and making healthy lifestyle choices at every stage can go a long way towards helping us live longer and reducing the risk of disability.
The writer is with Eastern Institute for Integrated Learning in Management(EIILM), Kolkata.