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Old Age Problems in Agra
Contents
Background
Methodology
Findings
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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.
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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.
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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
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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!
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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 intra-
familial 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 socio-
economic 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
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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
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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 post-
retirement 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 non-
availability 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 socio-
economic 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 familymembers 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 manyranging 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
inlaw 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 expressedconcern 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 communitiesSince 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-in-
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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 whowas 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.
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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.
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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 thepresent 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.
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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
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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 leastbe 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
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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
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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
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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 familymembers while only about
10% felt that they were being tolerated, 4% hadfelt the need to go to
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an old age home while 1% had no comments on theissue. 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
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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 daughtersin - law against the parentsin-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
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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.
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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.
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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
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Elderly
FACTS ABOUT
ELDERLY IN
INDIAMISSION &
VISIONPROBLEMS
OF THE
ELDERLYPROGRA
MMES AT
GLANCE
S.
No.Problem Need
1 Failing Health Health
2 Economic insecurity Economic security
3 Isolation Inclusion
4 Neglect Care
5 Abuse Protection
6 Fear Reassurance
7 Boredom (idleness) Be usefully occupied
8 Lowered self-esteem Self Confidence
9 Loss of control Respect
10Lack of Preparedness
for old age
Preparedness 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
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mainly due to infectious diseases, older people are
mostly vulnerable to non-communicable diseases. Failing
health due to advancing age is complicated by non-
availability 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
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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
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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 imposed purposefully or
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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 goings-
on 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
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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.
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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
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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
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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
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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 one-
self, 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,
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individualsand 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 individualsto 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
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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 programeven at higher level institutions or
organizationsfor 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
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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 self-
employed, including farmers, awareness can be
generated through the media and also 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.
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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
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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.
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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
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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
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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
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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
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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
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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
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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
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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 U
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