Society

Grey Cells

India seems hardly prepared to provide care for its rapidly aging population

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Grey Cells
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From the 1960s on, family planning spots on radio and TV have made us see ourselves as a country of couples with exasperating gaggles of children. So it isn’t surprising that we—and the government that put out those spots—have been slow to realise what we have become: a gerontic nation. The number of our aged is growing rapidly. “India will soon be home to the world’s largest population of those above 60 and this issue needs to be addressed urgently,” says Dr Nata Menabde, the who’s country head for India. “Even if India were ready to care for its current population of the aged—which it is not—it would have to rework everything due to the huge predictions for the future.”

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Official figures say 12 per cent of India’s population of 1.2 billion is over 60 years. That’s 144 million old people. Another official estimate is that, by 2025, the 60-plus will constitute 25 per cent of our population. Estimates by business set the graph steeper: they see India having 250 million senior citizens (above 60) very soon and the largest adult (above 18) population by as early as next year.

These changes, experts warn, will not only make unique demands on the economy, they will, given India’s demographic profile, create a sharp change in gender ratio and a stark difference between disease patterns in cities and villages. They attribute India’s rapid aging to an increase in life expectancy and a significant fall in fertility rates. There are more women than men among the aged now, but research predicts this will even out and reverse because of decreasing fertility and a skewed sex ratio that isn’t helped by the prevalent gender bias.

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There’s something to be said for Indians living healthier and longer, but the rapidity with which we are greying creates worries for state and society—how to keep the aged safe, for example. Also, how to provide for their healthcare and their psychological needs. Government, civil society and business are waking to this with expected degrees of energy. But experts say even if states have in place policies aimed at the aged, they are going to be overwhelmed by the challenge of attending to the most basic needs of the aged, leave alone loftier goals like bringing dignity to their waning years.

In the metros and big cities, where many old people live alone, physical security is a concern; in the villages, where 75 per cent of India’s aged live, the problems are of not having enough money and not having access to healthcare. “In my experience,” says Dr Murlidhara, an expert on senior living, “the old family system is very much functioning in our villages: children live with and look after their aged parents. That’s no longer the case in our cities, where it’s more of assisted living for the aged. Homes for the aged are occupied to capacity.” Business has recognised a monetisable need: investors from the US, Australia and elsewhere are looking to meet the demand with hospices. Many senior citizens are opting for them, though having to live in an old-age home, however swank, still bears a touch of stigma.

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Photograph by Sandipan Chatterjee

Debi Prasad Banerjee 80, Bithi Banerjee 69 Calcutta
“What if we both fall ill together?”

Some, like Radha, 69, who lives with her 77-year-old husband A.K. Satya Narayanan at their house in Chennai, refuse to compromise their independence. “It will be like staying in a hostel,” she says. “Your needs may be taken care of, but there are curfews and restrictions.” Debi Prasad Banerjee, 80, and his wife Bithi, 69, are another couple who live by themselves in their apartment in suburban Calcutta. They are among thousands of city-based aged wracked by a range of fears—of not being able to carry out daily chores, of losing property or money, of robbery, of medical emergencies. “I live in constant fear that both of us will fall ill at the same time,” says Banerjee.

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The specific complaints may vary from person to person, and region-based patterns may emerge. What there’s no doubt about is that national-level intervention is called for. Roused by the warnings, the Union ministry of health & family welfare has proposed a ‘National Institute of Aging’ with centres at the AIIMS, Delhi, and Madras Medical College, Chennai. The institute will seek structural solutions to India-specific problems, such as reaching rural areas, where 70-80 per cent of our aged live; the growing number of the 80-plus; and penury (30 per cent of our aged are poverty-stricken). These are indeed macro-level issues and existing laws offer little more than the lame assurance that the nation cares.

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Recently, the ministry also approved the National Programme for Healthcare for the Elderly (NPHCE), aimed at providing preventive, curative and rehabilitative care. It’s being implemented in 100 districts in 21 states before a nationwide rollout. The programme needs to target dementia in its various forms, hearing and vision disorders, diabetes and hypertension, cardiac problems, osteoporosis and arthritis: 70 per cent of our aged have one or more of these conditions.

The seemingly simple problem of protecting the urban aged from crime is in itself proving demanding. Last year, Delhi was among 34 cities worldwide that set themselves the goal of becoming aged-friendly through neighbourhood watches and better policing. The failure shows in the almost daily reports of old people being done to death by helps or burglars. As for the gargantuan challenge of policy-framing and implementation, the government could look up to some Asian exemplars. Indonesia has effective laws to give the aged access to basic social and healthcare services. In Sri Lanka, the National Council for Elders and the National Secretariat for Elders can prosecute neglectful children or relatives. Thailand’s holistic approach to providing social, health and economic security to the aged through family-, community- and institution-based intervention is considered a big success. India could learn from these countries; better still, it could evolve its own practices worthy of emulation. And if the government plans to make a beginning with one of its endless awareness campaigns, it might prove less wasteful if the radio and TV spots were not as sarkari-drab as the ones on family planning.

Profile Of An Old Country

  • 144 million Indians are of 60-plus years
  • 60-plus is the world’s largest growing age group
  • By 2013, India will be the country with the most aged population
  • Chief reasons for this: increase in life expectancy, decrease in fertility
  • By 2025, one in every five Indians will be a senior citizen
  • 70% of India’s old live in villages

States with high elderly population:

  1. Kerala
  2. Himachal Pradesh
  3. Tamil Nadu

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States with low elderly population:

  1. Jharkhand
  2. Assam
  3. New Delhi.

Dogged By Disease

  • One in every four aged persons suffers from depression
  • One in every three has arthritis
  • One in every five cannnot hear
  • One in every three suffers from high BP and related complications
  • One in every two has poor vision
  • One in every five is diabetic

By Amba Batra Bakshi with Pushpa Iyengar in Chennai, Dola Mitra in Calcutta

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