Syllabus
GS 1 – Salient features of Indian Society, Social Empowerment
GS 2 – Welfare Schemes for Vulnerable Sections, Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources
GS 3 – Inclusive Growth
GS 4 – Empathy, Tolerance and Compassion towards the weaker-sections, Case Studies
Source
The Hindu – 6/10/2023
Context
India ageing, elderly to make up 20% of population by 2050: UNFPA report
Application: where to apply?
When asked about
– Elderly Care
– Challenges faced by elderly
– India’s growing ageing population
– Healthy Ageing
– Social, Economic, Ethical Perspective on the elderly population
Content
Status of elderly population in India
- According to Census 2011, India has 104 million older people (60+ years), constituting 8.6% of the total population. Amongst the elderly (60+), females outnumber males.
- The decadal growth rate of the elderly population of India is currently estimated to be at 41%.
- According to the United Nations Population Fund’s (UNFPA) India Ageing Report 2023, the percentage of the elderly population in the country is projected to double to over 20% of the total population by 2050.
- India had 149 million older adults (10.5 %) in 2022.
Reasons
- High life expectancy: Advances in medicine, public health, nutrition, and sanitation have led to increasing longevity
- Decline of birth rate: According to the United Nations, the current birth rate for India in 2023 is 16.949 births per 1000 people, a 1.25% decline from 2022. The decline in the birth rate has resulted in a decrease in the proportion of young people and an increase in the proportion of elderly people in the population.
- Declining fertility rates: The current fertility rate for India in 2023 is 2.139 births per woman, a 0.93% decline from 2022. Improved access to contraceptives, increasing age at marriage, particularly among women, and declining infant mortality have led to declining fertility rates.
Challenges faced by the elderly population
Health Challenges
- Mental health problems: Mental health problems such as depression, anxiety, dementia and substance use disorders are faced by elderly. Roughly 15 % of elders (22 million in India) have serious mental illness. Elders with mental illness do not seek treatment and the “treatment gap“ is a staggering 90 % in India.
- Comorbidity: It is the concurrence of one or more clinical conditions in a single person. Chronic disease occurrence is more common with increasing age.
- Hearing loss and Cataract: It is a common condition in older age and can lead to social isolation and depression. Cataracts and refractive errors can cause vision impairment.
- Metabolic disorders: Metabolic disorders like Diabetes can lead to several complications such as heart disease, kidney damage, and nerve damage.
- Chronic diseases: Aging increases the risk of chronic diseases such as heart disease, arthritis, cancer etc.
Social Challenges
- Care infrastructure:Care infrastructure for the aged is not keeping up with the growing numbers.The number of elderly people is increasing, but the infrastructure to support them is not growing at the same pace.
- Increased dependency: As people age, they may become more dependent on others for their daily needs, such as food, shelter,medical care etc.
- Social isolation: Elderly people may experience social isolation due to factors such as living alone, lack of mobility, and loss of friends and family members.
- Ageism: Ageism refers to discrimination against people based on their age. Elderly people may face ageism in various forms, such as being denied employment or being treated unfairly in healthcare settings.
- Pessimism: Healthcare professionals may be pessimistic about treating mental health problems in elderly patients.
- Nihilism: Nihilism refers to a sense of hopelessness or despair. Elderly people may experience nihilism due to factors such as chronic illness, loss of independence, and social isolation.
- Feminisation and ‘ruralisation’ of the older population can lead to unique challenges in terms of access to healthcare and social services.
- Emotional, physical, sexual, and financial abuse by others including family members and caregivers.
- Social stigma: Elderly people with mental illness face a double stigma associated with ageing and mental illness.
- Literacy: Low literacy levels among the elderly can lead to difficulties in accessing information about healthcare services and other resources.
- Joint families are becoming increasingly rare due to migration, both within and outside the country, and smaller family sizes. The multi-generational interactions and bonds fostered in joint families are crucial to the well-being of elders while providing essential care for children and young adults.
Economic challenges
- Financial insecurity: More than 40% of the elderly in India are in the poorest wealth quintile, with about 18.7% of them living without an income. Such levels of poverty may affect their quality of life and healthcare utilization.
- Poverty: Elderly populations often lack access to basic necessities such as food, shelter, and healthcare. This can lead to malnutrition, illness, and other health problems.
- Out of pocket expenditure: Elderly people in India often face high healthcare costs due to chronic illnesses and other health problems. This creates a financial burden for those who are living on a fixed income.
- Lack of government support: The government provides limited support for elderly people, which can make it difficult for them to access services and support.
- Accessibility to health care services: Public buildings are inaccessible without ramps or handrails, pavements are non-existent, uneven, or used for parking, and public transport is limited. Many towns and cities in India are not “elder-friendly“.
- Gendered poverty : Poverty is gendered in old age, with older women more likely to be widowed, living alone, and dependent on family support.A high share of elderly women are out of the labour -force and lack savings.
What needs to be done? (Individual and Community Level)
- Develop other interests in life like music, sports, social work, domestic responsibilities etc. from a young age. This helps mitigate the feeling of lack of purpose after retirement which very often leads to depression.
- Need to ensure that mental health services are available for elders in our community. The coordinated actions of the individual, families, civic society, private organizations, non-governmental organizations, and government can achieve healthy ageing.
- Need to plan for our old age with financial savings and lifestyle changes to maintain good physical health and a satisfying social life.
- Healthy ageing, as a concept, should be introduced in the school curriculum.
- City and town planners should consider elder-friendly designs to improve mobility and reduce dependency.
- Retirement homes and elder care facilities may fill the void left by the loss of the joint family system.
Govt initiatives
- National Policy for Senior Citizens 2011:The Policy envisages State support to ensure financial and food security, health care, shelter and other needs of older persons, equitable share in development, protection against abuse and exploitation, and availability of services to improve the quality of their lives.
- The National Programme for Health Care of Elderly and Health and Wellness Centres under the Ayushman Bharat programme provides dedicated healthcare to the elderly at primary healthcare settings.
- National Social Assistance Programme (NSAP) scheme: The National Social Assistance Programme is a Centrally Sponsored Scheme of the Government of India that provides financial assistance to the elderly, widows, and persons with disabilities in the form of social pensions.
- Pradhan Mantri Vaya Vandana Yojana (PMVVY): Pradhan Mantri Vaya Vandana Yojana (PMVVY) is a Pension Scheme exclusively for senior citizens aged 60 years and above. The maximum Investment limit under this scheme is Rs 15 lakh per senior citizen.
- Rashtriya Vayoshree Yojana: Rashtriya Vayoshri Yojana is a scheme for providing Physical Aids and Assisted-living Devices for Senior citizens belonging to the BPL category. This is a Central Sector Scheme, fully funded by the Central Government.
- SACRED Portal: Senior Able Citizens for Re-Employment in Dignity (SACRED)’ is an IT platform that brings Senior Citizen employment seekers and employment providers together. The portal was launched by the Department of Social Justice and Empowerment, Ministry of Social Justice & Empowerment.
- SAGE Initiative: The SAGE (Seniorcare Aging Growth Engine) portal will be a “one-stop access” of elderly care products and services by credible start-ups.
Way Forward
- The demographic shift towards an ageing population necessitates a shift in focus from the traditional economic model to a care economy model that prioritizes the well-being of the elderly.
- A Comprehensive framework for pensions, social security, food security, Mental Health is needed for the Healthy ageing of the population.
- Approach elderly health in a way similar to maternal and child health, improving their physical, mental, and social wellbeing and providing long term care for chronic health problems both at the same time.
- Recognition of elderly care as part of primary care and universalization is of utmost importance. Palliative care and disability care and support have to be included in this along with preventive and therapeutic support for chronic diseases like diabetes and hypertension.
- Prioritize training of manpower [doctors, mid-level healthcare providers, nurses, Accredited social health activists (ASHA)] to meet the healthcare needs of the elderly.
- Research on elderly healthcare problems, healthcare delivery, treatment protocols for Indian settings, monitoring and evaluation of elderly care programs and palliative care should be prioritized and promoted actively by each state based on their local disease pattern.
- Geriatric health awareness, Geriatric care management and training in undergraduate and relevant postgraduate courses would help build the required expert manpower for improving the state of health in this vulnerable age group.
- Training and continuous education about the approach and management of common problems like hypertension, diabetes, heart disease, stroke, common neurological and mental health problems should be prioritized.
Keywords
- Care Economy: It is a term used to describe the activities and relationships that address the physical, psychological, and emotional needs of people of all ages. It includes both paid and unpaid care work that is essential for economies and human well-being.
- Ageism: Ageism refers to stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) towards others or oneself based on age.
- Nihilism: Nihilism is the belief that all values are baseless and that nothing can be known or communicated. In the context of elderly people, nihilism can refer to a sense of hopelessness, despair, and apathy that can arise from various factors such as chronic illness, social isolation, and loss of independence.
- Geriatric care management: Process of planning and coordinating care of the elderly and others with physical and/or mental impairments to meet their long term care needs, improve their quality of life, and maintain their independence for as long as possible.
- Super-agers: Medical science has identified a new group within the senior citizen category, called super-agers. The term refers to people in their 70s and 80s who have the mental or physical capability of their decades-younger counterparts.
- Healthy Ageing: It is a continuous process of optimizing opportunities to maintain and improve physical and mental health, independence, and quality of life throughout the life course.
An Ethical Perspective
“It is not the years in your life that count. It’s the life in your years”
Abraham Lincoln
- Theory of Erikson: Erik Erikson, a German-American psychoanalyst proposed ‘Ego integrity versus Despair’ as his final psychosocial development stage in a human.
- Ego integrity versus despair is the eighth stage of Erikson’s psychosocial stages of development during which the aging individual strives to accept the value of her life experience.
- According to him, older people should view their accomplishments positively. They would be filled with despair if they did not consider themselves successful.
- Acceptance in Indian culture: Indian culture emphasizes “acceptance“ of the past, the present and the future as a means of achieving “peace of mind“ in old age.
- “Accepting“ the limitations that old age imposes on us and “renouncing“ our responsibilities without a sense of suffering or loss are essential to age well psychologically.
- Inculcating Values: From an ethical perspective, the elderly are considered to be the bearers of wisdom and experience, and their guidance can help shape the moral compass of the younger generation. They hold the family firmly at all times and make them strong. They are the ideal mentor
- Custodians of cultural heritage: The elderly are often the custodians of cultural heritage, traditions, and customs. By imparting this knowledge to younger generations, they help preserve cultural heritage for future generations.
- Intergenerational Relationships: Intergenerational relationships can help foster mutual understanding and respect between different age groups.
Practice Question
Analyze the challenges and opportunities presented by India’s aging population, as highlighted in the UNFPA India Ageing Report 2023. What institutional responses can be implemented to address these challenges?
Reference