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Wednesday, February 1, 2023

Is India braced to take care of its elderly citizens?

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The elderly population in India has been increasing since 1961 – as per data from Population Projections for India and States 2011-2036, a report published by the National Commission on Population in July 2020. This has been attributed to greater longevity of life as a result of better healthcare and economic well-being.

During 2001-11, the elderly population grew by more than 27 million. This increase is expected to be 34 million in 2011-21 and 56 million in 2021-31.

The 2020 National Commission on Population report estimates that there will be nearly 138 million elderly persons in India in 2021, comprising of 67 million males and 71 million females.

The growth rate of the elderly population is higher than that of the general population. As a result, the proportion of the elderly in the general population has been increasing. While the general population has grown by 18 per cent in 2001-11 and 12.4 per cent in 2011-21, the elderly population has grown by 36 per cent each in the two decades.

The share of the global population aged 65 years or above is projected to rise from 10 percent in 2022 to 16 percent in 2050.

India’s growth rate stood at 2.3 percent in 1972, which has dropped down to less than 1 percent now. In this period, the number of children each Indian woman has during her lifetime has come down from about 5.4 to less than 2.1 now. This means that Indian has attained the Replacement Fertility Rate, at which a population exactly replaces itself from one generation to the next.

Fertility rates have been declining, so have mortality rates with increased access to healthcare and advances in medicine.

Population of 0-14 years and 15-24 years will continue to decline while those of 25-64 and 65 plus will continue to rise for the coming decades.

Amongst the elderly (60 plus), females outnumber males.

However, a harsh truth is that increase in longevity and decline of joint family and breakdown in social fabric pushes seniors into loneliness and neglect. A heathy life, with physical activity, good diet, avoiding tobacco, alcohol and other habit-forming substances is recommended. Positive attitude and mental wellbeing promote quality of life in advancing years.

According to a United Nations report, in the last few years, medical science has identified a new group within the senior citizen category, namely that of super-agers. The term refers to people in their 70s and 80s who have the mental or physical capability of their decades-younger counterparts.

With the world ageing at a rapid rate, it is estimated that by 2030 there will be 34 nations with over 20 percent population above 65 years. In recent years, long-term studies on “super agers” from across the globe are studying behaviours, habits and health indicators of < 90 years. Apart from those with dementia and cognitive decline, healthy agers are a subject of interest to researchers. While general health, family history, psychosocial aspects are being studied, the need for improved and targeted integrated-care approaches that are community-based, designed around needs of older persons and with effective coordination and long-term care systems are critical must-haves. This is true for every society, especially those with ageing and super-ageing populations.

Another interesting fact in the UN report is that around 1 in 6 people 60 years and older experienced some form of abuse in community settings during the past year.

Rates of abuse of older people are high in institutions such as nursing homes and long-term care facilities, with 2 in 3 staff reporting that they have committed abuse in the past year.

Rates of abuse of older people have increased during the COVID-19 pandemic.

Abuse of older people can lead to serious physical injuries and long-term psychological consequences.

Abuse of older people is predicted to increase as many countries are experiencing rapidly ageing populations.

The global population of people aged 60 years and older will more than double, from 900 million in 2015 to about 2 billion in 2050.

Globally, the population is ageing rapidly. Between 2015 and 2050, the proportion of the world’s population over 60 years will nearly double, from 12 percent to 22 percent.

Mental health and well-being are as important in older age as at any other time of life. Mental and neurological disorders among older adults account for 6.6 percent of the total disability (DALYs) for this age group. Approximately 15 percent of adults aged 60 and over suffer from a mental disorder.

NSO’s National Sample Survey (NSS) data from 2017-2018 notes that 70 per cent of the elderly in India were dependent on others for their daily living. Only 10 per cent and 11 per cent of females were economically independent in rural and urban areas respectively, compared to the 48 per cent and 57 per cent of males in rural and urban areas.

The NSO’s report Periodic Labour Force Survey 2018-2019 reveals that the participation of those aged 60-64 in economic activities has fallen from 49.3 per cent in 2011-12 to 40.9 per cent in 2018-19. About 72 per cent of men and 21 per cent of women of this age group participated in economic activities in rural areas, and 51 per cent of men and 10 per cent of women in urban areas.

Help Age India 2019 report shockingly reveals the following hard truths that: 29 percent Caregivers in the family (mainly son, daughter-in-law, daughter, son-in-law) felt the ‘burden of caregiving of an elder’ was Moderate to Severe, while 15 percent felt a Severe burden of caregiving, regarding the elderly.

Furthermore, 35 percent of the caregivers ‘never’ felt happy looking after the elderly. Up to 62 percent sons, followed daughter-in-law (up to 26 percent) and Daughters (up to 23 percent) took on the financial burden for daily needs of the elderly.

Only one tenth of elderly dependents (11 percent) contributed to the family resource pool. 25.7 percent caregivers felt fatigue and frustration result in aggressive behaviour towards their older relative. On an average, a family spends Rs.4125 looking after the elderly.

42.5 percent of caregivers always have to pay for the medicine bills of the elderly. While 65 percent of caregivers in the family have to leave the elderly person(s) alone by giving instructions for day-to-day activity management.

The report also revealed that 84.2 percent of the family caregivers have to leave the elderly at home with the support of a Maid Servant. Up to 32 percent of the caregivers reported to be extending physical care to elderly’ for Activities of Daily Living (ADL) such as help / assistance in changing clothes, walking, eating, bathing, toileting etc.

More than half of the elders sometimes require support to overcome psychological problems. Almost 70 percent of the elderly dependants sought emotional support from caregivers at the time of crisis. 29 percent elders always needed emotional support when they suffer from depression. 29 percent elders always needed emotional support when they suffer from lack of self-confidence and also same percentage for stress. 30 percent elders always needed emotional support when have fear of dependence, the report further highlighted.

India needs to brace itself to cater to its elderly population as the population of 0-14 years and 15-24 years will continue to decline while those of 25-64 and 65 plus will continue to rise for the coming decades.

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