Empowering India's Elderly | 18 Jun 2024

The phenomenon of ageing stands out as one of the most significant experiences of this century, marked by remarkable advancements in human longevity alongside historically low levels of reproduction.

According to Census 2011, India has 104 million older people (60+years), constituting 8.6% of total population. Amongst the elderly (60+), females outnumber males.It is expected that the country will have 193 million elderly persons, constituting about 13% of the total population by 2030. As per UNFPA Report 2023,the percentage of elderly population in the country projected to double to over 20% of total population by 2050.

Although the increasing number of elderly people may seem concerning, it is essential to understand the associated challenges posed by longer lifespans and emerging vulnerabilities for developing effective policies and programs to support an ageing population.

What are the Primary Factors Contributing to the Ageing Phenomenon in India?

• Increased Longevity :
  • One of the primary drivers of increased longevity in India is the remarkable improvement in healthcare services. Over the past few decades, there have been significant advancements in medical technology, treatments, and preventive care.
    • According to the World Health Organization,life expectancy in India has has improved by 5.2 years from 62.1 years in 2000 to 67.3 years in 2021.
• Improved Living Conditions:
  • Better living conditions, including access to clean water, sanitation, and improved nutrition, have also contributed to longer lifespans.
    • The Swachh Bharat Abhiyan has significantly increased sanitation coverage, reducing the prevalence of waterborne diseases.
• Decreased Fertility Rates :
  • India has implemented various family planning programs aimed at controlling population growth, which have been successful in reducing fertility rates.
    • As per the fifth round of NFHS conducted during the year 2019-21, the Total Fertility Rate (TFR) has declined to 2.0 children per woman less than the replacement level of fertility, which is 2.1 children per woman
• Socio-Economic Changes :
  • Socio-economic changes, such as increased female education and workforce participation, have also played a role in lowering fertility rates and increased
  • Higher education levels among women correlate with delayed marriages and fewer children.Urbanization leads to smaller family norms, as raising children in urban areas can be more expensive and demanding.
    • Kerala,known for its high literacy rates and advanced healthcare, Kerala has one of the highest life expectancies and lowest fertility rates in India. The state serves as a model for other regions in managing the ageing population.

What are the Various Challenges Associated with Elderly Population in India?

• Restrictions in Activities of Daily Living (ADL) :
  • About 20% of the elderly experience restrictions in activities of daily living, which include basic self-care activities like bathing, dressing, eating, and mobility.
  • Elderly individuals living alone or without adequate family support often struggle with ADL, leading to a loss of independence and increased need for caregiving services.
• Multi-Morbidity :
  • The coexistence of multiple chronic conditions is a common issue among the elderly, impacting their quality of life and increasing healthcare needs.
  • The Longitudinal Ageing Survey of India (LASI) reports that 75% of the elderly population suffer from one or more chronic diseases, such as hypertension, diabetes, arthritis, and cardiovascular diseases.
• Poverty :
  • Economic vulnerability is a significant concern for the elderly, particularly those without stable sources of income which affect their quality of life and healthcare utilisation.
  • More than 40% of the elderly in India are in the poorest wealth quintile, with about 18.7% of them living without an income.(India Ageing Report,2023)
• Changing Healthcare Needs:
  • In a demographic where the growth rate of elders far exceeds that of the young, the biggest challenge is to provide a range of quality, affordable, and accessible health and care services to the elderly.
  • They require an array of specialised medical services at home including tele or home consultations, physiotherapy and rehabilitation services, mental health counselling and treatment, as well as pharmaceutical and diagnostic services.
• Social Issues:
  • Factors such as familial neglect, low education levels, socio-cultural beliefs and stigma, low trust on institutionalised health-care services etc. exacerbate the situation for the elders.
    • Inequity in access to facilities compounds the problems for the elderly, who are already, physically, financially and at times psychologically restricted in understanding, and availing such facilities. Consequently, most of them live their years in neglect.
• ‘Inherently gendered’:
  • One of the emerging issues of population ageing is the “Feminization of Ageing”, that is many more women than men reaching older ages.
    • Census of India shows that the sex ratio of the elderly was considerably high (1028) in 1951 and subsequently dropped to about 938 in 1971, but finally increased up to 1033 in 2011.
  • “Poverty is inherently gendered in old age when older women are more likely to be widowed, living alone, with no income and with fewer assets of their own, and fully dependent on family for support.
• Inadequate Welfare Schemes:
  • Despite Ayushman Bharat and public health insurance schemes, a NITI Aayog report indicates that 400 million Indians do not have any financial cover for health expenses.
  • Despite the presence of pension schemes at centre and state level, a mere pittance as low as ₹350 to ₹400 a month is provided in some states which too is not universal.

What Steps Should be Taken to Empower the Elderly Population in India?

• Protection from Destitution:
  • The first step towards a dignified life for the elderly is to protect them from destitution and all the deprivations that may come with it. Cash in the form of a pension can help to cope with many health issues and avoid loneliness as well. That is why old-age pensions are a vital part of social security systems around the world.
    • Another critical area would be bringing reforms in the social security pensions. They also need other support and facilities such as health care, disability aids, assistance with daily tasks, recreation opportunities and a good social life.
• Emulating the Frontrunners:
  • The southern States and India’s poorer States such as Odisha and Rajasthan have achieved near-universal social security pensions. Their actions are worth emulating. It would be much easier for all States to do the same if the central government were to revamp the National Social Assistance Programme (NSAP).
• Recognising Concerns of Elderly Women:
  • The policy should also take cognisance of the fact that women, in India, on average outlive men by three years. The sex ratio of older people is projected to increase to 1060 by 2026. Since women in India are usually younger than their husbands, they often spend their later years as widows.
    • Therefore, the policy should particularly cater to the more vulnerable and dependent older single women so that they can live respectable and independent lives.
• Passing Maintenance and Welfare of Parents and Senior Citizens (Amendment) Bill, 2019:
  • The Ministry of Health and Family Welfare (MoHFW), Ministry of Social Justice and Empowerment (MSJE) and Ministry of Skill Development and Entrepreneurship (MSDE) have a pivotal role to play in the matter. Greater collaboration between them could get the ball rolling on the required reforms.
    • The Maintenance and Welfare of Parents and Senior Citizens (Amendment) Bill, 2019, seeks to regulate home-based care for older people. It proposes the registration of institutions providing home care services and prescribing minimum standards for them. However, it has not been passed since being introduced in Parliament in 2019.
• Building Elderly Inclusive Society:
  • One of the effective ways of ensuring proper health facilities to all the elderly in the Old-Age-Homes (OAHs) is to ensure a lesser number of the elderly people in these homes. Elderly are an asset to the society and not a liability, the best way of taking advantage of this asset is by assimilating them into the mainstream population rather than isolating them in old age homes.
• Transforming the Perception of the Elderly:
  • The perception of the elderly as liabilities can be transformed by innovative institutions and social agencies that empower them and integrate them into productive societal roles.
  • By leveraging their experience, skills, and wisdom, society can benefit from the active participation of older adults.
    • The University of the Third Age (U3A) is an international movement that offers lifelong learning opportunities to retired and semi-retired individuals. It encourages continuous education in various subjects, from technology to arts.
    • The Senior Employment Scheme in Singapore helps match elderly job seekers with employers who value their experience and reliability.

Conclusion

Innovative institutions and social agencies play a crucial role in transforming the perception of the elderly from liabilities to assets. By providing opportunities for education, employment, volunteering, health and wellness, and social inclusion, policy initiatives should empower the elderly and integrate them into productive societal roles.