Dr. K. Prabakar,
Social Work Foot Prints 4 (2)
The declining fertility and mortality rates and the increasing life expectancy at birth as well as at older ages lead to increase in the global population of persons aged 60 years and above. The 60+ population in India was more than 100 million in 2012 and that is estimated to be more than 323 million in 2050. As a proportion, one in five Indians will be 60 or over in 2050. Further, 44 million people are estimated to be in their eighties.
The phenomenal increase in the number and proportion of elderly people will pose serious social, economic, health care, political and other challenges to the central and state governments as well as to the Indian Society at large. In this book, edited by the well-known social gerontologist Prof.T.K.Nair, the twelve articles examine some of the issues concerning the Indian elderly in depth. More specifically the definition of old age, situation of older people in the villages, abuse and neglect of the elderly, the health care challenges and the role of traditional Indian medicine, life satisfaction in old age, national policy on senior citizens, social security, elder care legislation, research priorities in the field of ageing, elder care services in India, two models of community - based services for the elderly, and indifferent attitude of society towards old age are analysed in the articles.
The concept of old age is explained from different perspectives by Prof.Nair. He says “Old age is a relative concept which varies from society to society. Depending on the expectation of life, the definition of old age is found to vary from about 40 in some developing countries to 70 and beyond in some developed countries”. Ayurveda, the traditional system of Indian medicine, divides human life span into ten stages and categorizes the aging persons into two broad groups: Vriddha (60 to 80 years) and Jaratha (above 80 years). In ancient China, the calendar year was named with the combination of two sets of Chinese characters – one consisted of twelve characters and the other five characters. Therefore, on becoming sixty-one years old, the name of that year becomes same as that of the year of birth. Hence the sixty-first year after birth is called Kanreki (return of the calendar) which is often regarded as the beginning of old age or second childhood.
Dr.Nair refers to an integrated concept of age proposed by Psychologist James Birren. He differentiates the concepts of biological, psychological and social age. Biological age refers to the position of an organism with respect to its remaining potential longevity. Psychological age refers to an organism’s level of adaptability, that is, the state of those capacities which permit the individual to adapt to external and internal environmental demands. Social age is the individual’s position in expected age-graded social roles and social habits. A person’s functional age is viewed as a composite index of his/her potential biological, psychological and social capacities.
Dr.Nair concludes that old age defies any specific definition. It is not a mere statistical categorization or fact. “The social definition of old age depends on the norms of a particular society. Aging and being an older person are essentially social and cultural phenomena”.
The first research study on the elderly in India, perhaps, was that of Dr.H.M.Marulasiddaiah. “Old People of Makunti”, published in 1969, was based on a village study conducted five decades ago by him. The declining authority of the aged was empirically observed in the village. Professor K.Visweswara Rao’s article on the rural elderly in India analyses the situation of the older people in Indian villages. He also reviews the relevant policies and programmes.
Professor Devi Prasad’s article “Struggle for Survival: Narratives of Abuse and Neglect of the Elderly in Indian Families” presents heartrending case studies of the elderly who are victims of abuse and neglect. Dr.Devi Prasad says that studies have indicated that more than 95 percent of the abuse of elderly take place at home. A majority of the elderly live with their spouses, children, and grand children, and other relatives. That is why son, daughter-in-law, spouse and the daughter are frequently reported to be the abusers. While the typical profile of an elderly victim of abuse, whatever be the form of abuse, is found to be a ‘woman, widowed, of advanced age, poor and assetless’; a typical abuser is middle aged, a principal caregiver, and usually the offspring of the older person.
The case studies presented by Dr.Devi Prasad reveal different angles of the abuse of the elderly. One angle is that the patterns of elder abuse and neglect reflect and reinforce the prevailing negative stereotypes toward the elderly and their roles in society. The other angle is how we are constructing and explaining the phenomenon of maltreatment of the elderly in the larger context of socio-economic realities.
In the article “Research Priorities in the Field of Ageing”, Dr.Siva Raju says “the research on ageing in India was primarily focused on socio-economic and demographic profiles, living arrangements, problems of and services to the aged, interpersonal relationships especially of the urban elderly”. A combination of qualitative and quantitative approaches are required for a more comprehensive understanding of ageing issues. Also wide variation in levels of development and socio-economic status of people living in different geographical regions make national level studies on elderly essential. Analysis of both secondary and primary data needs to be attempted, wherever necessary, which in turn will help to focus on ageing issues, both at macro and micro levels.
According to WHO (2002) between 60-80% of the population in developing countries and a growing percentage in developed countries continue to avail services of traditional medical systems. In the article “Ageing Population in India: the Health System Role of Traditional Medicine”, Dr.P.M.UnniKrishnan of UN University observes that the approach to universal health coverage and health system development in India is predominantly based on modern medical approach. In the National Health Mission programmes traditional medicine is integrated marginally and mainly in the form of dispensable medicines and not as a holistic health care approach. Why are Ayurveda and other traditional medical systems not called for to address the health-care challenges of the elderly? There is a lot that these can offer in terms of preventive care, healthy lifestyles, early detection of likely manifestation through methods such as prakriti analysis, treatment methods such as panchakarma particularly in the case of chronic, debilitating conditions.
K.N.Ajith presents a case study of CEWA, the first community-based elder care project, while Dr.Kalpana Sampath’s case study is on a health care initiative, NMT. At a time when home for the aged was the form of elder care service for the elderly in India., Centre for the Welfare of the Aged (CEWA), formed in 1979, pioneered community-based elder care services in India.
Nightingales Medical Trust (NMT) is a voluntary organization working for the well-being of the elderly in and around Bangalore through various innovative, family-based support systems for the senior citizens of different socio-economic groups. Some of Nightingales’s projects have emerged as models and are replicated in other parts of the country, NMT’s Centre for Alzheimer’s has a team of psychiatrists, physiotherapists and psychologists who take care of the elders along with educating the family on the support required from them while dealing with Dementia or Alzheimer’s patients. NMT also provides short term or respite care for the family having dementia person with them. This service is a boon for the family members when they have to go out of station or just want a break from caring for a short period.
Prof.Nair examines in detail the schemes and laws initiated by the government in the article “The State and the Elderly”. He also analyses the “Elder Care Services in India” in another article. The Government of India formulated the National Policy on Older Persons in 1999 giving rise to hopes to millions of elderly in the country. But it remained almost a paper policy. So a revised one called the National Policy on Senior Citizens was framed in March 2011. But that policy is not yet notified by the government. The Maintenance and Welfare of Parents and Senior Citizens Act was a major legislation. But its implementation is far from satisfactory. The National Programme for Health Care of Elderly (NPHCE) in India, launched in 2010, to be introduced in 100 districts in 21 states has not been put in place. In the developed nations, economic development preceded populations ageing. But in India the reverse trend has been seen. The government does not appear to be serious about the implications of this demographic shift.
“Life Satisfaction in Old Age” has been assessed by Dr.Nair based on a field study in Chennai City and in two nearby villages. The mean life satisfaction score of the elderly studied is low, that is, 7.89 while the range of the life satisfaction scores is from 0 to 18. Life satisfaction score of the urban elderly is double that of the rural elderly. Life satisfaction is found to be associated with health status, economic condition and belief in re-birth.
In the concluding article “Old Age in an Indifferent Society”, Dr.Nair discusses Indian family’s changing role in caring for the elderly, issues relating to income security, “age-ism”, apathy of governments, and the growing indifference in Indian society towards the older people. The pejorative image of a person who is old simply because of his or her age is seen as a growing phenomenon in India too. Older persons are portrayed as sick, helpless and useless in television programmes in India. All over the world there is a growing demand for a state-funded, universal, non-means-related non-contributing pension scheme for the elderly. Dr.Nair advocates for a universal pension of Rs.2, 000 per month which should be indexed to inflation. On the whole, the book “Old Age in an Indifferent Society” is a very good contribution to the field of ageing.
Dr. K. Prabakar
CEO, Apollo Knowledge
Reviewer Name : Renuka Ramanujam
This book is a collection of articles on the growing needs of aging people and the apathetic attitude of society towards them. Aging is a natural process and there are around hundred million 60 plus citizens (2011-2012) which would rise further due to increase in life expectancy. The changing society and its individualistic and materialistic outlook have alienated the elderly from their family members and society at large. The various articles in the book look at aging from social, physical, economic and cultural perspectives and deal with policy needs and elderly care services that may help in the effective management of this phenomenon.
The author begins by specifying varied ways of defining “old age” according to culture, region and understanding of each society. However, the underlying principle in each society to understand old age is that with the passage of time, as measured by the chronological age, there is a reliable index of changes in minds and bodies, and in abilities causing limitations. Marulasiddaiah, in the article ‘Old People of Makunti’, a village located in Karnataka, portrays the shrinking control of older people over the younger generation. The younger generation no longer consults elders on any matter. In fact the elderly feels neglected and attribute this change as “Kalyug”. J. Vishweswara, in his article, “The Rural Elderly in India” brings out some significant facts that may induce the government to make some changes in policies and programmes for the elderly. According to Census of India, the majority of elderly (75%) live in rural areas and an equally large number are windows, A study conducted by Help Age India in seven states points out that one-fifth of the elderly live alone. Devi Prasad in his article portrays the neglect and abuse that elderly people face in the family. The prime reason, according to the writer, is their devalued social status and dependency on the family which increases as they advance in age. Another article deals with the traditional system of medicine, Ayurveda, in geriatric care and the policy directions needed to integrate traditional medical systems into geriatric care.
An interesting contribution is by the editor himself on “Life Satisfaction in Old Age”, using life satisfaction scale and statistical analysis to show variation based on variables: age, sex, marital status, health, children, place of residence and economic situation. T.K. Nair, discusses at length the responsibility of the State towards the elderly, the various Acts and provisions and the existing care services ranging from institutional care to community care. S. Siva Raju in his article points at the need to diversify research in the field of aging in India which will promote effective age-related policies. Aging needs a multi and inter-disciplinary perspective. There is a need to recognize this group as a resource group. Social gerontology should include issues which affect the later period of life like retirement, pension and welfare policy. The last section in the book deals with the community of concern for the elderly and concludes that the best place for the well-being of the elderly is the family itself. Nevertheless, it lists out various community centres that take care of the aged.
The presentation in the book is very simple, lucid and valuable and it covers almost all aspects related to old age. The book gives an insight into the various problems and challenges for the government and its citizens which requires a major shift in attitude towards old people.
Indian Social Institute