Saturday, May 18, 2013

Research Priorities in the field of Ageing in India : Some suggestions -S. Siva Raju


Research Priorities in the field of Ageing in India : Some suggestions
                                                                         S. Siva Raju
Background
The large scale social, economic and technological changes, which are taking place in the society have significantly transformed the pattern of formal and informal support systems available to the older people.  With the growth of “Individualization” in modern industrial life and materialistic thinking among the younger generation, there is greater alienation and isolation of the elderly from their family members and from society at large. Given the changes, the elderly face a number of problems and adjust to varying degrees.  These problems range from absence of ensured and sufficient income to support themselves and their dependents, to ill health, absence of social security, loss of social role and recognition, to the non-availability of opportunities for creative use of free time.  Given the constraint of resources, care of elderly has received a low priority so far in planning and programming social security provisions and services.

Issues of the older persons

            The issues of the older persons in India are many and complex.  They have become increasingly vulnerable not only due to their physical disabilities, but also due to social, economic, psychological and health related issues. 

For elders living with their families-still the dominant living arrangement-their economic security and well being are largely contingent on the economic capacity of the family unit.  Particularly in rural areas, families suffer from economic crisis, as their occupations do not produce income throughout the year. Inadequate income is a major problem of elderly in India (Siva Raju, 2002).  Nearly 90 percent of the total workforces are employed in the unorganised sector.  They retire from their gainful employment without any financial security like pension and other post retirement benefits. The Ministry of Social Justice and Empowerment, Government of India (1999) in its document on the National Policy for Older Persons, has relied on the figure of 33 percent of the general population below poverty line and has concluded that one-third of the population in 60 plus age group is also below that level.  Though this figure may be understated from the older persons point of view, still accepting this figure, the number of poor older persons comes to about 23 millions. As per the Policy, the coverage under the Old Age Pension Scheme for poor persons, which is 2.76 million (as on January 1997) will be significantly expanded, with the ultimate objective of covering all older persons below the poverty line.   
 
            These days, due to change in family structure, the elderly are not given adequate care and attention by their family members.  This trend is fast emerging partly due to growth of "individualism" in modern industrial life and due to the materialistic thinking among the younger generation.  These changes lead to greater alienation and isolation of the elderly from their family members and from society at large.  Due to the changes in the family structure and the value system, the respect, honour, status and authority, which the elderly used to enjoy in the traditional society, gradually has started declining and in the process the elderly are relegated to an insignificant place in our society (D’ Souza, 1971).  Though the young generation takes care of their elders, in spite of several economic and social problems, it is their living conditions and the quality of care, which widely differs from society to society.

 As older people become aware of their incompetencies, they begin to revise their ideas about themselves.  They also have to start coping with reduced income, change of status, loss of friends and spouse and lastly, their waning physical health.  Psychological changes accompany the passing of years, slowness of thinking, impairment of memory, decrease in enthusiasm, increase in cautionness and alternation of sleep patterns.  Social pressure and inadequate resources create many dysfunctional features of old age.  Further, it is well known that the incidence of mental illness among old people is much higher than among the young.  The psychological problems encountered by retired persons are much wider and its impact on the individual is entirely different as compared to those in the unorganised sectors.  Reduced health, reduced income and a sudden break with a particular kind of professional life results in various socio-psychological problems for the retired.  The attitude of family members towards retired persons changes and his attitude towards his family members also changes in this period of life.  Attitudes towards old age, degradation of status in the community, problems of isolation. loneliness and generation gap are the prominent thrust areas resulting in socio-psychological frustration among them (Mohanty, 1989).

            Most elderly are reported to bear a negative self-image and poor self-concept (Ramamurti and Jamuna, 1984).  Changes in looks and likeability and a feeling that others alienate the elderly greatly contribute to the negative self-image.  It was noticed that after the age of 50, people gradually manifest more problems and display poor adjustment and life satisfaction till the age of retirement.  However, after the retirement they slowly and gradually find adjustment and as such their life satisfaction and adjustment show higher index until the age of 70 when the negative effects of ageing again become more pronounced (Ramamurti, 1978). The significant determinants of Successful Ageing, according to some studies (Ramamurti and Jamuna, 1992, Niharika, 2004, Siva Raju, 2006), include self-acceptance of ageing changes, self-perception of health, perceived functional ability, perception of social support, inter-generational amity, belief in karma and after life, flexibility, range of interests, activity level, marital satisfaction, religiosity, certain value orientations and economic well-being.
Health problems and medical care are the major concerns among a large majority of the elderly.  The majority of them refrain from seeking medical aid from public hospitals due to many impediments, besides lack of money.  Some of the health problems of the elderly can be attributed to social values also.  The idea that old age is an age of ailments and physical infirmities is deeply rooted in the Indian mind and many of the sufferings and stresses within curable limits are accepted as natural and inevitable by the elderly. 

The existing medical facilities in India are inadequate and their utilisation by the public is very meagre.  The problem is more acute in the remote areas, where, whatever meagre facilities have been made available, are not optimally utilised by people (Siva Raju, 1991).  Instead, people go to private practitioners of indigenous medicine who live among them and who may not be qualified.  Getting proper medical aid is beyond the reach of the elderly, which may be due to their poverty, illiteracy, general backwardness and adherence to superstitious beliefs for curing illnesses and diseases. Poor people spend larger proportion of their income on medical bills than the rich.  Since medicines and consultations are very expensive, they take medicines only until the symptoms go away, and as a result, most of the leading ailments become chronic in nature. 

Research on Ageing in India
The Research Agenda on Ageing for the 21st Century which was jointly developed by the United Nations Office on Ageing and the International Association of Gerontology, was adopted by the Second World Assembly on Ageing at Madrid, Spain in 2002. It aimed to elaborate and implement public policies on ageing and influence the direction and priorities for scientific gerontology in the coming decades. According to UN (2002), “There is a need to assess the ‘state of the art’ of existing knowledge, as it varies across countries and regions, and to identify priority gaps in information necessary for policy development.” Accordingly, attempts are made recently to review the body of knowledge in the field of ageing and to identify the priority areas of research in the field of ageing in India (Prakash, I.J., 2004, Ramamurti, 2005, Siva Raju, 2006).

The science of gerontology is still in its infancy in India. The interest of social scientists and social work professionals on various ageing issues is of recent origin. At present academic institutions like Tata Institute of Social Sciences and SNDT University in Mumbai, International Longevity Centre in Pune, M.S. University in Baroda, Centre for Development Studies and Centre for Gerontological Studies in Trivandrum, Council for Social Development in Hyderabad, Sri Venkateswara University in Tirupati and Bangalore University in Bangalore have been actively engaged in research on ageing. The Census, National Sample Survey Organisations, Central Statistical Organisation and others collect and compile data on various ageing related issues like age and sex structure, rural urban residential patterns, literacy, martial status, work status dependency status, disability and health status and related information. Further organizations like ICSSR, ICMR, Planning Commission, Ministry of Social Justice and Empowerment and International Agencies like UNFPA, UNESCO, WHO and ESCAP sponsor projects that focus on issues related to ageing. These organizations also sponsor programmes and organize seminars conferences and workshops on ageing related issues.

The research on Ageing in India as on today 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. No doubt concerted efforts made by researchers have so far led to a better understanding of ageing issues. However the diversity that has emerged in the ageing process necessitates our research efforts to focus on different ageing issues in society. This in turn is expected to promote a development of  effective age-related policies and programmes. The review of the earlier studies reveal that most of them view the elderly as passive receivers of care. Further the problems of vulnerable elderly like widowed females, disabled, fragile older persons and those from the unorganized sector are inadequately covered. Most studies conducted to assess various issues of the elderly are exploratory and descriptive. Ageing needs a multi and inter-disciplinary perspective. The development of social gerontology reveals that disciplines like sociology, demography, psychology, anthropology, geography, law, social policy and administration, management, economics, nutrition, as well as varied professional training like social work, nursing, counseling and clinical psychology, focus on various ageing issues. However, no single disciplinary focus gives a holistic understanding. A combination of qualitative and quantitative approaches are also 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 need to be attempted, wherever necessary, which in turn will help to focus on ageing issues, both at macro and micro levels.

Research Priorities
Some of the areas of research on elderly which needs our attention on priority basis are:

  • Assessment of the impact of globalization on the living conditions of the elderly.
  • Study of vulnerability of elderly women, disabled, fragile older persons and those from the unorganized sector.
  • Focus on the rural and tribal elderly living conditions.
  • Effect of rural - urban migration of young members on the living conditions of their elderly.
  • Need assessment studies on establishment of day care and interactive centres for elderly in the community.
  • Impact of health problems on the quality of life of the elderly.
  • Study of linkages between nutritional and health status of the elderly.
  • Primary Health Care for the rural and tribal elderly.
  • Factors contributing for different forms of elder abuse.
  • Determination of ‘successful’ ageing, ‘healthy’ ageing, ‘productive’ ageing and ‘active’ ageing
  • Assessment of quality of life of elderly on the basis of life span approaches.
  • Assessment of family relations and social networks of elderly living in different socio-economic settings.
  • Issues and implications of networking of organizations working on ageing issues.
  • Assessment of areas for collaboration between Public and Private sector for enhancing the living conditions of the elderly.
  • Assessment of issues related to the  promotion of ageing in place.
  • Study of linkages between spirituality and ageing
  • Study of role of technology in the quality of life of elderly.
  • Assessment of voluntarism among the elderly living in different socio- economic settings
  • Study of opportunities and facilities that are required for enhancing the contribution of elderly to the family, community and society.

The focus of social gerontology is not only concerned with people in later life but also the social institutions which particularly affect that period such as retirement, pensions and welfare policy. Given the changes in the socio-economic profile of the elderly, there is a need to recognize them as the resource group and to develop suitable policies and programmes for their integration into the development process.

References
D'Souza, V.S. 1971 Changes in Social Structure and Changing Roles of Older People in India.  Sociology and Social Research 53 (3), 297-304.

Government of India 1999 National Policy on Older Persons.  Ministry of Social Justice and Empowerment, New Delhi. 

Mohanty, S.P 1989 Demographic & Socio-Cultural Aspects of Ageing in India:Some Emerging Issues.  In R.N.Pati & B.Jena (Eds.) Aged in India:          Socio-Demographic Dimension.  New Delhi: Ashish, 37-45.

Niharika, Gupta, 2004. Successful Ageing and Its Determinants, Ph.D. thesis, TISS, Mumbai (Mimeo)

Ramamurti, P. V. 1978 The Sixth decade and after.  Tirupathi: S. V. University Press.

Ramamurti, P.V. & Jamuna, D. 1984 Psychological Research on the Aged in India.  Journal of the Anthropological Society of India, 19, 3.

Ramamurti, P.V. & Jamuna, D. 1992 Markers of Successful Ageing Among Indian Sample, Basle, Switzerland, Sandoz Project Report.

Prakash , I.J., 2004, Ramamurti, 2005, Siva Raju, 2006, Identify the priority areas of research in the field of ageing in India

Siva Raju, S. 1991 "Health care system in India: Need for comprehensive evaluation", in `Primary Health care', Yesudian C.A.K. (ed.) Tata Institute of social Sciences, Bombay.

Siva Raju, S. 2002: “Health Status of the Urban Elderly: A Medico-Social Study”, Delhi, B. R. Publishing Co.

Siva Raju, S. 2002: “Meeting the Needs of the Poor and Excluded in India”, Situation and Voices, The Older Poor and Excluded in South Africa and India, UNFPA, Population and Development Strategies, No. 2, 93-110.

Siva Raju, S, 2006, Ageing in India in the 21st Century : A Research Agenda, Mumbai: Harmony- Celebrate Age


(Dr.S.Siva Raju is Professor and Dean, School of Development Studies,Tata Institute of Social Sciences.)

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