The Rural Elderly in India
K. VISWESWARA RAO
Introduction
In demographic terms, the 20th century was a century of
population growth and the 21st century would be century of aging.
The composition of age structure has been changing in India after independence
and there is a steep increase in the elderly population. The percentage of
child population below 14 years showed a substantial decline from 38.9 % to
total population and would further decrease to 19.7 % by 2050 whereas the
population of the elderly (60 +) grew sizably
from 5.6 %, in 1950 to 20.6 % by 2050. However, regional variations are
found in population of elderly as in 11 states/union territories of India such
as Andhra Pradesh, Himachal Pradesh, Karnataka, Kerala, Maharashtra, Punjab,
Tamil Nadu and others. have more than the national average (7.5%). With the
rapid changes in the social scenario and the emerging prevalence of nuclear
family set-ups in India in recent years, the elderly people are likely to be
exposed to emotional, physical and financial insecurity in the years to come.
This has drawn the attention of the policy makers and administrators at central
and state governments, voluntary organizations and civil society (Central Statistics Office, 2011).
Growth
of Elderly population In India
The Indian elderly population is currently
the second largest in the world. The decadal growth rate of elderly in India
shows that in 1951, the number of elderly (60+) was 20.190 million and this has
increased to 24.712 million (1961), 32.700 million (1971), 43.172 million (1981),
54.685 million (1991) and 77 million in 2001. Thus, the population of the aged
has increased about three fold during the period from 1950 to 2001. Further, the
absolute number of the elderly increases from 77 million in 2001 to 137 million
by 2021, and by 2050, India
will be home to one out of every six of the world’s older persons. The major
reasons for the phenomenal growth of the elderly is due
to the increase in life expectancy at birth as
well as at 60+ years. The expectation of life at birth
in India has increased from 41.9 for males and 40.6 for females during 1951-61,
to 64.1 to 65.6 for females, respectively by 2000. Life expectation at age 60
increased from 13. 8 years in 1971 to 16.29 in 2011 for males and 14.75 years to
18.18 for females. Similarly, life expectation at age 70 also increased during
this period for both males and females in future also it is going to be
increased.
The population of the aged (60+) has
increased from 13.80 for males and 14.75 for females in 1971, to 15.01 for
males and 16.23 for females in 1991 respectively. During the years 2000 – 2050,
the overall population in India will grow by 55 % whereas population of the
elderly (60 +) will increase by 326 % and those in the age group of 80+ by 700
% (Government of India, 2011). Projections for the immediate future include
further improvement in life expectancy, accelerated pace of growth of old
population, gradual tracking of gender ratio in favour of females (especially
among the older old), and altered patters of morbidity, disability and morality
(Kumar, 1997). Ensuring that they not merely live longer, but lead a secure,
dignified and productive life is a major challenge (Planning Commission , 2012).
Profile
of the Indian Rural Elderly
Of the total population of 77 million
elderly in 2001, the population of the older women was 39 million, whereas men
were 38 million. Literacy status indicates that 53 % among elderly males are
literate and female literacy is only 20 %.
Further, the majority of the elderly (75 %)
are living in rural areas and the rest (25 %) are in urban areas (Census of
India, 2001). The census data and the NSS Surveys 43rd round
(1987-88), 50th round (1993-94), and 52nd round (1995-96)
also found the rural urban differences, where a large percentage of the older
people lives in villages. The NSSO study indicates the elderly are concentrated
in rural India and there is also a movement of the elderly from urban to rural
areas. The report says the
number of elderly women is more than that of elderly men. Nearly three out of
five single older women are very poor, and two out of three rural elderly women
are fully dependants. There is an increasing proportion of elderly at 80-plus
ages, and this pattern is more pronounced among women.
The data on work status of the elderly
(NSSO, 2006) revealed that 36 % are still in the labour force and two-thirds
(64 %) of them are out of the labour force.
Over a quarter of elderly (26.9 %) are self – employed and the casual
labourers among the older population are to the extent of 7.4 %. Only 1.5 % of
them are in regular salaried employment. Elderly males are more economically
active as compared to elderly females. According to NSSO (42nd round),
there were 654 widows and 238 widowers per 1,000 old persons in rural
areas. The respective figures were 687
and 200 for urban areas. More than 65 per cent of Indian women live without a
spouse as compared to 29 per cent of older men.
Research (Marulasiddhiah, 1969; Vijaya
Kumar, 1991,) conducted on the rural elderly in various parts of India found
that majorities of the elderly were living with married sons(s). The study, undertaken in seven states of
India by HelpAge, found that one-fifth of the elderly live alone. This
proportion has registered a sharp increase in the past two decades and is more
evident in the case of elderly women. The housing data from Census 2011 also
point out that the number of households has increased substantially in the last
decade, and the number of persons per household has come down substantially.
Declining fertility, migration and nuclearisation of families are three
possible reasons for such reduction in household size. Across the States, there
is a substantial variation in the type of living arrangement, particularly in
the proportion of elderly persons living alone. The percentage of those living
alone or with spouse is as high as 45 % in Tamil Nadu, Goa, Himachal Pradesh,
Maharashtra, Punjab and Kerala.
The data on old age dependency ratio
revealed that it was higher in rural areas (125) than in urban areas (103).
Further, it was observed that a higher number of males in rural areas, 313 per
1000, were fully dependent as compared to 297 per 1000 males in urban areas
(NSSO, 2004). About 70% of the older people depend on others for their day to
day maintenance and 85.87% of the elderly women are dependent on others.
Policies and Programmes for the Elderly
In pursuance
of Article 41 of the Indian Constitution, government of India and state
governments have initiated policies and programmes for the elderly in India.
The National Policy on Older Persons (NPOP) was announced in January 1999 to
reaffirm the commitment to ensure the well-being of the elderly. The Policy
envisages State support to ensure financial security, health care, shelter and
other needs of older persons to improve their quality of life. Subsequently, a
Committee was set up to draft a new National Policy on Senior Citizens and the
Committee submitted its report on 30th March 2011. The new draft
Policy has been placed on the Website of Ministry of Social Justice and
Empowerment for comments from the general public and circulated to State
Governments for their response.
The
Maintenance and Welfare of Parents and Senior Citizens (MWPSC) Act was enacted
in December 2007, to ensure maintenance for parents and senior citizens and
their welfare. The Act contains 7 Chapters – maintenance of parents and senior
citizens, establishment of old age homes, provision of medical care, protection
of life and property of senior citizens, offences and procedure for trial etc. As
on March 31, 2011 the Act had been notified by 23 States and all UTs and they
are required to frame rules such as appointment of maintenance officers;
Constitution of maintenance and Appellate Tribunals etc. So far, 12 states
including Gujarat, Haryana, Kerala, Madhya Pradesh, Tamil Nadu, West Bengal
etc. have taken the steps for implementation of the Act.
The Scheme
of Integrated Programme for Older Persons (IPOP) is the major programme implemented
by the Ministry of Social Justice and Empowerment since 1992 and was revised in
2008. Under the Scheme, financial assistance is provided to NGOs, Governments,
Panchayati Raj Institutions/ Local Bodies for running and maintenance of old
age homes, day care centres, mobile medicare units, day care centres for
alzheimer's disease/ dementia patients, physiotherapy clinics, regional
resource and training centres, etc. Currently, 3 Regional Resource and Training
Centres (RRTCs) have been supported under the Scheme of IPOP. The Ministry of
Rural Development is administering the Indira Gandhi National Old
Age Pension Scheme (IGNOAPS), under which Central assistance is given
towards pension @ Rs. 200/- per month to persons above 60 years belonging to a
household below poverty line, which is meant to be supplemented by at least an
equal contribution by the States so that each beneficiary gets at least
Rs.400/- per month as pension.
The most recent intervention has been the
introduction of the National Programme for Health Care for Elderly (NPHCE) in 2010, with the objectives of providing preventive, curative and
rehabilitative services to the elderly persons at various level of health care
delivery system of the country. The major components of the programme are to
establish geriatric department in all the existing 8 Regional Geriatrics
Centres; strengthening healthcare facilities for elderly at various levels of
100 identified districts in 21 States of the country. Programme was initiated
in 30 districts of 21 identified States during 2010-11 and during 2011-12 the
programme is to be initiated in another 70 districts of 21 identified States.
National Non Communicable Diseases (NCD) Cell has been established at the
Centre to monitor the implementation of NPHCE.
The Ministry of Railways provides
facilities such as separate ticket counters for senior citizens at various
Passenger Reservation System (PRS) centres; provision of lower berth to male
passengers of 60 years and above and female passengers of 45 years and above;
40% and 50% concession in rail fare for male passengers aged 60 years and above
and female passengers aged 58 years and above respectively to senior citizens. The
Ministry of Finance provides income tax exemption for the elderly (60 +) up to
Rs. 2.50 lakh per annum and for elderly of 80 years and above up to Rs. 5.0
lakh per annum and the National Carrier, Air India, under the Ministry of Civil
Aviation provides air fare concession up to 50% for male passenger aged (65 +)
and female passenger aged (63 +). The Ministry of Road Transport and Highways
has taken initiatives for providing reservation of two seats for elderly in
front row of the buses of the State Road Transport Undertakings. Some State
Governments are giving fare concession to elderly in the State Road Transport
Undertaking buses. Besides these programmes, various state governments have
introduced old age pension schemes for the elderly and however, the eligibility
criteria, quantum of amount, etc. varies from state to state. NGOs like HelpAge
India and associations of older people are also rendering their services for
the older people in India.
Issues
of the Rural Elderly
The unconditional respect, power and
authority that older people used to enjoy in rural extended traditional family
is being gradually eroded in India in recent years. Some of the main problems
of senior citizens are related to security, healthcare, need for care and
maintenance. As early as in the mid fifties, Dube (1955) had highlighted the
gap between the ideal norms and actual practices in intra family relation in a
village of Andhra Pradesh. It was found in a study that when the persons
approached to old age, they gradually receded to the background and the control
of the household as well as village affairs had passed on middle aged persons
(Marulasiddaiah, 1969). The problems of economic, health, social, psychological,
dependence, widowhood among elderly women, restriction in their mobility,
verbal and physical abuse, besides habits such as smoking, consuming alcohol,
chewing tobacco etc. (Nair, 1980; Punia and Sharma, 1987; Himabindu, 1990; Rao,
1995; Vijaya Kumar, 1991; Avatharamu, 2003)
About 64 per thousand elderly persons in
rural areas and 55 per thousand elderly persons in urban areas suffer from one
or more disabilities. Most common disability among the aged persons was loco
motor disability as 3% of them suffer from it, next only to hearing disability
(for about 1.5%) and blindness (1.7% in rural areas, and 1% in urban areas) (Central Statistics Office, 2011). Findings of
a study conducted in Karnataka showed that a major proportion of the elderly
were out of the work force, partially or totally dependent on others, and
suffering from health problems with a sense of neglect by their family members.
There is a growing need for interventions to ensure the health of this
vulnerable group and to create a policy to meet the care and needs of the
disabled elderly (Lena, 2009).
The prevalence of the chronic diseases among
the aged is quiet high. While the elderly poor largely describe their health
problems, on the basis of easily identifiable symptoms, like chest pain,
shortness of breath, prolonged cough, breathlessness/ asthma, eye problems,
difficulty in movements, tiredness and teeth problems, the upper class elderly,
in view of their greater knowledge of illness, mentioned blood pressure, hear
attacks, and diabetes which are largely diagnosed though clinical examination
(Siva Raju, 2002; Mutharayappa and Bhat, 2008).
Elder abuse is another major problem of the
elderly in India and has been reported in many studies. The elderly were more
frequently subjected to verbal abuse (91.5 %), material abuse (78.7 %) and
physical abuse (74.4 %) and women were subjected to abuse more frequently as
compared to men. The elderly of advanced age, less education and poor financial
status were more prone to abuse (Mahajan, 1987; Avatharamu, 2003; Devi, 2006; Rao,
2007; Sebastian and Sekher, 2011).
Conclusions and Suggestions
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 per cent of the general
population below poverty line and has concluded that one – third of the
population in the 60 plus age group is also below that level. Though this figure may be understand from the
older people’s point of view, even at this estimate, the number of poor older
persons comes to about 23 million. As per
the Policy, the coverage under the Old Age Pension Scheme for poor persons is
only 2.76 million. The scope, coverage, eligibility criteria and the quantum of
pension vary from state to state. The combined national budget allocation for
the NOAPS comes to 0.6 per cent only as compared to 6 per cent of Central
Government revenue expended on pension for its employees (Irudaya Rajan, 2001).
Therefore, the Government should increase the monthly pension amount at least a
minimum of Rs. 1000/-per beneficiary and for senior citizens above 80 years of
age, the amount provided should be further enhanced. There is a need to
establish State Resource Training Centres in each state as it can monitor and
strengthen the programmes for the elderly.
In order to meet the health needs of the
rural elderly of BPL category, there is a need to strengthen the existing health care facilities
in primary health centres and district hospitals by setting up more geriatric centres, expansion of
geriatric wards under the NPHCE, etc. Lifestyle habits such as alcohol
consumption, regular smoking and tobacco chewing have adversely affects on
one’s ability to control diseases and increases morbidity among elderly
(NFHS-2). Alzheimer’s disease has now become a major public health and social
problem that is seriously affecting 3.7 million elderly and their families. This
number is expected to double by 2030 (ARDSI, Dementia India Report, 2010).
There is a lack of diagnostic and simple screening techniques to detect early
onset of Dementia due to inadequate knowledge and basic awareness about the
disease. Short-term and long term training programs on dementia management need
to be evolved to benefit various categories of care givers.
The
implementation of MWPSC Act, 2007 has been very poor. Further, the stakeholders
- elderly and their family members, NGOs, government functionaries etc. are not
completely aware of such legislation. Therefore, there is a need to make
special efforts in creating awareness about the provisions of the Act among
public through media campaign, organizing workshop/conferences, etc.
Greater involvement of Panchayats
at the village level, in dealing with the policies, programmes and problems of
the elderly and also to create awareness and sensitization programme regarding the needs for ensuring the well being, safety and
rights of elderly. Helpline services
for elderly should be set up in all districts of the country to provide
services for the elderly in difficulty circumstances. There is a need for setting up Commissions for senior citizens at
the national and state levels to address the various complaints and grievances
in a time bound and effective manner. Also there is a need for establishment of
a National Institute of Ageing which will carry out the task of evaluation of
various programmes for the elderly, human resource development, research
studies and documentation, etc. There
is an urgent need to ensure that professionally trained caregivers to meet the
growing demands of the elderly especially of above 70 years of age to ensure
quality care at home as well as in the institutions. Both print and electronic
media should focus on various issues viz. healthcare, security, need for care
and maintenance, etc. relating to elderly. There should be uniformity defining
the aged person in India as 60 years and above. Provision of free legal services to the elderly of low income groups; Issue
of Special Identity Cards for the elderly, as most of them are illiterate, so
as to enable them to avail various facilities provided by the government as
well as NGOs. Further, special attention to address the needs of the single,
widowed, abused, poor, disabled and elderly of 80 years and above, be given.
Whatever the programmes, concessions, benefits that are being implemented are
mostly concentrated / addressed to the needs of the urban elderly. Therefore, there
is a need to have a comprehensive development policy to address various issues
for rural older people in India.
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