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RSTV: DISCUSSION TODAY- TAKING CARE OF INDIA’S ELDERLY

RSTV


Introduction:

Longitudinal Ageing Study of India is India’s first and the world’s largest survey till date which provides a database on India’s older population and also stands to guide the policymakers to formulate policies and programs for the elderly population on the parameters of social, health and economic well-being. The study will also be used to strengthen and broaden the National Program for Older Persons as it includes a representative sample socio economic landscape of India and its states. India also has the world’s most ambitious Ayushman Bharat scheme which emphasizes the expansion of healthcare facilities.

Key Highlights:

  • LASI is a full–scale national survey of scientific investigation of the health, economic, and social determinants and consequences of population ageing in India.
  • The National Programme for Health Care of Elderly, Ministry of Health & Family Welfare has undertaken the Longitudinal Ageing Study of India, through International Institute for Population Sciences, (IIPS), Mumbai in collaboration with Harvard School of Public Health, University of Southern California,USA, Dte.GHS, United Nations Population Fund (UNFPA) and National Institute on Ageing.
  • The LASI, Wave 1 covered a baseline sample of 72,250 individuals aged 45 and above and their spouses including 31,464 elderly persons aged 60 and above and 6,749 oldest-old persons aged 75 and above from all States and Union Territories (UTs) of India (excluding Sikkim).
  • It is India’s first and the world’s largest ever survey that provides a longitudinal database for designing policies and programmes for the older population in the broad domains of social, health, and economic well-being.
  • The evidence from LASI will be used to further strengthen and broaden the scope of National Programme for Health Care of the Elderly and also help in establishing a range of preventive and health care programmes for older population and most vulnerable among them.
  • In 2011 census, the 60+ population accounted for 8.6% of India’s population, accounting for 103 million elderly people. Growing at around 3% annually, the number of elderly age population will rise to 319 million in 2050.
  • 75% of the elderly people suffer from one or the other chronic disease. 40% of the elderly people have one or the other disability and 20% have issues related to mental health. This report will provide base for national and state level programmes and policies for elderly population.
  • LASI data shall assist in addressing the broad aims of the Decade of Healthy Ageing and will lead to convergence within various national health programs and also promote inter-sectoral coordination with other line Departments/Ministries.
  • The LASI estimates, by 2050, 19% of the population, or 319 million, would be above the age of 60.
  • The proportion of people over 75 years of age is expected to be nearly 3.5 times the 2011 census number.
  • As the country turns older, there will be a concomitant need to provide larger sums for old-age security and post-retirement support.
  • And, LASI shows, along with a demographic transition, the country is also undergoing an epidemiological transition: The burden of morbidity is shifting to the older cohort, in which chronic and degenerative diseases will be more common than infectious diseases.
  • The survey highlights that 28% of the people aged 45 and above suffer from chronic diseases, and a quarter of elderly aged 60 and above have multi-morbidities.
  • Given the poor spend a relatively larger portion of their income as out-of-pocket expenditure on healthcare, the need for old-age security is sharply pronounced.
  • Although health insurance and government health cover schemes were expected to address this, LASI highlights that such schemes cover only a quarter of the households across the country.
  • On the pension cover front, the need is even direr. Although the government is attempting some sort of a start on this with the new social security code, LASI shows, until 2017-18, 78% of the population was neither receiving any pension and nor was expected to receive any.
  • While nearly half of the households were aware of these government schemes, only a quarter amongst the BPL families were availing their benefits. This was even lower for non-BPL households.
  • India has made commendable improvements over the last decade in terms of sanitation, electricity and improved source of drinking water. Now, the government needs to work towards expanding pension/social security coverage apart from health insurance/scheme coverage.
  • Ayushman Bharat needs to expand its reach, but the network of primary healthcare centres also needs to be strengthened.
  • LASI states that a major proportion of older adults from the poorest MPCE quintile utilise out-patient care from private health facilities, making them shell out extra in terms of out-of-pocket expenditure.
  • Before a large proportion of the population becomes elderly, the government needs to roll-out a wide-reach pension programme, which includes the informal sector workers; this can be on the lines of the NPS, though tweaked for government support in terms of pension-fund contribution for the poor.
  • Moving most existing subsidies, including the food subsidy under the National Food Security Act, to direct benefits transfer can unlock the funds for instituting such a scheme while continuing existing support to the vulnerable.
  • Given how the LASI survey shows that people have been denied food benefits, under the Annapurna scheme, owing to awareness, this would obviate the need to popularise government schemes.

Problems of elderly population in India:

  • Isolation and loneliness among the elderly is rising.
    • Nearly half the elderly felt sad and neglected, 36 per cent felt they were a burden to the family.
  • Rise in age-related chronic illness:
    • Heart disease, cancer, diabetes, and other chronic diseases will cause more death and illness worldwide than infectious or parasitic diseases over the next few years.
    • In developed nations, this shift has already happened. Dementia and Alzheimer’s disease are expected to almost double every 20 years, as life expectancy increases.
  • Special challenges for less developed nations:
    • Poorer countries will carry the double burden of caring for older people with chronic diseases, as well as dealing with continued high rates of infectious diseases.
  • Increasing need for long-term care:
    • The number of sick and frail elderly needing affordable nursing homes or assisted living centers will likely increase.
  • Rise in the Health care costs:
    • As older people stop working and their health care needs increase, governments could be overwhelmed by unprecedented costs.
    • While there may be cause for optimism about population aging in some countries, the Pew survey reveals that residents of countries such as Japan, Italy, and Russia are the least confident about achieving an adequate standard of living in old age.
  • Elderly women issues:
    • They face life time of gender-based discrimination. The gendered nature of ageing is such that universally, women tend to live longer than men.
    • In the advanced age of 80 years and above, widowhood dominates the status of women with 71 per cent of women and only 29 per cent of men having lost their spouse.
    • Social mores inhibit women from re-marrying, resulting in an increased likelihood of women ending up alone.
    • The life of a widow is riddled with stringent moral codes, with integral rights relinquished and liberties circumvented.
    • Social bias often results in unjust allocation of resources, neglect, abuse, exploitation, gender-based violence, lack of access to basic services and prevention of ownership of assets.
    • Ageing women are more likely to get excluded from social security schemes due to lower literacy and awareness levels.
    • Ageing individual is expected to need health care for a longer period of time than previous generations but elderly care for a shorter period of time

Conclusion:

  • The elderly are the fastest growing, underutilized resource that humanity has to address many other problems.
  • Re-integration of the elderly into communities may save humanity from mindlessly changing into a technology driven ‘Industry 4.0’ which futurists are projecting: an economy of robots producing things for each other.
  • Healthy elderly citizens can share their wealth of knowledge with younger generations, help with child care, and volunteer or hold jobs in their communities.
  • The elderly should be seen as a blessing, not a burden.
  • Rather than putting them aside, physically (and mentally), to be cared for separately, they should be integrated into the lives of communities where they can make a substantial contribution to improving social conditions.
  • The benefits of turning the ‘problem’ of the elderly into a ‘solution’ for other social problems is being demonstrated in several countries.