Care of The Elderly In India (Changing Configurarions)

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Ageing is a universal experience for everyone with diversity in meaning and interpretation. The global phenomenon of population ageing also afflicts India. Though the process of ageing of India’s population is still in its early phase, it is expected to gain momentum in the 21st century and pose a major problem to the country.

Care for the elderly is fast emerging as a critical element of public and private concern. The interface between the State and social institutions in the care of the elderly forms an important area of inquiry the book seeks to examine how India has been coping with the problems of the elderly. Issues such as the dynamics of care giving processes as also the family’s coping capability are also explored. It also seeks to understand the social aspects concerning aged women in the country as they go through the process of ageing. It focuses attention on the position of ageing women and their well-being. Another concern is to examine the modes of state intervention over time in the care of the elderly, and its impact on social institutions. This leads s to examine whether state intervention results in either diminishing or in reducing these institutions to the status of being a ‘residue’. This study also seeks to inquire into the patterns of social support, both formal and informal. It does not observe that provision of care is not a zero-sum activity and that is there a fixed quantum of care to be given nor is it divisible between public and private spheres. It argues that there is complementarily rather than competition between formal and informal care. It advocates that attempts be made to interweave formal care with informal care.

The book will be highly useful to social gerontologists, geriatricians, policy makers, planners, social scientists and all those interested in issues related to the elderly.

Dr. Arun P Bali is a sociologist and holds a MA., M. Litt. And Ph.D. degree in Sociology from the Centre for Advanced Study in Sodo1og Delhi School of Economics, University of Delhi. He was Fellow, Indian Institute of Advanced Smdic Shirnia from 1996 to 1998 where he worked on the monograph Care of the Elderly in India. Changing Configuration. He was JDPAD fellow affiliated to the International Institute of Asian Studies, Leiden and stationed at the has Branch Office at Amsterdam, Netherlands. His other puhlicanons include College Teachers: challenges and Responses; Bio-Social Dimensions of Ageing (ed); and The Prime Movers of Indian Society: Focus on Sociology of Professions (conjoint). He has also contributed papers in professional journals and books. His research interests are in the field of social gerontology sociology of social movements, sociology of professions and higher education. He is Managing Editor of the journal Indian Social Science Review.

Dr. Bali works as Director, Indian Council of Social Science Research, New Delhi.

Care of the elderly has emerged as a great complex problem all over the World in recent years. It has become a more complicated socio-economic and cultural problem in India due to a variety of historical factors such As changes in the traditional value system, rise of new economic pattern of life disintegration of joint family system, poverty, technological transformations, urbanization, etc. The present monograph on the Care of the Elderly in India situates the problem of ageing in India and tries to understand this problem in its various dimensions. It highlights the demographic profile of ageing and consequent emergent issues in the country. The next three chapters deal with the notion of care under various perspectives, seeks to understand the social aspects regarding aged women in the country and focuses on the role of the State in this task of caring. Lastly, it discusses the policies and programmers of the of elderly by the State and society in the context of changing demographic, economic and social issues.

I congratulate Dr. Arun P. Bali for producing a first rate monograph burning issue—the care of the elderly in India, on the basis of primary and secondary sources, along with facts and figures through its and tables. I am sure, the scholarly world as well as the Government welcome this highly interesting and valuable research in this I branch of sociological study.

The study was carried out by me during my tenure as Fellow at the Indian Institute of Advanced Study, Shimla.

Ageing is a universal human experience. It is multi-faceted and incredibly diverse. In the process of studying the “aged” one never realizes when the obliteration of the “subject-object” dichotomy takes pace. Herein lays the chakravyuha-like predicament where one knows flow to enter but the clues to exit do not lie in the hands of the “subject” but rather in the immutable processes of time. However, the predicament also brings out a certain amount of dynamic tension in a study She as this where all the time the “subject” feels the “object” within. E this self-conscious exploration of the elderly, I am deeply indebted to Anjali, who initiated me into the highly complex world of social gerontology.

I wish to express heartfelt thanks to the Indian Institute of Advanced study for offering me a fellowship to work on this subject, and also for providing an extraordinarily wonderful ambience to work in. My study (room) in Princess Corridor in the main building, in Bilaspur House later in Delvilla where I spent endless hours at my desk provided the stimulating, reflective and quiet environment for work.

Gratitude is expressed to Professor Mrinal Miri, the then Director, IIAS, for his constant encouragement to pursue this study, and for his counsel and help during my work.

I also acknowledge with thanks Professor Sujata Miri for her constant encouragement and words of advice on several aspects of the subject. I was very fortunate to have been in the company of scholars like Drs. O. C. Handa, Ramashray Roy, Shekhar Pathak, Krishna Sobti, and Chetan Singh,, all Fellows at the Institute during my stay at IIAS. They all Show tremendous interest in the study and engaged me in long discourses on various aspects of the subject. I benefited from the interactions with them.

I sincerely thank each one of them. My special thanks to S .A. Jabbar for help rendered at various stages of my work.

For keeping a constant tab on my health situation and keeping me going and for the keen interest evinced in my study, Dr. Meenu, Resident Medical Officer at the Institute deserves a word of thanks.

The ever smiling and cheerful staff in the library was very helpful whenever I needed a book, article, journal or sitting space. Whenever a new addition came to their notice they would place it on my desk or send a message to my Study. Mr. D.K.Mukherjee, Librarian, Ms. Alekha, Mr. Naukh Ram, and Ms. Sharda deserve my thanks for their help and co-operation.

I wish to express my thanks to the ICSSR, and in particular, its former Chairman, Professor D. M. Nanjundappa, for granting me leave to avail the fellowship offered by the Indian Institute of Advanced Study, and also for the tremendous support and encouragement given to me by him for pursuing this study. To all the respondents who willingly gave their time and shared their experiences, I am very grateful. Their co-operation made this study possible. A number of people helped me in various ways. I appreciate the help given by Dr. Kalyan Bagchi, President, and Society for Gerontological Research, New Delhi; Maj. Gen. S. S. Sandhu, Director General, Help Age India, New Delhi; Group Capt. A.W. Limaye, Deputy Director General, Help Age India, New Delhi; Professor Indira Jai Prakash, Department of Psychology, Bangalore University, Bangalore; Professor K.G Gurumurthy, Department of Anthropology, Karnatak University, Dharwar; Professor Partha N. Mukher;i, former Director, Tata Institute of Social Sciences, Mumbai; Professor P.K.B. Nayar, Chairman, Centre for Gerontological Studies, Tiruvananthapuram, and Dr. S. Vijaya Kumar, Council for Social Development, Hyderabad, during my fieldwork.

I am indebted to Anjali, Abhishek, and Prerana for their love, sacrifice, support and encouragement in enabling me to be at the HAS in Shimla to pursue my academic interests. They spent endless hours in discussing, planning and clearing several doubts. Without them it would simply not have been possible to complete this work. As a token of my love and affection, I have great pleasure in dedicating this book to them.

I appreciate the help and cooperation rendered by Mr. N. K. Malini, at the has, for seeing this work through the press.

The ageing of human populations of the world's regions is universal. Universal does not mean uniformity. The proportion of elderly persons is not the same in every population, nor is the rate at which populations are ageing. Throughout the twentieth century countries all over the world are experiencing a gradual growth in the proportion of the population aged 60 and over because of the demographic transition in terms of the sustained reduction in the fertility rate and the increase in the survival of the population. The major factors contributing to the changing demography are increased life expectancy due to control of neonatal and post-partum death rates, and the reduction in the birth rate. The developed countries have come to be characterised as 'grey' nations, while developing nations are also on their way to achieve this status. A general concern with the worldwide phenomenon of increasingly aged populations has existed for many years now. On the global level, the phenomenon of ageing was first highlighted in 1982 when the United Nations organised the World Assembly on Ageing in Vienna.

The process of ageing of populations has set in all developing countries. In 1990 the population aged 60 and above accounted for slightly more than nine per cent of the world's population. In absolute terms, it was nearly half a billion. This is likely to register a three-fold increase by the year 2030 AD when it would be approximately 1.4 billion (World Bank, 1994). A vast majority of this estimated elderly population would be living in the Third World countries. Demographic trends indicate that developing countries are ageing faster than did the developed countries. The increase will be most marked in Asia, particularly in countries like China and India. Major improvements in health' and medical services and control over infectious diseases have brought about substantial decreases in mortality rate while simultaneously resulting in rising life expectancies. As a result, most countries are experiencing substantial increases in their population, as well as in their older population. As a result, developing countries will have "old" demographic profiles at comparatively lower levels of per capita income as compared to the developed countries.

This global phenomenon of population ageing has its reverberations also in India. The process of ageing of India's population is still in its early phase. Whilst the elderly population in the country is generally still relatively small compared with those in the developing countries of the West, it is steadily increasing. Its elderly population, which was 55 million in 1991, is expected to reach 76 million by the year 2001 and 124 million by the year 2020. It is likely to touch 177.4 million by the year 2025 (Sharma and Xenos, 1992:95-96). Between 1991 and 2001 it is expected that while the general population would increase by 16.79 percent, the elderly population is likely to increase by 37 per cent. This is likely to further accelerate during the next 25 years. Between 2001 and 2025 the general population is likely to increase by 46.25 per cent whereas the elderly population is projected to be of the order of 133.6 per cent (Sharma and Xenos 1992:28). Such numbers in themselves constitute a compelling reason for treating population ageing as an issue of immediate concern. The phenomenon of population ageing and the issues related to it, which for long was considered to be typical of developed countries is also an emerging problem in developing countries.

The elderly population of India constitutes one of the smallest and least understood segments of the Indian population. Ignored and virtually invisible, the elderly have barely captured the attention of researchers in India. Their numbers have been growing steadily over the last few decades and this is likely to continue in the years to come. Developing nations like India have the additional burden of accommodating these demographic changes while simultaneously experiencing the strains of social change which modernisation entails. India also suffers from the problem of over-population, meager resources and sluggish or arrested development. The most critical features of her economy are its pervasive poverty and acute inequalities in income distribution, which indicate that an overwhelming majority of the elderly is either destitute or marginalised.

The main problem with the elderly in India is poverty. Majority of the older people still live in or on the margins of poverty. For those who work in the subsistence economy, their livelihood depends on the vagaries of the monsoon. Here, the elderly continue to work as long as physical abilities and health permit. They do not receive any pension nor have any income security when they can no longer work. On the other hand, the few who are employed in the formal or organised sector generally receive some pension when they retire. This pension is often very measly. On retirement, they seem to lose a major source of their livelihood as well as their identity. Because the elderly have little or insufficient money, they suffer from malnutrition, leading to depression and mental morbidity. Not only does poverty affect a substantial proportion of older people, but also it is likely to be an enduring experience. The high incidence of poverty and low incomes among older people is reflected in other measures of deprivation. This has significance for their quality of life in that the elderly have difficulties in meeting their basic needs. In later-life, the question of dependency looms large among them. Key resources for preventing dependency among these people are financial and material resources, health resources and domestic/caring resources.

Structural changes may well condition much behaviour but cultural factors are equally important. In India, the presence of the caste system largely determines the course of life and social status. In Indian society, respect for the elderly has since long been a part of its tradition and culture.

A growing ageing population has important implications both at the micro-and macro-levels. At the micro-level, it implies being concerned with the ways in which persons adapt their lives to the important transitions that occur across the life-course. It also implies coping with new issues arising from the adjustment on the part of individuals; young and old, to adjust to the new rhythms of life that stem from increased longevity. It involves attention being paid to problems and needs of the elderly such as health, emotional, psychological, and economic.

At the macro-level, challenges of a growing ageing population have increasingly drawn attention to the economic, education, health, familial, and social welfare concerns. Its impact on family structures and individual lifestyles which, in turn, influence the conditions of life of the elderly. It raises questions about society's ability to meet the various needs of the elderly _and the economic and social costs involved in supporting them. This has serious consequences on the nature and extent of health needs, the county's health care system as well as on employment opportunities. For the society at large, innumerable policy questions arise as the whole social fabric accommodates itself to the changing age . distribution. Thus, at the macro-level, it means, amongst others, different types of social demands on the state. The rise in the so-called burden of older persons on society and the family in the next century will be associated with numerous policy issues.

Two concerns of rapid population ageing have received much attention in gerontological research. First, concern has been expressed on whether ageing population will increase dependency on the state for welfare and financial assistance. Second, as more people live to older ages-a trend which will be increasingly upswing in the future-the concern is whether increase in such populations will put severe strains on: (i) the family as an institution and on its coping capability and, (ii)on the country's health care system. Concerns about issues relating to the growing proportions of the elderly has become even more intense due to socio-economic and demographic changes that are occurring in urban and rural segments.

In developing countries, problems of the elderly are often indistinguishable from problems of the population at large-poverty, malnutrition, unemployment, lack of shelter and inadequate health care. In these countries where resources are scarce, elderly persons are often denied the basics of life.

Viewed against the tremendous competing pressures on existing scarce resources in developing countries, the ageing of populations can be expected to have profound effects on most of the world's societies. It has already led to governments becoming increasingly concerned about the health and welfare of their aged population. It is important to bear in mind that rapid social and economic changes could well signify that no longer societies could rely on traditional support mechanisms but explore alternatives. Individuals will experience newer and newer problems as they deal with their own ageing, and of their families, and also by countries as they deal with rapidly increasing ageing of their population. Families and governments will face a great challenge in the years to come, in ensuring that the elderly persons of the future receive a humane and loving care in later life.

Far from being a separate issue, ageing is linked to other phenomena; researchers should study it in ways that permit its integration into a broad policy context. It is an appropriate starting point for examining economic, social and cultural aspects of provision of care for the elderly.

Throughout the world, the lives of the elderly and their families are influenced by dramatic economic and structural changes taking place in society. Rapid industrialisation and urbanisation have led to the emergence of massive and multifaceted problems for all sections of the population, more so for the elderly. These societal processes involve changes such as a shift from a subsistence to a monetary economy, migration from rural to urban areas. Modernisation has brought about changes in traditional values, attitudes, and expectations. It has also brought about changes in the power structure of the family, that is, has given rise to power sharing between the elderly and the younger generation. Increasing education, urbanization and industrialization have resulted in more and more women entering the employment market outside the home. As a result, changes in the family structure are being witnessed, and elderly individuals are experiencing diminishing economic and social status in the family and society.

ves of the elderly and their families are influenced by dramatic economic and structural changes taking place in society. Rapid industrialisation and urbanisation have led to the emergence of massive and multifaceted problems for all sections of the population, more so for the elderly. These societal processes involve changes such as a shift from a subsistence to a monetary economy, migration from rural to urban areas. Modernisation has brought about changes in traditional values, attitudes, and expectations. It has also brought about changes in the power structure of the family, that is, has given rise to power sharing between the elderly and the younger generation. Increasing education, urbanization and industrialization have resulted in more and more women entering the employment market outside the home. As a result, changes in the family structure are being witnessed, and elderly individuals are experiencing diminishing economic and social status in the family and society.