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Reproductive Health Package CSR PFI Section IV Ageing

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Reproductive Health Package CSR PFI Section IV Ageing

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Section IV

Ageing

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Section IV

AGEING

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chapter 14

AGEING

Unprecedented socio-economic growth and advances in the technological and medical field have

increased the human life span. The combination of high fertility and falling mortality has led to a

rise in the number of older people.

Getting old is a result of an interplay of biological, social, psychological and ecological factors. An

age whereby a person is considered old varies from society to society and within cultures but in most

societies those above 60 years are termed old. In India too the 60th year is considered as the beginning

of old age. Completion of the 60th year is called ‘shastipurti’.

Ageing is defined as the progressive and generalized impairment of functions resulting in the loss of

adaptive response to stress and in increasing the risk of aggregated diseases. Though the elderly are

plagued with several ailments and need greater healthcare, for every 3000 older people there is just

1 primary healthcare centre.

As one grows older there is greater loss in terms of loved ones or opportunities. These losses are very

difficult to cope with. It is therefore important to make the elderly feel wanted and loved and their

experience valued.

The population of the elderly in India was 12 million in the 1901 census. In the 1961 census it had

increased to 24 million, i.e. 5.63 per cent of the population. The growth in the older population has

been more rapid thereafter, being 43 million in 1981, 57 million (6.58 per cent of the population)

in 1991, and 77 million (7.5 per cent of the population) in 2001. The older population is projected

to increase to 177 million in 2025 and to 350 million in 2050. The growth rate among the different

cohorts of the elderly during the decade 1991–2001 was much higher than the general population

growth rate of 2 per cent per annum. Currently, 33 per cent of the elderly live below the poverty line,

90 per cent worked in their earlier years in the unorganized sector with no social security, 73 per cent

are illiterate and dependent on physical labour, 68 per cent have to work for their daily meals, and

70 per cent do not know about their rights nor about the social benefits given by the government.

At the global level, three-fourths of the elderly in the present century will be in the developing world.

In 1950 there were 200 million aged persons. The numbers increased to 5.7 billion (9.5 per cent of

the population) in 1995. The projected population growth in the category of the elderly is 10.8 billion

(20.7 per cent of the population) in 2050. In 2150 it is projected to constitute 30.5 per cent of the

population. Half of this increase will be in Asia, especially India and China.

The life expectancy for males in India has shown a rise from 42 years in 1951–60 to 58 years in 1986–

90 and is likely to increase to 67 years during 2011–16. For females the projected life expectancy is

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- - - - - - - - -C-O-R-P-O- R- -A-T-E-S-O-C-I-A-L-R-E-S-P-O- -N-S-IB-I-L-IT-Y- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

from 58 years in 1986–90 to 69 years in 2011–16. Men outnumber women in India even after age

60. In 1991 there were 29 million males as against 27 million females. This situation is likely to

continue even in 2016, but the number of widows of 60+ years (14.8 million) is almost four times

that of widowers (4.5 million) in 1991. Table 14.1 presents details.

Table 14.1. Number, Proportion and Sex Ratio of the Elderly, 2001–51

60 and above

70 and above

80 and above

Numbers

Percentage

Sex Ratio

Numbers

Percentage

Sex Ratio

Numbers

Percentage

Sex Ratio

2001

7.5

1028

2.9

991

0.5

1051

2011

8.2

1034

3.1

966

0.7

884

2021

133

9.9

1004

3.8

970

0.8

866

2031

179

11.9

964

4.8

930

843

2041

236

14.5

1008

891

1.4

774

2051

301

17.3

1007

132

7.6

954

1.8

732

Note: Numbers in millions; percentage is of the total population; sex ratio is number of males per 1000 females.

Source: Rajan, S.I., Population Ageing and Health in India, July 2006, CEHAT.

From the morbidity point of view, almost 50 per cent of the Indian elderly have chronic diseases and

5 per cent suffer from immobility. There are several vulnerable groups and a big disadvantaged lot are

elderly females who are one of the fastest growing segments, which will increase to become four times

the current figure by 2025 (V. Kumar 1997).

Women in the lower income groups age faster due to the triple burden of early marriage (while her

body is yet not fully developed), repeated childbirths, and domestic work many times coupled with

agricultural work for a major percentage of women, combined with low nutrition. An added psychological

problem is abandonment by their husbands for younger women (more common in tribal and hilly

regions).

The United Nations projects that by 2025 there will be 604 million women over the age of 60 in

the world population and 70 per cent will be living in rural poverty. Though women do not outlive

men in India they are more commonly widowed than men sine they are married to much older men

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and do not remarry. Men not only remarry but generally to a younger woman so they always have

someone to care for them in their old age. Women face greater marginalization on account of lesser

literacy, limited property or land rights, lesser access to and even less awareness about facilities and

opportunities.

The National Policy has made provisions for the elderly population, but it does not deal with specific

needs and programmes for older women, including issues related to reproductive health.

Implications of an Ageing Population

Pressures and fissures in the family are increasing, due to rising costs in bringing up children and

educating them and the costs involved in taking care of the elderly.

1. Constraints of space in urban areas and high rents compel migrants to leave the elderly behind

in the native places with no care-givers.

2. Changing Roles: In the traditional Indian society the elderly were respected and endowed with

special privileges and their wisdom and experience in life looked up to but urbanization,

modernization and nuclear families have affected these values. In joint families also, with

daughters and daughters-in-law working outside the home they cannot be care-givers anymore.

3. Women’s expectations have also changed, with greater desire for privacy and space and no

interest in taking the responsibility of care-giving.

Infections still take a heavy toll of the elderly population apart from well-known degenerative disorders.

Nutritional deficiencies are common and often sub-clinical, thus escaping the desired interventions.

Coronary heart disease, hypertension, mental and many other disorders in the elderly have been

reported as isolated observations, highlighting differences from those made in the Western countries.

The limitations of a developing country further influence the morbidity pattern in various ways. Socio-

economically, the traditional support of extended families is rapidly eroding, making the elderly

further vulnerable. This causes more emotional and psychological problems while the State finds itself

helpless in providing comprehensive care to its large chunk of elderly population.

Ninety per cent of the elderly are from the unorganized sector, without any pension, gratuity or

medical insurance. The capability of the elderly to do work affects their status in the family. Decline

in productivity and increasing dependence bring about a decline in status, affecting interpersonal

interactions and their becoming vulnerable to neglect.

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Fifty-five per cent of all women above 60 are widows, many without any support.

Health Needs of the Elderly

• Sufficient fluids: The body retains less water as

it ages. Hence it is important to have at least

eight glasses of water and other fluids daily.

• Regular Exercise: Exercise acts as a preventive

against many diseases and keeps the bones and

joints strong, besides producing a hormone called

‘Endorphins’, which make one feel good and

therefore mentally healthy.

• Taking prompt care and treating illness immediately.

• Being sexually active: There is no age limit for sexual pleasure.

• Keeping oneself busy in any activity – social or productive.

• Especially among women, menopause combined with ageing leads to weak bones and joints.

They therefore need a diet rich in calcium, estrogen and other minerals.

Common Health Problems

High blood pressure, a common problem among the elderly, has at first no symptoms until it gets

dangerously high. It can cause heart disease, kidney disease and stroke. Women above 40 years of age,

especially if they are overweight, would do well to get their blood pressure checked regularly.

Symptoms

Treatment

Frequent headaches

Dizziness

Ringing sound in the ears

Exercise regularly.

Avoid foods with too much fat, sugar and salt.

Avoid tobacco.

Take medicine regularly if advised by physician.

Varicose veins: In varicose veins, the veins in the legs get swollen, causing pain. Women who have

had many children are most susceptible. The problem has no medical solution.

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Treatment

Exercise the legs for twenty minutes daily.

Do not stand or sit with legs hanging for too long.

Avoid sitting cross-legged.

Use elastic bandages to hold the veins during the day.

While sleeping raise your feet up with the support of pillows.

Back pain: Among the many other causes, back pain could also result from the load of work that

women perform during their lifetime and aggravated by lack of nutrition (especially deficiency of

calcium).

Treatment

Regular exercise to stretch and strengthen the back muscles.

Massage.

Arthritis: Arthritis is a degenerative disease in which the joints get affected, causing pain and affecting

mobility. There is no cure for it. A diet rich in calcium and specific exercises can help in containing

further degeneration.

Symptoms

Treatment

Stiffness in joints, especially in the mornings Regular exercise (in consultation with

Pain and swelling in the knees

the physiotherapist) strengthens muscles

Difficulty in walking and other joint

and joints. Heat treatment relieves pain and

movements

stiffness. Medicines under supervision.

Problems with seeing and hearing: This disability, an inevitable outcome of old age, restricts mobility.

Symptoms

Treatment

Difficulty in reading and hearing

Headache (severe if glaucoma is present)

Blurred vision (cataract)

Spectacles and hearing aids.

Surgery for cataract.

Medicine or surgery for glaucoma.

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Anxiety and depression: Old age brings changes in the roles and status that the elderly enjoyed earlier

in the family and society. The problem is compounded by physical ailments, worry of the future and

also feelings of loneliness and neglect. This causes problems of adjustment and often causes anxiety

and depression.

Symptoms

Changes in eating and sleep patterns

Feeling sad and worthless

Losing interest in people and routine

activities

Feeling restless and fatigued

Treatment

Good nutrition.

Psychotherapy.

Alternative medicines and healing. Techniques

such as Yoga.

Having a good social network.

Dementia: Old people have difficulty in remembering things and thinking clearly. Dementia is the

loss of mental functions – such as thinking, memory, and reasoning – that is severe enough to interfere

with a person’s daily functioning. Severe dementia affects daily life considerably, making the elderly

dependent on others, and also causes problems in interpersonal relationships.

Symptoms

Treatment

Impairment of memory, attention or

orientation

Nutritional supplements like vitamin B12 and

folate help if it is due to deficiency.

Changes in mood, personality and behaviour Avoid drugs and alcohol.

Care of person is required within and outside

the home.

Diabetes: In diabetes, there is an increase in the blood sugar levels in the body due to insufficient

production of insulin. It is a silent killer. If the blood sugar level is not controlled by proper diet,

exercise and medication, it can cause other severe problems such as retinopathy, neuropathy, kidney

disease, heart disease, gangrene and even stroke.

Symptoms

Fatigue

Weight loss

Poor wound healing

Irritability

Frequent thirst

Frequent urination

Treatment

Regular exercise.

Controlled diet.

Medication under medical supervision.

A disciplined life.

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Chronic cough: This common problem among the elderly,

though not life-threatening, is a constant irritant requiring

changes in diet and lifestyle.

Common Health Problems of Ageing Women

Menopause: For women menopause (the end of monthly

bleeding) is an indication of approaching old age. Menopause

generally happens between the age of 45 and 55 years.

Symptoms

Change in monthly periods or sudden

stoppage

Hot flashes where one feels hot and

sweaty suddenly

The vagina becomes dry

Mood fluctuations

Treatment

Avoid spicy foods.

Minimize intake of tea and coffee.

Exercise regularly.

If symptoms are severe take HRT under medical

supervision.

Anaemia: Heavy bleeding may occur during the menopausal period due to hormonal changes and

possibly also due to the presence of fibroids in the uterus. Anaemia causes low haemoglobin and folic

acid levels. Anaemia causes not only physical problems but also affects mental health.

Symptoms

Constant fatigue

Pale look

Treatment

Eat foods rich in iron and also take supplements.

If heavy bleeding persists for more than three months consult doctor.

Breast Lumps: Women should regularly do self-examination of breasts. Older women may find lumps

in their breasts or armpits. Even if they are not painful it is absolutely important not to neglect them

because they can be cancerous.

Symptoms

Treatment

Lumps in breasts which may be painless or painful

Change in shape and size of the breast

Abnormal nipple discharge

Lump or mass present in the armpit

Check with doctor.

Surgery to remove lump, if malignant.

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Prolapsed Uterus: With age, the muscles that support the womb weaken. If the affected woman lifts

something heavy or even if she coughs or sneezes the uterus may fall out of the vagina. The risk is

higher in women whose uterus is damaged during childbirth or among those who have had multiple

children with little spacing.

Symptoms

Treatment

The uterus falls into the vagina or further Exercising muscles (squeezing exercise)

outside the vulva (due to weakened muscles) around the vagina and womb helps.

Pain in the lower back

Vaginal pessaries to hold the uterus in place.

Frequent urination or leakage

Surgery in acute cases.

Osteoporosis: After menopause a woman’s body produces less estrogen. One result is that the bones

become brittle, causing them to break easily. Once broken, the bones do not heal easily.

Symptoms

Treatment

The symptoms that generally emerge only in Eat foods rich in calcium and minerals.

the advanced stages

Even a light bump or a fall leads to a

fracture or collapse of a vertebra

Exercise regularly.

Some may also develop stooped posture and HRT if advised by physician.

loss of height

Severe back pain (in advanced stage)

National Policy on the Elderly

The United Nations Principles for Older Persons, adopted by the UN General Assembly in 1991, and

the Proclamation on Ageing and the Global Targets on Ageing for the year 2001, adopted by the

General Assembly, are intended to encourage governments to design policies and programmes for the

care of the ageing population.

India’s National Policy on the Elderly seeks to assure older persons that their concerns are national

concerns and they will not live unprotected, ignored or marginalized. It is aimed at ensuring that the

elderly can live the last phase of their life with dignity and not be treated as liabilities. The policy

• advocates an age-integrated society with strong bonds between generations;

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• advocates that 60 is not the cutoff date for dependency and that older persons can also be active

and productive;

• expects that the State will extend financial security, healthcare, shelter and other welfare needs

of the elderly;

• seeks to ensure that the elderly get an equal share in development benefits;

• recognizes that the State will allocate greater budgets for the rural and urban poor;

• emphasizes the need to expand social and community services for the old, especially women,

to make facilities easily accessible to them and that rural areas are adequately covered.

These aspirations, however, remain far from being realized. Hence individuals and corporate houses

will have to work collectively to achieve these goals.

The recent announcement by the government of the policy of reverse mortgage is an imaginative policy

measure for the elderly people who have a home but no income.

What the Corporate Sector Can Do

Considering the future projections about the growing proportion of the elderly it is time that the

government and organizations concerned with human welfare come together to contribute towards

strengthening social security and extending financial security, healthcare, shelter, welfare and other

needs of older persons, protect them from abuse, neglect and exploitation, provide opportunities for

them and in general improve the quality of their life.

Considering the wide spectrum and diverse segments of the elderly, attention needs to be paid to the

problems of the elderly in both rural and urban settings and also in the unorganized sector.

1. Financial security: Tax benefits for those who have an income; old-age pension for the elderly

below the poverty line; pension schemes especially for widows.

2. Income-generating schemes for the elderly by NGOs; poverty alleviation schemes – loans to

promote sericulture, dairy, poultry and handicrafts, etc.

3. Shelter: In the absence of family support a strong social security system is required. Old Age

homes for those who have no support; housing schemes for different income segments and also

group housing having all services, facilities and security for older people.

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4. Protection of life and property: Older people are often targets of fraud and physical and

emotional abuse. Often family members force them to part with their ownership rights. Widows

are the most vulnerable and their rights of inheritance, occupancy and disposal are at times

violated by their own children and relatives. Hence, the police need to keep a vigil to protect

older persons. There should be helpline services and they should also be provided with free legal

aid. Speedy disposal of complaints of the elderly should be brought into practice.

5. Village committees should be constituted to enforce a code of conduct so that the elderly living

in joint families do not face neglect or are denied their basic rights.

6. Day care centres in the absence of care-givers at home.

7. Associations for senior citizens and retired persons: Women should be encouraged to join and

participate. Funds for these associations and provision of housing space.

8. Free medical services or medical insurance: Besides other diseases diabetes and hypertension,

which have a higher incidence among the aged will pose a burden to the aged themselves and

their families. Economic dependence compels the elderly to ignore their ailments unless they are

acute.

9. Geriatric hospitals or special wards in hospitals: The increasing number of the elderly will have

a direct impact on the demand for health services. Additional resources for geriatric care will

have to be mobilized without affecting the quota for the other segments of the population. Also,

there is a need to ensure that the elderly do not have to wait in long queues.

10. Mobile medicare units which will provide medicare at the doorstep to the needy and

underprivileged elderly. This service has already been sponsored by Helpage India in some cities.

11. Domiciliary health services for the aged in the rural areas. Medical teams should visit these areas

and give services after making prior announcement of their visit.

12. Mental health services to be expanded and strengthened. Old people are considered senile and

mental illness is treated as an inevitable part of old age and largely remains untreated, especially

in women. There is very little awareness about the importance of being mentally healthy.

13. Training of health professionals in care of the old.

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14. Awareness about the nutrition needs of the elderly needs to be spread by distributing leaflets

and through the media.

15. NGOs to be encouraged and assisted with grants.

16. Research funds for gerontological research.

References

http://www.helpageindia.org

Bose, A. and M. Shankardas, 2004. “Growing Old in India: Voices Reveal, Statistics Speak”, Delhi:

B.R.

Chakraborti, R.D., 2004. “The Greying of India: Population Ageing in the Context of Asia”, New

Delhi: Sage.

Dey, A.B. (ed.), 2003. “Health Care of Older People: A Manual for Trainers of Community Health

Workers”, New Delhi: AIIMS.

Jai Prakash, I., 2002. “Ageing: The Diverse Experiences”, Bangalore University.

John, U., 2002. “Aged: Problems and Prospects”. In L.T. Bhai (ed.), Ageing: Indian Perspective, New

Delhi: Decent Books.

Kumar V., 1997. “Ageing in India–an Overview”, Indian J Med Res. 106: 257–64 (October).

Markidas, K.S. (ed.), 1989. “Ageing and Health: Perspectives on Gender, Race, Ethnicity and Class”,

New Delhi: Sage.

Mohanan, P., 2002. “Problems of the Aged: A Sociological Analysis” In L.T. Bhai (ed.), Ageing:

Indian Perspective, New Delhi: Decent Books.

Rajan, S.I., U.S. Mishra, P.S. Sarma, 1999. “Indian Elderly: Burden or Challenge”, New Delhi: Sage.

Raju, S.S., “Networking of Organizations Working for Care of Older Persons in Mumbai: Issues and

Implications”.

Vaidyanathan, K.R., 2002. “Ageing with Dignity”, New Delhi: Reliance.

VHAI, 1994. “Where Women Have No Doctor : A Resource Guide for Women’s Health”. Chapter

8: Growing Older, New Delhi : Voluntary Health Association of India.

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POPULATION FOUNDATION OF INDIA

B-28, Qutab Institutional Area, Tara Crescent, New Delhi 110 016

Tel. No : 42899770, Fax : 42899795

Website : www.popfound.org, E-mail : popfound@sify.com