Population ageing is a global issue, which has been recognized to have implications on the health care and social welfare systems. The process whereby the proportion of children in the population decreases and those of old persons increases is known as the “ageing of population”. The global population of elderly has constantly been increasing during the second half of the last century. This has been possible due to easy availability of life saving drugs, control of famines, and various communicable diseases, better awareness and supply of nutrition and health facilities and comparatively better overall standard of living. These achievements have resulted in drastic reduction in mortality rates and substantial increase in the life expectancy at birth and the overall span of people. This phenomenon has been experienced by developed countries in the mid of 20th century. During the last thirty years, this has been emerging as a significant problem in developing countries also.

The number of people 60 years and over in the globe is 673 million in 2005 and is expected to increase to 2 billion by 2050, almost a triple increase and the first quarter of 21st century is going to be called as ‘The age of ageing’. More developed regions have almost one-fifth of their population over 60 years but 8 per cent in the less developed regions. And the share of older persons living in these countries is expected to rise from 64 per cent to nearly 80 per cent in 2050.

India, like many other developing countries in the world, is presently witnessing rapid ageing of its population. According to World Population Prospects, UN Revision, 2006, the po;ulation of aged in India is currently the second largest in the world. Even though the proportion of India’s elderly is small compared with that of developed countries, the absolute number of elderly population is on the high. There has been tremendous increase in the number of elderly population since independence in India from 20.19 million in 1951 (5.5 per cent of total population) to 43.17 million in 1981 and 55 million in 1991. According to 2001 census around 77 million population is above 60 years which constitutes 7.5 per cent of the total population of the country. This number is expected to increase to 177.4 million in 2025. (The growth rate of the population (1991-2001) of elderly has been higher (2.89) than overall growth rate (2.02) of the total population. According to World Population Data Sheet- 2002, 4 per cent of the Indian population are in the age group of 65+ which accounts for 41.9 million. This phenomenon of growing population of senior citizens has been the result of recent successes in the achievement of better health standards and a longer span of life for our citizens. Due to this dependency ratio for the old had risen from 10.5 per cent in 1961 to 11.8 per cent in 1991; it is projected to be 16.1per cent by 2021.

Defining the Concept

Ageing is a continuous, irreversible, universal process, which starts from conception till the death of an individual. However, the age at which one’s productive contribution declines and one tends to be economically dependent can probably be treated as the onset of the aged stage of life. Old age is the last phase of human life cycle, which is again universally true. The use of the words ‘elderly’, ‘older persons’, and ‘senior citizens’, in both popular and scholarly work gives the impression that they are a homogenous group, but in fact there is considerable variation between and among various categories of older people and also between societies. As such it is difficult to provide a clear definition. Different writers have viewed ageing in different contexts as the outcome of biological, demographic, sociological, psychological or other processes.
The WHO defines those aged 60 -74 years as elderly. In 1980 the UN recommended 60 years as the age of transition for the elderly segment of the population, and has been categorized as follows:

1. Young Old- between the ages of 60-75 years.

2. Old-Old- between the ages of 75-85 years.

3. Very Old- 85 years and above

World Population Data Sheet- 2002 considers aged population as population in the age group of 65+ as old. In the Indian context, the age of 60 years has been adopted by the census of India for the purpose of classifying a person as old, which coincides with the age of retirement in government sector. The terms Young-Old for 60 to 69, Old-Old for 70 to 79 and Oldest Old for 80 to 89 have been used.

Changing Social Structure and Institutions

Indian society is undergoing rapid transformation under the impact of industrialization, urbanization, technical and technological change, education and globalization. Consequently, the traditional values and institutions are in the process of erosion and adaptation, resulting in the weakening of intergenerational ties that were the hallmark of the traditional family. Industrialization has replaced the simple family production units by the mass production and the factory. Economic transactions are now between individuals. Individual jobs and earnings give rise to income differentials within the family. Push factors such as population pressure and pull factors such as wider economic opportunities and modern communication cause young people to migrate especially from rural to urban areas.

With the rapidly increasing number of aged compounded by disintegration of joint families and ever increasing influence of modernization and new life styles, the care of elderly has emerged as an important issue in India. Providing care for the aged has never been a problem in India where a value based joint family system was dominant. However, with a growing trend towards nuclear family set-up, and increasing education, urbanization and industrialization, the vulnerability of elderly is rapidly increasing. The coping capacities of the younger and elder family members are now being challenged under various circumstances resulting in neglect and abuse of elderly in many ways, both within the family and outside.

Sociologically, ageing marks a form of transition from one set of social roles to another, and such roles are difficult. Among all role transformation in the course of ageing, the shift into the new role of the ‘old’ is one of the most complex and complicated. In an agriculture based traditional society, where children followed their parent’s occupation, it was natural that the expertise and knowledge of each generation were passed on to the next, thus affording older persons a useful role in society. However, this is no longer true in modern society, in which improved education, rapid technical change and new forms of organization have often rendered obsolete the knowledge, experience and wisdom of older persons. Once they retire, elderly people find that their children are not seeking advice from them anymore, and society has not much use for them. This realization often results in feeling of loss of status, worthlessness and loneliness. The growth of nuclear families has also meant a need for changes in role relations. Neither having authority in the family, nor being needed, they feel frustrated and depressed. If the older person is economically dependent on the children, the problem is likely to become even worse.

Nuclear households, characterized by individuality, independence, and desire for privacy are gradually replacing the joint family, which emphasizes the family as a unit and demands deference to age and authority. Children who migrate often find it difficult to cope with city life and elect to leave their old parents in the village, causing problems of loneliness and lack of care givers for old parents. Parents in this circumstance cannot always count on financial support from their children and may have to take care of themselves. They continue to work, although at a reduced pace.

Another development impacting negatively on the status of older people is the increasing occurrence of dual career families. Female participation in economic activity either as workers or as entrepreneurs has increased considerably in the recent past in the urban informal sector, and the middle class formal sector, as well as in the rural areas. In the rural informal sectors, increased expenditure on education, health and better food require high incomes. This development has implications for elderly care. On the one hand, working couples find the presence of old parents emotionally bonding and of great help in the caring for their own children. On the other hand, high costs of housing and health care are making it harder for children to have parents live with them. This is true both in rural and urban areas.

Hence the changing factors in the family in its structure and function are undermining the capacity of the family to provide support to elderly and the weakening of the traditional norms underlying such support’ leading to neglect and abuse of older people in family.

Disabilities in old age

The disabilities that a person experiences in the course of ageing are multiple in nature. For some, ageing enhances status and enriches life satisfaction, but for many others, it may be difficult and problematic. On one hand, getting old provides opportunity to relax, enjoy and do things they always wanted to do, but never had the time for when they were young. On the other hand, old age also implies increasing physical, mental and psychological disabilities. Such disabilities are the result of many factors. With the increasing age and decreasing health, the older person begins to depend unknowingly physically and psychologically on either the kinship group or the existing social support network.

Economic Problems

Economic factors definitely play a major role in generating care for elderly people. The economic status, of the family, as well as that of the care-receiver, the functional ability status of the care receiver and care giver is an additional factor that appears to contribute to the burden. Economic dependence is one of the major factors that very often affects the wellbeing of older persons. Economic dependence is manifested in two ways. First, the status of economic dependence may be caused by retirement for a person employed in the formal sector. Secondly, for a person in the rural or urban informal sectors, it may result from their declining ability to work because of decreased physical and mental abilities. Sometimes older persons are also faced with economic dependence when management responsibilities for matters relating to finances, property or business are shifted to children, pushing the older person into a new status of economic dependence.

Psychological Problems

The common psychological problems that most of the older persons experience are : feeling of powerlessness, feeling of inferiority, depression, uselessness, isolation and reduced competence. These problems along with social disabilities like widowhood, societal prejudice and segregation aggravate the frustration of elderly people. Studies report that conditions of poverty, childlessness, disability, in-law conflicts and changing values were some of the major causes for elder abuse.

Health Problems

Health problems are supposed to be the major concern of a society as older people are more prone to suffer from ill health than younger age groups. It is often claimed that ageing is accompanied by multiple illness and physical ailments. Besides physical illness, the aged are more likely to be victims of poor mental health, which arises from senility, neurosis and extent of life satisfaction. Thus, health status of aged should occupy a central place in any study of the elderly population. In most of the primary surveys, the Indian elderly in general and the rural aged in particular are assumed to have some health problems like cough, poor eyesight, anemia and dental problems. The proportion of the sick and bed ridden among the elderly is found to be increasing with advancing age, the major physical disabilities being blindness and deafness. Besides physical ailments, psychiatric morbidity is also prevalent among large proportion of elderly. Given the prevalence of ill health and disability among the elderly, there is also lack of the provision of medical aid, and proper familial care, in addition, while public health services are insufficient to meet the health needs of the elderly.

Since a large majority of older Indians live in rural areas, discussion of ageing in India is essentially a discussion of ageing in rural areas. Almost eight out of ten older people in India live in rural areas. According to 2001 census, 78 per cent of elderly people in India resided in rural areas. Women comprise a slightly higher proportion than men, basically due to higher female expectancy at birth. Pervasive poverty and inequalities of income, coupled with a very inadequate safety net, has meant that majority of older persons become marginalized or even destitute. The poor among elderly people have been losing out even as economic development is taking place in the country as a whole.

Ageing is predominantly a women’s problem. Not only do women live longer but most of them are widows. They face serious discrimination with respect to their rights and are over burdened with familial responsibilities. This adversely affects their health, nutrition and mental well being. Irrespective of economic, marital or educational status, elderly women face an emotional void in their life. A women explanation for distress among elderly female is the ‘empty nest syndrome’. The empty nest’ period may indeed bring in depression in the course of their diminishing role in the family. Extra provisions of care and support are required to redeem them from their miserable plight.

Added to this is the problem of widows in our society today. Approxiamately 99 per cent of India’s elderly population lives below the poverty line and 50 per cent of them are widows. They are especially vulnerable to poverty, inadequate care and neglect in old age. The tradition of women marrying men older than them by several years, the increasing life expectancy of women, social disapproval of widow remarriage, patrilinieal inheritance, and problems of finding employment all render widows more vulnerable than most other groups in society. Their situation become worse when they own very little or no assets of their own and do not have an independent source of income. Single persons, particularly women are more vulnerable in old age as few people are willing to take care of non-lineal relatives.

Government’s Role in the Rehabilitation of Aged

Since independence the Indian government has been committed to supporting the old people in our society with certain interventionist welfare methods. The year 1999 was declared by the UN as the International Year of Older Persons followed on 13th Jan 1999, by the Government of India approving the National Policy for Older Persons for accelerating welfare measures and empowering the elderly in ways beneficial to them. Maintenance and Welfare of Parents and Senior Citizens Act, 2007 provides legal sanctions to the rights of the elderly. In addition constitutional provisions for old age security, old age pension, establishing old age homes, expanding geriatric services, liberalizing housing policy for elders have also been undertaken.

Social security benefits

In the context of changing intergenerational relationships, economic dependence on children is a major factor determining the quality of life of elderly. As such, social security by the state assumes great importance. Unfortunately, at present, there is very little in terms of social security from the state in India. Only those who work in the public sector or for large private companies have benefits such as pensions and provident funds. However, for the most of the 90 per cent of elderly persons who work in the informal sector, there are scarcely any benefits. The only available benefits for the poor are:

1. The National Old age Pension of 75 rupees per month, which is universal but available only to destitute people over the age of 65 years.

2. Various state schemes, with benefits ranging between Rs.60 to Rs. 250 per month, meant generally for people aged 65+ and below the poverty line, and

3. Benefits for widows, with benefits below Rs. 150 per month.

With the constantly increasing cost of health care and housing, these benefits fall far short of supporting even minimal basic needs. The right of parents without any means of their own to be supported by their children has been recognized by section 125(I) (d) of the Code of Criminal Procedure 1973, and section 20 (3) of the Hindu Adaptation and Maintenance Act, 1956. More recently, in 1996, the Government of the state of Himachal Pradesh passed the Parents’ Maintenance Bill requiring children to take care of parents with no means and to provide assistance to those neglected by their children. The Governments of Maharashtra, Goa and others are in the process of passing similar bills.

Role of Old Age Homes as care givers

The concept of the old age home, though not very common in India, is not unknown. The first old age home was established in Bangalore in 1983 by the Bangalore Friends-in Need society and was called the ‘(obb Home)’. According to Help Age India estimates, there are 728 institutions at present, perhaps a majority of them in urban areas. Kerala has the largest number of old age homes. More than 60 per cent of the old age homes in India are of the charitable type, meant for destitute or very poor persons. About 20 per cent of them are of the ‘pay and stay’ type and another 20 per cent are mixed. About 15 per cent of the homes were for women exclusively. In recent years, there has been rapid increase in the number of old age homes and they are gradually gaining acceptance, especially by those who see these institutions as a better alternative than living in a son’s home where you are not wanted. There is a debate going on in India at present among seniors’ organizations, nongovernmental organizations and others about whether this growth should be allowed, supported or curbed. There is a strong feeling that proliferation of old-age homes would make it easier for children to shirk their responsibility for taking care of their aging parents by placing them in institutions. Increasing institutionalization of elderly people would lead to erosion of the desirable traditional family values and may even lead to the breakup of the institution of family itself. While this is the possibility in view of decline in traditional filial obligations among children and lack of an adequate social security safety net, there is also need for various types of institutions to accommodate the increasing number of elderly parents whose children are unable or unwilling to care for their parents.

In spite of the government’s and NGO’s efforts in rehabilitating the aged in India they are still the most vulnerable group facing multiple problems and hence require proper care and attention. Ageing is a natural process. ‘Old age is an incurable disease’. But more recently J.S. Ross commented, “You do need old age, you protect it, you promote it, and you extend it”. A man is as old as he feels and woman as old as she looks. Hence there is need for proper care and protection for the elderly in the changing scenario. Following suggestions may go a long way in changing the life of elderly in India:

1. Efforts should be made to strengthen the family care, because the preferred source of support for the aged is still the family - informal system where the notion of care is embedded within a tradition of social obligations that are understood and reciprocated. The reciprocal care and support within multi-generational families of parents, grandparents and children should be encouraged. Traditional values of filial obligations can also be reinforced in school curricula and through the media.

2. The Institutional care must be able to enhance relationships within families that incorporate both young and old persons. There is a need for effective legislation for parents’ right to be cared for by the children.

3. The existing health care systems are not sufficient to meet the physical and health needs of the ageing population such as old age security, establishing old age homes, expanding geriatric services and liberalizing the welfare policy for older persons. It is necessary to increase public awareness of the need for protection of this sub group. There is a great need to protect the target group i.e. rural old, and old women, and widows.

4. There is also need for the elderly to remain active, to know that they still have a part to play in the family or community to which they belong and can make a useful co contribution to nation and society as a whole.