problems of elderly - issues & implications

7/30/2019 Problems of Elderly - Issues & Implications

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Health of the Elderly in India: Issues and ImplicationsS. Siva Raju

IntroductionGiven the trend of population ageing in India, the elderly face a number of problems andadjust to them in varying degrees. These problems range from absence of ensured andsufficient income to support themselves and their dependents, to ill-health, absence ofsocial security, loss of social role and recognition, and the non-availability ofopportunities for creative use of free time. For a developing country like India, the rapidgrowth in the number of older population present issues, barely perceived as yet, thatmust be addressed if social and economic development is to proceed effectively. Gore(1993) opined that in developed countries population ageing has resulted in asubstantial shift in emphasis between social programmes causing a significant changein the share of social programmes going to older age groups. But in developing societythese transfers will take place informally and will be accompanied by high social and

psychological costs by way of intra-familial misunderstanding and strife. Among theproblems of elderly, health problems and medical care are the major concern among alarge majority of the elderly. The present paper focuses on the health of the elderly inIndia. This is based on a comprehensive review of the studies conducted on the elderlyin India and also suggests measures to improve their health status.

Health Conditions of the ElderlyIt is obvious that people become more and more susceptible to chronic diseases,physical disabilities and mental incapacities in their old age. As age advances, due todeteriorating physiological conditions, the body becomes more prone to illness. The

illness of the elderly are multiple and chronic in nature. In the later years of life, arthritis,rheumatism, heart problems and high blood pressure are the most prevalent chronicdiseases affecting the people. Some of the health problems of the elderly can beattributed to social values also. The idea that old age is an age of ailments and physicalinfirmities is deeply rooted in the Indian mind, and many of the sufferings and physicaltroubles within curable limitations are accepted as natural and inevitable by the elderly.Regarding the health problems of the elderly, having different socio-economic status, itwas found (Siva Raju, 2002) that while the poor elderly largely attribute their healthproblems, on the basis of easily identifiable symptoms, like chest pain, shortness ofbreath, prolonged cough, breathlessness / asthma, eye problems, difficulty inmovements, tiredness and teeth problems; the upper class elderly, in view of their

greater knowledge of illnesses, mentioned blood pressure, heart attacks, and diabeteswhich are largely diagnosed through clinical examination. Gore (1990), by analyzingthe social factors affecting the health of the elderly, concluded that, while there were nodata showing direct relationship between income level and health of elderly individuals,it could be assumed that the nutritional and clinical care needs of the elderly were bettermet with adequate income than without it. If so, the poor countries and the poorer

Professor, Unit for Urban Studies, Tata institute of Social Sciences, Deonar, Mumbai-400088, India


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segments of the elderly population within each country would experience problems ofhealth and well being.

The idea that old age is an age of ailments and physical infirmities is deeply rooted inthe Indian mind, and many of the sufferings and physical troubles within curable

limitations are accepted as natural and inevitable by the elderly

Some clinical studies have found that multiplicity of diseases was normal among theelderly and that a majority of the old were often ill with chronic bronchitis, anemia,hypertension, digestive troubles, rheumatism, scabies and fever. Some of the cases ofdisability among the elderly, as reported by a few medical studies, were difficulty inwalking and standing, partial or complete blindness, partial deafness and difficulty inmoving some joints, indigestion and mild breathlessness. Joshi (1971), through hisclinical study of the elderly, opined that the differential ageing phenomena, both physicaland mental, appear to depend on environmental and social factors such as diet, type ofeducation, adjustment to family and professional life, and consumption of tobacco and

alcohol. Purohit and Sharma (1972), in their clinical study, observed that males werereported to have more ailments (average: 4.07) than females (average: 3.85). Further,they also found that the older patients had under-reported the incidents of diseasesduring the survey and that some of the serious and significant ailments were revealedonly on closer examination. Desai and Naik (1972) by comparing the pre-andpostretirement situation of health of the retired persons in Greater Bombay, inferred thatif a retired person keeps himself/herself fit before and immediately after his/ herretirement, he/she continues to be free from illness during the post-retirement period;but once an illness starts, before or just after the retirement period, he / she continues toface it during the post-retirement period too. The study of the Medical Research Centreof the Bombay Hospital Trust (Pathak, 1975), based on the post-treatment analysis ofthe records of 1,678 patients admitted in the Bombay Trust Hospital during the years of1970 and 1971, revealed that a good number of patients had gone through more thanone major illness in the past. The author expected that there was a higher incidence ofdisease in the subjects than mentioned in the records since the patients mentioned onlysuch symptoms that they considered serious. In another study of the hospital data,Pathak (1982) found that 62.6 per cent of the elderly patients had cardiovascularailments, 42.4 per cent had gastrointestinal problems, 32.5 per cent had urogenitalproblems, 19.8 per cent had nervous breakdowns, 19.2 per cent had respiratoryproblems, 11.6 per cent had lymphatic problems, 7 per cent had high or low bloodpressure, 11.2 per cent had ear and eye problems. 4.8 per cent had orthopedic, 5.7 percent had surgical problems while 37.3 per cent of the elderly had problems with all theirsystems.

Darshan et. al (1987) carried out a study of older persons in various slums scattered inand around the city of Hissar. Among the 85 subjects interviewed by them, 67.1 percent were sick at the time of the survey. Out of these, 73.7 per cent were suffering fromchronic illness. Gupta and Vohra (1987) observed that only a few elderly withpsychiatric disorders were being cared for in the inpatient-wards in hospitals or asresidents of homes. A more recently conducted medico-social study of the urban elderly


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in Mumbai (Siva Raju, 1997) has revealed that the influence of the factors like,educational status, economic status, age, marital status, perception on living status,addictions, degree of feeling idle, anxieties and worries, type of health centre visited andwhether or not taking medicines, on both the perceived and actual health status of theelderly is found to be significant and vary considerably across different classes and

sexes of the elderly. Such a wide sex difference in this stratum is probably due togreater prevalence of health problems; compulsions to continue in labour force, and theresultant stress; and worries about unfinished tasks, which the male elderly mostly face.

At an advanced age, due to restricted physical activity, a majority of elderly change theirliving habits, especially their dietary intake and duration of sleep. There is a generalperception in the community that since the old lead a sedentary life, they should eat lessfood, have more rest and develop more religious interest to occupy them. Severalfactors like lack of physical movement, absence of a work routine, ill-health, etc. areobserved to be responsible for irregularity in the sleeping schedule of the elderly (SivaRaju, 1997). The allocation of less time to sleep among the lower strata of the elderly,

probably indicate the compulsions for them to work. Besides, inadequate facilities in thehousehold go against resting or sleeping during the day. Mental health of the elderly isanother important area in understanding their overall health situation. It is generallyexpected that the elderly should be free from mental worries since they have alreadycompleted their share of tasks and should lead a peaceful life. But, often, the unfinishedfamilial tasks like education of children, marriage of daughter(s), etc, becomes a sourceof worry over a period of time. It is noticed (Siva Raju, 1997) that the worries among thepoor are probably about inadequate economic support, poor health, inadequate livingspace, loss of respect, unfinished familial tasks, lack of recreational facilities and theproblem of spending time.

Some of the earlier research works (Purohit and Sharma, 1972; Pathak, 1975; Mishra,1987; Sati, 1988) had reported that there was a considerable difference in theperception of old people of their health status and the reality. It was presumed that suchdifferences narrow down as socio-economic status of elderly increases, because withhigher education and income they would have greater access to health/ medicalinformation and services. There is a general perception among the elderly that they areprone to illnesses mainly due to their advanced age and that it is natural to suffer fromsuch health problems at that age. However, in reality, most of their diseases are minorin nature and curable at the initial stage itself. Most of them neglect the illnesses andpostpone seeking medical aid. In some cases, due to neglect of timely medication, thehealth problems become aggravated and sometimes lead to death. Although the retiredpersons enjoy pension benefits, a large number of the elderly in India, who do notbelong to the 'employed', category, do not enjoy any social security benefits. During theservice period, certain medical facilities such as free treatment and supply of medicinesfrom the government hospitals / dispensaries are provided to the employees. But thesefacilities may not be available after retirement when the old people are really in need ofsuch subsidies. Thus retired government servants face a hard time after retirement ifthey are the victims of any serious illness.


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There appears to be a significant difference in the health situation of the elderly living inrural areas when compared to urban areas. The elderly people living in rural areasappear to be much healthier as compared to those residing in urban areas. Interestinglythe prevalence of chronic disease among females is higher than among males in thecase of urban areas while reverse is the case in rural areas (CSO, 2000). Further,

prevalence of various types of physical disabilities was found to be quite high amongthe elderly. All types of disabilities were also found to be more prevalent in rural areasas compared to those in urban areas.

Utilization of Health Care Services by the ElderlyAs the physiological condition deteriorates and responds only slowly to medication, theelderly need medical advice and treatment regularly to minimize their health problems.However, seeking medical aid is a costly affair, unless it is from a public hospital. Butmost of the public health care centres are plagued with many problems like improperhygiene, overcrowding and inadequate infrastructure in terms of health, human power,

medicines and the necessary medical equipment. Further, generally the elderly are thelast segment in a household to seek or to demand the medical aid, in view of thegeneral perception in society that not much can be done about the health problems ofold age.

Health care system at various levels in our country is designed for the generalpopulation and no special provision preferences are so far provided in the system totake care of the elderly in our society. At present, the old have to compete with the othersegments of our population in getting the public health care facilities. The poor stratautilize public health centres mainly because of free treatment facilities and its nearnessto their residences. Majority of the well- to-do and to a certain extent the MIG elderlyutilize mostly the private health care facilities. The advantages cited by those who utilizeprivate source(s) of medical care mainly include: good treatment, quick relief, lesswaiting time to see a doctor, cleanliness of the hospital premises, adequate interestshown by doctor, convenient time and nearness of its location (Siva Raju, 1997).

India's health system, though rests on a well-conceived infrastructure to make healthavailable to its people, the paradox, however, is that inspite of the availability of thefacilities, their utilization is very meager hardly 10 to 20 per cent (Griffith, 1963; JohnHopkins University, 1976). The problem is more acute in the remote areas, where,whatever meager facilities have been made available, they are not optimally utilized bythe people. Instead, people go to practitioners of indigenous methods, who are notqualified, such as traditional birth attendants, faith healers and other privatepractitioners who live and work among them (Siva Raju, 1986). Majority of studiesconducted so far, on the utilization of existing health care services in India haverevealed the very poor image the government health centres have among the people.

Among the small proportion of villagers who use the facilities, a majority are dissatisfiedwith the services, mainly because of the non-availability of medicines and theimpersonal behaviour of the health functionaries.


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Health care system at various levels in our country is designed for the generalpopulation and no special provision preferences are so far provided in the system totake care of the elderly in our society.

A fact that has been found universally valid is the relationship between poverty and ill

health. Many of the communicable diseases, especially debilitating diseases like feverand diarrhoea, take a heavy toll on the poor. In the case of both acute and chronicdiseases the lower socio-economic status groups fare very badly compared to thehigher socioeconomic status groups. The same trend is seen in case of disabilities andhandicaps too. It is seen that in both cases morbidity shows a steady pattern; whateverbe the illness its prevalence increases as socio-economic status goes down. Theseindications from the above facts clearly indicate that poor people are more vulnerablethan the rich; women; and those who stay in villages have a higher incidence ofdiseases than men and urban people. Also poor people spend larger proportion of theirincome on medical bills than the rich. Since medicines and consultations are veryexpensive, they take medicines only until the symptoms go away, and as a result, most

of the leading ailments become chronic in nature. Getting proper medical aid was foundto be beyond the reach of the elderly, which may have been due to their poverty,illiteracy, general backwardness and adherence to superstitious beliefs for curingillnesses and diseases.

Upadhyay as early as in 1960, expressed his doubts as to whether India would be ableto afford health services for the elderly population. Sahni (1982) is of the view that thehealth policy should be included as an integral part of health services of the elderlypopulation. Bose (1988) suggested creating mobile geriatric units and special countersor days in the general hospitals for attending to the elderly population. Bakshi (1987)was of the view that geriatric wards, outpatient units and special counters need to besetup in hospitals. Pathak (1982) suggested that aids such as dentistry, spectacles andhearing aids need to be given to the needy old. Darshan et.al. (1987) stressed the needfor frequent medical camps for the benefit of the rural old population. Mehta (1987) hassuggested a three pronged approach for care of the elderly being: (a) provision ofcurative services; (b) legal protection and (c) health education to take care of medicaland health problems of the aged. It is clear from the above review of earlier studies onhealth of the elderly that the health and well-being of the elderly are affected by manyinterwoven aspects of their social and physical environment. These range from their life-style and family structure to social and economic support systems, to the organisationand provision of health care. The pattern of various inputs for developing theappropriate social policy for the welfare of the elderly may have to be suitably modifiedin view of the diversity of the factors and their differential influence on the livingconditions of the elderly.

ConclusionThe trend in the size and growth rate of the elderly population in the country reveals thataging will become a major social challenge in the future when vast resources will needto be directed towards the support, care and treatment of the old. Therefore, it is high


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time suitable policy measures to minimize the problems of elderly in the country wereadopted. The following are some of the measures suggested to improve the healthstatus of the elderly in India:

Health education of the elderly should form an important aspect of the health

care so that they could learn certain do's and don'ts related to the differentdiseases and inculcate these in their behavioral patterns through constantpractice so as to prevent the occurrence of diseases or reduce the effects ofillnesses.

There is a necessity to train both indigenous and allopathic doctors to handle thespecific illnesses associated with aging.

It is necessary to set up subsidized health care for the elderly with special units inhospitals and with free or highly subsidized medicines. Subsidized health carewould also represent an indirect transfer of resources to the family.

Creation of special geriatric wards in major hospitals, setting up of specialcounters and geriatric out-patients units in existing hospitals will greatly help the

elderly. Social gerontology needs to form a part of the syllabus for medical professionals

and paraprofessionals so that they could integrate health education along withthe health care provided to the elderly persons.

A proper coordination between health care and welfare measures needs to beattempted for that would be most cost effective as well as more efficient.

Majority of the elderly especially those among the poor are working on full timebasis, irrespective of their health status, mainly to earn a living. There is anecessity to introduce community based income generating schemes for thebenefit of the poor elderly.

Among the poor strata of elderly, the non-availability of food may be a major

factor responsible for reduced in-take and consequent poor health. In view ofthis, supplementary nutrition programmes targeting needy elderly in the poorlocalities may be considered on a priority basis, which ultimately helps them inimproving their health status.

Use of appropriate aids, regular medical checkups, and intake of medicinesamong the poor elderly is almost absent, in spite of their requirement from healthpoint of view. Therefore, local NGOs working even on other issues of societymay regularly interact with the elderly of their community and see that thebenefits reach them in time.

Community members have to be sensitized about the problems of the elderly sothat a greater commitment and involvement could be ensured in order to include

"care for the elderly" within the purview of Primary Health Care.


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ReferencesBakshi. H,.S.1987 An Approach to Support Services for the Elderly. In M.L. Sharma andT.M, Dak (Eds.) Ageing in India: Challenge to the Society. Delhi: Ajanta Publications,228-231.

Bose. A.B. 1988 Policies and Programmes for the Ageing in India. In A.B.Bose and K.D. Gangrade (Eds.) The Ageing in India:Problems and Potentialities, New Delhi:

Abhinav Publications.

Central Statistical Organisation. 2000 Elderly in India: Profile and Programmes, Ministryof Statistics and Programme Implementation, New Delhi, Government of India.

Darshan, S., Sharma, M.L and Singh, S.P. 1987 Health Needs of Senior Citizens. InM.L.Sharma and T.M.Dak (Eds.) Ageing in India: Challenge Jar the Society. Delhi:

Ajanta, 207-213.

Desai, KG. and Naik. R.D. 1972 Problems of Retired People in Greater Bombay.Bombay: Tata Institute of Social Sciences.

Gore, M.S. 1990 Social Factors Affecting the Health of the Elderly. In R.L.Kane,J.G.Evans and Macfadyen (Eds.) Improving the Health of Older People:A World View.New York: Oxford University Press.

Gore, M.S. 1993 The Elderly in an Ageing Society, Contributed to Volume IV ofEncyclopedia on Ageing,Japan.

Griffith, D.H.S. 1963, "Final Report on Public Health Programmes", SEA/PHA/30,Andhra Pradesh: WHO Project.

Gupta, P. &Vohra, A. A. 1987 Pattern of Psychiatric Morbidity. In M.L.Sharma &T.M.Dak (Eds.) Ageing in India: Challenge for theSociety. Delhi: Ajanta, 214-221.

John Hopkins University, 1976, Functional Analysis of Health Needs and Services, NewYork: Asia Publishing House.

Joshi, C.K 1971 Medical Problems of Old Age, Indian Journal ofGerontology, 4 (3 & 4).

Mehta, S.R. 1987 Strategy for Health and Medical Care of the Aged. In M.K Sharma&T.M. Dak (Eds.)Ageingin India: Challenge for the Society. Delhi: Ajanta Publications,222-227.

Mishra, S. 1987: Social Adjustment in Old Age. Delhi: B. R. Publishing Co.


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Pathak, J.D. 1975 Inquiry into Disorders of the Old, Part I Bombay:Medical ResearchCentre, Bombay Hospital Trust.

Pathak. J.D. 1982 Health Problems of the Aged in India. In KG.Desai (Ed.) Ageing inIndia-Bombay: Tata Institute of Social Sciences. 43-53.

Purohit, C.K & Sharma, R. 1972 A Study of Aged 60 Years and Above in Social Profile.Indian Journal of Gerontology, 4 (3&4), 71-83.

Sahni, A. 1982 Health Services for the Aged in India: An International Perspective. InKG. Desai (Ed.) Ageing in India, Bombay: Tata Institute of Social Sciences.

Sati, P.N. 1988 Retired And Ageing People-A Study of Their Problems. Delhi: MittalPublications.

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Population- Perspectives andIssues, Vol. 9, No.2, pp. 80-89.

Siva Raju, S. 1997 "Medico- Social Study on the Assessment of Health Status of theUrban Elderly", Bombay, Tata Institute of Social Sciences, (Mimeo).

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Upadhyay, S.K 1960 Geriatrics: Its Need in India. Journal of Indian Medical Association,35 (12), 561-563.


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