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Problems of Elderly - Issues & Implications

Problems of Elderly - Issues & Implications

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Published by: Śáńtőśh Mőkáśhí on Oct 31, 2012
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12/04/2012

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Health of the Elderly in India: Issues and Implications
S. Siva Raju
 
Introduction
Given 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 of social security, loss of social role and recognition, and the non-availability of opportunities 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 andpsychological 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 Elderly
It 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. Theillness 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 of breath, 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 better met 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
 
segments of the elderly population within each country would experience problems of health 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 curablelimitations are accepted as natural and inevitable by the elderlySome 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 of disability 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 of education, adjustment to family and professional life, and consumption of tobacco andalcohol. 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/ her retirement, 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 of the records of 1,678 patients admitted in the Bombay Trust Hospital during the years of 1970 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 of disease 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 cardiovascular ailments, 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 per cent had surgical problems while 37.3 per cent of the elderly had problems with all their systems.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 per cent 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
 
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 andsexes 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 their living 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 minor in 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 of such subsidies. Thus retired government servants face a hard time after retirement if they are the victims of any serious illness.

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