SOCIAL AND HEALTH STATUS OF ELDPERLY PEOPLE LIVING IN RURAL

AREA

RESEARCH PROPOSAL
SUBMITTED TO:
Dr. Badri Aryal
COURSE COORDINATOR

BACHELOR OF DEVELOPMENT STUDIES (BDEVS)

SCHOOL OF DEVELOPMENT AND SOCIAL ENGINEERING
POKHARA UNIVERSITY
POKHARA, KASKI

SUBMITTED BY:
ASHEEM DHAKAL
SECTION A
SEVENTH SEMESTER

November, 2022
TABLE OF CONTENTS:
CHAPTER ONE: INTRODUCTION
1.1 Background
1.2 Statement of Problem
1.3 Objectives
1.4 Research Questions
1.5 Significance of Study
1.6 Limitation of the Study

CHAPTER TWO: LITERATURE REVIEW

CHAPTER THREE: RESEARCH METHODLOGY
3.1 Study Area
3.2 Research Design
3.3 Study Population, Sample Size and Sampling Procedure
3.4 Nature and Sources of Data
3.5 Methods of Data Collection
3.6 Reliability and Validity
3.7 Ethical Consideration
3.8 Method of Data Analysis

REFERENCES
ANNEXES
Annexes 1 Questions

CHAPTER ONE: INTRODUCTION

1.1. Background of the Study
In human life cycle there are generally three phases-child, working age and old age. Age under
the 15 years is known as the child age. According to the census 2001, there are 39.36 percent
children out of total people in Nepal. Working age of people is the age of 15-60 years or defined
as independent, active people. In the census 2001 it is found that 54.15 percent people are in
active age in Nepal. Elderly is the group of people above 60 years of age or defined as the stage
of mental and physical decreasing or inability. It is well known that old people are the senior
people of the country. They should be respected at the every sector of the society. In this stage
they need to be well cared and full support from family community and the country. Symptoms
of the elderly people:

 Wrinkle appear in the face and sensory organs become less active.

 Inability of mental work: late learning, quick forgetting, confusion and repetition.

 Physical, weakness: feeling exhausted. Within short period, feeling or insecurity, increasing
selfish attitude, feeling own self as a character of mercy and the development of one-side
insistence.

 Increment in religious feeling and being a bit rigid and being conservative
As the people grow older their physical abilities deteriorate and their control over their own
resources may weaker. It has been observed that when people get older elderly people expect
support from their families, relatives and the state so that they could lead a healthy life as
dignified citizen in return for the contributions to made in the past. But neither the major of the
families more the state institutions are poised to listen sincerely the quite voices of the older
people in Nepal. In the context of Nepal ageing has becomes a very important demographic and
social issues (Bisht , 2005). The study of ageing is a major scientific challenge because of many
conceptual and practical problems. Ageing is a theoretical construct. It is neither readily
identificable nor observation. The great majority of gerontological theory focuses on age as the
independent variable in order to infer that a parameter of interest is altered by a particular
ageing process (Donald, 1998). The concept of ageing identified in the context of western
experience and tradition has been based on proportions of population aged 65 years or over, for
developing countries, a lower age limit of 60 years has been more relevant. While most
international agencies use population aged 65 and over as elderly population. There are some
countries of small scale where population, aged 50 and over are considered elderly. The
operative definition of old age limits to 60 years, 65 years, 70 years on above. The beginning of
old age is also characterized by the time from which the capacity to do work begins to be
affected by biological, physical and mental conditions of people (UNFPA, 2001).
People aged 60 or over are considered as elderly. Firstly, age 60 is the usual retirement age for
civil servants in Nepal. This retirement age is, in a way recognize of their status as elderly
secondly, age (59) is the upper limit of economically active population and that this ratio has
obtained a universal endorsement. Thirdly because life expectance is low and that our accesses
to medical and other health facilities are limited people grow physically weaker and older
earlier than most developed countries (Subedi, 1999). The majority of the elderly people in
Nepal are living in rural areas depending upon their agricultural profession and living under the
poverty. The majority of the older people suffer from the cumulative effects of a life time of
deprivation, entering old age in a poor state of health and without saving or marital asset. They
lack the means to fulfill their most basic needs such as food, proper housing, clothes, health core
and safe drinking water. They also lack access to resources and income generating
opportunities (Bisht, 2005).
1.2. Statement of Problem
Elderly people are respected persons in the society and they are sources of social values and
norms. They have knowledge, experience and maturity in life, their contribution is necessary in
the society. However, they are facing different kinds of problems in their later life such as,
economic, physical, social, mental, professional, family problems and aloneness. Decreases in
fertility and mortality rates with improvement in life expectancy have led to rapid increase to
the elderly population in Nepal. There are over 20000 new elderly people added to the 60 years
and over age group each year. The government of Nepal has a policy of providing social security
for elderly people living in the country who are aged 75 years and above since 1992/93. The
security is in terms of Rs.200 per month. Every senior person has a right to have this security.
However there is a lack of regularity and availability in time of this security for the service
receives due to lengthy and inefficient administrative as well as bureaucratic process. So, there
is an urgent need of investigation whether the elderly people are getting this security.
Health care and food security are two major requirements of elderly people to be healthy and
manage the longer life. Elderly people are influence by traditional values and they have less
faith on the modern treatment. Therefore, it is necessary to identify where do elderly people
prefer to go if they become ill. In what respects the elderly people are getting food and what
ways they are obtaining food are other areas of investigation. There is very little research done
in the field of elderly population in Nepal. What ever studies are available, are done based on
studies carried out for other purpose and not for the case of elder (Subedi, 1999). As a result,
very little is known about the real situation of elderly people and their problem from the
perspectives of elderly themselves. Due to the increase of family disinfections, rural-urban
migration is creating a social distance. The elderly population are in isolation because youth
population are migrating to the town looking for job. Economic condition of the country is
decreasing day by day, where, the government is not is a state to invest for their elderly people.
As the earnings of the young people are not satisfactory and good and in addition, they have to
spend those manly for their children which means that the elderly are neglected as they have no
earnings of their own. Biologically and economically elderly people are unproductive. Young
population have for bear the burden of the dependent population. If the government social
organization are not timely aware in this matter, the problem of elderly will become more
serious and in near future the elderly people will be most vulnerable group on the society
1.3 Objective of the Study
Now a days the absolute number of elderly population is increasing. This increase affects
various aspect of life. So, the study mainly concerned with the current status of the elderly
people living in Chhumrung.

 To identify and analyze socio-economic and demographic characteristics of elderly peoples

living in Chhumrung

 To analyze the health care system of elderly people living

 To analyze the psychological status elderly people living

 To analyze the status of females elderly people in comparison to males elderly people.
1.4 Significance of the Study
The ageing population is an important part of the society or country. The effects of
modernization and other infrastructure also affect the life of old people. The nuclear family is
emerging in the society and young people want to live, with his/her own wife and children and
separately which affects the elderly people to fulfill basic needs and other necessary things.
Elderly people are source of knowledge, they contribute significance role for the development of
the country and they also give sound suggestions in the family in a proper way. Elderly people
are passing through different mental and psychological state due to the expansion of nuclear
family intergenerational gap, modernization, urbanization, occupational and they have been
facing so many problems . They have one of the most neglected social groups in Nepal. Their
voices are often dominated and ignored (Bisht, 2003). In this situation, the elderly people are
seeking emotional and financial support from family community and national level. This study
may also be helpful for the different institutions working with ageing, governmental as well as
non-governmental organizations, policymakers and planners to understand the life of elderly in
rural areas and their overall situation, which, may be helpful to formulate plans and policies and
to act accordingly for their well being. It may also be useful for the further study for concerned
people and institution

CHAPTER TWO: LITERATURE REVIEW

Aging is a natural biological process. The impact of the accumulation of various
molecular and cellular damage causes a change in the biological aspect. This causes a
gradual decrease in physical and mental activity, which can increase the risk of disease
and, eventually, death. The problem of aging is becoming more acute as life expectancy
rises. Although the population is getting younger, the elderly face a variety of
challenges. A person becomes old due to a variety of factors. The major characteristics
that cause a person to age are a decrease in physical strength, an increase in mental
tension, a decrease in immunity power, and a significant increase in sickness.
In Nepal, the government has categorized the population according to the age group into young,
mature, and aged. Young people who are less than 15 years of age and elderly people who are
60 years of age and over are taken as dependent and thus unproductive, whereas the mature
population (15-59 years of age) is conceived as productive (economically active) and
reproductive (Subedi, 2004). Ageing is an emerging issue in Nepal. The aged population in Nepal
is increasing day by day as compared to the last decade. The elderly population in Nepal is
growing at a rate three times faster than the annual population growth rate (1.35%) between
2001 and 2011 (Bhandari, 2021). The study shows that the proportion of the elderly population
is low in Terai compared to mountain and hilly areas (Aryal, 2019). According to the 2011 CBS,
the elderly population is 8.13 percent of the total population of Nepal and the dependency ratio
is high. The elderly is usually regarded with respect in Nepalese society. In Nepal, an elderly
man is socially involved in numerous village matters, such as settling disputes, arranging
marriages, and supervising various rites such as nuptials, initiation, birthdays, and death. If the
person is wealthy, his patronage for village affairs would be greater because he helps the needy,
organizes regular feasts, and provides hospitality to visitors. In the Hindu religious system,
parents are considered gods, and children are encouraged to respect them as if they were
deities. The elderly is cared for and honored in Nepalese society thanks to the socialization
process. During significant occasions such as alphabet learning (Saraswati puja) and numerous
festivals such as Dashain, children are initially subjected to receiving blessings from the old. Not
only youngsters, but also visiting relatives, accept the blessing by prostrating themselves at the
feet of the elderly. In Nepalese society, children are raised in such a way that they are taught
that not taking care of the needs of the elderly, disrespecting the elderly, and emotionally
hurting them by speaking anything can result in sins that cannot be atoned for. For the
socialization of children, the elderly in Nepal plays a vital role. Children are socialized by the
means of storytelling, which includes sharing their life stories. As a consequence, children are
integrated into the family and society easily. Since the elderly provide love and care to the
grandchildren, children grow up with plenty of knowledge of their grandparents and are closely
attached to them. In Nepali family, when father becomes older, bed ridden and dying, all the
managerial tasks of household are inherited by the son. It seems that the loyalty and
attachments of the children to the aged parents, especially the father is because of the traditions
of inheritance which is a major economic and political factor. Especially in the rural areas,
elderly people tend to be illiterate, have limited sources of income, and have poor health and
nutrition, leading to an increased burden of both infectious and chronic diseases and further,
they lack access to general health and social services. Joint family system was the traditional
familiar system in Nepal. But because of modernization and development activities, the joint
family system is ruptured. In this family hierarchy, age and sex are the main ordering principles.
Elders have great authority than young in Nepalese society (Regmi, 1993). However, it has
begun to represent the elderly as feeble, dependent, and vulnerable members of the household
and society (Subedi, 2004), which was uncommon in rural culture. They are physically frail,
psychologically fragile, and financially disadvantaged, but they are also a wealth of knowledge.
In many affluent countries, NGOs, INGOs, and health and welfare organizations are looking for
volunteers among the expanding number of retirees (Healy, 2004). Elderly individuals play an
essential role in supporting and maintaining informal social networks, which tie families across
generations. They not only receive assistance and support, but they are also net providers, at
least up to the age of 75 (Grille, 2014). They can give child care, financial, economic, and
emotional support to family members, as well as aid others outside the household with daily
living tasks. Grandparenting has become an important social duty in an age when people have
more living parents than children. Grandparenthood is advantageous not just to grandparents
who value it as an essential part of their lives, but it is also beneficial to grandkids (Frempong et
al., 2013).
At the same time, elderly adults follow the law more than other age groups since they commit
fewer crimes against property and people (Healy, 2004). As a result, it is critical to recognize
these social elements of the aged population in order to properly deal with them by providing
them with adequate respect to survive in society. The elderly’s home, elderly people’s daycare
center, and elderly people’s club are all rapidly opening for the administration of elderly
people’s lives, just as Montessori and child care centers are (MoWCSC, 2017). Elderly homes
serve an important function in providing shelter to the homeless and elderly who have no one
to care for them. Elderly homes are places where elderly people can reside and be cared for and
fed, either for a fee or for free (Supreme Court, 2017). These houses provide an alternative
destination for elderly people who have recognized their family’s troubles. In Nepal, these
elderlyoriented organizations for the welfare of the elderly are not on the government’s priority
list (Lamichhane, 2017).
The combined effect of decreased fertility, lower mortality, and improved health systems has
resulted in an increase in the proportion of the world’s elderly population. The world’s
population is aging, and the number of elderly people in developing countries is fast increasing
in comparison to developed countries (Aryal, 2019). The aging of the population poses
numerous challenges to the social, economic, and healthcare systems (Bhandari, 2019). To
address these concerns and needs, the Nepalese government has created different policies and
social security programs such as Old Age Allowance (OAA), old age pension for public servants,
old age home, and other health-related services. The Nepalese government is committed to
numerous regional and international conventions that enhance the wellbeing of the country’s
older citizens. Former Prime Minister Manmohan Adhikari established the Old Age Allowance
for senior citizens. In December 1994, the CPN (UML) government announced a universal flat
pension of 100 rupees for all citizens over the age of 75. (Rai, 2017). At the moment, the OAA
has been enhanced to Rs 4,000 under the social security program, and the government is
distributing it to people over the age of 68 beginning in fiscal year 2022/23, which begins in
mid-July. Previously, it was available only to people over the age of 70. (Nepal News, 2022). The
allowance is distributed through municipal ward offices in urban areas. The Government of
Nepal (GoN) has enacted a number of measures to enhance the wellbeing of senior citizens.
Similarly, the fiscal year (2078/79 B.S.) provides for the free distribution of 98 different drugs
from government health institutions. It has also been said that rehabilitation centers with health
services will be constructed for people with complete disabilities, and that free screening for
non-communicable diseases will be conducted once a year in local level health institutions for
inhabitants over the age of 40. The government intends to build a geriatric care facility with 165
beds and a hospital with 45 beds in Gothatar, Kathmandu (MoF, 2022). In 1938 B.S., Nepal
created Panchadewal Pakshala (a place to cook food), which later became known as Social
Welfare Centre Elderly’s Home Pashupati in 2034 B.S., (Pashupati Elderly’s Home, 2021). The
Ministry of Women, Children, and Senior Citizens oversees the PEHP. This is the sole
government-run nursing home. Many privately opened elderly homes have been sprung up to
provide care and support to the elderly, and many elderly have begun to live in those homes.
In 1938 B.S., Nepal created Panchadewal Pakshala (a place to cook food), which later became
known as Social Welfare Centre Elderly’s Home Pashupati in 2034 B.S., (Pashupati Elderly’s
Home, 2021). The Ministry of Women, Children, and Senior Citizens oversees the PEHP. This is
the sole government run nursing home. Many privately opened elderly homes have sprung up to
provide care and support to the elderly, and many of those homes have begun to live in those
homes. These are the needs of today’s Nepalese society, and in order to establish such
institutions for the elderly, NGOs, social workers, and their agencies should step forward, and
the state should assist them in the future. According to the present status of elderly homes,
there are approximately 80 elderly homes associated with the Social Welfare Council from 2034
B.S. to 2077 B.S. (SWC, 2020), with approximately 1700 elderly residents. Many of them are
destitute and in need of decent care, assistance, and basic necessities.
In the last 10 years’ data, there are 20 elderly homes which got approval from the SWC and they
are from all over the Nepal. The elderly home suffers from a variety of issues such as physical
facilities, infrastructure, and supplementary support, among others. As a result, the elderly in
nursing homes may not enjoy their daily lives. This is a severe problem that has to be
discovered and addressed. But the key here is whether these homes are functioning correctly
and giving adequate care to the elderly. As a result, this study is based on elderly adults who are
residents of PEHP.

Chronic diseases, physical disabilities, mental illnesses, and other comorbidities are
more common in an aging population. [Boutayeb,2005] The health needs and problems
of the elderly cannot be considered in isolation.A wide range of determinants such as
social concerns (children moving out of their parents' home in search of employment,
leaving them isolated without any physical support in daily activities);[ Song, 2013]
maltreatment of the elderly;[WHO,2011] lack of knowledge and awareness about risk
factors; food and nutritional requirements;[WHO,2013] psychoemotional concerns
(isolation, mental stress, difficulty in keeping themselves occupied);[WHO,2003]
financial constraints (i.e. definite financial constraints); inadequacies in the government
healthcare system); and physical correlates; determine medical problems and, as a
result, have a significant impact on the elderly's quality of life.
Mental disorders in the elderly are a major public health concern, with the elderly
having a higher prevalence of mental disorders (Fei, 2009). According to the 2010
Global Burden of Disease Study, mental and substance use disorders were responsible
for 22.9 percent of all Years Lived with Disability (YLDs) and 7.4 percent of all Disability
Adjusted Life Years (DALYs) (Whiteford et al., 2013). According to the WHO, 15% of
older people (60 years) have a mental disorder, accounting for 6.6% of total DALYs
among older adults (WHO, 2016)
Over 20% of adults aged 60 and up suffer from a mental or neurological disorder
(excluding headache disorders), and mental and neurological disorders account for 6.6
percent of all disability (disability adjusted life years-DALYs) among people over 60.
These disorders account for 17.4 percent of Years Lived with Disability in older people
(YLDs). Dementia and depression are the most common mental and neurological
disorders in this age group, affecting approximately 5% and 7% of the world's older
population, respectively. Anxiety disorders affect 3.8 percent of the elderly population,
substance use disorders affect nearly one percent, and a quarter of self-harm deaths
occur in people aged 60 and up. Substance abuse problems in the elderly are frequently
overlooked or misdiagnosed (WHO, 2017).
Joint pain was the most common chronic illness in the elderly (67.20 percent), followed
by gastrointestinal (51.10 percent) and hypertension or blood pressure (39.60 percent)
(Kunwar,2021).
A study on depression in the elderly revealed that the majority of the elderly people
suffered from depression (80.7 percent ). Females were more likely than males to suffer
from depression. The respondents' age, gender, marital status, and previous occupation
all have a significant relationship with their level of depression. Furthermore, there was
a significant relationship between depression level and activities for entertainment in
elderly homes (Dhungana,2020).

CHAPTER THREE: RESEARCH METHODOLOGY

3.1. Study Area: The study is going to be conducted among the population of.
3.2. Research Design: In this research, cross-sectional, exploratory and descriptive
research design will be adopted.
3.3. Study Population, Sample Size and Sampling Procedure: In this research, the
study population will be the the population of. Furthermore, each 50 people will be
taken as sample size for this study through convenience sampling technique or
voluntary sampling technique.
3.4. Nature and Sources of Data: Quantitative data will be collected for this research.
For the study, primary sources of data will be collected using structured and semi-
structured questionnaire with closed-ended question. Similarly, qualitative data will
also be collected.
3.5. Methods of Data Collection: Primary data will be collected by using structured
questionnaire with close-ended questions. Qualitative data will be collected by using
Key Informant Interview (KII).
3.6. Method of Data Analysis: All the collected quantitative data will be edited, filtered
and endered in SPSS for the analysis. Descriptive statistic will be used for further
anlaysis. Output will be showed by using frequency, percentage, cross tabulation, pie-
chat, mean, minimum value and maximum value.

References:
Acharya, P. (2011). The situation of population ageing and social security for elderly people in
Nepal. Health Prospect, 10, 61–63. Aryal, G. (2019). The status of elderly people in Nepal. Patan
Pragya, 5(1), 11–18.
Bhandari, K. (2019). Social security system of elderly population in Nepal. NUTA Journal, 6, 18–
24. https://www.sciencegate.app/document/10.3126/nutaj.v6i1-2.23223
Bhandari, K. (2021). Demographic process of population ageing in Nepal. Patan Pragya, 9(2),
115–127. https://www.sciencegate.app/document/10.3126/nutaj.v6i1- 2.23223
Frempong, F., Adjei, P. O. W., & Iddrisu, A. (2013). Exploring recreational activities of the aged in
Jachie in the Ashanti Region of Ghana. International Journal of Physical and Social Sciences, 3(6),
62.
Gautam, T. R. (2008). Migration and the problem of old age people in Nepal. Dhaulagiri Journal
of Sociology and Anthropology, 2, 145–160.
Gorman, M. (2004). Age and security. Help Age International, London, UK. Grille, R. (2014).
Overpopulation is not the problem-a sustainable world begins! Heart to Heart Parenting.
https://hearttoheartparenting.org/index.php/2014/05/01/ overpopulation-is-not-the-
problem-a-sustainable-world-begins/
Healy, J. (2004). The benefits of an ageing population. Discussion paper. Australia Institute.
Australian National University.
https://australiainstitute.org.au/wpcontent/uploads/2020/12/DP63_8.pdf
Help Age Global Network (HAGN). (2019). Ageing population in Nepal. https://
ageingasia.org/ageing-population-nepal.
Khanal, H. (1998). Status report on population aging in Nepal. [Unpublished report]. UNFPA.
Khanal, R. (2020, May 29). Minimum eligible age for elderly allowance reduced to 68 from 70
years. Nepal Republic Media Pvt Ltd.
Lamichhane, S. (2017). Senior citizens and old age homes: A study of pushing factors and level
of satisfaction in old age homes of Kaski district. Central Department of
Sociology/Anthropology, Tribhuvan University.
Mishra, S., & Chalise, H. N. (2018). Health status of elderly living in government and private old
age home in Nepal. Asian Journal of Biological Sciences, 11, 173–178.
Ministry of Finance (MoF). (2022). Nepal budget 2078/79 B.S. Ministry of Finance, Kathmandu.
Ministry of Women, Children and Senior Citizens (MoWCSC). (2017). Diwa Sewa Kendrako
Addhyan Pratibedan. Ministry of Women, Children and Senior Citizens, Kathmandu.
Dhungana, A. R. (2020). Factors Associated with Depression among Elderly People Living In Old
Aged Homes of Pokhara, Nepal. Journal of Health and Allied Sciences, 10(1), 8-12.
https://doi.org/10.37107/jhas.175
Kunwar, T. (2021). Physical and Mental Health Problems of Elderly People at Nagarjun
Municipality in Kathmandu. Humanities and Social Sciences Journal, 13(1), 201–216.
https://doi.org/10.3126/hssj.v13i1.44564
World Health Organization. Nutrition for older persons. [Last accessed on 2013 May 15].
Available from: http://www.who.int/nutrition/topics/ageing/en/index1.html .
World Health Organization. Towards policy for health and ageing. [Last accessed on 2013 May
22]. Available from: http://www.who.int/ageing/publications/alc_fs_ageing_policy.pdf . 
 Boutayeb A, Boutayeb S. The burden of non-communicable diseases in developing countries. Int
J Equity Health. 2005;4:2. [PMC free article] [PubMed] [Google Scholar]
World Health Organization. Elder maltreatment. 2011. [Last accessed on 2013 May 15].
Available from: http://www.who.int/mediacentre/factsheets/fs357/en/
Song, Y., Ma, W., Yi, X., Wang, S., Sun, X., Tian, J., Wang, S., Zheng, C., Zhang, B., Xu, Z., & Marley, G.
(2013). Chronic Diseases Knowledge and Related Factors among the Elderly in Jinan, China.
PLoS ONE, 8(6), e68599. https://doi.org/10.1371/journal.pone.0068599
Brodsky, J., Habib, J., & Hirschfeld, M. J. (2003). Key policy issues in long-term care. World Health
Organization.
World Health Organization (WHO). (2017). Mental health and older adults. https://
www.who.int/mediacentre/factsheets/fs381/en
Fei, M., Chang-Qu, Y., Wang, T., Yin, J., Xu Bin, J., & Han Ding, Q. (2009). Prevalence and
distribution of cognitive impairment no dementia (CIND) among the aged population and the
analysis of socio-demographic characteristics, 23 (2), 130-138.
Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., Charlson, F, J.,
Norman, R. E., Flaxman, A. D., Johns, N., Burstein, R., Murray, C. J., & Vos, T. (2013). Global burden
of disease attributable to mental and substance use disorders. School of Population Health,
382(9904),1575-1586. https://dx.doi.org/10.1016/S0140-6736 (13)61611-6