India has more elderly people than ever before. Most of them have little social security and cannot afford healthcare. While the government seems ill-prepared to provide them care, private players are rushing to offer expensive facilities and services. Jyotsna Singh reports on the challenge and possible solutions
Living to a ripe old age should be a cause for celebration. Alas, it was not so for Usha John, once a sprightly, hard-working and fiercely independent IAS officer. After retirement, John lived in her bungalow in the upmarket Hauz Khas of Delhi, aided by a few housekeepers. But over the years, they deserted her. “In March, I received a call from one of her neighbours who informed that they had not seen any activity in John’s house for a long time,” says Mathew Cherian, chief executive of HelpAge India, a non-profit working for the rights of the elderly. “When we visited her house, we discovered a frail figure.” She was barely 19 kg. Cherian rushed her to the All India Institute of Medical Sciences (AIIMS), where the doctors informed that she had hardly eaten anything for two to three months and was suffering from cancer. The 85-year-old spinster died in the hospital a month later. Some relatives of her sister, who lives in Mumbai, came to complete hospital formalities.
Unlike John, 82-year-old Urmila Devi has two sons who are doing quite well for themselves. Yet she is living out her dotage in an old-age home in Kanjhawala in north-west Delhi. Her sons live in the same city, but no one has come looking for her in the past three years, say attendants at the old-age home, run by Triveni Devi Charitable Society. “Since the death of my husband 10 years ago, I have developed some mental disorder and tend to forget eating or taking medicines on time,” says Devi, flipping through the photographs from her younger days, kept carefully by bedside. “My children would often speak harsh words for being a burden on the family.” She left home after one such tiff with her son’s family.
There is no dearth of such stories of loss and loneliness in the country, which is undergoing a rapid transformation—both socially and demographically.
Due to improved healthcare worldwide, the average lifespan of an individual has increased in the last few decades. India is no exception. According to the Census of India, the life expectancy of an Indian was 52 in 1975. Today, an average Indian man lives beyond 67 years and women about 70 years, according to the Union Ministry of Health and Family Welfare. There is, however, a downside to the success story. Increased longevity means there are more elderly people than before. From 56.5 million in 1991, the number of elderly (those above 60) has increased to 103.2 million in 2011—the largest ever in the country’s history. According to the Union Ministry of Statistics and Programme Implementation (MoSPI), by 2050 a greying India will have a quarter of its population to look after. A sizeable portion of them would be very old (80 and above) and widows, as women tend to live longer. Most of this ailing, frail population would be living in villages (see ‘India greying’ and ‘State of our elders’).
Many other countries are witnessing similar demographic change. But the rapidly ageing population is a matter of worry for India because of two reasons. One, attitude towards the elderly is changing. Though India’s traditional piety requires children to look after their parents, nuclear families have little time or resources for their ailing parents. Increased migration from rural areas also forces the younger generation to leave their elders alone back home. Finances are stretched and healthcare expensive. Worse, nearly 90 per cent of the elderly worked in the informal sector and do not receive social security coverage, like pension and mediclaim, post retirement, according to HelpAge India. They either continue to work beyond retirement age or suffer from neglect and alienation.
Two, the government seems little bothered about the growing acuteness of the problem and ill-prepared for the mounting responsibility. Apathy of the political class is evident from the fact that the ruling United Progressive Alliance spent just 151 words for the elderly in its 81-page Report to the People 2012-13. There was no mention of the performance of the programmes for the elderly in the report. This is surprising because the average age of the Cabinet is 65 years. Even in this general election, the manifestos of major political parties pay mere lip service to the issues of the elderly.
Care, an age-old problem
What goes without saying is that older people have a depleting health that needs constant care and management. The problems could range from debilitating joint pain and constant coughing to life-threatening heart diseases and cancer. A 2011 report by the Ministry of Social Justice shows that 160 of every 1,000 elderly living in urban areas suffer from heart diseases. Urinary problems are more common among aged men, while most aged women suffer from joint problems. Of every 1,000 elderly, nearly 64 in rural and 55 in urban areas have one or the other form of disability, such as hearing difficulty, poor vision or locomotive impairment.
Lately, depression has emerged as another common ailment among the aged. According to a study published in Neurosciences in Rural Practice in 2011, about 22 per cent of the elderly in India—or every fifth elderly in the country—are depressed. The worldwide average is 10.3 per cent. The study, led by Ankur Barua of Melaka-Manipal Medical College, Malaysia, analysed figures from Asia, Europe, Australia, North America and South America. This is a scary situation because more often than not an elderly suffers from more than one disease.
“These are the problems of old-age and are interrelated. There is natural decay of the body and every ailment need not be treated the way it is done for other age groups,” says A B Dey, head of the geriatrics department at AIIMS. “So, there is a need for geriatricians who are trained to see the person in the context of age and give less medicine for maximum advantage.” Besides, Dey says, most elderly are not aware of their illnesses, even if they are at a later stage of life-threatening diseases like heart problems and cancer. They think the symptoms are part of the ageing process. Between July 2012 and July 2013, his department and the Indian Council of Medical Research assessed the health of 1,643 above-60 people who visited the general out-patient department of AIIMS and followed them up for one year. To their surprise, they found only 15 per cent patients alive by the end of the year; 30 per cent died within the first month of treatment. “We now check patients for a set of diseases even if they approach us for some other ailment,” he adds.
For someone like Urmila Devi, who suffers from high blood pressure, diabetes and neurological disorder, visiting a geriatrician would not only save her from the trouble of approaching multiple doctors and save precious pension money, she would also be diagnosed of any hidden disease before it is too late. But a geriatrician is not easy to come by.
Much hope was pinned on the Union health ministry when it opened National Programme for Health Care of the Elderly (NPHCE) in June 2010. It is the first programme with special focus on the health requirement of the aged. Under NPHCE, the ministry promised to establish geriatric departments in eight super-specialised hospitals and strengthening healthcare facilities for the elderly in each district. Under the first phase (2010-2012), NPHCE was planned to cover 100 districts of 21 states and union territories. The remaining 540 districts were to be covered during 2012-17. But it is yet to keep its word.
Lov Verma, secretary of the ministry, told Down To Earth, “We have opened geriatric out-patient departments in eight hospitals and indoor (hospitalisation) services in six. We plan to open National Institutes of Ageing (nodal agency for research and healthcare) at AIIMS and Madras Medical College in Chennai.”
Doctors at the geriatric departments say they are yet to receive the promised Rs 20 lakh per annum, meant for subsidising medicines and tests. District-level implementation of the programme also remains a far cry.
The government’s apathy towards the elderly becomes evident from the fact that in 2012-13, the ministry released only Rs 1.15 crore of the Rs 50 crore allocated for the elderly under National Health Mission. The same year, the ministry released Rs 68.56 crore out of the allocated Rs 150 crore for NPHCE. However, the utilisation of the fund remains poor. According to a January 2014 report by industry body ASSOCHAM and KPMG, a company that offers advisory services, Kerala, the state with one of the largest elderly populations, has utilised only 8 per cent of the Rs 8.79 crore received under NPHCE.
Such apathy comes as no surprise in a country that drafted its National Policy on Older Persons only in 1999. “The policy, meant to address issues relating to ageing in a comprehensive manner, failed to provide relief to the elderly, primarily due to lack of focus of the government and no will towards its implementation,” says Cherian.
Financial crunch, health problems and living alone have emerged as the top three fears of the elderly, according to the ASSOCHAM-KPMG report. And cashing in on these are the real estate sector and private healthcare facilities.