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jaalakam july-august 2003 |
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Aging: Concerns and Anxieties by Kumudam Unni
An old man loved is winter with flowers The universal phenomenon of aging cannot be stopped for it is inevitable. The elderly population is growing much faster than the population as a whole. Due to improved health facilities, life standards and other socio-economic factors, average life expectancy has gone up considerably which resulted in sharp increase in the elderly population. In the Indian context, people who have attained 60 years and above are considered old whereas in developed countries it begins only at 65 years. The rapid aging of population, particularly of people over the age of 85 is a worldwide phenomenon. Our older citizens on a daily basis are reminded both of their expendability as also of the deeming coarseness society displays towards them. Be it the way they are treated within the family, the woeful inadequacy of healthcare provisions directed towards the old, the increasing incidence of the violence they face - it is evident that the modern Indian society is ill prepared to meet the challenges posed by the graying of its population. A part of this problem can be traced to material scarcities. The elderly and the infirm are invariably passed over in favor of those classified as productive and useful. But equally, the problem lies in the fetishisation of youth. Modern industrial and post-industrial cultures foreground the vitality and energy of the young as against the wisdom and experience of the old. Like religion and law, medicine is a moral enterprise as it defines and manages individuals deemed undesirable by the broader culture. Over the course of the 20th century, deviance has increasingly been medicalized as is evident when a drunkard is considered to "suffer" from alcoholism and the slow learner in school has a "learning disorder". Instead of viewing the disorientations of older persons being the result of personal and social change, they are viewed as symptoms of "senility". It is likely that in earlier times, aging as a problem did not preoccupy societies. Life expectancy was, in any case low. The notions of "Vanaprastha" and "Sanyasa" probably evolved as a response to the need of displacing the old. There is nothing inherently problematic about growing old. And yet in most nations of the world, old age is increasingly understood in " social problem" terms. As well al must age and eventually die, any cultural belief system that cannot provide security, meaning and self-esteem for those who reach the conclusion of life will eventually have to change. Old age was powerful in China, Sparta, in the Greek oligarchies and in Rome up until the second century before Christ. It played no political part whatsoever in the periods of change, expansion or revolution. Social behavior relation to old age There is a general tendency in old age to shift towards more sedentary, more advisory and supervisory activities, to those involving more mental exertion than physical and those directed towards group maintenance more than economic production. In all societies the mores prescribe some mutual responsibility within the family as between old people and their adult children. Saving for old age appears to be a near universal desire and effort even if it is not always successful. All societies value life and seek to prolong it even in old age. Since at least the 18th century, social observers have argued that there is an inverse relation between social development and the status of older persons, a historical shift from veneration to degradation. Adam Smith wrote in 1776, how among native Americans, age was the basis of rank and precedence, whereas in "opulent and civilized" nations, its role was residual. Two hundred years later Ernest Burgess in "Aging and Western Societies" (1960) came in to the same conclusion, citing urbanization and mass production of commodities as the chief culprits which together undermined the economic basis of the extended family and decreased the number of self-employed. This loss of extended family support was to isolate the aged and with their loss of decision-making power in the workplace arose the pressures for their retirement- a form of social death to create openings for young workers that formerly occurred by death when life expectancies were shorter. Aging is most usefully viewed as a process, one element of which is an inexorable decline across a broad range of bodily capabilities, reflexes and muscle tone, acuity of vision, hearing and other senses, fertility and potency, scalp hair, color, smoothness of skin, efficiency of immune system, height and percent of weight accounted for by muscle. The mental side of declivity include loss of memory ( especially short - term memory ), diminution in reckless physical courage and in sexual desire, decreased willingness to take financial risks, impairment of puzzle - and problem-solving ability and reduced willingness to adopt new ideas or reexamine one's old ideas. With age, sociological changes occur between aging individual, family and friends due to loss of peers and contemporaries. This can lead to isolation unless a concerted effort is made, to say socially active. Getting out and being can counter loneliness. Being involved and busy focuses on the present and future. As babies thrive when cuddled and touched, so do adults. When opportunities to hug and be hugged diminish with losses, create new ones. A handshake or a pat on the back helps. Grandchildren can provide opportunities for physical closeness or create opportunity through surrogate grand parenting. In fact, new stimuli and a positive attitude are attributed to 'successful' aging. Ageism Ageism is defined as a process of systematic stereotyping and discrimination against old people because they are old, allows younger generation to see them as different from themselves. At times, ageism becomes an expedient method by which society promotes viewpoints about the aged in order to relieve itself from responsibility towards them. The life expectancy of ancient Romans was 22 years. The lowest lifespan today is 38 years in Sierra Leone. The highest is in Japan where a male is expected to live for 76 years and a female for 83 years. The average lifespan in India today exceeds 62 years. The global increase in longevity has led to population explosion of older people. India's elderly population (60+) which in 1996 was 60 million is projected to rise to 76 million in 2001 and 113 million by 2016. Meanwhile there has been a steady decline in global birth rates due to fewer children per family, changes in gender relations, several culturally tolerated alternatives to traditional institutions of family and marriage such as cohabitation, gay families, staying single, many married professional women preferring to remain childless etc. Modernity is considered to be inversely related to fertility and the desire to discover self-fulfillment in one's progeny. A drop in birth rates has important repercussions for the elderly. In proportional terms, fewer young and middle-aged people will be available for the older population in the years to come. In a society marked by individualism potential hostility between the younger and older age groups can be mediated by the analogy that their relationship is analogous as that between individual and culture; the former is high in energy and the latter in information. Growing ageism can be checked by encouraging social measures and strengthening institutions. Even though most episodes of elderly maltreatment take place within the family, it nevertheless remains the most important institution for initiating a revolution in the society to effectively combat ageism. It is within the family rather than through the state that we can visualize a possibility of ameliorating the condition of the elderly. Nation Policy on older persons The Directive Principles of State Policy in our constitution enjoy the state to provide public assistance to older persons within the limits of its economic capacity. The early social welfare interventions for this group included old age pensions and shelter. These were introduced by the state governments in the fifties and sixties and now, most states have some form of old age pensions scheme. The National Policy on Older Persons was announced by the government in 1999, declared as the International Year of Older Persons by the UN. The year 2000 had been declare as the National Year of Older Persons by the Government of India. The National Policy reflects a few basic and interlinking concerns. These include the impact of demographic changes overtaking the country's population in the wake of an increase in health coverage and the adoption of small family norm resulting in an increase in the responsibility of the working population for the elderly care; the magnitude of the task of reaching even minimal social assistance to the large numbers of the elderly, the effect of changes in the economy due to urbanization and industrialization, the introduction of new technology, new lifestyles and values on the structure and functioning of families and their capacity to care for the elderly. The policy refers to the legal rights of parents without any means, to be supported by their children having sufficient means. These rights are enshrined in the Criminal Penal Code as well as in the Hindu Adoption and Maintenance Act 1956. The provision for maintenance of parents by children under these statutes is not to provide minimum income or old age security but to prevent destitution and vagrancy. The National Policy for Older Persons highlights: The need to regard life as a continuum and the age after 60 as another phase. the need to create an age-integrated society with strong bonds between different generations and thereby create conditions suitable for the elderly to stay with their families. Health Issues A nationwide survey conducted by the National Sample Organization reported that nearly 45% of the elderly in India suffered chronic illness. Among infectious disease, pneumonia is fifty times more common in the elderly than in adolescents. It accounted for half the deaths causes due to respiratory diseases excluding cancer. Urinary tract infectious are particularly common in the elderly. The most common cause for this is insertion of catheter. Elderly individuals usually face a higher risk of developing mental as well as physical morbidity. The incidence of mental illness is strongly influenced by socio-economic factors like educational levels, degree of economic support, whether living alone and so on. The feelings of loneliness, self-pity and dissatisfaction with life show a high correlation with mental problems. The magnitude of mental morbidity in India is a cause of concern. Two-thirds of mental morbidity is affective disorders especially depression while one-third is dementia. Another common problem is mania, accounting for 16% of the psychiatric diagnosis. Mania is more common in males and is often accompanied by organic brain syndrome. The main risk factors for mental morbidity are loss of fortune, fall in self-esteem, sense of helplessness, poor education, substandard health, social and gender discrimination, financial debt and status as a widowed person. Other Issues In most developed countries, there are approximately 65 men for every 100 women in the age group of 65 +. Generally in developing countries, there are more old men than old women. The sex ratio will probably fall in many developing countries with female life expectancy projected to increase faster than male life expectancy. Marital status has the greatest impact on living arrangements of the elderly. In most developing countries, more than 50% of women aged 65+ are widowed and in some countries, more than 75% of women aged 75+are widowed. In contrast, there is no country in which more than 40% of men aged 75+ are single. In developed countries, the proportion of persons aged 65+ who live alone ranges from 10%(Japan) to 90% (Sweden). This proportion is smaller in developing countries where there is a tradition of multigeneration households and both married and widowed older persons commonly live with their children and grandchildren. Trends in Kerala The population is aging more rapidly in Kerala than in any other state in India. As per 1991 census, Kerala had the highest proportion of 60+ population (8.8%), followed by Himachal Pradesh (8.1%) and Punjab (7.8%). By the year 2021, Kerala is expected to have elders 20% of the entire population. Kerala is fast becoming an "Aged Society", a status now enjoyed by the developed countries. While Kerala's annual population growth rate is 1%, the number of the elderly in the state is growing at 3.5%, according to a study by S. Irudyarajan of the Center for Development Studies, Trivandrum. Aging will have to be a special concern of the State. Due to rapid changes in the society resulting in the decline in the joint family system, there is an increasing need to find an alternative institution which can cater to the needs of our senior citizens. The prevalence of nuclear families is an increasing phenomenon with the result that some elderly are unable to live securely and run a house and therefore, have to move to old age homes. Irudyarajan found that the number of old age homes in the state has risen from 19 in 1950 to 134, the highest in the country. The homes cater to 4176 senior citizens, 1496 of them men. The study notes that : 6% of the senior citizens in these homes had no one to care for them. 19% decided themselves to enter the home 8% had problems with their children 1% because their children were away. The highest number of old age homes are in Kottayam district (31) followed by Ernakulam (27) and Trichur (25). Wynad has no old age homes yet. The study also notes that: 32% of the inmates were in their 60s 36 % in their 70s 19 % in their 80s 3% in their 90s. Further, 77 % of the women in the homes were older than men. In Kerala, 83 % of the rural and urban elderly males and 72% of the rural and urban elderly females who are economically dependant are supported by the children. This indicates the almost total reliance on the family in case of the elderly who are economically dependant. The solidarity of the family sustains the elderly. The psycho-physical problems which the elderly confront due to aging and associated socio- cultural, nutritional and environmental factors demand that we perceive the health of the elderly within a holistic perspective. The maxim of adding years to life implies that the elderly receive adequate state and social support to live an active and socially productive life. Our cultural ethos gives a special place to the elderly as wise people and councilors of the society. Geriatric support aimed at improving the competence of the elderly to ensure their active participation in the society should be considered in evolving any policy on aging care. The experience and wisdom of old age and its gainful utilization would be beneficial for both the elderly as well as the younger generation
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