India is ageing fast. Over the next few decades it will turn from a ‘young’ country to an ‘old’ country. The number of the elderly persons (60+) will rise from the current 9 crore to 31.5 crore by 2050, constituting 20 percent of the total population. They will need financial security, healthcare, housing, social security and safety and meaningful engagement on an unprecedented scale. How ready we are to take care of them depends on where we stand today.

UNFPA attempts to answer that through a study, called “Report on the status of elderly in selected states of India, 2011” and released on November 19, 2012. In collaboration with several institutions, it carried out a survey in seven states – Himachal Pradesh, Kerala, Maharashtra, Odisha, Punjab, Tamil Nadu and West Bengal – which have a higher than national average of the elderly population. The sample size was 1,280 households in each state and each households had at least one elderly aged 60 years or above. The findings are a revelation and useful to devise appropriate policy response. Some of the key ones are as follows:

Socio-economic and demographic profile

• Almost 60 percent of the elderly are heads of the households they live in, with a substantially higher number of elderly male occupying this position compared to the elderly women
• More than one-third households have a monthly per capita expenditure below Rs 1,000, and only 17 percent more than Rs 2,500
• In Odisha, 60 percent of households belong to the lowest wealth quintile, while it is just 5 percent in Kerala, Punjab and Himachal Pradesh
• About two-fifths have BPL card
• About 27 percent had outstanding loans and 13 percent took loan for health care
• Around 16 percent receive financial transfers from their children, relatives or others, of which 96 percent are from within India
• 50 percent elderly are without formal education. Among women, it is higher – 66 percent
• 60 percent are married; 38 percent widowed. Widowhood is 59 percent among elderly women
• On average, 4 children were born to married women, of whom 3.5 surviving

Work and income status
 

• Almost 39 percent elderly men and 11 percent women are working. The majority is in 60 to 69 age group but among the oldest (80 and above), 13 percent men and 3 percent women work
• 71 percent work because of economic necessity, and not by choice
• More than 80 percent workers are main workers
• They work primarily in unorganized sector where productivity and pay are low
• Less than 10 percent (15 percent men, 3 percent women) get employer’s pension
• Nearly 75 percent elderly men and a little less than 50 percent elderly women have some type of personal income – substantial portion being from agriculture or wages
• 75 percent are fully or partially dependent on others to meet their economic needs
• More than 50 percent with own income contribute to household budget
• Significant proportions of elderly own assets (land, housing, jewellery or savings), the magnitude of ownership is marginal
• Inheritance is a significant way of acquiring wealth in rural areas, in urban areas wealth is usually self-acquired

Living arrangement and familial relations
 

• About 80 percent co-reside with spouses and children and in some cases, other relatives
• One in 10 elderly woman live alone
• Only 0.3 percent prefer living in old age homes
• About 25 percent of elderly receive money transfers from non-resident children and 8 percent elderly transfer money to their children
• 10 percent of elderly are subjected to abuse – verbal, physical, emotional or other. Abuse is higher in rural areas
• Source of abuse: From outside the family for elderly men and from within for elderly women

Well-being, health care
 

• Self-rated health analysis show about 55 percent rating their health as poor or fair on a 5-point scale
• Mental health status measured show nearly 50 percent require further health assistance to understand their health status
• Over 5 percent have serious functionality issue; nearly 50 percent have problems of vision
• 30 percent have risky health behavior (more men than women) – smoking, chewing tobacco or drinking alcohol
• Nearly 66 percent suffer from at least one chronic ailment – arthritis, hypertension, diabetes, asthma and heart disease
• Women have higher prevalence rates of chronic condition and more likely to suffer from arthritis, hypertension and osteoporosis
• Men are more likely to suffer from heart disease, skin and renal diseases
• More than 90 percent sought treatment for acute ailments, with about 40 percent each from public and private healthcare facilities (90 percent in Odisha depend on public care while 78 percent in Punjab on private healthcare). Financial insecurity remains the most common reason
• 10 percent were hospitalized in the year prior to survey, with a higher (10 percent) men than women (8 percent). Rates varied from 19 percent in Kerala to 6 percent in Punjab
• Hospitalisation is equally distributed between private and public care but women were more likely to use free care while men relied on private care
• Burden is substantial with Rs 1,000 spent for each episode of outpatient care
• Out of pocket expenditure for hospitalization (Rs 11,177 per episode) is a cause of concern with private hospital expenses nearly double that of public hospitals

Awareness and utilization of social security system
 

• More than 70 percent aware of pension schemes but only 40 percent know about Annapurna scheme
• More than 85 percent in Himachal Pradesh, Kerala, Punjab and Odisha are aware of pension schemes while it is lowest in case of West Bengal
• Only 18 percent of elderly belonging to BPL households are beneficiaries of pension scheme but only 3.5 percent utilize Annapurna. Only 25 percent women utilize the national widow pension scheme
• Only 40 percent are aware of concessions in train, bus tickets; 20 percent know about preference in phone connections and higher interest rates on small savings; 13 percent aware of income tax benefits; 30 percent know of MNREGS
• 9 percent use train, bus concessions and negligible in case of other facilities
• 14 percent are aware of national health insurance scheme (RSBY) and only 7 percent BPL households have registered under it

Recommendations

• Opportunities need to be provided for improving socio-economic status and access to healthcare
• Extension of social pension and health insurance to women
• Stronger inter-generational bonding needs to be encouraged and at community level, a greater involvement of elders in decentralized bodies
• Effective implementation of national policy and programmes and adequate resource allocations for physical, financial and human resources for well-being of the elders
• NGOs and private sector be engaged in creating elder friendly environment
• Data and research gaps in understanding issues of the elderly needs to be undertaken within the cultural context and appropriate monitoring system have to be put in place

A draft National Policy for Senior Citizens, 2011, is currently pending with the government. Hopefully, when the cabinet takes it up for approval, adequate attention is paid to the issues flagged off by UNFPA.