Table Of ContentS. Irudaya Rajan
Udaya S. Mishra
Senior
Citizens
of India
Emerging Challenges and Concerns
Senior Citizens of India
S. Irudaya Rajan Udaya S. Mishra
(cid:129)
Senior Citizens of India
Emerging Challenges and Concerns
123
S. IrudayaRajan Udaya S.Mishra
Centrefor Development Studies Centrefor Development Studies
Ulloor, Medical CollegeP.O. Ulloor, Medical CollegeP.O.
Thiruvananthapuram, Kerala, India Thiruvananthapuram, Kerala, India
ISBN978-981-15-7739-0 ISBN978-981-15-7740-6 (eBook)
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Contents
1 Prologue to Ageing Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 The State of Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.3 The Knowledge Pool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.3.1 The National Sample Survey, Round 60, 2004 . . . . . . . . 4
1.3.2 The National Sample Survey, Round 71, 2014 . . . . . . . . 4
1.3.3 The LASI Pilot Survey 2010 . . . . . . . . . . . . . . . . . . . . . 5
1.3.4 The LASI Survey 2016 . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.3.5 The Indian Human Development Surveys,
I (2004) and II (2011–12). . . . . . . . . . . . . . . . . . . . . . . . 6
1.3.6 SAGE Waves 0(2002–2004), 1(2007–2010),
2(2014–15), and 3(2018–19). . . . . . . . . . . . . . . . . . . . . . 6
1.3.7 The Longitudinal Kerala Ageing Survey I
(6 Waves)—2004, 2007, 2010, 2013, 2016 and 2019. . . . 7
1.3.8 The Longitudinal Kerala Ageing Survey II
(3 Waves)—2013, 2016 and 2019. . . . . . . . . . . . . . . . . . 8
1.3.9 Kerala Institutional Ageing Survey (KIAS) 2006 . . . . . . . 8
1.3.10 Building a Knowledge Base on Population Ageing
in India (BKPAI). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.3.11 The National Family Health Surveys I (1992–93),
II (1998–99), III (2005–06) and IV (2015–16). . . . . . . . . 9
1.4 Organization of the Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1.5 Summing up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
2 The Demographics of Ageing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2.2 The Magnitude. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
2.2.1 Persons Aged 60 Years and Above. . . . . . . . . . . . . . . . . 24
2.2.2 Nonagenarians and Centenarians. . . . . . . . . . . . . . . . . . . 32
v
vi Contents
2.3 Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
2.3.1 Age Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
2.3.2 Sex Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
2.3.3 Sex Ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
2.3.4 Rural–Urban Distribution . . . . . . . . . . . . . . . . . . . . . . . . 45
2.4 Measures of the Ageing Process . . . . . . . . . . . . . . . . . . . . . . . . . 55
2.4.1 Broad Age Structure. . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
2.4.2 Median Age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
2.4.3 The Index of Ageing . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
2.4.4 Dependency Ratios . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
2.5 Social and Economic Dimensions . . . . . . . . . . . . . . . . . . . . . . . . 68
2.5.1 Literacy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
2.5.2 Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
2.5.3 Economic Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
2.5.4 Living Arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
2.6 Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
3 Economic Dependence and Physical Disability: Supporting
Mechanisms and Coping Strategies. . . . . . . . . . . . . . . . . . . . . . . . . . 119
3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
3.2 Conceptual Framework. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
3.3 Economic Dependency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
3.4 Disability of the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
3.5 The Double Burden: The Co-existence of Economic
Dependency and Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
3.6 Supporting Mechanisms and Coping Strategies. . . . . . . . . . . . . . . 150
3.6.1 Public and Private Health Interventions. . . . . . . . . . . . . . 153
3.6.2 Family-Level Intervention. . . . . . . . . . . . . . . . . . . . . . . . 163
3.6.3 Self-efforts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
3.7 Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
4 Morbidity, Health Care and Health Interventions . . . . . . . . . . . . . . 173
4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
4.2 Conceptual Framework. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
4.3 Morbidity Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
4.3.1 Chronic Morbidity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
4.4 Health Care and Utilization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
4.5 Health Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
4.6 Recommendations and Insights . . . . . . . . . . . . . . . . . . . . . . . . . . 211
4.6.1 Summing up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Contents vii
5 Policy, Programmes and Welfare Schemes . . . . . . . . . . . . . . . . . . . . 221
5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
5.2 The National Policy for Senior Citizens. . . . . . . . . . . . . . . . . . . . 223
5.2.1 Areas of Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
5.3 Welfare Schemes/Programmes. . . . . . . . . . . . . . . . . . . . . . . . . . . 237
5.4 Schemes in Banking and Tax Department . . . . . . . . . . . . . . . . . . 239
5.5 Employees’ State Insurance (ESI) Act 1948. . . . . . . . . . . . . . . . . 240
5.6 Establishments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
5.7 Summing up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
6 Unexplored Facets of the Elderly: Kerala Ageing
Surveys—A Longitudinal Enquiry . . . . . . . . . . . . . . . . . . . . . . . . . . 245
6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
6.2 Kerala Ageing Survey I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
6.3 Kerala Ageing Survey II [W1 (2013), W2 (2016)
and W3 (2019)] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248
6.4 An Exploration of the Kerala Ageing Survey First Set . . . . . . . . . 249
6.4.1 Diseases Among the Elderly and Household Patterns. . . . 250
6.4.2 Falls Among the Elderly. . . . . . . . . . . . . . . . . . . . . . . . . 251
6.4.3 Falls in 2004: Alive or Dead . . . . . . . . . . . . . . . . . . . . . 252
6.4.4 Subjective Well-Being Inventory (SUBI). . . . . . . . . . . . . 252
6.4.5 Panel Data Analysis of Subjective Well-Being. . . . . . . . . 253
6.4.6 General Health Questionnaire (GHQ) . . . . . . . . . . . . . . . 254
6.4.7 Causes of Death Among the Elderly in 2004 Survey . . . . 255
6.5 Exploration of the Kerala Ageing Survey Second Set . . . . . . . . . . 256
6.5.1 Handgrip Measurements Among the Elderly . . . . . . . . . . 256
6.6 Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
7 Recommendations: New Emerging Areas and Unexplored
Avenues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
7.2 Major Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264
7.3 Strategic Insights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
7.4 Unexplored Areas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
7.5 Summing up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
About the Authors
Prof. S. Irudaya Rajan is Professor at the Centre for Development Studies,
Thiruvananthapuram, Kerala, India. He was the President of the Association of
Gerontology (AGI, India) as well as Kerala Economic Association (KEA). He has
close to four decades of research experience and has published extensively in
national and international journals on social, economic, health and demographic
facets of population ageing. He is the lead author of the book India’s Elderly:
Burden or Challenge? (1999) and has edited the books Social Security for the
Elderly: Experiences from South Asia (2008); India’s Aged: Needs and
Vulnerability (2017); Elderly Care in India: Societal and State Responses
(Springer, 2017) and Abuse and Neglect of the Elderly in India (Springer, 2018).
Professor Rajan has been involved in several projects on ageing funded by the
United Nations (UN), United Nations Fund for Population Activities (UNFPA),
World Bank (WB), International Labour Organization (ILO), HelpAge
International,SouthAsianNetworkofEconomicInstitutes,Indo-DutchProgramon
Alternatives in Development (IDPAD), Shastri Indo-Canadian Institute and
International Development Research Centre. He has also undertaken considerable
researchoninternationalmigrationandistheEditoroftwoseries–IndiaMigration
Report and South Asia Migration Report. He is the Founder Editor-in-Chief of the
international journal Migration and Development.
Prof.UdayaS.Mishra isaStatistician/DemographerservingasaProfessoratthe
Centre for Development Studies, Thiruvananthapuram, Kerala, India. He is
engaged in research and teaching on population and development issues and has a
number of national and international publications to his credit. He has served in
various capacities of guiding scientific research in social sciences. During his two
and a half decades of teaching and research experience, he has contributed in the
areas of ageing, health, nutrition as well as population policy and programme
evaluation. His research interests include measurement issues in health and equity
focus in evaluation of outcomes.
ix
Chapter 1
Prologue to Ageing Research
Abstract The dimensions of ageing research and the challenges senior citizens in
India face form the rationale behind both the present study and the significance of
thisbookinthecontemporaryworld,particularlyinthemidstofthevastknowledge
ofgeriatricresearch.Specifically,theawarenessoftheplightofseniorcitizensand
the major data sources available in the country regarding this segment of the
population are the two aspects explored in this chapter. The gaps in the present
knowledge pool and the ways to plug some of these loopholes using the infor-
mation available are also discussed. Finally, a brief description of the contents of
the book is enclosed to convey a comprehensive idea of the work.
1.1 Introduction
Accordingtothepopulationprojectionsmadebytheauthorsofthiswork,Indiahas
around 136 million people who crossed the age of 60 in 2020. They constitute
nearly10%ofthetotalpopulation(RajanandSunitha2015).Thisbookisaboutthe
status of older individuals, the analysis of which exposes multiple facets of the
phenomenon of ageing and its evolving dynamics in various states in India.
Ademographicaccountoftheelderlypopulaceservestoelaborateonaspectssuch
as health, dependence and disability as well as the living arrangements. The
demographictransitionthatcausedtheshiftfromayoungerpopulationtoanelderly
onepresentswide-rangingandcomplexhealth,socialandeconomicchallengesthat
willintensifyinthefuture(Kavita2018;Kumudini1996;Rajanetal.1999;Liebig
andRajan2003a,b;Sahooetal.2009;JohnsonandRajan2010;MishraandRajan
2017; World Bank 1994, 2011; James 2011; Gridhar et al. 2014).
Thestructuralchangesindemography,ifnotperceivedandactedupon,canhave
far-reaching effects on the future planning and perspectives of any nation (Bose
and Shankardass 2004; Rajan 1989; Rajan and Zachariah 1998; Lamb 2000;
Cohen 1998; Raju 2017). The massive challenges of a growing burden of
non-communicable diseases withtheir inherent differential features, along with the
needs and vulnerabilities of an increasing female older population and income
©SpringerNatureSingaporePteLtd.2020 1
S.IrudayaRajanandU.S.Mishra,SeniorCitizensofIndia,
https://doi.org/10.1007/978-981-15-7740-6_1
2 1 ProloguetoAgeingResearch
insecurity,canposeserious threatstoeconomic and social well-being (Rajan etal.
1995, 1996, 2000, 2001, 2003; Rajan 2008; Bhat 1992).
While such an account of emerging concerns regarding the rising magnitude of
the elderly population is not rare, this book may be different on numerous counts.
Here, the elderly population is accounted for beyond the individual domain to that
of the household and much of the analysis is done in a dynamic manner to
accommodate a life course perspective of the ageing process. Obvious conditions,
includingthe deterioration in health, disability and dependent status of the elderly,
are notleft out (Prasad 2007, 2010; Sreerupa etal. 2018;Rajan 2004, 2006, 2007,
2010;Alam2006;Lamb2000).However,thescrutinydifferentiatestheseelements
undervariedaspectssuchashouseholdconditioning,genderdynamicsandregion,
all of which provide a better understanding of the patterns of demographic trends.
TheinformationsetobtainedfromperiodicNationalSampleSurveys(NSS)and
thedecadalcensushasbeenputtousetoofferawiderandenrichedappreciationof
the demographic reality evolving in India. This exercise that manifests a truly
Indianexperiencehasitsownshareofimplicationsforcountriesinthedeveloping
regionsoftheworldaswell.Thedevelopednationshavebeenconfrontedwiththe
issue of population ageing. The strategies and policies of the governments con-
cerned to that effect have been in keeping with thepaceofageing that is slow and
gradual. Nevertheless, the similar process is rather rapid in developing countries
like India which lacks adequate recognition and preparedness in terms of policies
andprogrammes(RajanandKumar2003;RajanandMishra2014).Thisstudyaims
to provide an insight into this phenomenon, which has simply been described as
alarming without taking into consideration the inevitable reality with optimism.
1.2 The State of Affairs
In India, the declining fertility, reduction in mortality and augmented life expec-
tancy significantly contribute to population ageing. This scenario has significantly
changed the age structure of the populace in a manner that is highly favourable to
elderly groups. When compared with the younger cohort, the rising hump in the
numberofolderindividualscanbeseeninthecountry’sagepyramids.Meanwhile,
the increase in the old age dependency ratio raises the concern that the nation is
moving into a growing scarcity of resources regarding public intervention pro-
grammes, including old age pensions and health care.
Manyissuescropupintheconceptualizationandexecutionofageingresearchin
India.Thebasicdefinitionofageinginthecountryisinitselfdebatable(Rajanand
Mishra1995).Istheconceptofageingonthebasisofretirementfromajobreallya
viable optionfor planningandbuildingstrategies for seniorcitizens? The question
iscrucialinthecontextofthehighunemploymentratesandlackofadequatesocial
security measures that has prevailed at this time, irrespective of non-working or
working people in the unorganized sectors in India. Meanwhile, a considerable
section of older persons work in the informal sector without retirement and are
