17. Entertainment, hobbies, computers & travel
Learn to find the things in life that keep you entertained, happy and make your life interesting and enjoyable. It could be your passion for a game of cards with friends, listening to your favourite music, your interest in pets or cooking up lip-smacking dishes.
Here are a few hints: · Its never too late to take interest in a hobby. The only requisite is that you should find it interesting. · Go to a bookstore and browse the books on all subjects that you think might interest you. This is a good way to pick up a hobby. · Search for like-minded people, clubs and activities. The Internet is a great place to do this. · If you have a lot of knowledge in your favourite hobby, approach schools and colleges to encourage youngsters to start a club. Offer your services to educate them on this.
· Set aside some time to pursue your interests. This will make you look forward in anticipation and keep your spirits alive. · Social service can bring a lot of. satisfaction and sense of achievement. See if there is a club near you where you can offer to do some service. Better still, start a club. You might not get a good response initially, but never give up.
BOOKS
Books are great companions. They provide food for thought, entertainment, humour, education and much more to anyone who befriends them, Seniors, especially those who were voracious readers in their younger days, find that books are their best companions, in spite of the varying entertainment provided by television and the media.
TRAVEL
It is common practice in India for the elderly to go on a pilgrimage, or visit their children who live far away. This is a nice way to spend one’s time. The elders not only get spiritual satisfaction but also a lot of happiness when they are able to bond with their grandchildren.
COMPUTERS
The very attitude of neglecting to learn something because one is old is wrong and this is more important where computers are concerned.
Computers can be used by elders for. · Sending and receiving e-mail · Communicating with their children and grand children · Making new friends and interacting with like-minded people. · Reaching their business contacts. · Using the Internet for information or entertainment. · Storing all information relating to investments, insurance, etc. · Day to day accounts • Copies of important documents Computers are user friendly and elders can easily learn to use year old knows to use the
e-mail and the Internet. One can take help of someone who is familiar with tile use of computers or join a computer class offering the basics. It will just take a few hours of practice to familiarise oneself.
18. The Second Career
Unlike in the US, Europe and other developed countries, where the social security system and health services take care of the retired elderly, the resources in India both from the government and the private sector is very limited to provide the elderly many basic benefits like health care, food, housing and insurance. Many children of this generation are sadly neglecting the need of their parents. In fact the joint family system has broken down leading the youngsters to stay away from their parents most often letting the elders to fend for themselves. Many of the retired Indians have invariably borrowed heavily on their retirement funds to conduct their daughter’s marriage or for some such expenses, which they are not able to pay back.
For all these reasons it is up to the elderly to find a definite source of income for themselves. And what better to do it than find a comfortable job ?
But a second career is not for economic reasons alone. It keeps the elderly physically and mentally occupied, and in turn helps them to lead an active life. It also increases their self-confidence and self-esteem. So even those who are financially comfortable can decide to take up career and enjoy the benefit of healthy living.
While a “quiet life” may seem an excellent idea for people who have worked all their lives, most of the elders cannot remain idle and sit back after a while. Moreover, the invaluable benefit of being in good health by keeping the body and mind busy, cannpt be over emphasised.
So, to work or not is an individual decision that will have to be taken depending on one’s own desire and circumstances. The work need not be necessarily a paid job. It could even be voluntary service or work rendered by a neighbourhood association. One could teach music or hold cookery classes. There is no doubt that a person who is active remains sound in body and mind.
Unfortunately, the jobs open to most elders are limited. It is for the society to recognise this and make available more jobs for the elderly. The Central and State governments should took at this growing elderly population and make available those kind of jobs that ‘Senior Citizens can handle comfortably.
One should learn to adjust with society and accept some limitations. The job available may not be exactly of the same status as when one was younger. But it is the dignity of work that matters.
You can browse through the classified advertisements and appointment ads in the local dailies for a suitable opening or insert an inexpensive ad in the classified columns of the local dailies offering your services (Free Ads and AD Mag will publish your ad without any charge).
19. Money Matters
Most often, after their retirement the elders in India have no income at all. In the villages the conditions are worst. About 37.5 percent of the total Indian population is in the work force in one way or the other. Out of this only about 11 % is covered under institutionalised Provident fund/pension schemes (35 million), the remaining 89% remains uncovered without any social security provision . Even those persons who are getting pension will have to be careful since it is doubtful whether the government can pay pension for long. At present, the government spends Rs. 29,000 crores on pension. This expenditure is going to rise and soon match with half the salaries bill of the employed population. This spells danger to the financial structure of the nation. The government is considering this very deeply. It will not be surprising if the pensioners have to face ‘golden handshake’ schemes in the near future. Many other schemes are also being considered. There will be some schemes in which the employees will have to contribute a part of their salaries for the pension.
Earlier the interest rate on deposits had risen up to 16%. Now, the rates have fallen down up to 8% and will be brought down further to 5 to 6%.
It is for these reasons that the senior citizens have to form a policy for the management of their finances, taking into consideration that they are going to face heavy reduction in their income. For this, they will have to have a very clear idea of their financial· expectations and responsibilities.
FINANCIAL EXPECTATIONS:
· Regular income suitable for economic stratum.
· Provision for unexpected and accidental occasions.
· Should be able to take care of financially dependent persons.
· Provision for daughter’s wedding.
FINANCIAL RESPONSIBILITY:
· One must pay proper income tax.
· One must take full care when investing money. Economic safety should be the prime consideration
· One must make financial provision for the spouse and other dependents so that they will be looked after even after one’s death. For this purpose, the spouse must have full knowledge of the financial matters.
Some elderly persons can stay with their children after their retirement. Thus the burden of their expenditure is lightened to some extent. But this arrangement is becoming increasingly inconvenient because of nuclear family system coming into practice. In short, it is essential that one must be self-reliant.
The following basic financial needs to be taken care of as one gets older.
FIXED EXPENSES:
House rent, house tax, repairs of the house, gas, electricity, servant’s salary, vehicle insurance, medical expenses, religious expenses (Deepavali, Xmas, Ramzan, etc.)
CHANGING EXPENSES:
Food, clothes, traveling, small repairs, contributions, post, telephone, etc.
The amount spent on these necessities is based on one’s financial status and lifestyle. One gross way of determining the financial status of a family is to delete one-third amount from the joint annual income of a couple and observe the style in which the couple lives in the two-third of the income. This decides the financial status of the couple. If the saving habit has been neglected in the period of employment, it will have to be followed in the retirement period and one-third of the annual income will have to be saved. In the present times of loan culture, wrong decisions are taken under the irjJluence of attractive advertisements. Essential safety measures like living with one’s means, monthly savings, etc. are not undertaken arid people find them selves facing economic disaster. A survey has found that most of the senior citizens become a financial liability to the succeeding generation, within a couple of years after their retirement. There might be some other reasons also for this. Some of the common problems faced by the senior citizens are mentioned below and they should get the correct information to avoid them: ·
Ups and downs in the existing share market take place so fast that it is becoming difficult for the senior citizens to follow them and indulge in the market. Sometimes the dealings in the share market can prove to be dangerous for the common senior citizen. The same holds true with equity schemes of mutual funds. Only constant transactions can bring benefits in these two areas but age prevents the senior citizens from doing so.
Some finance companies, industries pay more interests. But chances are that these might be risky and illegal too. Common man who cannot probe deeply into these schemes, falls a prey for them and loses even the invested amount. Some private and cooperative banks al~o offer higher interest rates, but it is essential to be cautious there also .
Some senior citizens hand over their earnings and movable and immovable properties to their sons in their lifetime, and become financially dependent on them. In these circumstances, the death of the husband can raise many problems for the wife and she can be made to lead a humiliated life.
· Ignorance of Income tax rules prevents many persons from taking proper decisions.
· They cannot increase their earnings. Some have to pay fine on income tax unnecessarly. Some avoid paying income tax altogether, which is not only improper but illegal too.
· The failure to make a Will can cause tremendous loss for the person and his spouse and humiliation follows.
· Women generally avoid learning and looking after financial management. So they face numerous problems and humiliation after the death of their husbands.
INVESTMENTS
The decisions about investment vary according to the individuals. The decisions are taken in accordance with the condition, needs and wishes of every individual. But one thing is common - none of them is prepared to take risk and yet many investors are cheated. They lose their entire money as they do not anticipate this failure.
Before making any investment two vital points need to be considered, one is how much risk of losing money is involved and the other is how much return can be expected from it. Increasing age makes us less prepared to face risk and lose money and we turn to safe/reliable investments. But risk and returns go hand in hand. It is better to reject attractive offers of large returns on
One should try and avoid eating into the capital but try to increase it if possible. The following guidelines will be useful
DO’s
· Take all the decisions only after full consideration. Study the information available about each investment very carefully.
· Keep a diary about the maturity dates and renewals of deposits/investments.
Keep a check on interest received.
· Consult an expert whenever necessary.
· Keep all certificates, notices, etc. In a safe place well outside the reach of anybody.
· Keep the originals of all important papers in bank lockers.
DON’TS
· Avoid flock mentality - Do not invest in schemes without proper consideration, just because many people, friends, relatives are doing the same.
· Do not take any decisions because the commission, brokerage or reward is attractive.
.Do not be dazzled by the name of a big company or an individual and believe blindly that the schemes they have launched must be good and invest in it .
· Do not be carried away by a flood of emotions. Be courageous and say No.
These are some suggestions for managing your income and living within your means:
1. THRIFT: Maintain a diary to record your daily expenses under various items, take yearly stock and decide on avoidable spending. You could cut down on items like giving presents, entertainment and eating out expenditures
2. GOOD HEALTH: Regular exercises and proper diet help to preserve good health and reduce the chances of falling ill. Thus medical expenses can be saved. Regular medical check-ups with doctor’s advice and proper care can go a long way in saving medical expenses.
3. MIGRATION: Instead of living in costly cities like Bangalore, Chennai, Mumbai, one can migrate to smaller towns. One can even think of selling the flat or house and buy a smaller and cheaper house in small town and use tlle savings in investments towards a regular income.
4. COMMUNITY LIVING: In this scheme, two or three lonely couples or persons could come together. and stay under one roof and maintain themselves by pooling together a part of their income, This will help reduce the expenses of everybody. And everyone will get good support from each other in the times of difficulty.
5. COMMUNITY BUYING: If three or more senior couples form a group and purchase fresh vegetables, fruits, daily necessities from wholesale market, they can save a lot of expenses. The couples can take turns in doing the marketing and make it a weekly or fortnightly affair.
6. MEDICARE: LICs Scheme like “Nav Prabhat” and “Senior Citizens’ Unit Plan (SCUP)” from UTI offer risk and medical care for senior citizens. Such schemes can protect seniorc citizens from expenses for prolonged illnesses, accidents, thefts, etc.
Classification of safety in investment is given below:
Signs indicating evaluation of credibility Utmost safety FAAA or MAAA High safety FAA or MAA Sufficient safety FA or MA Fair safety . FB or MB High risk FC or MC Company endangered FD or MD
20. Making Your Will
As one becomes older there is need to facilitate the easy disbursement of one’s possessions and properties to one’s loved ones and dependents, so that there will be no legal battles among them. For this reason it is advisable that everyone with some property or wealth should prepare a “WILL’
A “Will” can be defined as “A legal statement written by an individual, stating the manner in which his or her wealth may be distributed after his or her demise” A , person making a Will is known as a “Testator”.
It is best that one consults an advocate before preparing a Will. It would be better if the advocate is a person in whom you have the’ utmost confidence.
Here are some guidelines to prepare a WILL:
· It is better to make a Will at a younger age. As and when events or changes in the family or circumstance necessitate changes, the Will can be altered. One of the advantages of making a Will at an earlier age is that unscrupulous relatives could contest the legality of the Will made by a very old person on the basis that the person was not of sound mind when the Will was made.
· A Will must always be dated. If more than one will is made then the 0ne having the latest date will nullify all other wills.
· A Will should be Simple, Precise and Clear Otherwise there may,be problems for the legal heirs. Sometimes relatives and others may try to distort the interpretation of the Will for their own benefit.
· A Will can be hand-written or typed out. No stamp paper is necessary.
· There should be an “Executor of the Will” who would be entrusted with the responsibility of ensuring that the assets are distributed according to the provisions of the Will. The Testator (person making the Will) should take prior consent of the person whom he or she wishes to name as the Executor.
· A Will should be signed by the Testator in the presence of at least two witnesses who have to attest the same. The full names and addresses of the witnesses should be clearly indicated in the Will. It would be better if one of the witnesses is a medical practitioner, but this is not essential. The practitioner should certify that the Testator is of sound mind (especially if the Testator is of an advanced age) and he or she should also note his or her registration number and degree (educational qualification). A witness should not be a beneficiary of the Will. A witness should also not be an Executor of the Will.
· Each page of the Will should be serially numbered and signed by the Testator and the Witnesses. This is to prevent substitution, replacement or insertion of page by persons with fraudulent intentions. At the end of the Will the Testator can indicate the total number of pages in the Will. Corrections if any should be countersigned.
· The Will may be kept in a safe place like a bank vault. The Executor. and the beneficiaries should be informed where the Will is kept. It is advisable to keep a signed copy of the Will with a trusted advocate. · .Sometimes the value of certain items of the assets (example: value of share certificates) may fluctuate. In such situation, it is better to mention percentage of such item/s which should go to each beneficiary. · .Whenever changes in the f~mily circumstances or other reasons necessitate any changes in the Will in the intervening period (from the time of making the Will to the time of demise of the testator), the structure of the will can be amended. Even if there are changes in the nature of the property or assets, an Amendment may be needed.
· For making changes only in certain clauses of the Will, a Codicil (supplement’) is to be prepared which should be read in conjunction with the Will and which has the power to make appropriate changes in the relevant clauses of the Will.
· If there are too many changes in the Will, it is better to prepare an entirely new Will. · It is not compulsory for one to register a Will with the registering authority, but in case any property or asset is given to any charitable Organisation, then registration should be done.
· A person’s Will becomes operative only after his or her demise. There is no restriction in the way a person can deal with his or her property even after writing a Will.
Acknowledgements
1. Dr. Indira Jai Prakash, Bangalore University. a. Aging - The Indian Experience. b. Psychological Gerontology.
2. Dr. G. D. Thapar, M.D. - Life After Fifty.
3. Dr. V S. Natarajan - a. Healthy Ageing b. Ageing India: Problems and solution.
4. S. Vijaya Kumar - Social Security for the Elderly in India.
5. Seniorindian.com.
6. Sreevals and P S. Nair - Elderly and Old Age Homes in Kerala.
7. S. Narayanrao, B.E. - Yoga for Senior Citizens.
8. Senior Citizens Forum, Pune - 7th Seminar Report.
9. Book of Life.
Tuesday, August 26, 2008
The Elderly - Part III
14. Common Ailments in the Elderly
The structural and functional changes with advancing years is the ‘ageing process’. The theories for ageing as per Gerontologists are loss of irreplaceable cells, production of unsound cells, limited capacity for division and accumulation of waste products. Due to structural changes most organs tend to become smaller in size but some like prostate may increase in size. In the same individual different organs age at different periods. It depends on how much an organ is insulted. Ageing process sets faster in lungs than the other organs in a chronic smoker. Economically poor and those adopting irregular habits in younger age, age prematurely. Functional changes of most organs on the decline will not affect healthy to a great extent. There is decrease in gastric secretions, sluggish colonic movements, reduction in kidney function and decline in hormone functions.
Certain benign changes which can be effectively tackled are cataract, deafness, abnormal taste, dry skin pigmentation and growing of facial hair in women. The old person is prone to develop multiple diseases due to degeneration (arthritis), Infection (pneumonia), neoplasms (cancer) and miscellaneous conditions (obesity, nutritional deficiency, etc.).
The more common ailments, their prevention and treatment is outlined below:
If the blood pressure goes above 160/95 mg. in a person of 60 years or above it is Hypertension. more common in urban (40%) than in rural (18%) elderly. It may be silent or with symptoms like headache, giddiness, breathing difficulty, swollen legs or chest pain. If untreated, it may lead to heart attack, stroke, kidney failure or eye problems. Once diagnosed, mild to moderate hypertension can be treated by regular exercise, nonsmoking, less salt intake and meditation. If not drugs control blood pressure. Homeopathy is also effective in controlling Hypertension.
Familial obesity, restricted activity, mental stress and drugs like steroids result in another common disease, Diabetes Mellitus with ultimate complications like loss of vision, kidney failure, heart attack, stroke or tingling and numbness in limbs. The diagnosis is confirmed when fasting blood sugar is above 120 mg and post prandial blood sugar (1-12 hours after meal) is above 160 mg. When diet restriction and exercises fail, then drugs or insulin keep blood sugar under control with minimal interference to quality of life.
Obesity is more harmful to men than women and obese people are prone to arthritis, hypertension, diabetes, raised cholesterol, gallstones, falls and fungal infections, etc. Restricting calories intake to 1000 cal per day and regular exercises are the solutions.
Heart Attack occurs when blood supply to heart is reduced. In 1/3rd of patients, the symptoms are seven excruciating central chest pain spreading to left side of arm or sides of neck associated With profuse sweating and vomiting. In rest of them, it may be indicated by gastric problem, sudden extreme weakness, breathing difficulty or mental tension. ECG, ECHO, treadmill and coronary angiogram confirm the attack and is managed medically and if not, by coronary angioplasty or bypass surgery. Abstinence from smoking, reduction 0f overweight, control of diabetes, BP and high cholesterol and avoiding sedentary habits, stress and strain prevent heart attack. An intake of 150 mg Aspirin after the meal is advisable under medical supervision.
When the blood supply to the brain reduces, one side of the body faits to function and results in paralysis. A block, clot or bleeding from any artery may reduce blood supply due to hypertension, diabetes mellitus, smoking, high cholesterol etc. And on confirmation by brain CT scan, stroke has to be treated by management of risk factors and physiotherapy.
Due to too much of acidity or loss of mucousal resistance in stomach or upper part of small intestine, peptic ulcer is not uncommon in old age with complaints of stomach pain and blood vomiting. It can be diagnosed by endoscopy and treated medically or by surgery.
Want of fibre diet, disease of stomach and intestine, thyroid deficiency, mental depression, certain drugs, lack of exercises and less fluid intake lead to constipation affecting bowel movement. The complications are chest pain, giddiness during straining for stools, anxiety, hernia, varicose veins in legs and obstruction of intestine.
Constipation can be managed by increased fluid intake, exercises, drugs and high fibre diets like Ragi, Wheat, Bran, Greens, Banana Stem, Cabbage, Cauliflower, Bitter gourd, Dates, Mango, Papaya, Pepper, Coriander and Omum.
Obstructive Jaundice, more common than infective type, in old age is due to the obstruction of flow of bile from gall bladder to intestine due to gall stones, cancer of pancreas or drugs. Tests including ultrasonogram should be done without delay and treated early.
Tuberculosis commonly silent without cough, phlegm or blood in the phlegm, in aged is indicated by loss of weight, weakness or low grade temperature and is more common in diabetics and smokers. On diagnosis by chest X-ray and with modern treatment cure is possible within a year.
Lung Cancer should be suspected among chronic smokers when there is change of voice, persistent cough with rapid loss of weight and could be diagnosed by chest X-ray and bronchoscopy. Treatment by chemotherapy or surgery can be contemplated.
Arthritis are .of two types, Degenerative arthritis involving knee, hip back bone and neck bone are more common than Rheumatoid rtritis involving joints of hand and feet. Arthritis is managed by weight reduction, pain relievers, physiotherapy and surgery.
Urinary problems confronted by elders are frequent urination, scanty and burning urination associated with chills and fever due to enlarged prostate (only in males), infection, diabetes and drugs. Appropriate antibiotics are prescribed as treatment.
Secretion of less or excess hormone causes Thyroid Disease. When the thyroid grand situated in front of the neck, secretes less hormone, the symptoms are lethargy, excess weight, dry skin and change of voice. When it seretes excess hormone it results in excess of appetite, weight loss, sweating, tremors of hand and prominent eye ball. On confirmation by hormone assay tests, the patient receives treatment.
Elderly people are more prone to Cancer. Men are prone to develop cancer of the mouth, stomach, lungs, rectum, liver and prostate and women to cancer of erus, breast, stomach, oesophagus and rectum. Warning signals for cancer are 1. Change in bowel or bladder habits 2. Sore throat which does not heal 3. bleeding or discharge 4, Lump in breast and elsewhere 5. Difficulty in swallowing 6. Change in mark or mole 7. Nagging cough 8. Progressive weight loss with anaemia.
Hernia, piles, hydrocele, intestinal obstruction/ perforation, gall stone, enlarged prostate, uterine mass, lump anywhere, fractures, gangrene, bleeding inside the brain are some of the. surgical problems which the elderly face. Age is not a contraindication for surgery but the risk and complications are more in old age.
Gradual decline of libido or sexual impulse is normal with advancing age but rapid decline may be due to diabetes, cancer, urinary problems, liver disorders and mental depression. Sexuality for the aged is a good thing for those who want it.
Depression is the commonest mental illness in the old age. These persons lose interest in life, eat less, lose weight, suffer from sleeplessness and constipation. They are vulnerable for suicidal attempts and need counselling and antidepressants. With the recent advances in medical therapy they can be cured and those who fail to respond require electro convulsive therapy. A mental illness of increasing inability to remember, to learn, to think and to reason known as Dementia may be due to Alzheimer’s disease in which lack of communication between brain cells due to damages or small clots affect blood supply to brain. The reason for this condition is not known and is often irreversible and progressive. The management is mainly supportive and symptomatic and the old person merits consideration, kindness and respect as a human being.
The word ‘Geriatrics’ was derived from the Greek word ‘Gerios’ (old age) and ‘iatros’ (medicine). Geriatrics is considered as a separate speciality because of difference in diagnostic, therapeutic and social problems. Psychological attitude of elders leads to diagnostic error on the part of doctor hindering early detections and prompt treatment. History taking in the elderly patients is beset with communic,ation barriers of mental impairment and deafness. They attribute problems to their age and tend to suffer in silence. Practical skill and experience are needed to obtain adequate histories in geriatric work. As regards therapeutic problems, elderly are more prone for drug side-effects. This is due to reduced lean body mass, diminished kidney function and altered organ sensitivity.
Since the elderly suffer from multiple diseases, multiple drug therapy is common which leads to more side-effects, drug interaction and omission. Elders should take drugs on the advice of doctors as side effects will be more serious than the disease itself. For healthy ageing, periodic health check-up, at least once a year, is essential. Many old age diseases are either preventable or treatable. Health check-up detects silent diseases, makes early diagnosis and prevents complications, Proper nutrition is vital for promotion of health and prevention of illness.
Quality of diet is more important than the quantity. The general guidelines are more fluid intake, inclusion of dietary fibre and at least one fruit and two glasses of milk. Aged are advised to have a heavy breakfast, moderate lunch and light dinner. Physical exercise is good for all ages, more so in old age. Regular exercise improves blood circulation in all organs to maintain normal function. It reduces obesity, cholesterol, BP, blood sugar, prevents constipation and promotes sound sleep. Consult your physician before choosing an exercise according to individual physical capacity. Brisk walking 3 to 5 Kms or 40-60 minutes in the morning on empty stomach and if possible in the evening too is advisable. Regular exercise and proper calcium intake in diet prevent loss of bone (osteoporosis) and other minerals from the spine which could lead to low back pain or fracture. Mild exercises performed daily to give full range of movement to all joints keep away arthritis. Periodic eye check to detect cataract or glaucoma, ENT check up to remove wax and defective hearing and dental check up as tooth decay affects general health are mandatory.
Mental health is as important as physical health in old age.Due to progressive loss of neurons the brain of a 70 year old person weighs only 56% when compared to its original weight. This results in mental depression, memory loss and anxiety. Brain atrophies and disuse and sensitivity is six times greater in those who have withdrawn from people and life. Loneliness leads to depression which may lead to death. For this right from middle age itself, one should plan for a hobby to keep onself occupied during old age. Hobbies like gardening, indoor games, meditation, bhajans, religious discourses, reading, interacting with others, etc. help the aged persons maintain a sound mental health and enable to age gracefully.
15. Exercises for the Elderly
Exercise is enjoyable, easily incorporated into your lifestyle, cost-free, and guaranteed to positively affect your health and longevity. If you did nothing else different, but incorporated some type of regular exercise into your schequle, you would ensure a life unencumbered by reduced energy and illness. Logic dictates that if exercise is beneficial and rejuvenates the body, then inactivity should accelerate the ageing process. Inactivity has been demonstrated to take a considerable toll on heart function, bones, the blood nerves, body composition, brain waves and the immune system in several studies. Given below are some simple exercises and regimens you could follow.
The following are some recommended strengthening and flexibility exercises. Do only those you feet comfortable doing. As your body adjusts to the new activities, you can gradually add more repetitions and other exercises. Start slowly with two-three repetitions of each exercise you choose.
Strengthening Exercises:
1. Finger squeeze: Strengthens hands; good for circulation. Straighten arms in front at shoulder level, palm down. Make a fist, then release. Turn palms up, make a fist and release.
2. Shoulder shrug:
Strengthens your back and shoulders, help relaxation. Lift shoulders up towards your ears, then back, down and relax.
3. Arm circles: Strengthens shoulders and upper back. Start with arms straight out to the side at shoulder level. Rotate arms from shoulders forward and then backward.
4. Shoulder touch: Increases flexibility of shoulders, elbows and helps tone upper arms. Start with arms straight out to the side at shoulder level. Bend elbow and bring palm of hands to shoulders. Turn palm away and push arm down to start position.
5. Leg flexion - extension: Strengthens hip muscle. Stand erect, holding on to a chair or table for support Lift one leg forward, then back from the hip. Be careful not to lean forward and back.
6. Side leg lift: Strengthens hip and thigh muscles. Stand erect holding on to a chair or table for support. Raise one leg to the side and down. Try not to lean or bring your leg forward. You can try this lying on your side, too. 7. Alternate leg lunges: Strengthens upper thighs and inside of legs. Also stretches back of leg. Start with feet shoulder-width apart. Hold on to something for support if you like. Step forward about 18" to 24" with right leg. Keep left heel on the floor. Shove off with the right leg and return to start position.
8. Calf raises : Strengthens lower leg and ankle. Start with feet shoulderwidth apart. Hold onto something for support if you like. Raise up on your toes, lifting heels. Slowly lower yourself back down to your heels.
9. Leg extension: Strengthens upper thigh muscles and tones lower abdomen Sitting in chair, back straight, knees bent, and feet flat on the floor tighten knee and raise foot up. Alternate with each leg.
10. Squat: Strengthens front thigh muscles. Start with feet shoulder-width apart. Hold on to the back of a chair for support. Keep back straight and slowly bend knees as if you are going to sit. Slowly return to start position. Do not go down too far This will improve as you get stronger.
11. Toe raises: Strengthens ankles. Standing or sitting with feet shoulderwidth apart, raise your toes up off the floor as if tapping to music.
12. Ankle circles: Strengthens ankles. Standing or sitting, make circles with each ankle, to the right and then the left.
13. Abdominal strengthening: Strengthens stomach muscles providing support for your back. Stand or sit straight. Take a deep breath in through your nose, then slowly exhale through your mouth as if blowing out a candle. Feel your stomach go in as you blowout. Hold stomach tight after blowing out, then relax and repeat.
14. Sit-up: Advanced abdominal strengthening. Lay on the floor with your knees bent and feet flat. Reach with your arms toward your knees, raising your head and shoulders off the floor You should readily feel your stomach muscles tighten. Slowly return head and shoulders to the floor Work up to doing five-ten repetitions.
Flexibility Exercises:
1. Neck circles: Maintains joint motion. Standing, or sitting in a chair, slowly move chin over to one shoulder and then to the other as if nodding “no”. Slowly lift your chin up slightly and back down toward your chest as if nodding “yes”. Repeat several times.
2. Flexed leg back stretch: Maintains flexibility in torso, low back, and legs. Stand with knees slightly bent and feet shoulder-width apart. Slowly and gently slide hands down front of legs, bringing finger tips toward the floor. You should feel a stretch in the back of your legs. Hold for the count of five when you start to feel the stretch. Stay within your comfort range - no more than five repetitions.
3. Side bends: Maintains trunk flexibility.Stand with feet shoulder-width apart. Slide right hand down right leg towards knee. Repeat to left side. Hold for five seconds; five repetitions to each side.
4. Trunk rotation : Maintains trunk flexibility. Stand with feet shoulder-width apart and knees slightly bent. Turn from your waist to the right, then left.
5. Back arch Stretches abdominal wall, chest, maintains flexibility. Do not do this exercise if you have a history of back problems. On stomach: Place hands by shoulders, slowly push up on arms and arch back. Keep hips down. Try to straighten elbows completely if back is comfortable. Return to stomach; three-four repetitions.
6. Overhead reach: Stretches shoulder girdle and rib cage. Take a deep breath in as you raise your arms overhead. Exhale slowly as you lower your arms behind your head or to your shoulders, then return to your sides.
7. Achilles stretch: Stretches the calf muscle. Stand facing a wall. with feet two-three feet away. Straighten arms, leaning into the wall. Move left leg forward 1/2 step, right leg backward 1/2 step or more. Keep right heel on floor Lean toward the wall with weight on forward Leg. Stretching the heel tendon of the right leg. Hold five-ten seconds; reverse legs; three-five repetitions.
8. Shin and quadriceps stretch: Kneel on both knees. turn to right and press down on right with right hand and hold.Keep hips thrust forward. Do not sit on heels. Repeat on left side.
9. Hip and thigh stretch: Kneel with right knee directly. Above right ankle and stretch left leg backward so knee touches floor. Place hands on floor or seat of chair for balance.
WALKING
After the age of 65 or so, the age of participation in active games should be considered over. The only suitable form of exercise at this age is walking which should be continued till the end. Walking provides many benefits of more strenuous activities, without much exertion. For this activity you can progress at your own pace, no equipment is required and you can walk alone or with friends.
The benefits of walking are: ·
.It promotes more restful sleep
.A reduction of tension and stress
Weight reduction. You burn up 320 calories per hour by walking 3 miles per hour For every 11 hours of walking you will loose one pound (3500 calories equals one pound)
·Walking improves circulation and is a good cardiovascular exercise. .Improves the ability to take in oxygen.
Tips for Walking:
· Walk with your head erect and your stomach in.
· Walk on your whole foot.
· Avoid walking when it is very hot or cold.
· Let your arms swing freely.
· Begin with a 15 to 20 minute walk and walk at a slower pace for the first several Minutes as a warm up.
Use comfortable shoes or footwear.
16.Yoga for the Elderly
“Yoga is skill in Action” states Bhagavadgeeta. This is to say, in addition to the skill to improve one’s body, Yoga also comprises techniques that act on one’s mind and emotions providing a “Complete philosophy of Living”. In simple words, practising Yogasana and Pranayama is to achieve good health, keep fit, mentally and physically to be able to cope with various turbulences of life and take up the challenge to go beyond them with renewed vigour.
Yoga is meant for almost anybody between the age of 8 to 80 years. Many examples of persons who have started Yoga as late as 69 years have achieved all benefits. Hence Senior Citizens are advised to practise Yoga. Padmasri Yogacharya B. K. S. Iyengar in more than 65 years of dedicated service has helped thousands of patients through Yoga therapy as a non-conventional medicine.
SVYAS has done a lot of scientific research at their unique centre “Prashanti Kutir” at Jigni, 20 kms from Bangalore under the guidance of medical specialists in allopathy and other systems of medicine and has evolved a capsule consisting of prayer, yogasanas, pranayamas, meditations to reach the needs of common man and accordingly have opened more than 50 Yoga training centres in Bangalore. Yoga has to be practised - whether Asanas, Pranayan1as, Meditations, etc. - under the guidance of a qualified Guru.
The structural and functional changes with advancing years is the ‘ageing process’. The theories for ageing as per Gerontologists are loss of irreplaceable cells, production of unsound cells, limited capacity for division and accumulation of waste products. Due to structural changes most organs tend to become smaller in size but some like prostate may increase in size. In the same individual different organs age at different periods. It depends on how much an organ is insulted. Ageing process sets faster in lungs than the other organs in a chronic smoker. Economically poor and those adopting irregular habits in younger age, age prematurely. Functional changes of most organs on the decline will not affect healthy to a great extent. There is decrease in gastric secretions, sluggish colonic movements, reduction in kidney function and decline in hormone functions.
Certain benign changes which can be effectively tackled are cataract, deafness, abnormal taste, dry skin pigmentation and growing of facial hair in women. The old person is prone to develop multiple diseases due to degeneration (arthritis), Infection (pneumonia), neoplasms (cancer) and miscellaneous conditions (obesity, nutritional deficiency, etc.).
The more common ailments, their prevention and treatment is outlined below:
If the blood pressure goes above 160/95 mg. in a person of 60 years or above it is Hypertension. more common in urban (40%) than in rural (18%) elderly. It may be silent or with symptoms like headache, giddiness, breathing difficulty, swollen legs or chest pain. If untreated, it may lead to heart attack, stroke, kidney failure or eye problems. Once diagnosed, mild to moderate hypertension can be treated by regular exercise, nonsmoking, less salt intake and meditation. If not drugs control blood pressure. Homeopathy is also effective in controlling Hypertension.
Familial obesity, restricted activity, mental stress and drugs like steroids result in another common disease, Diabetes Mellitus with ultimate complications like loss of vision, kidney failure, heart attack, stroke or tingling and numbness in limbs. The diagnosis is confirmed when fasting blood sugar is above 120 mg and post prandial blood sugar (1-12 hours after meal) is above 160 mg. When diet restriction and exercises fail, then drugs or insulin keep blood sugar under control with minimal interference to quality of life.
Obesity is more harmful to men than women and obese people are prone to arthritis, hypertension, diabetes, raised cholesterol, gallstones, falls and fungal infections, etc. Restricting calories intake to 1000 cal per day and regular exercises are the solutions.
Heart Attack occurs when blood supply to heart is reduced. In 1/3rd of patients, the symptoms are seven excruciating central chest pain spreading to left side of arm or sides of neck associated With profuse sweating and vomiting. In rest of them, it may be indicated by gastric problem, sudden extreme weakness, breathing difficulty or mental tension. ECG, ECHO, treadmill and coronary angiogram confirm the attack and is managed medically and if not, by coronary angioplasty or bypass surgery. Abstinence from smoking, reduction 0f overweight, control of diabetes, BP and high cholesterol and avoiding sedentary habits, stress and strain prevent heart attack. An intake of 150 mg Aspirin after the meal is advisable under medical supervision.
When the blood supply to the brain reduces, one side of the body faits to function and results in paralysis. A block, clot or bleeding from any artery may reduce blood supply due to hypertension, diabetes mellitus, smoking, high cholesterol etc. And on confirmation by brain CT scan, stroke has to be treated by management of risk factors and physiotherapy.
Due to too much of acidity or loss of mucousal resistance in stomach or upper part of small intestine, peptic ulcer is not uncommon in old age with complaints of stomach pain and blood vomiting. It can be diagnosed by endoscopy and treated medically or by surgery.
Want of fibre diet, disease of stomach and intestine, thyroid deficiency, mental depression, certain drugs, lack of exercises and less fluid intake lead to constipation affecting bowel movement. The complications are chest pain, giddiness during straining for stools, anxiety, hernia, varicose veins in legs and obstruction of intestine.
Constipation can be managed by increased fluid intake, exercises, drugs and high fibre diets like Ragi, Wheat, Bran, Greens, Banana Stem, Cabbage, Cauliflower, Bitter gourd, Dates, Mango, Papaya, Pepper, Coriander and Omum.
Obstructive Jaundice, more common than infective type, in old age is due to the obstruction of flow of bile from gall bladder to intestine due to gall stones, cancer of pancreas or drugs. Tests including ultrasonogram should be done without delay and treated early.
Tuberculosis commonly silent without cough, phlegm or blood in the phlegm, in aged is indicated by loss of weight, weakness or low grade temperature and is more common in diabetics and smokers. On diagnosis by chest X-ray and with modern treatment cure is possible within a year.
Lung Cancer should be suspected among chronic smokers when there is change of voice, persistent cough with rapid loss of weight and could be diagnosed by chest X-ray and bronchoscopy. Treatment by chemotherapy or surgery can be contemplated.
Arthritis are .of two types, Degenerative arthritis involving knee, hip back bone and neck bone are more common than Rheumatoid rtritis involving joints of hand and feet. Arthritis is managed by weight reduction, pain relievers, physiotherapy and surgery.
Urinary problems confronted by elders are frequent urination, scanty and burning urination associated with chills and fever due to enlarged prostate (only in males), infection, diabetes and drugs. Appropriate antibiotics are prescribed as treatment.
Secretion of less or excess hormone causes Thyroid Disease. When the thyroid grand situated in front of the neck, secretes less hormone, the symptoms are lethargy, excess weight, dry skin and change of voice. When it seretes excess hormone it results in excess of appetite, weight loss, sweating, tremors of hand and prominent eye ball. On confirmation by hormone assay tests, the patient receives treatment.
Elderly people are more prone to Cancer. Men are prone to develop cancer of the mouth, stomach, lungs, rectum, liver and prostate and women to cancer of erus, breast, stomach, oesophagus and rectum. Warning signals for cancer are 1. Change in bowel or bladder habits 2. Sore throat which does not heal 3. bleeding or discharge 4, Lump in breast and elsewhere 5. Difficulty in swallowing 6. Change in mark or mole 7. Nagging cough 8. Progressive weight loss with anaemia.
Hernia, piles, hydrocele, intestinal obstruction/ perforation, gall stone, enlarged prostate, uterine mass, lump anywhere, fractures, gangrene, bleeding inside the brain are some of the. surgical problems which the elderly face. Age is not a contraindication for surgery but the risk and complications are more in old age.
Gradual decline of libido or sexual impulse is normal with advancing age but rapid decline may be due to diabetes, cancer, urinary problems, liver disorders and mental depression. Sexuality for the aged is a good thing for those who want it.
Depression is the commonest mental illness in the old age. These persons lose interest in life, eat less, lose weight, suffer from sleeplessness and constipation. They are vulnerable for suicidal attempts and need counselling and antidepressants. With the recent advances in medical therapy they can be cured and those who fail to respond require electro convulsive therapy. A mental illness of increasing inability to remember, to learn, to think and to reason known as Dementia may be due to Alzheimer’s disease in which lack of communication between brain cells due to damages or small clots affect blood supply to brain. The reason for this condition is not known and is often irreversible and progressive. The management is mainly supportive and symptomatic and the old person merits consideration, kindness and respect as a human being.
The word ‘Geriatrics’ was derived from the Greek word ‘Gerios’ (old age) and ‘iatros’ (medicine). Geriatrics is considered as a separate speciality because of difference in diagnostic, therapeutic and social problems. Psychological attitude of elders leads to diagnostic error on the part of doctor hindering early detections and prompt treatment. History taking in the elderly patients is beset with communic,ation barriers of mental impairment and deafness. They attribute problems to their age and tend to suffer in silence. Practical skill and experience are needed to obtain adequate histories in geriatric work. As regards therapeutic problems, elderly are more prone for drug side-effects. This is due to reduced lean body mass, diminished kidney function and altered organ sensitivity.
Since the elderly suffer from multiple diseases, multiple drug therapy is common which leads to more side-effects, drug interaction and omission. Elders should take drugs on the advice of doctors as side effects will be more serious than the disease itself. For healthy ageing, periodic health check-up, at least once a year, is essential. Many old age diseases are either preventable or treatable. Health check-up detects silent diseases, makes early diagnosis and prevents complications, Proper nutrition is vital for promotion of health and prevention of illness.
Quality of diet is more important than the quantity. The general guidelines are more fluid intake, inclusion of dietary fibre and at least one fruit and two glasses of milk. Aged are advised to have a heavy breakfast, moderate lunch and light dinner. Physical exercise is good for all ages, more so in old age. Regular exercise improves blood circulation in all organs to maintain normal function. It reduces obesity, cholesterol, BP, blood sugar, prevents constipation and promotes sound sleep. Consult your physician before choosing an exercise according to individual physical capacity. Brisk walking 3 to 5 Kms or 40-60 minutes in the morning on empty stomach and if possible in the evening too is advisable. Regular exercise and proper calcium intake in diet prevent loss of bone (osteoporosis) and other minerals from the spine which could lead to low back pain or fracture. Mild exercises performed daily to give full range of movement to all joints keep away arthritis. Periodic eye check to detect cataract or glaucoma, ENT check up to remove wax and defective hearing and dental check up as tooth decay affects general health are mandatory.
Mental health is as important as physical health in old age.Due to progressive loss of neurons the brain of a 70 year old person weighs only 56% when compared to its original weight. This results in mental depression, memory loss and anxiety. Brain atrophies and disuse and sensitivity is six times greater in those who have withdrawn from people and life. Loneliness leads to depression which may lead to death. For this right from middle age itself, one should plan for a hobby to keep onself occupied during old age. Hobbies like gardening, indoor games, meditation, bhajans, religious discourses, reading, interacting with others, etc. help the aged persons maintain a sound mental health and enable to age gracefully.
15. Exercises for the Elderly
Exercise is enjoyable, easily incorporated into your lifestyle, cost-free, and guaranteed to positively affect your health and longevity. If you did nothing else different, but incorporated some type of regular exercise into your schequle, you would ensure a life unencumbered by reduced energy and illness. Logic dictates that if exercise is beneficial and rejuvenates the body, then inactivity should accelerate the ageing process. Inactivity has been demonstrated to take a considerable toll on heart function, bones, the blood nerves, body composition, brain waves and the immune system in several studies. Given below are some simple exercises and regimens you could follow.
The following are some recommended strengthening and flexibility exercises. Do only those you feet comfortable doing. As your body adjusts to the new activities, you can gradually add more repetitions and other exercises. Start slowly with two-three repetitions of each exercise you choose.
Strengthening Exercises:
1. Finger squeeze: Strengthens hands; good for circulation. Straighten arms in front at shoulder level, palm down. Make a fist, then release. Turn palms up, make a fist and release.
2. Shoulder shrug:
Strengthens your back and shoulders, help relaxation. Lift shoulders up towards your ears, then back, down and relax.
3. Arm circles: Strengthens shoulders and upper back. Start with arms straight out to the side at shoulder level. Rotate arms from shoulders forward and then backward.
4. Shoulder touch: Increases flexibility of shoulders, elbows and helps tone upper arms. Start with arms straight out to the side at shoulder level. Bend elbow and bring palm of hands to shoulders. Turn palm away and push arm down to start position.
5. Leg flexion - extension: Strengthens hip muscle. Stand erect, holding on to a chair or table for support Lift one leg forward, then back from the hip. Be careful not to lean forward and back.
6. Side leg lift: Strengthens hip and thigh muscles. Stand erect holding on to a chair or table for support. Raise one leg to the side and down. Try not to lean or bring your leg forward. You can try this lying on your side, too. 7. Alternate leg lunges: Strengthens upper thighs and inside of legs. Also stretches back of leg. Start with feet shoulder-width apart. Hold on to something for support if you like. Step forward about 18" to 24" with right leg. Keep left heel on the floor. Shove off with the right leg and return to start position.
8. Calf raises : Strengthens lower leg and ankle. Start with feet shoulderwidth apart. Hold onto something for support if you like. Raise up on your toes, lifting heels. Slowly lower yourself back down to your heels.
9. Leg extension: Strengthens upper thigh muscles and tones lower abdomen Sitting in chair, back straight, knees bent, and feet flat on the floor tighten knee and raise foot up. Alternate with each leg.
10. Squat: Strengthens front thigh muscles. Start with feet shoulder-width apart. Hold on to the back of a chair for support. Keep back straight and slowly bend knees as if you are going to sit. Slowly return to start position. Do not go down too far This will improve as you get stronger.
11. Toe raises: Strengthens ankles. Standing or sitting with feet shoulderwidth apart, raise your toes up off the floor as if tapping to music.
12. Ankle circles: Strengthens ankles. Standing or sitting, make circles with each ankle, to the right and then the left.
13. Abdominal strengthening: Strengthens stomach muscles providing support for your back. Stand or sit straight. Take a deep breath in through your nose, then slowly exhale through your mouth as if blowing out a candle. Feel your stomach go in as you blowout. Hold stomach tight after blowing out, then relax and repeat.
14. Sit-up: Advanced abdominal strengthening. Lay on the floor with your knees bent and feet flat. Reach with your arms toward your knees, raising your head and shoulders off the floor You should readily feel your stomach muscles tighten. Slowly return head and shoulders to the floor Work up to doing five-ten repetitions.
Flexibility Exercises:
1. Neck circles: Maintains joint motion. Standing, or sitting in a chair, slowly move chin over to one shoulder and then to the other as if nodding “no”. Slowly lift your chin up slightly and back down toward your chest as if nodding “yes”. Repeat several times.
2. Flexed leg back stretch: Maintains flexibility in torso, low back, and legs. Stand with knees slightly bent and feet shoulder-width apart. Slowly and gently slide hands down front of legs, bringing finger tips toward the floor. You should feel a stretch in the back of your legs. Hold for the count of five when you start to feel the stretch. Stay within your comfort range - no more than five repetitions.
3. Side bends: Maintains trunk flexibility.Stand with feet shoulder-width apart. Slide right hand down right leg towards knee. Repeat to left side. Hold for five seconds; five repetitions to each side.
4. Trunk rotation : Maintains trunk flexibility. Stand with feet shoulder-width apart and knees slightly bent. Turn from your waist to the right, then left.
5. Back arch Stretches abdominal wall, chest, maintains flexibility. Do not do this exercise if you have a history of back problems. On stomach: Place hands by shoulders, slowly push up on arms and arch back. Keep hips down. Try to straighten elbows completely if back is comfortable. Return to stomach; three-four repetitions.
6. Overhead reach: Stretches shoulder girdle and rib cage. Take a deep breath in as you raise your arms overhead. Exhale slowly as you lower your arms behind your head or to your shoulders, then return to your sides.
7. Achilles stretch: Stretches the calf muscle. Stand facing a wall. with feet two-three feet away. Straighten arms, leaning into the wall. Move left leg forward 1/2 step, right leg backward 1/2 step or more. Keep right heel on floor Lean toward the wall with weight on forward Leg. Stretching the heel tendon of the right leg. Hold five-ten seconds; reverse legs; three-five repetitions.
8. Shin and quadriceps stretch: Kneel on both knees. turn to right and press down on right with right hand and hold.Keep hips thrust forward. Do not sit on heels. Repeat on left side.
9. Hip and thigh stretch: Kneel with right knee directly. Above right ankle and stretch left leg backward so knee touches floor. Place hands on floor or seat of chair for balance.
WALKING
After the age of 65 or so, the age of participation in active games should be considered over. The only suitable form of exercise at this age is walking which should be continued till the end. Walking provides many benefits of more strenuous activities, without much exertion. For this activity you can progress at your own pace, no equipment is required and you can walk alone or with friends.
The benefits of walking are: ·
.It promotes more restful sleep
.A reduction of tension and stress
Weight reduction. You burn up 320 calories per hour by walking 3 miles per hour For every 11 hours of walking you will loose one pound (3500 calories equals one pound)
·Walking improves circulation and is a good cardiovascular exercise. .Improves the ability to take in oxygen.
Tips for Walking:
· Walk with your head erect and your stomach in.
· Walk on your whole foot.
· Avoid walking when it is very hot or cold.
· Let your arms swing freely.
· Begin with a 15 to 20 minute walk and walk at a slower pace for the first several Minutes as a warm up.
Use comfortable shoes or footwear.
16.Yoga for the Elderly
“Yoga is skill in Action” states Bhagavadgeeta. This is to say, in addition to the skill to improve one’s body, Yoga also comprises techniques that act on one’s mind and emotions providing a “Complete philosophy of Living”. In simple words, practising Yogasana and Pranayama is to achieve good health, keep fit, mentally and physically to be able to cope with various turbulences of life and take up the challenge to go beyond them with renewed vigour.
Yoga is meant for almost anybody between the age of 8 to 80 years. Many examples of persons who have started Yoga as late as 69 years have achieved all benefits. Hence Senior Citizens are advised to practise Yoga. Padmasri Yogacharya B. K. S. Iyengar in more than 65 years of dedicated service has helped thousands of patients through Yoga therapy as a non-conventional medicine.
SVYAS has done a lot of scientific research at their unique centre “Prashanti Kutir” at Jigni, 20 kms from Bangalore under the guidance of medical specialists in allopathy and other systems of medicine and has evolved a capsule consisting of prayer, yogasanas, pranayamas, meditations to reach the needs of common man and accordingly have opened more than 50 Yoga training centres in Bangalore. Yoga has to be practised - whether Asanas, Pranayan1as, Meditations, etc. - under the guidance of a qualified Guru.
The Elderly - Part II
6. The Carer
Increased longevity need not necessarily mean healthy and disease-free life. Invariably chronic ailments. disability and dependency reduce quality of life. Age in combination with disability reduces the ability of the person to carry out even basic ADL (Activities of Daily Living), such as bathing. dressing. feeding. etc. Many older people become immobile due to illness. due to falls or due to joint problems. Such dependent elderly require prolonged and consistent care. Similarly, cognitively impaired elderly need to be supervised continuously. Long term care for impaired or disabled elderly is a difficult task. Care givers, both professional and familial, face the risk of burn out.
Traditionally. the task of caring was predominantly by women, be they spouse. daughter or daughter-in-law. But as the family and especially the role of women are changing to meet the new demands created by economic transitions. the family’s ability and sometimes commitment for caring for its older member is diminishing. As· more and more women are becoming active in their own careers and begin to work full time, the task of caring for the old is becoming more difficult. While creating support system for those families who can. and desire to. care for elderly relatives, planning is needed for the care of those who cannot and will not be cared for by family members.
Care giving may result from different motivations..Yet the consequences of providing of an intense nature over a long period can be rather similar Research has found negative social, psychological, economic, and physical consequences to family members from the often unrelenting demands of elderly relatives. ‘Cost’ or ‘burden’ of care given depends on several factors - age, sex, health of care giver, availability of help, social support, to mention a few. It also depends on the type of disability, level of cognitive impairment, presence of behavioural problems, age, duration of illness of the care recipient.
Counselling is often essential for care givers. They may need inputs in the following areas - information about the care recipient’s illness, respite from care, opportunity to interact with people in similar circumstances, participation in self-help groups, individual counselling, practical assistance and reasonable financial compensation.
‘Granny Bashing’
A darker side of family care giving is ‘Elder Abuse’. This may manifest as physical, psychological, financial abuse or as neglect. First reported in British scientific journals as ‘Granny Bashing’, reports are appearing in Indian journals also at present. Elderly are supposed to face overt/or covert abuse, face economic deprivation, social neglect and religious abuse (especially widows).
7. National Policy on Ageing
India presents a sad picture when it comes to the care of the elderly. There is no baseline data about aged in the country, there is no comprehensive s8cial security provision for the people, there is no universal medicare system for all, a sizeable number of aged live under poverty line, institutional facilities are totally inadequate for the number of people who require such care, there is no conscious planning to meet the needs of the elderly, public awareness of issues involved in elderly care is low, and finally, there is no comprehensive National Policy for the elderly.
The exercise of national policy formulation continued, by fits and starts, since 1993. At last, in 1999, Ministry of Social Justice and Empowerment came out with a policy for the elderly and submitted to the then parliament for formal approval. But due to lack of political will it is still at the stage of “on paper - under consideration”. Even in preparing recommendations no particular exercise has been made to examine the basic problems of the elderly. Except recommending community based social services, encouraging NGOs to start old age homes and day care centres, special schemes for the elderly under existing housing scheme, the policy makers have largely neglected the following aspects:
Elderly in rural and tribal areas; elderly women and widows; active, handicapped, infirm and immobile elderly; elderly abuse and or isolation; social participation of the elderly; social integration and community participation rather then segregation; orientation, training and placement of active elderly; culture and recreation; care, protection and security; patterns of care (self-care, informal care, community and family care, institutional care, no care); death with dignity and decent cremation or burial.
Night care centres, halfway homes, mobile libraries; health and mental health facilities, hospices and terminal care; family courts, consumer courts; special assistance cells for the clearance of bills; lok adalats as mediating institutions, etc.
While the perspective of the policy is welfarist, in that the State will act as major provider, only paltry resources and residual services would be provided. States have shown ambivalence toward the policy and expect the centre to share a major burden. Left to themselves, they are most likely to ignore the problem of the elderly on the pleas of scarcity of resources.
8. UN Principles for Older People
To add life to the years that have been added to life, . the United Nations General Assembly adopted the following Principles for Older Persons on 16th December, 1991 (Resolution 46/91)
I) INDEPENDENCE
1) Older persons should have access to adequate food, water, shelter, clothing and health care through the provision of income, family & community support and self-help. 2) Older persons should have the opportunity to work or have access to other income-generating opportunities. 3) Older persons should be able to participate in determining when and at what pace withdrawal from the labor force takes place. 4) Older Persons should have access to appropriate educational and training programmes 5) Older persons should be able to live in environments that are safe and adaptable to personal preferences and changing capacities. 6) Older persons should be able to reside at home for as long as possible.
II) PARTICIPATION
7) Older persons should remain integrated in society, participate actively in the formulation and implementation of policies that directly affect their well-being and share their knowledge and skills with younger generations. 8) Older persons should be able to speak and develop opportunities for service to the community and serve as volunteers in positions appropriate to their interest~ and capabilities. 9) Older persons should be able to form movements or associations of older persons.
III) CARE
10) Older persons should benefit from family and community care and protection in accordance with each society’s systems or cultural values. 11) Older persons should have access to health care to help them to maintain or regain the optimum level of physical, mental and emotional well-being and to prevent or delay the onset of illness. 12) Older persons should have access to social and legal services to enhance their autonomy, protection and, care. 13) Older persons should be able to utilise appropriate levels of institutional care providing protection, rehabilitation and social and mental stimulation in a human and secure environment. 14) Older persons should be able to enjoy human rights and fundamental freedoms when residing in shelter, care or treatment facility, including full respect for their dignity, beliefs, needs and privacy and for the right t’O make decisions’ about their care and quality of their lives.
IV) SELF-FULFILMENT
15) Older persons should be able to pursue opportunities for the full development of their potential. 16) Older persons should have access to the educational, cultural, spiritual and recreational resources of society. 17) Older persons should be able to live in dignity and security and be free of exploitation and physical or mental abuse. 18) Older persons should be treated fairly regardless of age, gender, racial or ethnic background, disability or other status, and valued independently of their economic contribution. “People are created to give something back to the world. The best way to solve problems is to work together with compassion towards betterment of human life through helping improve the quality of all individuals”.
9. Positive Attitude & Life-enhancing Activities
Disease-free, functional living without a clear sense of realisable purpose, while of some value in that it may afford opportunities for normal evolutionary growth, will not provide awareness of meaning to your life that is important to have.
Two vital factors for healthy, long life, over both of which we have control, are mental attitude and lifeenhancing activities. Optimism, the basis of hope and faith, should be habitually cultivated until it is the dominant mental attitude. Cheerfulness and optimism actually beneficially influence the body’s chemistry, enlivening its functions and strengthening the immune system. Pessimism, fear, doubt, depression, mental and emotional conflicts, and other negative states depress the body’s immune system and disturb normal biological functions of organs and glands. Life-enhancing activities keep us in the flow of relationships and cosmic forces which contribute to our total wellness and encourage biological systems to function harmoniously.
Why is it that some people are old at what should be healthy, functional middle age while others are youthful into their seventh, eighth, and even ninth decades or longer? Genetic disposition may playa role, but not as much as we may too quickly presume. The determining factors are more likely related to mental attitude, states of consciousness, the kind and amount of physical activity, and diet. This is the opinion of many physicians, and the testimony of an increasing number of men and women who are enjoying healthy life into what used to be considered advanced years. For many people, who have traditional ideas about ageing, the various symptoms believed to be associated with it begin to manifest because they expect them too! Ageing then becomes a wish fulfilling prophecy; what is anticipated is demonstrated in fact.
In an article published in a national magazine, a medical doctor wrote of his extensive studies on ageing. He found that if you list all the changes in muscles, bones, brain, cholesterol, blood pressure, sleep habits, sexual performance, psychological characteristics, and other symptoms - and complete a list of similar changes which result from physical inactivity, there is striking comparison. Indications are that many of the bodily changes we tend to contribute to normal ageing processes are in fact caused by disuse, by inactivity.. The five components of what may be called as Disuse Syndrome are cardiovascular vulnerability, musculoskeletal fragility, obesity, depression, and premature ageing - all of which we can do something about.
Physical conditioning determines how well our bodies transport oxygen necessary for good metabolism. Exercise improves the body’s ability to take in and transport oxygen to the blood stream. By exercising regularly, and maintaining muscle mass, metabolism is more efficient. Exercise also keeps our bones in better condition, stronger and with minimum loss of calcium. Without exercise our energy reserves diminish, we “feel older” and more tired and tend to become more easily depressed.
(Source: ‘Book of Ltfe’)
10. Mind over Body
There is evidence that stimulating the brain can actually reverse the process of mental deterioration. Though memory is known to fail with age, it appears that memory and other mental processes are improved by increasing physical and mental activity.
As people get older, especially after retirement, they tend to be less active, physically and mentally.
The less stimulated by the environment, the less active neurons, or nerve cells become. In a sense the brain goes into hibernation. But it can be reawakened. If mental activity increases, new branch-like extensions called dendrites sprout in the neurons. These dendrites establish connections with other neurons, receiving information and forming networks that create strategies for problem-solving. In other words, the brain benefits from exercise, almost as if it were another muscle. So, the more the mind continues to work, the greater the chances of retaining mental function. That is why one must stay intellectually engaged, be it a game of chess or community service.
The best way to avoid mental rigidity is by keeping an open mind about new and different ways to do things. Learning to use a computer, trying to do old tasks in new ways - the more the challenge the better. Above all, there is great individual variation in the way mental function changes with age. Experts say that major deterioration is not built into the brain. The challenge is to find ways to compensating for whatever decline that does occur And the first step is to cultivate those dendrites by putting your mind to work which deteriorates with age, but recent studies show that this is not so. Deterioration of mental function is most often due to some pathological changes in the brain and not due to just ageing. While it is true that some of the brain’s functions are at their peak early in life, judgement and wisdom continue to improve as we age, whereas short-term memory and quickness of recall may decline.
Recently it has been proposed by many schools of thinking that visualising the killer cells in your immune system as fighting against the organisms that cause disease can actually get the body to produce a response against them. This is part of a system of alternative therapy which is also called Holistic Medicine. Whether it is called “treating the whole patient”, holistic medicine or some other name, it boils down to the very logical fact that we are the sum of our minds and our bodies. Emotions and feelings have a powerful impact on physical symptoms.
Many of the so called alternative therapies emphasising the mind/body connection are increasingly acknowledged by medical professionals as effective methods for coping with health problems.
We know from recorded history that ancient medical science was based on the idea that mind and body are intimately interconnected, and that successful treatment required the healer to take both into account. Hippocrates, the father of Western Medicine, cautioned physicians to study the mind as well as the body. But over the centuries, the Western world began discounting this wisdom. Scientist-philosophers like Descartes believed that medicine should devote itself to understanding and curing the body’s ills.
This mind set produced the modern Western approach to curing illness, in which the only valid treatments are considered to be those that have been proven to work in rigorous scientific studies. Many invaluable means of treatment have resulted from this method, but clinical medicine today still can’t cure everything. Gradually a new idea has evolved, or re-evolved; that mind and body are constantly interacting. Since our emotions seemingly have the power to ravage our bodies or to heal them, why not use them to our advantage rather than ignoring them ? body’s ability to adapt to ageing is really great. But this ability should not be misused; it should be put to judicious and optimal use to enhance health and longevity. In order to do so, we must first understand the changes which occur in the body systems with age.
11. Body Changes in the Elderly
Increased longevity need not necessarily mean healthy and disease-free life. Invariably chronic ailments. disability and dependency reduce quality of life. Age in combination with disability reduces the ability of the person to carry out even basic ADL (Activities of Daily Living), such as bathing. dressing. feeding. etc. Many older people become immobile due to illness. due to falls or due to joint problems. Such dependent elderly require prolonged and consistent care. Similarly, cognitively impaired elderly need to be supervised continuously. Long term care for impaired or disabled elderly is a difficult task. Care givers, both professional and familial, face the risk of burn out.
Traditionally. the task of caring was predominantly by women, be they spouse. daughter or daughter-in-law. But as the family and especially the role of women are changing to meet the new demands created by economic transitions. the family’s ability and sometimes commitment for caring for its older member is diminishing. As· more and more women are becoming active in their own careers and begin to work full time, the task of caring for the old is becoming more difficult. While creating support system for those families who can. and desire to. care for elderly relatives, planning is needed for the care of those who cannot and will not be cared for by family members.
Care giving may result from different motivations..Yet the consequences of providing of an intense nature over a long period can be rather similar Research has found negative social, psychological, economic, and physical consequences to family members from the often unrelenting demands of elderly relatives. ‘Cost’ or ‘burden’ of care given depends on several factors - age, sex, health of care giver, availability of help, social support, to mention a few. It also depends on the type of disability, level of cognitive impairment, presence of behavioural problems, age, duration of illness of the care recipient.
Counselling is often essential for care givers. They may need inputs in the following areas - information about the care recipient’s illness, respite from care, opportunity to interact with people in similar circumstances, participation in self-help groups, individual counselling, practical assistance and reasonable financial compensation.
‘Granny Bashing’
A darker side of family care giving is ‘Elder Abuse’. This may manifest as physical, psychological, financial abuse or as neglect. First reported in British scientific journals as ‘Granny Bashing’, reports are appearing in Indian journals also at present. Elderly are supposed to face overt/or covert abuse, face economic deprivation, social neglect and religious abuse (especially widows).
7. National Policy on Ageing
India presents a sad picture when it comes to the care of the elderly. There is no baseline data about aged in the country, there is no comprehensive s8cial security provision for the people, there is no universal medicare system for all, a sizeable number of aged live under poverty line, institutional facilities are totally inadequate for the number of people who require such care, there is no conscious planning to meet the needs of the elderly, public awareness of issues involved in elderly care is low, and finally, there is no comprehensive National Policy for the elderly.
The exercise of national policy formulation continued, by fits and starts, since 1993. At last, in 1999, Ministry of Social Justice and Empowerment came out with a policy for the elderly and submitted to the then parliament for formal approval. But due to lack of political will it is still at the stage of “on paper - under consideration”. Even in preparing recommendations no particular exercise has been made to examine the basic problems of the elderly. Except recommending community based social services, encouraging NGOs to start old age homes and day care centres, special schemes for the elderly under existing housing scheme, the policy makers have largely neglected the following aspects:
Elderly in rural and tribal areas; elderly women and widows; active, handicapped, infirm and immobile elderly; elderly abuse and or isolation; social participation of the elderly; social integration and community participation rather then segregation; orientation, training and placement of active elderly; culture and recreation; care, protection and security; patterns of care (self-care, informal care, community and family care, institutional care, no care); death with dignity and decent cremation or burial.
Night care centres, halfway homes, mobile libraries; health and mental health facilities, hospices and terminal care; family courts, consumer courts; special assistance cells for the clearance of bills; lok adalats as mediating institutions, etc.
While the perspective of the policy is welfarist, in that the State will act as major provider, only paltry resources and residual services would be provided. States have shown ambivalence toward the policy and expect the centre to share a major burden. Left to themselves, they are most likely to ignore the problem of the elderly on the pleas of scarcity of resources.
8. UN Principles for Older People
To add life to the years that have been added to life, . the United Nations General Assembly adopted the following Principles for Older Persons on 16th December, 1991 (Resolution 46/91)
I) INDEPENDENCE
1) Older persons should have access to adequate food, water, shelter, clothing and health care through the provision of income, family & community support and self-help. 2) Older persons should have the opportunity to work or have access to other income-generating opportunities. 3) Older persons should be able to participate in determining when and at what pace withdrawal from the labor force takes place. 4) Older Persons should have access to appropriate educational and training programmes 5) Older persons should be able to live in environments that are safe and adaptable to personal preferences and changing capacities. 6) Older persons should be able to reside at home for as long as possible.
II) PARTICIPATION
7) Older persons should remain integrated in society, participate actively in the formulation and implementation of policies that directly affect their well-being and share their knowledge and skills with younger generations. 8) Older persons should be able to speak and develop opportunities for service to the community and serve as volunteers in positions appropriate to their interest~ and capabilities. 9) Older persons should be able to form movements or associations of older persons.
III) CARE
10) Older persons should benefit from family and community care and protection in accordance with each society’s systems or cultural values. 11) Older persons should have access to health care to help them to maintain or regain the optimum level of physical, mental and emotional well-being and to prevent or delay the onset of illness. 12) Older persons should have access to social and legal services to enhance their autonomy, protection and, care. 13) Older persons should be able to utilise appropriate levels of institutional care providing protection, rehabilitation and social and mental stimulation in a human and secure environment. 14) Older persons should be able to enjoy human rights and fundamental freedoms when residing in shelter, care or treatment facility, including full respect for their dignity, beliefs, needs and privacy and for the right t’O make decisions’ about their care and quality of their lives.
IV) SELF-FULFILMENT
15) Older persons should be able to pursue opportunities for the full development of their potential. 16) Older persons should have access to the educational, cultural, spiritual and recreational resources of society. 17) Older persons should be able to live in dignity and security and be free of exploitation and physical or mental abuse. 18) Older persons should be treated fairly regardless of age, gender, racial or ethnic background, disability or other status, and valued independently of their economic contribution. “People are created to give something back to the world. The best way to solve problems is to work together with compassion towards betterment of human life through helping improve the quality of all individuals”.
9. Positive Attitude & Life-enhancing Activities
Disease-free, functional living without a clear sense of realisable purpose, while of some value in that it may afford opportunities for normal evolutionary growth, will not provide awareness of meaning to your life that is important to have.
Two vital factors for healthy, long life, over both of which we have control, are mental attitude and lifeenhancing activities. Optimism, the basis of hope and faith, should be habitually cultivated until it is the dominant mental attitude. Cheerfulness and optimism actually beneficially influence the body’s chemistry, enlivening its functions and strengthening the immune system. Pessimism, fear, doubt, depression, mental and emotional conflicts, and other negative states depress the body’s immune system and disturb normal biological functions of organs and glands. Life-enhancing activities keep us in the flow of relationships and cosmic forces which contribute to our total wellness and encourage biological systems to function harmoniously.
Why is it that some people are old at what should be healthy, functional middle age while others are youthful into their seventh, eighth, and even ninth decades or longer? Genetic disposition may playa role, but not as much as we may too quickly presume. The determining factors are more likely related to mental attitude, states of consciousness, the kind and amount of physical activity, and diet. This is the opinion of many physicians, and the testimony of an increasing number of men and women who are enjoying healthy life into what used to be considered advanced years. For many people, who have traditional ideas about ageing, the various symptoms believed to be associated with it begin to manifest because they expect them too! Ageing then becomes a wish fulfilling prophecy; what is anticipated is demonstrated in fact.
In an article published in a national magazine, a medical doctor wrote of his extensive studies on ageing. He found that if you list all the changes in muscles, bones, brain, cholesterol, blood pressure, sleep habits, sexual performance, psychological characteristics, and other symptoms - and complete a list of similar changes which result from physical inactivity, there is striking comparison. Indications are that many of the bodily changes we tend to contribute to normal ageing processes are in fact caused by disuse, by inactivity.. The five components of what may be called as Disuse Syndrome are cardiovascular vulnerability, musculoskeletal fragility, obesity, depression, and premature ageing - all of which we can do something about.
Physical conditioning determines how well our bodies transport oxygen necessary for good metabolism. Exercise improves the body’s ability to take in and transport oxygen to the blood stream. By exercising regularly, and maintaining muscle mass, metabolism is more efficient. Exercise also keeps our bones in better condition, stronger and with minimum loss of calcium. Without exercise our energy reserves diminish, we “feel older” and more tired and tend to become more easily depressed.
(Source: ‘Book of Ltfe’)
10. Mind over Body
There is evidence that stimulating the brain can actually reverse the process of mental deterioration. Though memory is known to fail with age, it appears that memory and other mental processes are improved by increasing physical and mental activity.
As people get older, especially after retirement, they tend to be less active, physically and mentally.
The less stimulated by the environment, the less active neurons, or nerve cells become. In a sense the brain goes into hibernation. But it can be reawakened. If mental activity increases, new branch-like extensions called dendrites sprout in the neurons. These dendrites establish connections with other neurons, receiving information and forming networks that create strategies for problem-solving. In other words, the brain benefits from exercise, almost as if it were another muscle. So, the more the mind continues to work, the greater the chances of retaining mental function. That is why one must stay intellectually engaged, be it a game of chess or community service.
The best way to avoid mental rigidity is by keeping an open mind about new and different ways to do things. Learning to use a computer, trying to do old tasks in new ways - the more the challenge the better. Above all, there is great individual variation in the way mental function changes with age. Experts say that major deterioration is not built into the brain. The challenge is to find ways to compensating for whatever decline that does occur And the first step is to cultivate those dendrites by putting your mind to work which deteriorates with age, but recent studies show that this is not so. Deterioration of mental function is most often due to some pathological changes in the brain and not due to just ageing. While it is true that some of the brain’s functions are at their peak early in life, judgement and wisdom continue to improve as we age, whereas short-term memory and quickness of recall may decline.
Recently it has been proposed by many schools of thinking that visualising the killer cells in your immune system as fighting against the organisms that cause disease can actually get the body to produce a response against them. This is part of a system of alternative therapy which is also called Holistic Medicine. Whether it is called “treating the whole patient”, holistic medicine or some other name, it boils down to the very logical fact that we are the sum of our minds and our bodies. Emotions and feelings have a powerful impact on physical symptoms.
Many of the so called alternative therapies emphasising the mind/body connection are increasingly acknowledged by medical professionals as effective methods for coping with health problems.
We know from recorded history that ancient medical science was based on the idea that mind and body are intimately interconnected, and that successful treatment required the healer to take both into account. Hippocrates, the father of Western Medicine, cautioned physicians to study the mind as well as the body. But over the centuries, the Western world began discounting this wisdom. Scientist-philosophers like Descartes believed that medicine should devote itself to understanding and curing the body’s ills.
This mind set produced the modern Western approach to curing illness, in which the only valid treatments are considered to be those that have been proven to work in rigorous scientific studies. Many invaluable means of treatment have resulted from this method, but clinical medicine today still can’t cure everything. Gradually a new idea has evolved, or re-evolved; that mind and body are constantly interacting. Since our emotions seemingly have the power to ravage our bodies or to heal them, why not use them to our advantage rather than ignoring them ? body’s ability to adapt to ageing is really great. But this ability should not be misused; it should be put to judicious and optimal use to enhance health and longevity. In order to do so, we must first understand the changes which occur in the body systems with age.
11. Body Changes in the Elderly
Change is the inevitable law of nature. Nothing can remain static in this world. This is equally true of the human body. After birth, the body gradually grows to full bloom and its functions reach their peak at about the age of 30. Thereafter the functions slowly decline over the next five or six decades.
Nature has provided vast reserves in the body system. For example, normal life is perfectly possible with only 15 per cent of the kidney tissue; loss of spleen or tonsils makes no measurable difference to the body because other tissues with similar functions are able to compensate this loss. However, these reserves are more and more encroached upon as age advances and age related decrements in physiological functions are inevitable. By the age of 80 certain measurable parameters would have declined by 50 to 70 per cent. The capacity to perform physical work progressively declines, metabolic processes and body body reflexes slow down, and ability to withstand stress and strain is reduced.
The natural process of ageing is so gradual that it is hardly perceptible. The vast reserves in our body do not let us feel difference of age. In fact the elderly person should normally fell fit and fine, and only under stress of sudden or severe physical effort should there be any difference between him and a younger person. The body’s ability to adapt to ageing is great. But this ability should not be misused; it should be put to judicious and optimal use to enhance health and longevity. In order to do so, we must first understand the changes which occur with age.
REGULATION OF BODY CHEMISTRY
Life consists of series of chemical reactions occurring in each of the millions of cells of which our body is made. Chemical processes constantly regulate the blood chemistry within narrow limits on a moment to moment basis. For example, if a person has eaten too much of sugar and there is danger of inordinate rise of sugar in blood, the pancreas immediately releases more insulin into Circulation; if a person has taken too much fluids, increased urination corrects the situation. The chemistry of blood which forms the internal environment of all body cells, therefore, remains fIxed within narrow limits at all times and under all circumstances. With age, the speed of this regulation slows down because all physiological functions, including cardiorespiratory, digestive and excretory, decline. The elderly are therefore not able to adapt to changes in food, environment and temperature, and to stresses and strains as easily as younger people. Moderation becomes necessary in their daily activities, including eating, working, environmental changes of temperature, humidity, etc. They are, for the same reason unable to detoxicate or excrete drugs with as much ease and speed as younger people. Doctors therefore suitably lower or alter the dosage of drugs administered to them.
BRAIN
Consequent to these changes in the chemical milieu at the cellular level, changes occur in various body systems. Alterations of metabolism in. the brain and its offshoots cause certain deficiencies or alterations, which account for changes in sleep rhythm, sex drive, body temperature regulation and certain degenerative disorders.
ENDOCRINE GLANDS
Changes occur in the endocrine glands which secrete various hormones. For example, diminished production of insulin by the pancreas causes increased incidence of diabetes in the elderly. Ovarian failure occurs at menopause in women, resulting in loss of child bearing capacity and diminished production of female sex hormone. The endocrine changes in the male are less dramatic and include decrease in the production of male sex hormone.
IMMUNE SYSTEM
The immune system, our bodyguard against infections, slowly and gradually withers away. This has great relevance to certain diseases. Proneness to infections increases, which become more acute and severe, and incidence of cancers are more common in the elderly.
BONES
Bones get depleted of calcium and protein matter (osteoporosis), and become fragile and liable to fracture easily.
ARTERIAL OBSTRUCTIONS - HEART ATTACKS AND STROKES
Significant degenerative changes occur in the arteries of the body, especially those supplying blood to the brain, heart, kidneys and legs. A fatty substance, called cholesterol, is deposited in their walls over the years, causing obstruction to the flow of blood. This obstruction, is the cause of heart attacks, strokes, etc.
OTHER SYSTEMS
Similarly, decrements of function occur in all other systems - digestive, excretory, respiratory, etc. This is the natural process of ageing, which occurs in every one of us. The body’s ability to adapt to ageing is truly remarkable. Unfortunately some of us strain or over-tax this ability by adopting unhealthy lifestyles - excessive smoking, consumption of intoxicants like alcohol, poor living conditions with atmospheric and environmental pollutants, which invariably hasten the ageing process.
12. Diet & Nutrition
Are any changes in the food habit necessary in the later years of life? At the outset we may say that there is no basic difference between the diet of the young and that of the elderly. We only have to take into consideration the decrements in physiological functions of the body, including digestion, which decrease with age, the reduced needs of the body for energy production consequent to reduced physical activity, and certain disease conditions which are more common during the later years of life, which place restrictions on certain foods. As the energy requirements of the body decrease, the amount of food intake should be correspondingly reduced, otherwise you will be adding to body weight, which is not healthy. Moreover, reduced intake of food will be easy on your digestion. Secondly, you should rest a while after meals and not rush to work or exercise, because a large amount of blood is diverted to the abdomen for digestion and less is available for the needs of the heart. For the same reason sexual intercourse should be avoided for a few hours after the meal.
A diet that provides for all our metabolic needs, but is very low in calories increases the life span. Recent research has shown that low calorie diet of 20 calories per kg of ideal body weight increases the life span of experimental animals by almost 40 per cent. This diet is sufficient for body needs but it is nonfattening. For instance, if a person’s ideal (not actual) weight is 70 kg he needs only 1400 calories per day. Most of the extra calories in our diet are contributed by refined sugar and fats (ghee, butter and vegetable oils). They are for the most part empty calories and contain little else. To obtain a healthy diet, you will have to cut down the consumption of these articles of food and concentrate your attention on vegetables, fruit, cereals, pulses, lowfat milk and its products, low fat meats, chicken and fish. Nutritious food is one that contains all the essential nutrients - proteins, fats, carbohydrates, vitamins and minerals. A well balanced diet should contain all these in correct proportions and adequate amounts. Proteins, fats and carbohydrates provide the energy required for various activities. Vitamins and minerals do not supply the energy but play an important role in the regulation of several essential metabolic processes in the body.
The food should be nutritious, though small in amount. The quality not quantity matters. Even a sparse diet can be nutritious. For example 100 gms of wheat contains nearly 12 gms protein, while the same quantity of rice has only 6.4 gms protein. Similarly, 100 gms Ragi contains 344 mg of Calcium. The food should be mainly vegetarian, some non-vegetarian, with milk and milk products, though ghee and butter may be restricted because of their high cholesterol content. For same reason milk may be allowed to stand for a few hours and cream may be skimmed off before consumption. The best cooking medium for regular use is any vegetable oil which does not solidify in cold weather These oils are low in saturated fats. Highly greasy dishes or fried foods should be avoided as they add to the body weight. For the same reason sweets need to be restricted.
Ghee and butter need to be restricted but need not cut down altogether, unless some health problems, likee heart disease, prohibits it.
Bread and chapatis should be made from whole bran wheat flour and not from refined flour (maida) from which the fibre has been removed. The elderly require sufficient fibre or roughage in their diet to avoid constipation. This fibre is undigestable carbohydrate present in the food. Rough fibre is not well-tolerated by the intestine in old people. But the tender fibre of vegetable, fruits and whole grain cereals will encourage normal bowel movements. The elderly tend to use harmful laxatives and mineral oils. This should be substituted by a fibre-rich diet and adequate fluid intake. Some good source of dietary fibre are: Ragi, Wheat, Italian Millet, Horsegram, Green, leafy vegetables, Plantain stem, Drumstick, Bittergourd, fruits like dates, figs, guava, wood apple and sweet lime. (See table for fibre content of common foods)
Pulses have good amount of proteins and should be taken adequately.
Regarding non-vegetarian diet, it has to be said that fish is positively useful for the heart, chicken and fowl have no disadvantage while mutton, beef and pork may preferably be restricted. Avoid organ meats in particular because of their high cholesterol content. Eggs should also be taken in strict moderation, less than 5 per week. The yolk (yellow part) contains the highest amount of cholesterol.
The consumption of fresh vegetables, fruits, nuts and seeds should be increased for their vitamin, mineral and fibre contents. Their antioxidant factors prevent many diseases and delay the degenerative process of ageing.
Dietary Fibre Content of Common Foods (100 gms.) Fibre (g) .
Ragi (Madua) 3.6 Sundaikai (dry) 17.6 Rice 0.2 Ridge gourd 0.5 Rice bran 4.3 Snake gourd 0.8 Wheat (whole) 1.2 Cashew nut 1.3 Wheat (flour) 1.9 Coconut (fresh) 3.6 Bengal gram (whole) 3.9 Groundnut (roasted) 3.1 Bengal gram (dhal) 1.2 Walnut 4.1 Green gram (whole) 4.1 Asafoetida 4.1 Horsegram (whole) 5.3 Cardamom 20.1 Peas (dry) 4.5 Chillies (dry) 30.2 Red gram (dhal) 1.5 Chillies (green) 6.8 Soyabean 3.7 Cloves 9.5 Kuppakeerai 6.1 Coriander 32.6 Agathi 2.2 Fenugreek seeds 7.2 Cabbage 1.0 Garlic {dry) 0.8 Corriander leaves 1.2 Ginger (fresh) 2.4 Curry leaves 6.4 Pepper (dry) 14.9 Fenugreek leaves 1.1 Omum 21.2 MulIa Keerai 1.1 Tamarind pulp 5.6 Beetroot 0.9 Turmeric 2.6 Carrot 1.2 Gooseberry 3.4 Colocasia 1.0 Apple 1.0 Onion 0.6 Potato 0.4 Banana (ripe) 0.4 Yam 1.0 Dates (dried) 3.9 Beans 1.9 Figs 2.2 Bittergourd 1.7 Grapes 2.8 Brinjal 1.3 Guava 5.2 Broad beans 2.0 Jackfruit 1.1 Cauliflower 1.2 Lemon 1.7 Cluster beans 3.2 Mango 0.7 Cucumber 0.4 Papaya 0.8 Double beans 4.3 Pomegranate 5.1 Drumstick 4.8 Sapota 2.6 Knol Khol 1.5 Seethaphal 3.1 Ladies finger 1.2, Tomato 0.8
13. The Role of Antioxidants
The major problems faced in the advancing years are the ravages of old age. The riddle we have to solve is how to stave off diseases and stay healthy till the end. In this context some startling new facts have come to light recently about the capacity of some of the vitamins. Traditionally, it has been thought that lack of vitamins produces deficiency diseases like rickets and scurvy. It is now being increasingly realised that this is not the whole story, and that some of the vitamins can have many more positive and far-reaching effects by way of prevention of serious diseases of old age.
Some tentative conclusions have emerged, which can be immediately utilised much to the benefit of tIle people above 40 or 50. Preventing or delaying the onset of chronic degenerative diseases will mean better quality of life to them and a substantial reduction in the cost ‘of medical care in the years to come.
So far 13 vitamins have been identified in the foods that we eat. There is no doubt that many more factors still remain to be identified. The vitamins play a vital role in helping to regulate the biochemical reaction within the cells and in converting food into energy and living tissue. Some vitamins can be manufactured by the body but most have to be supplied through food.
New research evidence suggests that the traditional views about vitamins and minerals have been too narrow, and that these nutrients play a much more vital role in promoting health and vitality than it has been thought in the past. Vitamins in doses much higher than necessary to prevent deficiency diseases may protect a person from a number of diseases common in old age - cancer, heart attacks, strokes, Parkinson’s disease, cataracts, etc., and ward off the ravages of ageing.
DIET AND HEALTH
Some simple facts which have emerged from worldwide surveys are important A consistent link between diet and health has been found. A diet rich in fruits and fresh vegetables is associated with lowered incidence of cancer and heart attacks. Lowered intake of vitamin C is associated with high risk of cancer and high intake of calcium-containing foods with low incidence of fragile bones in the elderly (osteoporosis). Vitamin K, which had so far been known to promote blood clotting and help prevent bleeding, is now also known to help bones retain calcium and thus prevent osteoporosis. Deficiency of folic acid, one of the vitamins of B group, is now linked with cancer of cervix.
Not very long ago, vegetarians were considered second-rate humans and inferior in health status to nonvegetarians. It is now recognised that the vegetarian diet is healthier and that vegetarians in general live longer, because they are less prone to heart attacks and cancers The main reason is that a vegetarian diet provides most of the antioxidants which offer protection against free radicals.
WHAT ARE FREE RADICALS?
Oxygen-free radicals are formed as a by product of cell metabolism and exposure to sunlight, ozone, car exhaust, tobacco smoke and other environmental pollutants in the atmosphere of towns and cities. These radicals are volatile and unstable. They play havoc with cells by destroying them outright. Their cumulative effect is believed to be at the root of the ageing process and such diseases as heart attacks, strokes, cancer, cataracts, etc.
WHAT ARE ANTIOXIDANTS ?
Vitamins A, C and E have made the most exciting news as a result of current research. These vitamins offset the devastating effects of free radicals by neutralising and defusing them. They are called antioxidants. It is not considered unlikely that these vitamins may one day revolutionise medical care by prolonging life and making one healthier beyond what one thinks possible today.
VITAMIN C
Vitamin C is especially concentrated in the eye, and in high doses, along with vitamin E, reduces the risk of cataract to less than half, and delays its appearance by at least 10 years. The role in preventing cancer and heart attacks has already been mentioned.
VITAMIN E
This vitamin has been widely used for its reputed power to enhance sexual performance, but without much scientific evidence. It has now been found to be particularly helpful in preventing free radicals from injuring the heart. Experiments have shown that vitamin E injected within two hours of a heart attack reduces the expected damage to heart muscles by more than 75 per cent.
Vitamin E also seems to boost the immune system in old people, thus helping them to ward off infections. It may also provide great protection to the lungs by neutratising the harmful effects of pollutants like car exhaust and tobacco smoke. Vitamin E holds out much hope for the patients of Parkinson’s disease. especially the early cases. It delays the appearance of tremors, muscle rigidity and loss of balance, and thus postpones the need for active treatment.
VITAMIN A
Beta carotene is the naturally occurring precursor of vitamin A. a deep orange coloured compound found abundantly in sweet potatoes, carrots and cantaloupes (sarda). It is converted by the body into vitamin A according to the needs of the body. It is, therefore, impossible to have an overdose, while vitamin A in very large doses (5 times the usual dose) is toxic to the liver Beta carotene protects one against heart attacks. Even those with a previous history of heart disease are protected from future attacks. And if it is given along with low dose aspirin (100 mg. Daily). the protection is almost complete.
Beta carotene may prove powerful enough to ward off cancer as well. The incidence of cancer of the lung, breast, prostate, cervix and colon is much lower in Japan and Norway, where the diet is rich in this vitamin. Three to six months of daily beta carotene pills have dramatically reduced pre-cancerous mouth lesions.
We can appreciate how important fresh vegetables and fruits are for health and well being, not only for their known beneficial factors but possibly many factors not yet known to science. There is nothing wrong with nonvegetarian diet (except those with high cholesterol content) but when latter is taken to the exclusion of vegetables and fruits, then it is harmful.
DOSE OF ANTIOXIDANTS
The amount of an.tioxidants necessary to ward off diseases is much higher than the amount necessary toprevent deficiency diseases. To ensure full intake, the following daily doses are currently recommended: Beta Carotene 25 mg. or Vitamin A 5000-10000 unitsVitamin C 100mgVitamin E 100mg.
Whereas the diet should be rich in fresh green vegetables and fruits, many persons unfortunately just do not eat enough of them.
Then there are those whose diet is restricted because of some chronic disease, or alcoholics who do not eat much, or those with strong likes and dislikes. Taking a multivitamin pill a day which contains the above amounts of vitamin A, C and E, in addition to vitamin B complex and minerals, may be a good policy to ensure proper intake of essential nutrients. Presently the formulations available in the market (Becadexamine, Supradyn, Multibionta, etc.) Usually contain enough of all vitamins except vitamin E, which may have to be taken separately (Evion 100 mg.)
Enough evidence is already available to justify taking moderately high doses of antioxidants as suggested above but we may have to wait for some more time before still higher doses can be recommended. In the meantime it would be a wise strategy to take plenty of fruits and leafy and other vegetables including broccoli, carrots (gajar), spinach (palak) and squash (chapan kaddu), and a vitamin pill in addition. However useful the antioxidants and other vitamins may prove to be, they cannot take the place of good healthy habits. Also one should keep one’s mind receptive to new ideas and research on this as it is a very important topic. The last word on antioxidants is yet to be said.
The Elderly - Part I
This book was published in the year 2002
THE ELDERLY
By Mohan Pai, Omashram Trust, Bangalore
Managing Trustee
Omashram Trust, Bangalore
October 15, 2002
Vijayadashami
1. The Age of Ageing
Graying population is one of the most ‘significant characteristics’ of the 20th century and the first quarter of the 21st century known as the “age of ageing”. Along with the world population, Indian Elderly are also “ageing in old age”. Ageing is a phase of life and a biological process. Every organism born, ages with time and decays. Ageing is a life-long activity - from birth we grow older through infancy to childhood to adolescence to adulthood and onwards. The most widely used measure of ageing is chronological age, since it is the simplest and most comparable. But chronological age in itself is inadequate to explain the condition of people in later life. The term ‘old’ is often associated with alteration in individual’s biological, psychological and health capabilities and changes in social roles. People aged sixty years and over are also considered as persons in the “third age”.
DEMOGRAPHY AND AGEING
Demographers interpret ageing as an outcome of changes in fertility and mortality rather than a natural process in itself. The term “demographic transition” refers to a process where by society moves from a situation of high fertility and mortality to one of lower rates. This transition is characterised first by decline in infant and childhood mortality as infectious and parasitic diseases are controlled., Reduction in fertility implies a decline in the proportion of the young in the population. Reduction in mortality means longer life span due to control of epidemics and life threatening diseases. Whole population begin to age when fertility rates decline and mortality rates at all ages improve. “Population Ageing” involves a shift from high mortality! high fertility to low mortality/ low fertility. India is now undergoing such a demographic transition. The population of elderly (60 +) in India has risen from 5.6% in 1960 to 6.3% in 1980 and is expected to be 7.7% by 2001 and 9.5% in 2020. India will soon qualify as a “Graying Nation” as per U.N. Definition. Life expectancy at birth was as low as 32 years in 1947 and by 1990 it had risen to around 60 years. The crude birth rate that was 42 per 1, 000 population has declined to 30 in 1990. It is estimated that crude birth rate now may be. around 25 and crude death rate less than 9 per thousand.
Kerala State is a good example which perhaps is, passing through the last stage of demographic’ transition. As per the latest estimates (lIPS and ORG Macro, 2001), life expectancy at birth is around 74. The below replacement level fertility and high life expectancy have resulted, inevitably, in having the highest proportion of aged population in the country. As per estimates, Kerala has 11 % of population above 60 years. This has resulted in the fast growth of small sized nuclear families during the last two decades.
Over time, the older population itself will grow older. There were 8.2% people above 75 years in 1996. There are now 76 million people in 60+ age group. One out of seven older persons in the world is from India.
In India, age 60 is used as a cut off point to identify people as old. However. this is an arbitrary way of labeling a person as old. Ageing is a highly complex process. Not every one ages with same speed and in the same manner. Physical, social, economic, psychological, educational and cultural factors determine the ageing process. Old people are a heterogeneous lot, much more so in India. Different parts of the country are experiencing varying levels of development. Urban and rural areas present contrasts in factors that determine quality of life. In developing countries, there is a trend for premature ageing as a result of illiteracy, poor hygiene, malnutrition, poverty and such other factors.
2. The Plight of the Elderly
As human life advances from childhood to youth and from youth to manhood, at every stage there is a meaningful and responsible role to play. At the same time, every stage of human life is exposed to numerous “risks” and “hazards” associated with occupation and age. In this process, as it advances from manhood to old age, new stresses and strains engulf human existence. The family has generally been. the traditional primary source of the social, economic, psychological and physical support for the aged. However, the elderly get affected due to lack of support from children who would have grown into adulthood and are in the web of fulfilling their own priorities. Joint family system is slowly vanishing from the society and nuclearisation of the family is the process of the present day social set-up. And due to lack of any worthwhile scheme of social insurance or social assistance these elderly become one of the marginalised and vulnerable sections of the society. Emerging changes in the demographic, social and cultural mores of the society is also one of the major causes behind the unfavourable scenario of the twilight zone of human life. The intensity of old age problems varies from rural to urban, and ageing from person to person and of course from men to women
ECONOMIC CONDITION
The problems of the elderly essentially concern:
1. Lack of Income Security
2. Absence of appropriate Health Care
3. Deprivation of Social and Emotional needs
4. Lack of Personal Security.
In general older people are considerably poorer than young active members in the work force. In India old age is associated with lowering of economic status, financial insecurity and at times abject poverty. The reasons are:
1. Only about 10 per cent of the people are employed in organised sector where they can expect regular income, pension or other benefits after retirement. As of 1991, there were 7 million elderly who were employees in public and private sector and 53 million in unorganised sector. Low wages, job insecurity, lack of legal and governmental provision to protect their rights make 90% wage earners vulnerable to poverty.
2. 60% of those who get retirement benefit, are found to become fhlancially dependent on others within two to three years after their retirement.
3. Joint families used to provide succour to the old, disabled and infirm earlier. Nuclear families cannot or may not provide for economic needs of older member.
4. Though the needs of elderly reduce to begin with, as years go by, they increase due to health reasons. It is then difficult to cope with the declining finances. Hence, physical, financial and emotional dependence goes on increasing.
5. Increasing number of elderly get disillusioned and lead a miserable life resulting out of their blind faith and love for their children.
6. There is a large segment of older women who had always been dependentr economically on the family. They will be hard hit, if families are not supportive in their old age.
7. Traditionally, children were considered as “old age security”. With decline in birth rates, and nuclear families, old people are forced to fend for themselves.
8. In India, there is already considerable poverty. People living in marginalised conditions are likely to become increasingly so when they grow old and disabled.
9. Health problems increase with ageing. India lacks comprehensive medicare policy. Even optimal health care is expensive. As people live longer, they outlive their resources (if any) as medical expenses eat into their savings.
Dependency
Economic well being of a society is often measured by dependency ratio. Persons under 15 years and above 60 are assumed to be economically inactive and depend on population aged 16-59. Dependency ratios are calculated taking these three segments of population. Inadequate income and poverty lead to dependency on bread earning/care taker group (16-59 years of age). Dependence rate is very high in India, and is around 53 percent in 2001. For every working person in the future, there will be 2 dependent persons. In turn this trend creates economic, social, health and psychological . pressure on care givers. The National Sample Survey Organisation (NSSO) 42nd round of studies show that nearly half of the aged persons in India are fully dependent on others. Out of these three fourths· are supported by their children. Rural elderly work for longer time as agriculture labourers, while urban elderly seek re-employment. In a country with high unemployment rate, this may not be easy. At times poor health may act .as an obstacle for reemployment.
STATUS OF THE OLD IN INDIA
75 per cent suffer from physical disability.
60 per cent face a great sense of alienation. ·
48 per cent are extremely lonely. ·
46 per cent face economic problems.
MAJOR FACTORS RESPONSIBLE FOR THE SENSE OF DEPRIVATION
40 per cent feel unwanted by their children.
35 per cent feel no one helps them or speaks consolatory words. ·
35 per cent are unhappy due to disrespect in the family. ·
33 per cent are worried about bad health.
52 per cent aged of both sexes do all their work themselves, including cooking their meals, and feel a sense of loss about daughters-in-law not helping out. Only 1 per cent enjoy this facility.
PROBLEMS DUE TO ECONOMIC INSUFFICIENCY
67 per cent feel the family treats them with contempt as they are no longer working.
25 per cent suffer from depression.
12 per cent have no hope of economic support from any source.
10 per cent suffer from a sense of economic alienation.
(Source: UGC-sponsored research project on “Sociology of ageing among the senior citizens” in urban UP).
3. The Elderly Women
Ageing is universal, both men and women age. Yet, ageing issues of women merit special attention. Gender makes a difference to the ageing experience. Gender is a very important variable influencing quality of life at any age, especially in old age. Ageing has become a ‘gender issue’ because due to demographic changes, there will he 604 million older women in the world by 2025. 70% of these will be in developing countries and 70% of them will be living in rural poverty. In most advanced countries women outsurvive men by four to 8 years. India is one of the few countries where sex ratio is biased in favour of men. The reason for this trend has to be sought in the sociocultural practices of our country and the general low status of women. Life expectancy of women is gradually rising in India too, and in older age group, women tend to have longer life expectancy. Biological advantage females have over male asserts itself in the 70+ age group and percentage of old women will be 50.9 and that of men 49.1 beyond the seventh decade. Older women in India face ‘triple jeopardy’- that of being female in patriarchal culture, of being old in a fast changing society, and of being poor.
Poverty: Women tend to be poorer as they are likely to work in domestic, agricultural, informal settings. This work is hardly monetised. There is considerable difference between older men and women in work force partiipation rates.
Illiteracy (only 8% of older women were literate in 1981) and unemployment make women dependent on others.
Widowhood: The main social effect of extension of life in later years for women is the extended period of Widowhood. Percentage of widows is disproportionately larger in India than that of widowers. Much lower proportion of men were widowed compared to women in extreme age. Main reasons that can be attributed to this phenomena are longer life of women compared to men; usual practice of young women to get married to older men and widowed men permitted to remarry which is prohibited for widowed women. NSS data shows that 60, 65 and 70 years, percentage of widows was around 56, 58 and 78 percent. In the same age group, percentage of widowers was around 14,17 and 27%. Widowhood makes an important difference to health, socioeconomic status, morbidity and even mortality.
Health: Older women’s health is affected by a life time of poor nutrition, multiple pregnancies, poor reproductive health care apart from other causes. Women have considerably more morbidity than men. A higher percentage of women are physically immobile due to illness. If they live longer, they may become victims of more disabling disorders such as cancer, osteoporosis, arthritis and AD.
Women as a group are more depressed. Most studies report lower life satisfaction· and poor psychological well being in women. More than any other problem, mental health of women is conditioned by social and cultural factors. Depression arises out of widowhood, loneliness, unpleasant life circumstances, lack of social support and poverty.
Some statistics about Older Women: There are 974 women per 1000 men in India. There were 33 million widows in 1991. Only about 10% of older women are literate. 60% of older women are chronically ill. 80% are totally economically dependent. Women are the primary care givers for elderly .
4. Morbidity in the Elderly
Indians above sixty years of age display considerable morbidity. The number of blind persons among the elderly was estimated to be around 11 million in 1996. The prevalence of blindness is ten times higher in older age group than the prevalence in total population. 60% of elderly have hearing impairment (about 38 million in 1996). Hypertension is twice as common among urban than rural, and twenty times higher when compared to prevalence rate in total population. Nearly five million elderly were diagnosed as hypertensive in 1996. There will be considerable under reporting as in rural areas adequate diagnostic facilities are not available. An estimated 9 million in 64 + age category were diagnosed as having coronary heart disease (CHD). Prevalence rate of CHD was 244 and 237 per 1000 male and female persons. There were around 5 million diabetic persons in higher age group in 1996, prevalence being highest among urban females. Based on population based cancer registries, an estimated 0.35 million elderly had diagnosed cancer. Prevalence rate of peptic ulcer was similar to that of total population around 0.2 million in 1996.
It has been repeatedly pointed out that the progress India has made in extending the life-span of its citizens has not been carried over to providing healthy and disability-free old age. About 5% of older people in urban and rural area are said to be physically immobile. Nearly 60 per cent of those immobile were from 70 + age group.
Difficulties with Activities of Daily Living (ADL) a good measure of functional competence, increase with age. In India, the percent of those chronically ill rises from 39 in 60—64 to 45 in 65-69 and 55 in 70+ age groups. In rural areas, impairment of vision and difficultly in mobility are common in old age. Vision and mobility are two important factors determining independence in later years. In the absence of availability of corrective surgery, medical facilities and prosthetic aides, rural elderly will be more vulnerable. Another common geriatric problem is acute confusional state which is almost as non-specific as vomiting in children! Common causes are infection, cerebral hypoxia, cerebral ischaemia (stroke, MI, etc.), Metabolic (hypoglycaemia, uremia), iatrogenic (barbiturates, L-Dopa), depression, abrupt changes in the environment, social stresses. Pressure sores are one of the special hazards facing patients who are old, ill and immobile. They may be superficial or deep, but require vigilant nursing care. Instability leading to falls and immobility are also common in older people. Age related changes in flexibility, reduction in visual and sensory acuity, neurological diseases, cardio vascular diseases, environmental factors (poor lighting, slippery floors, steep stairs, uneven mats), and certain type of medicines cause falls in elderly. Arthritis is a common and often chronic condition among the aged. A major consequence of this is the limitation of abilities and negative impact on ADL and IADL (Instrumental Activities of Daily Living). This is due to age related changes in cartilage of the joints. Ageing, obesity, trauma are some of the predisposing factors. Pain is the symptom, which leads to stiffness and restriction of joint movement.
Nutritional deficiency is also common among aged. It does not occur as a result of ageing alone. It occurs as a result of reduced intake (may be due to teeth problem), impaired absorption and excessive utilisation. Apart from. this economic and environmental factors play a role. Widespread chronic infection, poor environment, unsanitary conditions, lack of personal hygiene, ignorance about nutrition, etc. cause malnutrition.
The elderly are considered high risk group for multiple morbidity - physical, mental and social. The prevalence rate of mental morbidity among those aged 60+ was estimated at 89/1000 which projected onto the population yielded a figure of nearly 4 million. Affective disorders, particularly depression is the most common diagnosis in this age group. Neurotic disorders are relatively infrequent. Affective disorders, particularly depression, later paraphrenia and dementias form the bulk of morbidity in higher age group. The risk of psychiatric illness increases pari passu with age. The overall prevalence of psychiatric morbidity rises from 71.5 percent of those over 60 (but below 70) to 124 in the 70s to 122 in those over 80. Nearly 43% of psychiatric outpatients in 60+ age group are said to suffer from geriatric depression.
Not only is depression more common in older age groups, the elderly also form a high risk group for self destructive behaviour . Suicide rates increase sharply and is around 12/100,000 while it is 7/100,000 for general population. The ratio of ‘completers’ to ‘attempters’ is around 1.7, while it is 1.15 in younger age group. Women have higher rate of depression. Psychological factors, chronic diseases, social problems, isolation and losses combine to push elderly into depression. Recent studies show that depressive disorders are aggravated by physical iIIness. A significant feature of late life illness is that )psychiatric disorder is seldom an ‘isolated event’. Comorbidity is common with patients displaying a minimum of 6 to 12 symptoms and having two or three clinical diagnosis. Psychiatric disorders are associated with opthalmalogical,. degenerative, arthritis, neurological, cardiovascular, dermatological, hearing, urinary, nutritional and neoplastic disorders, in that order of frequency. Dementia is being called the ‘disease of our century’.The prevalence rate of dementia in those aged 65 + is around 27/1000 in urban and 35/1000 in rural areas. Around 35-40% of these is diagnosed as Alzheimer’s Disease (AD). As the number of elderly increases in the population, a concomitant rise in proportion of dementia is also expected. In a majority of cases dementia does not begin till age 65 and over. However, an estimated 5-10% develops the symptoms in middle age. Though dementia is less common than depression in Indian elders, it causes severe stress to family care givers. Persons with Alzheimer’s (pronounced Altz-Hi-Merz) exhibit only minor symptoms in the beginning that are often attributed to other illness. Gradually, the person becomes more forgetful. As memory loss increases, changes also appear in judgement, concentration, behaviour and personality. AD is not a normal part of ageing, it is a disease. The distinctive changes caused in the brain confirm the diagnosis on autopsy. These changes are not caused by hardening of arteries, nor is it contagious.
As yet, prevention and cure of the disease is not known, though several approaches are described. The level at which a dementing person is able to function is affected by other factors. This is often referred to as ‘excess disability’. These are secondary psychiatric symptoms, presence of other illness or reactions to medication, sensory impairments, or stressors.
Drugs are not the answer to all problems of elderly patients. Loneliness, loss of affection and support often complicate their ill health. Sometimes drug treatment may produce adverse effects that are worse than disease itself. Drug interaction, higher incidence of side effects and effect of multiple prescription should be kept in mind while treating an older person.
5. Shelter needs of the Elderly
Families are in continuous process of change, and that patterns observed at any given time represent ongoing negotiation between family values and social change. From an agrarian joint family system, families are becoming, urban, nuclear and individualistic. Families are rarely self-sufficient and are often subjected to tremendous pressure and adjustments as a result of rapid socioeconomic change.
For a very long time Planners and Policy makers ignored the problems of older people, complacent that ‘our traditional’ joint family system would take care of the elderly. With industrialisation, youngsters started migrating to cities. Increased urbanisation brought in nuclear families. Physical distance and financial independence severed ties with natal household. When cities drew young ablebodied working force from rural areas, it created pockets of poverty with old and infirm unable to keep alive the rural economy. The force of customs, traditions and control of caste and kinship diluted in urban areas. As women entered the workforce, old people lost their traditional carers. While people live longer, require long-term care, there are not enough people around to meet such demands. All this has repercussions on care giving and caring for elders as well as living arrangements.
A host of factors such as gender, health status, presence of disability, socioeconomic status and cultural tradition influence living arrangement of older people. Family, still appears to be the natural habitat of older Indians. Living with spouse and children, followed by living with a married son (and his family) is the preferred living arrangement. Living with a married daughter is less preferred. Least preferred is living in an old age home. While ordinarily the elderly persons live with their family, circumstances are developing in such a way that many of them have had to live independently or under institutional care. NSS (1986-87) reports that 8% of urban and 5.9% of rural elderly live alone. Sometimes the health condition of the persons may be such that the concerned families may not be able to provide the necessary care. In some cases there may be no family at all. At the worst, the families might have abandoned them and the elderly persons need to seek institutional care.
Living alone is often due to widowhood, migration of children and due to adjustmental problems. In urban areas, there is a trend for older women to live alone. There is another pattern of living arrangement - an older person usually a widow is shunted from the house of one child to another, as no one child is willing to provide continuous care.
INSTITUTIONALISATION
The idea of institutionalisation of the aged has been largely borrowed from the western societies, whose values and norms are quite different from that of India. The requirements of institutionalisation cannot be denied for those aged people who are neither able to manage their own affairs nor do they have any person to look after them. Usually living in an old age home evokes a picture of apathy, dependence and sadness. The inmates often confront problems due to highly ipstitutionalised, depersonalised and bureaucratic atmosphere in OAHs. They face problems with adjustment with tight and rigid schedule, total or near total separation from the family/social milieu, anxiety over entrusting oneself to a new environment, diminished physical capacity and very close and frequent encounters with death and ailments in the institution.
Old Age homes are, generally, the last resort for the aged. In the absence of joint family system, nuclearisation of families, the old parents are left with no other alternative than joining the old age homes. According to a study conducted in the old age homes of Maharashtra (Dandekar, 1996) almost 64 per cent of inmates had nobody to take care of them, and among them 45 per cent had no money. Economic consideration is one of the main reasons for choosing old age homes and even if there is family to support, the domestic environment and poor interpersonal relationships also push the aged to old age homes.
There were around 354 old age homes in 1997. By 2001 the number of old age homes in the country has grown to 969. Many such homes are run on charity and inmates are poor. In major cities, relatively well to do people are opting to live in condominiums built for the elderly. Expensive but well maintained old age homes are also appearing. Construction companies are promoting senior housing projects with medical and recreational facilities. It is important to realise that where a person lives in old age will make a significant difference to availability of care, nature and amount of care, emergency help, social interactions and well being in general .
THE ELDERLY
By Mohan Pai, Omashram Trust, Bangalore
Preface
Omashram is very happy to put together this document about the elderly in India. We have tried to cover as many aspects about the old age as possible and by no means the document is all comprehensive. The material contained here has been gleaned from various sources - books, articles, documents, etc. The “old age” population is growing at an accelerated rate all over the world and India is no exception. In 1991, the population of 60 years and above was 56 million (6.8%). In 1999, it has crossed 70 million and is expected to reach 177 million by 2025. The growth rate of elderly population (37.3%) is twice that of general population (16.8%). One out of seven elderly in the world is an Indian. Average expectation of life from 60 years in 1991 is expected to reach 70 years by the year 2025. Dramatic demographic changes pose multiple challenges. The country is not geared to manage such a large older population. The rapid rise in elderly population is not met with expansion of health care and social security measures. There is a very realistic fear that the quality of life of the population might be compromised. The age-old joint family system in India is steadily breaking down. About 30% of elders live separately. Loneliness, dependency, poverty, lack of protection for their lives and property are some of the main problems faced by the elders. Hardly about 11 % of the elderly in India are covered by the various pension and retirement schemes and the large majority (89%) remains uncovered without any social security protection. Government support and efforts have been tardy and half hearted, lacking both resources and political will. The main purpose of this document is to create and spread awareness about the plight of the elderly and to help the elderly work towards ‘active ageing’ and improving quality of life.
Managing Trustee
Omashram Trust, Bangalore
October 15, 2002
Vijayadashami
1. The Age of Ageing
Graying population is one of the most ‘significant characteristics’ of the 20th century and the first quarter of the 21st century known as the “age of ageing”. Along with the world population, Indian Elderly are also “ageing in old age”. Ageing is a phase of life and a biological process. Every organism born, ages with time and decays. Ageing is a life-long activity - from birth we grow older through infancy to childhood to adolescence to adulthood and onwards. The most widely used measure of ageing is chronological age, since it is the simplest and most comparable. But chronological age in itself is inadequate to explain the condition of people in later life. The term ‘old’ is often associated with alteration in individual’s biological, psychological and health capabilities and changes in social roles. People aged sixty years and over are also considered as persons in the “third age”.
DEMOGRAPHY AND AGEING
Demographers interpret ageing as an outcome of changes in fertility and mortality rather than a natural process in itself. The term “demographic transition” refers to a process where by society moves from a situation of high fertility and mortality to one of lower rates. This transition is characterised first by decline in infant and childhood mortality as infectious and parasitic diseases are controlled., Reduction in fertility implies a decline in the proportion of the young in the population. Reduction in mortality means longer life span due to control of epidemics and life threatening diseases. Whole population begin to age when fertility rates decline and mortality rates at all ages improve. “Population Ageing” involves a shift from high mortality! high fertility to low mortality/ low fertility. India is now undergoing such a demographic transition. The population of elderly (60 +) in India has risen from 5.6% in 1960 to 6.3% in 1980 and is expected to be 7.7% by 2001 and 9.5% in 2020. India will soon qualify as a “Graying Nation” as per U.N. Definition. Life expectancy at birth was as low as 32 years in 1947 and by 1990 it had risen to around 60 years. The crude birth rate that was 42 per 1, 000 population has declined to 30 in 1990. It is estimated that crude birth rate now may be. around 25 and crude death rate less than 9 per thousand.
Kerala State is a good example which perhaps is, passing through the last stage of demographic’ transition. As per the latest estimates (lIPS and ORG Macro, 2001), life expectancy at birth is around 74. The below replacement level fertility and high life expectancy have resulted, inevitably, in having the highest proportion of aged population in the country. As per estimates, Kerala has 11 % of population above 60 years. This has resulted in the fast growth of small sized nuclear families during the last two decades.
Over time, the older population itself will grow older. There were 8.2% people above 75 years in 1996. There are now 76 million people in 60+ age group. One out of seven older persons in the world is from India.
In India, age 60 is used as a cut off point to identify people as old. However. this is an arbitrary way of labeling a person as old. Ageing is a highly complex process. Not every one ages with same speed and in the same manner. Physical, social, economic, psychological, educational and cultural factors determine the ageing process. Old people are a heterogeneous lot, much more so in India. Different parts of the country are experiencing varying levels of development. Urban and rural areas present contrasts in factors that determine quality of life. In developing countries, there is a trend for premature ageing as a result of illiteracy, poor hygiene, malnutrition, poverty and such other factors.
2. The Plight of the Elderly
As human life advances from childhood to youth and from youth to manhood, at every stage there is a meaningful and responsible role to play. At the same time, every stage of human life is exposed to numerous “risks” and “hazards” associated with occupation and age. In this process, as it advances from manhood to old age, new stresses and strains engulf human existence. The family has generally been. the traditional primary source of the social, economic, psychological and physical support for the aged. However, the elderly get affected due to lack of support from children who would have grown into adulthood and are in the web of fulfilling their own priorities. Joint family system is slowly vanishing from the society and nuclearisation of the family is the process of the present day social set-up. And due to lack of any worthwhile scheme of social insurance or social assistance these elderly become one of the marginalised and vulnerable sections of the society. Emerging changes in the demographic, social and cultural mores of the society is also one of the major causes behind the unfavourable scenario of the twilight zone of human life. The intensity of old age problems varies from rural to urban, and ageing from person to person and of course from men to women
ECONOMIC CONDITION
The problems of the elderly essentially concern:
1. Lack of Income Security
2. Absence of appropriate Health Care
3. Deprivation of Social and Emotional needs
4. Lack of Personal Security.
In general older people are considerably poorer than young active members in the work force. In India old age is associated with lowering of economic status, financial insecurity and at times abject poverty. The reasons are:
1. Only about 10 per cent of the people are employed in organised sector where they can expect regular income, pension or other benefits after retirement. As of 1991, there were 7 million elderly who were employees in public and private sector and 53 million in unorganised sector. Low wages, job insecurity, lack of legal and governmental provision to protect their rights make 90% wage earners vulnerable to poverty.
2. 60% of those who get retirement benefit, are found to become fhlancially dependent on others within two to three years after their retirement.
3. Joint families used to provide succour to the old, disabled and infirm earlier. Nuclear families cannot or may not provide for economic needs of older member.
4. Though the needs of elderly reduce to begin with, as years go by, they increase due to health reasons. It is then difficult to cope with the declining finances. Hence, physical, financial and emotional dependence goes on increasing.
5. Increasing number of elderly get disillusioned and lead a miserable life resulting out of their blind faith and love for their children.
6. There is a large segment of older women who had always been dependentr economically on the family. They will be hard hit, if families are not supportive in their old age.
7. Traditionally, children were considered as “old age security”. With decline in birth rates, and nuclear families, old people are forced to fend for themselves.
8. In India, there is already considerable poverty. People living in marginalised conditions are likely to become increasingly so when they grow old and disabled.
9. Health problems increase with ageing. India lacks comprehensive medicare policy. Even optimal health care is expensive. As people live longer, they outlive their resources (if any) as medical expenses eat into their savings.
Dependency
Economic well being of a society is often measured by dependency ratio. Persons under 15 years and above 60 are assumed to be economically inactive and depend on population aged 16-59. Dependency ratios are calculated taking these three segments of population. Inadequate income and poverty lead to dependency on bread earning/care taker group (16-59 years of age). Dependence rate is very high in India, and is around 53 percent in 2001. For every working person in the future, there will be 2 dependent persons. In turn this trend creates economic, social, health and psychological . pressure on care givers. The National Sample Survey Organisation (NSSO) 42nd round of studies show that nearly half of the aged persons in India are fully dependent on others. Out of these three fourths· are supported by their children. Rural elderly work for longer time as agriculture labourers, while urban elderly seek re-employment. In a country with high unemployment rate, this may not be easy. At times poor health may act .as an obstacle for reemployment.
STATUS OF THE OLD IN INDIA
75 per cent suffer from physical disability.
60 per cent face a great sense of alienation. ·
48 per cent are extremely lonely. ·
46 per cent face economic problems.
MAJOR FACTORS RESPONSIBLE FOR THE SENSE OF DEPRIVATION
40 per cent feel unwanted by their children.
35 per cent feel no one helps them or speaks consolatory words. ·
35 per cent are unhappy due to disrespect in the family. ·
33 per cent are worried about bad health.
52 per cent aged of both sexes do all their work themselves, including cooking their meals, and feel a sense of loss about daughters-in-law not helping out. Only 1 per cent enjoy this facility.
PROBLEMS DUE TO ECONOMIC INSUFFICIENCY
67 per cent feel the family treats them with contempt as they are no longer working.
25 per cent suffer from depression.
12 per cent have no hope of economic support from any source.
10 per cent suffer from a sense of economic alienation.
(Source: UGC-sponsored research project on “Sociology of ageing among the senior citizens” in urban UP).
3. The Elderly Women
Ageing is universal, both men and women age. Yet, ageing issues of women merit special attention. Gender makes a difference to the ageing experience. Gender is a very important variable influencing quality of life at any age, especially in old age. Ageing has become a ‘gender issue’ because due to demographic changes, there will he 604 million older women in the world by 2025. 70% of these will be in developing countries and 70% of them will be living in rural poverty. In most advanced countries women outsurvive men by four to 8 years. India is one of the few countries where sex ratio is biased in favour of men. The reason for this trend has to be sought in the sociocultural practices of our country and the general low status of women. Life expectancy of women is gradually rising in India too, and in older age group, women tend to have longer life expectancy. Biological advantage females have over male asserts itself in the 70+ age group and percentage of old women will be 50.9 and that of men 49.1 beyond the seventh decade. Older women in India face ‘triple jeopardy’- that of being female in patriarchal culture, of being old in a fast changing society, and of being poor.
Poverty: Women tend to be poorer as they are likely to work in domestic, agricultural, informal settings. This work is hardly monetised. There is considerable difference between older men and women in work force partiipation rates.
Illiteracy (only 8% of older women were literate in 1981) and unemployment make women dependent on others.
Widowhood: The main social effect of extension of life in later years for women is the extended period of Widowhood. Percentage of widows is disproportionately larger in India than that of widowers. Much lower proportion of men were widowed compared to women in extreme age. Main reasons that can be attributed to this phenomena are longer life of women compared to men; usual practice of young women to get married to older men and widowed men permitted to remarry which is prohibited for widowed women. NSS data shows that 60, 65 and 70 years, percentage of widows was around 56, 58 and 78 percent. In the same age group, percentage of widowers was around 14,17 and 27%. Widowhood makes an important difference to health, socioeconomic status, morbidity and even mortality.
Health: Older women’s health is affected by a life time of poor nutrition, multiple pregnancies, poor reproductive health care apart from other causes. Women have considerably more morbidity than men. A higher percentage of women are physically immobile due to illness. If they live longer, they may become victims of more disabling disorders such as cancer, osteoporosis, arthritis and AD.
Women as a group are more depressed. Most studies report lower life satisfaction· and poor psychological well being in women. More than any other problem, mental health of women is conditioned by social and cultural factors. Depression arises out of widowhood, loneliness, unpleasant life circumstances, lack of social support and poverty.
Some statistics about Older Women: There are 974 women per 1000 men in India. There were 33 million widows in 1991. Only about 10% of older women are literate. 60% of older women are chronically ill. 80% are totally economically dependent. Women are the primary care givers for elderly .
4. Morbidity in the Elderly
Indians above sixty years of age display considerable morbidity. The number of blind persons among the elderly was estimated to be around 11 million in 1996. The prevalence of blindness is ten times higher in older age group than the prevalence in total population. 60% of elderly have hearing impairment (about 38 million in 1996). Hypertension is twice as common among urban than rural, and twenty times higher when compared to prevalence rate in total population. Nearly five million elderly were diagnosed as hypertensive in 1996. There will be considerable under reporting as in rural areas adequate diagnostic facilities are not available. An estimated 9 million in 64 + age category were diagnosed as having coronary heart disease (CHD). Prevalence rate of CHD was 244 and 237 per 1000 male and female persons. There were around 5 million diabetic persons in higher age group in 1996, prevalence being highest among urban females. Based on population based cancer registries, an estimated 0.35 million elderly had diagnosed cancer. Prevalence rate of peptic ulcer was similar to that of total population around 0.2 million in 1996.
It has been repeatedly pointed out that the progress India has made in extending the life-span of its citizens has not been carried over to providing healthy and disability-free old age. About 5% of older people in urban and rural area are said to be physically immobile. Nearly 60 per cent of those immobile were from 70 + age group.
Difficulties with Activities of Daily Living (ADL) a good measure of functional competence, increase with age. In India, the percent of those chronically ill rises from 39 in 60—64 to 45 in 65-69 and 55 in 70+ age groups. In rural areas, impairment of vision and difficultly in mobility are common in old age. Vision and mobility are two important factors determining independence in later years. In the absence of availability of corrective surgery, medical facilities and prosthetic aides, rural elderly will be more vulnerable. Another common geriatric problem is acute confusional state which is almost as non-specific as vomiting in children! Common causes are infection, cerebral hypoxia, cerebral ischaemia (stroke, MI, etc.), Metabolic (hypoglycaemia, uremia), iatrogenic (barbiturates, L-Dopa), depression, abrupt changes in the environment, social stresses. Pressure sores are one of the special hazards facing patients who are old, ill and immobile. They may be superficial or deep, but require vigilant nursing care. Instability leading to falls and immobility are also common in older people. Age related changes in flexibility, reduction in visual and sensory acuity, neurological diseases, cardio vascular diseases, environmental factors (poor lighting, slippery floors, steep stairs, uneven mats), and certain type of medicines cause falls in elderly. Arthritis is a common and often chronic condition among the aged. A major consequence of this is the limitation of abilities and negative impact on ADL and IADL (Instrumental Activities of Daily Living). This is due to age related changes in cartilage of the joints. Ageing, obesity, trauma are some of the predisposing factors. Pain is the symptom, which leads to stiffness and restriction of joint movement.
Nutritional deficiency is also common among aged. It does not occur as a result of ageing alone. It occurs as a result of reduced intake (may be due to teeth problem), impaired absorption and excessive utilisation. Apart from. this economic and environmental factors play a role. Widespread chronic infection, poor environment, unsanitary conditions, lack of personal hygiene, ignorance about nutrition, etc. cause malnutrition.
The elderly are considered high risk group for multiple morbidity - physical, mental and social. The prevalence rate of mental morbidity among those aged 60+ was estimated at 89/1000 which projected onto the population yielded a figure of nearly 4 million. Affective disorders, particularly depression is the most common diagnosis in this age group. Neurotic disorders are relatively infrequent. Affective disorders, particularly depression, later paraphrenia and dementias form the bulk of morbidity in higher age group. The risk of psychiatric illness increases pari passu with age. The overall prevalence of psychiatric morbidity rises from 71.5 percent of those over 60 (but below 70) to 124 in the 70s to 122 in those over 80. Nearly 43% of psychiatric outpatients in 60+ age group are said to suffer from geriatric depression.
Not only is depression more common in older age groups, the elderly also form a high risk group for self destructive behaviour . Suicide rates increase sharply and is around 12/100,000 while it is 7/100,000 for general population. The ratio of ‘completers’ to ‘attempters’ is around 1.7, while it is 1.15 in younger age group. Women have higher rate of depression. Psychological factors, chronic diseases, social problems, isolation and losses combine to push elderly into depression. Recent studies show that depressive disorders are aggravated by physical iIIness. A significant feature of late life illness is that )psychiatric disorder is seldom an ‘isolated event’. Comorbidity is common with patients displaying a minimum of 6 to 12 symptoms and having two or three clinical diagnosis. Psychiatric disorders are associated with opthalmalogical,. degenerative, arthritis, neurological, cardiovascular, dermatological, hearing, urinary, nutritional and neoplastic disorders, in that order of frequency. Dementia is being called the ‘disease of our century’.The prevalence rate of dementia in those aged 65 + is around 27/1000 in urban and 35/1000 in rural areas. Around 35-40% of these is diagnosed as Alzheimer’s Disease (AD). As the number of elderly increases in the population, a concomitant rise in proportion of dementia is also expected. In a majority of cases dementia does not begin till age 65 and over. However, an estimated 5-10% develops the symptoms in middle age. Though dementia is less common than depression in Indian elders, it causes severe stress to family care givers. Persons with Alzheimer’s (pronounced Altz-Hi-Merz) exhibit only minor symptoms in the beginning that are often attributed to other illness. Gradually, the person becomes more forgetful. As memory loss increases, changes also appear in judgement, concentration, behaviour and personality. AD is not a normal part of ageing, it is a disease. The distinctive changes caused in the brain confirm the diagnosis on autopsy. These changes are not caused by hardening of arteries, nor is it contagious.
As yet, prevention and cure of the disease is not known, though several approaches are described. The level at which a dementing person is able to function is affected by other factors. This is often referred to as ‘excess disability’. These are secondary psychiatric symptoms, presence of other illness or reactions to medication, sensory impairments, or stressors.
Drugs are not the answer to all problems of elderly patients. Loneliness, loss of affection and support often complicate their ill health. Sometimes drug treatment may produce adverse effects that are worse than disease itself. Drug interaction, higher incidence of side effects and effect of multiple prescription should be kept in mind while treating an older person.
5. Shelter needs of the Elderly
Families are in continuous process of change, and that patterns observed at any given time represent ongoing negotiation between family values and social change. From an agrarian joint family system, families are becoming, urban, nuclear and individualistic. Families are rarely self-sufficient and are often subjected to tremendous pressure and adjustments as a result of rapid socioeconomic change.
For a very long time Planners and Policy makers ignored the problems of older people, complacent that ‘our traditional’ joint family system would take care of the elderly. With industrialisation, youngsters started migrating to cities. Increased urbanisation brought in nuclear families. Physical distance and financial independence severed ties with natal household. When cities drew young ablebodied working force from rural areas, it created pockets of poverty with old and infirm unable to keep alive the rural economy. The force of customs, traditions and control of caste and kinship diluted in urban areas. As women entered the workforce, old people lost their traditional carers. While people live longer, require long-term care, there are not enough people around to meet such demands. All this has repercussions on care giving and caring for elders as well as living arrangements.
A host of factors such as gender, health status, presence of disability, socioeconomic status and cultural tradition influence living arrangement of older people. Family, still appears to be the natural habitat of older Indians. Living with spouse and children, followed by living with a married son (and his family) is the preferred living arrangement. Living with a married daughter is less preferred. Least preferred is living in an old age home. While ordinarily the elderly persons live with their family, circumstances are developing in such a way that many of them have had to live independently or under institutional care. NSS (1986-87) reports that 8% of urban and 5.9% of rural elderly live alone. Sometimes the health condition of the persons may be such that the concerned families may not be able to provide the necessary care. In some cases there may be no family at all. At the worst, the families might have abandoned them and the elderly persons need to seek institutional care.
Living alone is often due to widowhood, migration of children and due to adjustmental problems. In urban areas, there is a trend for older women to live alone. There is another pattern of living arrangement - an older person usually a widow is shunted from the house of one child to another, as no one child is willing to provide continuous care.
INSTITUTIONALISATION
The idea of institutionalisation of the aged has been largely borrowed from the western societies, whose values and norms are quite different from that of India. The requirements of institutionalisation cannot be denied for those aged people who are neither able to manage their own affairs nor do they have any person to look after them. Usually living in an old age home evokes a picture of apathy, dependence and sadness. The inmates often confront problems due to highly ipstitutionalised, depersonalised and bureaucratic atmosphere in OAHs. They face problems with adjustment with tight and rigid schedule, total or near total separation from the family/social milieu, anxiety over entrusting oneself to a new environment, diminished physical capacity and very close and frequent encounters with death and ailments in the institution.
Old Age homes are, generally, the last resort for the aged. In the absence of joint family system, nuclearisation of families, the old parents are left with no other alternative than joining the old age homes. According to a study conducted in the old age homes of Maharashtra (Dandekar, 1996) almost 64 per cent of inmates had nobody to take care of them, and among them 45 per cent had no money. Economic consideration is one of the main reasons for choosing old age homes and even if there is family to support, the domestic environment and poor interpersonal relationships also push the aged to old age homes.
There were around 354 old age homes in 1997. By 2001 the number of old age homes in the country has grown to 969. Many such homes are run on charity and inmates are poor. In major cities, relatively well to do people are opting to live in condominiums built for the elderly. Expensive but well maintained old age homes are also appearing. Construction companies are promoting senior housing projects with medical and recreational facilities. It is important to realise that where a person lives in old age will make a significant difference to availability of care, nature and amount of care, emergency help, social interactions and well being in general .
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