POPULATION AGEING AND HEALTH IN INDIA
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Background Paper Series 1
W0S1M ageing
SOM]
MlM'li to Hl
S Irudaya Rajan
Centre for Enquiry Into
Health and Allied Themes
POPULATION AGEING AND
HEALTH IN INDIA
S 1RUDAYA RAJAN, Fb d
The Centre for Enquiry into Health and Allied Themes (CEHAT), Mumbai
First Published in July 2006
By
Centre for Enquiry into Health and Allied Themes
Survey No. 2804 & 2805
Aaram Society Road
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Tel. : 91-22-26673571 / 26673154
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© CEHAT
ISBN: 81-89042-44-0
Printed, at:
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Parel, Mumbai-400 012.
09597
FROM THE RESEARCH DESK
Health and Human rights has explicit
intrinsic connections and has emerged as
powerful concepts within the rights based
approach especially so in the backdrop of
weakening public health system, unregulated
growth of the private sector and restricted
access to healthcare systems leading to a
near-total eclipse of availability and
accessibility of universal and comprehensive
healthcare. A rights-based approach to health
uses International Human Rights treaties and
norms to hold governments accountable for
their obligations under the treaties. It
recognises the fact that the right to health is
a fundamental right of every human being and
it implies the enjoyment of the highest
attainable standard of health and that it is
one of the fundamental rights of every human
being and that governments have a
responsibility for the health of their people
which can be fulfilled only through the
provision of adequate health and social
measures. It gets integrated into research,
advocacy strategies and tools, including
monitoring; community education and
mobilisation; litigation and policy formulation.
Right to the highest attainable standard is
encapsulated in Article 12 of the International
Covenant on Economic, Social and Cultural
Rights. It covers the underlying preconditions
necessary for health and also the provisions
of medical care. The critical component
within the right to health philosophy is its
realisation. CEHAT’s main objective of the
project. Establishing Health as a Human Right
is to propel within the civil society and the
public domain, the movement towards
realisation of the right to healthcare as a
fundamental right through research and
documentation, advocacy, lobbying,
campaigns, awareness and education
activities.
The Background Series is a collection of
papers on various issues related to right to
health, i.e., the vulnerable groups,health
systems, health policies, affecting
accessibility and provisions of healthcare in
India. In this series, there are papers on
women, elderly, migrants, disabled,
adolescents and homosexuals. The papers are
well researched and provide evidence based
recommendations for improving access and
reducing barriers to health and healthcare
alongside addressing discrmination.
We would like to use this space to express
our gratitude towards the authors who have
contributed to the project by sharing their
ideas and knowledge through their respective
papers in the Background Series. We would
like to thank the Programme Development
Committee (PDC) of CEHAT, for playing such
a significant role in providing valuable inputs
to each paper. We appreciate and recognise
the efforts of the project team members who
have worked tirelessly towards the success
of the project ; the Coordinator, Ms. Padma
Deosthali for her support and the Ford
Foundation, Oxfam- Novib and Rangoonwala
Trust for supporting such an initiative. We
are also grateful to several others who have
offered us technical support, Ms Sudha
Raghavendran for editing and Satyam
Printers for printing the publication. We hope
that through this series we are able to
present the health issues and concerns of the
vulnerable groups in India and that the series
would be useful for those directly working on
the rights issues related to health and other
areas.
Chandrima B.Chatteijee, Ph.D
Project In Charge (Research)
Establishing Health As A Human Right
ABOUT THE AUTHOR
Population Ageing and Health in India
S. Irudaya Rajan, PhD, is Professor at the Centre for
Development Studies (CDS), Thiruvananthapurarn, Kerala,
Formerly, he was a doctoral fellow at the International
Institute for Population Sciences, Mumbai, and recipient of
the Gold Medal (First Rank) for the best student in
Demography during 1982-83. He is a lead author of the book,
India’s Elderly: Burden or Challenge?, published by Sage
Publications. His other book, An Aging India: Perspectives,
Prospects and Policies, co-edited with Phoebe Liebig of the
Andrus Gerontology Centre, University of Southern
California, Los Angeles, has been released by the Haworth
Press, United States of America. He is presently coordinating
major projects for Global Development Network of South
Asian Network of Economic Institutes, Indo-Dutch Progam
on Alternatives in Development, Shastri Indo-Canadian
Institute and International Development Research Centre.
He has co-authored/co-edited several books and articles in
international journals on issues relating to Kerala and has
been a consultant for World Bank. He has been involved in
coordinating three major surveys in Kerala namely the
Fertility Survey, Migration Survey and Aging Survey.
iv
CONTENTS
I.
Introduction...............................................................................................................................
1
II.
Ageing: The Indian Scenario .............................................................................................
1
III.
Emerging Ageing Scenario, 2001-2051........................................................................
3
IV.
Marital Status of the Elderly............................................................................................
7
V.
Living Arrangements among the Elderly .....................................................................
o Studies on Living Arrangements among the Elderly .................................................
o The Second National Family Health Survey Some new Observations......................................................................................................
7
8
10
Dependency among the Elderly ....................................................................................
14
o
Health Status of the Elderly............................................................................................
Utilisation of Health Services:...........................................................................................
o Policy Prescriptions ..............................................................................................................
18
30
32
References..................................................................................................................................
33
VI.
VII.
v
LIST OF TABLES
1.
2.
3.
4.
5,
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
Number and Proportion of Elderly in the Indian Population by
Age Groups, 1961-2001............................................................................................................
Sex Ratio and Growth Rate among the Indian Elderly, 1971-2001 ...............................
Life Expectancy at ages 60 and 70 for Indians..................................................................
Number. Proportion and Sex Ratio of the Elderly, 2001-2051.........................................
Percentage Distribution of Elderly by Age and Sex, 1998-99 .........................................
Head of the Household among the Elderly, 1998-99 (Percent) ......................................
Percentage Distribution of the Elderly by their Living
Arrangements, 1998-99 ..........................................................................................................
Dependency Status among the Indian Elderly.................................................................
Fully Dependent Elderly by Sex and Place of Residence in Major States...................
Basic Needs Unmet among the Indian Elderly ................................................................
Classification of the Indian Elderly by Sex and Place of Residence
on the basis of at least one Basic Need Unmet.................................................................
Percentage of Elderly with no Property by Sex and Place of Residence
in the Major States of India ..................................................................................................
Health, Disease and Disability profile among the Elderly in India, 1995-96............
Percentage of Elderly who reported having Good.Health by Regions of
India, 1995-96 .............................................................................................................................
Percentage of Elderly who reported having good health by
Scheduled Caste and Tribes, 1995-96.................................................................................
Disease patterns among the Elderly by Scheduled Caste/Tribes, Others ...............
Disease Profile among the Elderly by Regions of India, 1995-96 .................................
Disabilities among the Elderly by Social Groups in India. 1995-96.............................
Disability Profile among Elderly by Regions of India. 1995-96.......................................
Morbidity Particulars among the Elderly with social groups, 1995-96 ........................
Medical attention at death among the Elderly.................................................................
Utilisation Pattern of Health Services among the Elderly.............................................
2
2
3
4
11
12
13
14
15
16
17
18
20
20
21
22
23
25
26
28
29
31
LIST OF FIGURES
1. Age Pyramid for India - 1961, 2001 &2051 ...........................................................................
2. Percentage of elderly 60 or above by sex, 1901 - 2051.........................................................
vi
5
6
POPULATION AGEING AND
HEALTH IN INDIA
and China contributing a significant
proportion of this growing elderly (Irudaya
Rajan, Sarma and Mishra 2003).
I. INTRODUCTION
Projected increases in both the absolute
and relative size of the elderly population
in many third world countries is a subject
of growing concern for public policy
(Kinsella and Velkoff 2001; World Bank
2001; United Nations 2002; Bordia and
Bhardwaj 2003; Liebig and Irudaya Rajan
2003). The combination of high fertility and
declining mortality during the twentieth
century has resulted in large and rapid
increases in elderly populations as
successively larger cohorts step into old
age. Further, the sharp decline in fertility
experienced in recent times is bound to
lead to an increasing proportion of the
elderly in the future. Since these
demographic changes have been
accompanied by rapid and profound socio
economic changes, cohorts might differ in
their experience as they join the ranks of
the elderly.
II. Ageing: The Indian Scenario
The 2001 census has shown that the
elderly population of India accounted for
77 million. While the elderly constituted
only 24 million in 1961, it increased to 43
million in 1981 and to 57 million in 1991.
The proportion of elderly persons in the
population of India rose from 5.63 per cent
in 1961 to 6.58 per cent in 1991 (Irudaya
Rajan, Mishra and Sarma, 1999) and to 7.5
per cent in 2001. This is true of other older
age cohorts too. The elderly population
aged 70 and above which was only 8
million tn 1961 rose to 21 million in 1991
and to 29 million in 2001. Besides, the
proportion of elderly above 70 in the total
population increased from 2.0 per cent in
1961 to 2.9 per cent in 2001. The Indian
population census reported 99,000
centenarians in 1961 their number rose
to 138,000 in 1991. The growth rate among
different cohorts of elderly such as 60 plus,
70 plus and 80 plus during the decade
1991-2001 was much higher than the
general population growth rate of 2 per cent
per annum during the same period.
However, the sex ratio among the elderly
in India has favoured males as against the
trend prevalent in other parts of the world
(Tables 1 and 2).
The number of elderly in the developing
countries has been growing at a
phenomenal rate; in 1990 the population
of 60 years and above in the developing
countries exceeded that in the developed
countries.
According to
present
indications, most of this growth will take
place in developing countries and over half
of it will be in Asia, with the two major
population giants of Asia, namely India
(Irudaya Rajan, Mishra and Sarma 1999)
1
S Irudaya Rajan
Table 1: Number and Proportion of Elderly in the Indian Population by
Age Groups, 1961-2001
Percent of Elderly to the total population
Number (in Millions)
60+
70+
80+
90+
100+
1961
25
9
2
0.5
0.01
1971
33
11
3
0.7
0.01
1981
43
15
4
0.7
0.01
1991
57
21
6
1
0.01
2001
77
29
8
n.a
n.a
1961
5.6
2
0.6
0.1
0.02
1971
6
2.1
0.6
0.1
0.02
1981
6.49
2.33
0.62
0.1
0.02
1991
6.76
2.51
0.76
0.2
0.02
2001
7.5
2.9
0.8
n.a
n.a
Note: Compiled by the author from the last five population censuses.
Table 2: Sex Ratio and Growth Rate among the Indian Elderly, 1971-2001
Sex Ratio of Elderly (males per 1000 females)
60+
70+
80+
90+
100+
1971
1066
1030
950
897
798
1981
1042
1026
990
892
844
1991
1075
1084
1090
1019
896
2001
1028
991
1051
n.a
n.a
Growth of Elderly (Percent)
1971-81
2.78
3.13
2.54
0.66
0.19
1981-91
2.72
3.08
4.35
5.08
0.44
1991-2001
3.04
3.32
2.35
n.a
n.a
Note: Estimated by the author from the last four censuses.
Mishra 2003). In India, the sex ratio of the
aged as well as that of the old-old favours
males. Reasons for more males in old age
may consist of under-reporting of females,
especially widows, age exaggeration, low
female life expectancy at birth, and excess
female mortality among infants, children
and adults (Sudha and Irudaya Rajan
2003; Mari Bhat 2002). Notwithstanding
the several analytical and statistical
problems
indicated
above,
the
preponderance of females in extreme old
ages needs to be brought to the attention
of planners and policy makers.
India is one of the few countries in the
world where males outnumber females.
This phenomenon among the elderly is
intriguing because female life expectancy
at ages 60 and 70 is slightly higher than
that of males. However, at any given age,
contrary to what we would normally expect,
there are more widows than widowers and
reasons for this unusual phenomenon
need to be identified. Life expectancy at
birth among Indian males had been higher
than that among females until the first half
of the 1990s. Apart from this unusual
demographic pattern of excess female
mortality during infancy and childhood,
the phenomenon of age exaggeration
among the aged complicates the analysis.
Thus, the above observation of more males
in old age does not reveal a true picture of
elderly persons (Irudaya Rajan, Sarma and
Population Ageing And Health In India
Available findings on ageing suggest that
fertility has played a predominant role in
the ageing process compared to mortality.
In India, there has been a substantial
reduction in mortality compared to fertility
2
S Irudaya Rajan
Table 3: Life Expectancy at ages 60 and 70 for Indians
Female
Male
1970-75
1976-80
1981-85
1986-90
1991-95
1995-99
eO
50.5
52.5
55.4
57.7
59.7
60.8
e60
13.4
14.1
14.6
14.7
15.3
15.7
e70
8.6
9.6
9.7
9.4
10
10.3
eO
49
52.1
55.7
58.1
60.9
62.5
e60
14.3
15.9
16.4
16.1
17.1
17.7
e70
9.2
10.9
11
10.1
11
11.6
Note: Compiled from life tables produced by the Registrar General of India for various periods.
m. Emerging Ageing Scenario, 2001-2051
since 1950. For instance, while the crude
birth rate declined from 47.3 during 195161 to 22.8 in 1999, the crude death rate
fell steeply from 28.5 to 8.4 during the
same period. Logically, therefore, India is
expected to undergo a faster decline in
fertility in the immediate future compared
to mortality, because mortality is already
at a low level. The ageing process in India
will, therefore, be faster than in other
developing countries. Moreover, the
transition from high to low fertility is
expected to narrow the age structure at its
base and broaden the same at the top. In
addition, improvement in life expectancy
at all ages will allow more old people to
survive, thus intensifying the ageing
process. In this context, an examination of
the increasing life expectancy indicates
that the gain will be shared by older people
and will increase their longevity. Table 3
provides evidence to support this—males
are expected to live 16 years beyond age
60 and 10 years beyond age 70 and the
corresponding years for females are 18 and
1 1 respectively. Urban females are
expected to live for an additional two years
at age 60 compared to their rural
counterparts.
Population Ageing And Health In India
The major objective of this paper is to assess
the emerging ageing scenario of India in
the first half of the 21st century and for this,
the elderly population of India has been
projected for the next 50 years. Table 4
gives a profile of the elderly classified by
ages 60 and above, 70 and above and 80
and above in terms of size, proportion and
gender dimensions. Figure 1 depicts
India’s age pyramids at three demographic
regimes—high fertility and mortality
(1961), moderate fertility and low mortality
(2001), and low fertility and low mortality
(2051). Figure 2 assesses the percentage
of elderly in the population by sex.
For the projections, the 2001 census age
data published by the Registrar General of
India has been used as the base population;
assumptions on future fertility and
mortality trends are based on past trends
as revealed by the Sample Registration
System and other sources such as the first
and second round of National Family
Health Surveys (Visaria and Irudaya Rajan
1999; Guilmoto and Irudaya Rajan 2001;
2002). The projection period ranges from
3
S Irudaya Rajan
Table 4: Number, Proportion and Sex Ratio of the Elderly, 2001-2051
60 and Above
Numbers (in million)
Percentage to tire total population
Sex Ratio (males per 1000 females)
70 and Above
Numbers (in million)
Percentage to the total population
Sex Ratio (males per 1000 females)
80 and Above
Numbers (in million)
Percentage to the total population
Sex Ratio (males per 1000 females)
2001
2011
2021
2031
2041
2051
77
7.5
1028
96
8.2
1034
133
9.9
1004
179
11.9
964
236
14.5
1008
301
17.3
1007
29
2.9
991
36
3.1
966
51
3.8
970
73
4.8
930
98
6
891
132
7.6
954
8
0.5
1051
9
0.7
884
11
0.8
866
16
1
843
23
1.4
774
32
1.8
732
Note: According to the 2001 census. India was administratively divided into 28 states and 7 Union Territories.
Population Projections have been made specifically for the present paper.
2001 to 2051. It is also important to note
that projected elderly population above 60
years of age in 2051 were already bom in
1991 and were 10 years old in 2001. Given
our assumptions regarding mortality, the
projections are likely to be valid.
of elderly persons above 70 years of age
(old-old) is likely to increase more sharply
than those 60 years and above. The oldold are projected to increase five-fold
between 2001-2051 (from 29 million in
2001 to 132 million in 2051). Their
proportion is expected to rise from 2.9 to
7.6 per cent. Although we have found
excess males in the age group 60 and
above, the old-old sex ratio is favourable to
females. The oldest old (80+) among the
elderly in India is expected to grow faster
than any other age group in the population.
In absolute terms, it is likely to increase
four-fold from 8 million in 2001 to 32
million in 2051.
The size of India’s elderly population aged
60 and above is expected to increase from
77 million in 2001 to 179 million in 2031
and further to 301 million in 2051. The
proportion is likely to reach 12 per cent in
2031 and 17 per cent in 2051. However,
the sex ratio among the elderly favours
males, which is contrary to the experience
of other developing nations. The number
Population Ageing And Health In India
4
S Irudaya Rajan
Figure 1
Age pyramid for INDIA,1961
80+
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
Female
[23 Male
Age pyramid for INDIA, 2001
80 +
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
B Male
Population Ageing And Health In India
Female
5
S Irudaya Rajan
Age pyramid for INDIA, 2051
80 +
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
Figure 2: Percentage of Elderly 60 and Above by Sex, 1901-2051
Population Ageing And Health In India
6
S Irudaya Rajan
IV.
Marital Status of the Elderly
of spouse is a major disaster in old age and
such individuals deserve suitable and
adequate social safety nets irrespective of
gender. Designing policies to protect
elderly females, particularly widows,
should form a major welfare programme in
the country.
The marital status of the elderly assumes
special significance in the context of care
in old age as those who are married seem
to fare better in all economic and social
aspects than those who are single. A major
concern relates to the increasing
proportion of elderly women, especially
widows in the population. Two reasons are
given for the marked gender disparity in
widowhood in India
V.
The overall reduction in general and infant
mortality rates and the steady increase in
average age at death have resulted in the
growth of the elderly population around the
world. According to the National Family
Health Survey-2, eight per cent of the
population reported that they were in the
age group 60 or above (International
Institute for Population and Sciences,
2000). The conventional living patterns
among the elderly have changed
drastically following the reduction in
fertility and the increase in life expectancy
at older ages. In India, the traditional
practice has been for people to live with
their children in old age; this is not
necessarily with the intention of receiving
support; often the rest of the family also
benefits from the arrangement. For
example, when the younger women of the
household go to work, the grandparents
take care of their children. On the
International Day for the Older Persons,
(2003), the United Nations
(2003)
addressed healthy older people as a
resource for their families, societies and the
economy of their respective countries.
longer life span of women
compared to men,
(ii) the general tendency for women to
marry men older than themselves
(Gulati and Irudaya Rajan 1999).
(i)
Besides, widowed men are more likely to
remarry and thus restore their earlier
status. Though the relationship between
the well-being of the elderly and their
marital status cannot be spelt out
precisely, any change in the marital status
of the elderly deserves careful
examination.
According to the 2001 census, 33.07 per
cent of the elderly in India are without
their life partners. The widowers among
men form 14.98 per cent as against 50.06
per cent widows among women. However,
the proportion of widows and widowers in
the 1991 census were 15.5 per cent and
54.0 per cent respectively. Over the last ten
years, the widowhood percentages have
declined for both sexes; however, the
decline has been more marked among
women. Among the oldest-old (80 years
and above), widowhood is much more
common. Almost half of them live without
the spouse. A gender-wise analysis of the
latest population census shows that 71.11
per cent of women were widows, while only
28.89 per cent of males were widowers. Loss
Population Ageing And Health In India
Living Arrangements among the Elderly
The term ‘living arrangement’ is used to
refer to one’s household structure (Palloni,
2001). Irudaya Rajan, Mishra and Sarma
(1995) explain living arrangements in
terms of the type of family in which the
elderly live, the headship they enjoy, the
place they stay in and the people they stay
with, the kind of relationship they maintain
7
S Irudaya Rajan
with their kith and kin, and the extent to
which they adjust to the changing
environment. While dealing with the
welfare of any specific group, it is important
to study their pattern of living
arrangement. The elderly, being less
independent, need the care and support
of others in several respects. Taking care
of the elderly refers mainly to emotional
support; on the other hand, support given
to the elderly refers to financial and
material support. The former type of support
is expected from family members or persons
who are close to them, whereas, the latter
is supposed to be a joint effort of the
immediate family and society
in living arrangements, family structure
and mode of retirement affect the old
adversely (D’Souza, 1989). Leaving the
parental home for education and
employment results in elderly parents
having to live alone at home until the
children come back (Gaymu, 2003). The
overall well-being of the elderly consists
of their physical, mental and social well
being. It is widely known that the erosion
of the traditional norm whereby the elderly
generally live with children or relatives
reduces the well-being of the older
population (Palloni, 2001). However, that
it is not necessarily so is shown by the
experience of industrialised nations where
the government has fostered systems to
meet the economic and social needs of the
elderly
There exist several living patterns for the
elderly such as living with the spouse,
living with children and living in old age
homes. Living alone or with the spouse is
the most stable living arrangement for
people who are not too old yet, whereas for
the oldest-old, living with a child or
grandchild is the most stable arrangement
(Wilmoth, 1998). Researchers have put in
a lot of effort to investigate the determinants
leading to a specific living arrangement.
Living arrangements are influenced by a
variety of factors including number and
availability of children and other relatives,
kinship patterns of society, location of
household, marital status, financial status,
availability of services and physical and
mental well being of the elderly
(Schafer, 1999; Kan, Park and Chang,
2001). Attitude towards and perception
about the living place is another important
component that decides where they should
live (Chen, 1998).
Studies on Living Arrangements among
the Elderly
Legare and Martel (2003) have attempted
to highlight the differences and similarities
regarding the living arrangements of the
elderly in Canada, Switzerland, United
Kingdom and Finland, and to investigate
the effects of these differences and
similarities in demographic trends. The
countries studied show great similarities
in living arrangements, notwithstanding
their cultural differences. Living alone is
becoming popular although gender
differences do exist. A good proportion of
elderly women live alone while their male
counterparts live with the spouses, a
phenomenon explained by the higher life
expectancy among females. Emerging
demographic trends and increasing
divorce rates influence the living
arrangements at old age greatly (Legare
and Martel 2003; Martel and Carriere
2003). In Asian countries, support and care
of the elderly come mostly from the family.
Martel and Carriere (2003) also found that
The effects of living arrangement on the
physical and psychological well-being of
the elderly have also been examined by
researchers. According to them, changes
Population Ageing And Health In India
8
S Irudaya Rajan
per cent of the elderly above age 60 lived
with at least one of their children. This
article foresees some of the gaps in the
government’s support systems for the
elderly and the future challenges that
might be faced by this population group and
their care-givers.
prevalence of widowhood and divorce rates
have different impacts on the living
arrangements of the elderly.
Besides living arrangements, housing
conditions of the elderly are a prominent
research area, as everyday environment
has a direct impact on the well-being of
individuals (Gaymu, 2003; Knodel and
Auh, 2002). Gaymu identified the life-cycle
effect on living arrangements. Commonly
observed living arrangement patterns are
of two types: parents benefiting with extra
space when children are away and
children living together with parents when
they are not healthy. Knodel and Auh
(2002) give a broad profile of Vietnam’s
older
population
including age
distribution, marital status, education,
economic activity and household work,
religious adherence, quality of house and
living arrangements. However, the study
identifies the remarkable stability in the
living arrangement of Brunei elders with
respect to co-residence of children, and
thereby keeps away the common fear of
desertion of elderly parents socially. The
article adds, “the result makes clear that
many older Vietnamese men and women
are not simply dependent, but in turn, are
likely to contribute to stability in living
arrangement”.
In Thailand, despite major demographic
and social changes, an extensive familial
system of support and care is maintained
(Knodel and Chayovan, 1997). However,
some recent data indicate that the
proportion of parents living with at least one
child in the same dwelling unit is
declining. But the article does not consider
this an erosion of the support system, since
daily contact between older parents and
non-co-resident children compensates for
this decline. Another study on Vietnam has
identified that married sons constitute the
most important source of social security in
addition to the finding that the family
constitutes the most important source of
social support and security (Anh et.al,
1997).
Yet another study on living arrangements
and health status of the elderly in rural
China, Jun (2002) has constructed a health
index by taking into account physical,
mental and social well-being variables. The
study has shown that aged people who live
alone have the poorest health status
compared to others. Mba (2002) addresses
the demographic and socio-economic
correlates of the living arrangements of
elderly women. The study identifies several
of these variables and draws major policy
conclusions. It strongly suggests that there
is evidence of some convergence of Lesotho
to the Western family system.
From the recent surveys conducted in
Singapore, Philippines, Thailand and
Vietnam, it was found that children
continue to be an important source of
support to the elderly (Knodel and
Debavalya, 1997). Natividad and Cruz
(1997) examined living arrangements
among the Filipino elderly in terms of
gender, marital status and place or
residence. Although it is common for the
elderly to live with their children, they are
not passive recipients of support. Chan
(1997) found that in Singapore, about 90
Population Ageing And Health In India
Living arrangements among the Indian
elderly using National Family Health
Survey-I was addressed by Irudaya Rajan
9
S Irudaya Rajan
and Kumar (2003). The study presents
detailed characteristics of living
arrangements among the elderly in India
in terms of headship, average household
size and marital status. The article draws
attention to the fact that only 6 percent of
the elderly in India live in a household
where their immediate relatives are not
present. Furthermore, the paper put
forward a few policy prescriptions to
enhance the well-being of the Indian
elderly. Chen (1998) investigated the
consequences of the living arrangements
on the elderly in Taiwan. The study
acquires special importance, as many
Asian countries are expected to follow the
Taiwan experience.
Models were
formulated to predict the probability of
living in a specific household structure.
The study identified migration, resource
change and life cycle events as significant
factors that decided living structure
during old age.
child mortality, maternal and child health
and utilisation of health services. It covered
99 percent of India’s population living in
all the 26 states. The survey collected
information from 91,196 households in 25
states (excluding Tripura due to delay in
data collection) and interviewed 89,199
eligible women in the age group, 15-49. It
also included information on 32,393
children bom during the three-year period
preceding the survey. The survey has not
collected detailed information on the
elderly. However, the household
questionnaire has incorporated a few
features regarding the elderly population
including living arrangements. The
present analysis that highlights the pattern
of living arrangements is based on NFHS2.
According to the NFHS-2, 7.9 percent of the
Indian population is aged 60 and above
(UPS, 2000). Out of the sample, 9511
respondents live in urban areas, while their
rural counterparts numbered 29583. The
sex ratio of the elderly population was 920
females per for 1000 males, although when
viewed age-wise, the sex ratio is favourable
to females with advancing age.
The Second National Family Health
Survey - Some new Observations
The National Family Health Survey (NFHS2), undertaken in 1998-99 collected data
on fertility, family planning, infant and
Population Ageing And Health In India
10
S Irudaya Rajan
Table 5: Percentage Distribution of Elderly by Age and Sex, 1998-99
Urban
Total
60-64
65-69
70-74
75-79
80-84
85-89
90+
Total (%)
Total Sample
Male
35.49
24.55
20.96
8.74
6.3
2.04
1.92
100
20440
Female
38.67
25.55
17.99
7.48
6.1
2.09
2.12
100
18654
Total
37.01
25.02
19.55
8.14
6.21
2.06
2.02
100
39094
Male
35.95
25.42
19.93
9.57
5.69
2.15
1.29
100
4796
Female
35.12
26.32
18.75
8.7
6.26
2.4
2.46
100
4715
Rural
Total
35.54
25.86
19.35
9.14
5.97
2.27
1.87
100
9511
Male
35.35
24.28
21.28
8.48
6.49
2.01
2.12
100
15644
Female
39.87
25.29
17.73
7.07
6.05
1.99
2.01
100
13939
Total
37.48
24.75
19.61
7.82
6.28
2
2.07
100
29583
Note: Tables generated from the raw data by the author.
until their old age. Four in every five males
are married currently, while the
magnitude diminishes to half of this among
their female counterparts. This reduction
is compensated by the category widowed
in the case of females, which could be
explained by the fact that women live
longer than men and that women are
usually married to men who are older.
Widows have additional problems due to
their low levels of literacy. They have no
independent income; their only source of
livelihood is their children (Chen, Martha,
1988). It is necessary that the government
should initiate policies and programmes
specially designed to take care of widows
at advanced ages.
Among the elderly, urban and rural
differences with respect to age are
negligible. Except for an excess of 5
percent of rural females in the age group
60-64 compared to the rural males, the
gender differences are not very visible with
the place of residence (Table 5). Almost 50
percent of the elderly males had no
education, while the situation is even
worse in the case of females (80 percent).
As the majority of elderly in India are
illiterate, their living conditions mostly
depend upon their co-residence with
children and their ability to work and earn
an income beyond the officially designated
age of retirement. According to the NFHS
(1999-2000), 63 percent of the males and
58 percent of the females continue to work
beyond 60. As they grow older, the work
participation rate declines: however, even
at 80 and above, 22 percent of males and
17 percent of females continue to work in
India. Higher work participation among the
elderly is also due to the lack of proper
social security safety nets and high levels
of poverty (Irudaya Rajan. 2004: Liebig
Phoebe and Irudaya Rajan. 2003)). Only
very few (1.3 percent among males and 0.7
among females) remain never married
Population Ageing And Health In India
It was reported that almost 84 percent of
elderly males in the age group 60-64 were
heads of households as against 16 percent
among women. This is also true among
rural and urban households. Even at the
time of death (90 years and above) almost
half of the elderly males were heads of
households. The highest percentages of
female-headed households are found
among widowed and divorced women
(Table 6).
11
S Irudaya Rajan
Table 6: Head of the Household among the Elderly, 1998-99 (Percent)
Rural
Urban
60-64
65-69
70-74
75-79
80-84
85-89
90+
Total
Never married
Married
Widowed
Divorced
Total
Male
Female
Male
Female
Male
Female
85.67
83.35
76.99
73.2
65.2
53.4
41.94
79.73
39.19
83.94
59.23
100
18.42
18.21
22.62
20
18.64
22.12
12.07
19.24
12.96
1.16
29.78
33.33
83.73
81.81
77.83
74.98
64.83
60.51
46.83
78.79
32.49
84.18
58.46
50
15.22
15.35
16.67
14.21
14
13.36
7.14
15.17
13.58
1.97
24.56
27.59
84.19
82.18
77.64
74.52
64.91
58.75
46.06
79.01
34.32
84.12
58.61
68.75
15.96
16.09
18.24
15.91
15.2
15.9
8.59
16.19
13.33
1.79
25.95
29.79
Note: Tables generated from the raw data by the author.
The household size is an indication of the
degree of bond among the generations. If
more and more people are living together,
the elderly are likely to get better attention
including care during sickness. If we
define any household, which has more
than five members as a joint family, nearly
71 percent of the households in India
qualify. As of now, Indian women, on an
average, have three children. If any family
has more than six members (consisting of
children, parents and at least one of the
grandparents), they are most likely to be
three-generation households. Almost half
of the households in India are threegeneration households.
percent), followed by never married (10
percent) and widows (7 percent). In terms
of place of residence, 33 percent of the
elderly live in eight member-households
in rural areas compared to 28 percent in
urban areas. On an average, the elderly
reside in households with at least seven
members. Urban households have a smaller
average family size than rural households.
The status of the current co-residence
among the Indian elderly has also been
analysed by sex and place of residence.
Interestingly, only 2.9 percent of the
elderly live alone and another 1.26 percent
with others - relatives or non-relatives.
More elderly women (4.07 percent) live
alone compared to elderly men (1.77
percent). In other words, only four percent
of the elderly in India are living in a
household where their immediate relatives
are not present. Another seven percent of
the elderly live with their spouses alone,
possibly due to the migration of their
children (Table 7)
As of now, single-member families are rare
in India. However, among the elderly, 1.7
percent of males and 4.5 percent of the
females are found to live alone. Close to
10 percent of the households consist ofjust
two members. In terms of marital status,
divorced persons are likely to live alone (17
Population Ageing And Health In India
12
S Irudaya Rajan
Table 7: Percentage Distribution of the Elderly by their Living Arrangements, 1998-99
Rural
Urban
Male Female Total
1.97
3.49
2.72
8.1
4.86
6.51
Male
1.7
8.27
Living alone
With spouse only
With spouse,
children and
58.7 40.75 49.86 59.15
grand children
With children and
grandchildren
29.17 48.75 38.81 30.13
With other relatives 1.97
2.11
2.04
0.75
0.04
0.07
With non-relatives 0.1
0.01
Total (percent)
100
100
100
100
Total Sample
4796 4715 9511 15644
Total
Female
4.33
6
Total
2.92
7.22
Male
1.77
8.22
Female
4.07
5.65
Total
2.86
7.01
42.62
51.5
59.02
42.05
51.01
45.97 37.47
1.06
0.89
0.02
0.01
100
100
13939 29583
29.86
1.09
0.03
100
20440
46.83
1.38
0.02
100
18654
37.86
1.23
0.03
100
39094
Note: Tables generated from the raw data by the author.
A little over half the elderly (51 percent)
live with their spouses, own children and
grandchildren; almost 38 percent live with
their children and grandchildren as their
spousep are no more. Thus only two
categories, namely those who live with
spouse, children and grandchildren, and
those who live with children and
grandchildren but without spouse, are
predominant among the Indian elderly.
Though much disparity is not noticed
between rural and urban households, the
differences are pronounced between men
and women.
elderly who live with children and
grandchildren are likely to be widows or
widowers. There are more widows in India
than widowers who reside in large
numbers with their children and
grandchildren.
According to the NFHS, 58 percent of the
elderly women are widows as against 17
percent of the men who are widowers. In
all, 59 percent of the elderly widowers are
reported as heads of households as against
26 percent widows. However, 31 percent
of elderly widowers and 58 percent of
elderly widows are reported as parents
living in the households of their children.
The same pattern is also true of both rural
and urban households. Almost 93 percent
of widowers and widows live with their
children and grandchildren. Only 10
percent live alone or with other relatives.
The family still provides strong support to
the
elderly.
Another
interesting
observation arising from this analysis is
that around 7 percent of widows live with
their sons-in-law as against just 3 percent
among widowers.
According to the NFHS, close to 60 percent
of the male elderly live with their spouses,
children and grandchildren;
the
corresponding percentage for the female
elderly is only 42 percent. On the other
hand, close to 50 percent of the female
elderly live with their children and
grandchildren (without spouse) and only
30 percent of the males live with their
children and grandchildren but without
their spouse. This finding can be
interpreted in a different manner too. The
Population Ageing And Health In India
13
S Irudaya Rajan
associations.
Though every household in India may not
have an elderly member, some households
could have more than one elderly member.
Almost 58 percent of households had one
elderly member above 60 years of age, 39
percent of households had two elderly
members and 3 percent of households had
three or more elderly members. The pattern
is similar in both rural and urban areas. If
the households have more than two elderly
members, who are they and what is their
relationship to the head of the household?
Interestingly, many households do
accommodate elderly relatives such as
mother and father-in-law, uncles and
aunts. It is possible that some households
in which the head of the household is an
elderly member, has his parents (80+) with
them. This is a situation where four
generations live under one roof.
VI.
Dependency among the Elderly
The National Sample Survey in its 52nd
round (July 1995-June 1996) focused on
issues such as economic independence,
chronic ailments, retirement and
withdrawal from economic activity and
familial integration among the elderly 60
and above. This was a large-scale sample
survey conducted throughout the country.
The elderly covered in the sample
consisted of 16,777 males and 16,428
females (for details, see Table 8).
Using the raw data on economic
independence, this paper has attempted an
assessment of the level of poverty among
the Indian elderly according to sex, place
of residence and marital status by major
states. All the elderly in the sample were
asked to state their economic dependence,
which was coded into three categories: not
dependent, partially dependent and fully
dependent. We presume that fully
dependent elderly need economic support
in old age as they are below the poverty
line. They should be integrated into
various poverty alleviation and social
security programmes. Tables 9 and 10
provide some details.
It is evident that a suitable policy needs to
be framed towards restoring familial care
of the elderly in view of the drastic social
changes that have taken place in the wake
of modernisation. It goes without saying
that prompt action for the provision of social
security to the vulnerable poor elderly is
called for before things worsen.
Alternatives such as old-age homes may
also be thought of with the support of non
governmental organisations and voluntary
Table 8: Dependency Status among the Indian Elderly
Male Female Total
30.7
36.4
24.7
Not dependent
17.9
17.1
Partially dependent 18.6
51.4
45
58.2
Fully dependent
10491 9954 20445
No of Elderly
Total
Urban
Rural
Male
38.6
16
45.5
6286
Female
22.4
13.4
64.2
6473
Male Female
Total
37.2
23.8
30.4
15.6
17.6
14.7
45.2
60.6
55
12759 16777 16428
Total
30.6
16.6
52.8
33205
Note: Estimated by the author using the National Sample Survey data (52nd round).
Population Ageing And Health In India
14
S Irudaya Rajan
Table 9: Fully Dependent Elderly by Sex and Place of Residence in Major States
Male
Andhra Pradesh
46
50.7
Assam
Bihar
36.7
Gujarat
45.3
54.1
Haryana
Himachal Pradesh 36.3
Jammu Kashmir 37.7
Karnataka
50.4
Kerala
53.4
Madhya Pradesh 42.1
Maharashtra
46.7
49.4
Orissa
57.2
Punjab
43.7
Rajasthan
42.1
Tamil Nadu
Uttar Pradesh
39.7
49.8
West Bengal
45
India
Female
64.9
69
54.6
58
65.9
37.7
61.6
58.8
57.7
51.4
52.3
62.4
67.9
54.8
52.4
54.9
67.1
58.2
Total
Urban
Rural
Total
55.3
58.6
45.1
51.8
60
37
48.4
54.9
55.8
46.7
49.6
55.6
62.4
49.6
46.8
47
58.2
51.4
Male
43.1
45.1
37.4
46.5
51.1
30
34.8
52.8
53.4
45.5
45.9
40.4
46.9
42.6
40.3
46.9
46.9
45.5
Female
59.1
57.1
63.2
63.6
66.7
52.2
72.3
66.7
66.9
59.4
62.9
69.6
70.2
60
60.8
64.7
64.6
64.2
Total
Male
Female
Total
51.5
50.9
49.9
55.4
59.1
40.6
51.4
59.9
61
52.2
54.4
55.9
58.5
52.1
50.4
56
55.5
55
44.8
49.5
36.8
45.9
52.8
35.6
36.8
51.6
53.4
43.3
46.3
47.5
53.2
43.2
41.2
41.6
48.3
45.2
62.2
66
56.5
60.7
58.2
39.3
64.7
62.4
61.4
53.9
57.3
64.1
68.8
56.9
57.1
57.8
65.8
60.6
53.6
56.8
46.2
53.5
55.7
37.4
49.3
57.3
57.8
48.6
51.9
55.6
60.8
50.6
48.8
49.5
56.9
52.8
Note: Estimated by the author using the National Sample Survey data (52nd round).
that more than half of their elderly women
depended on others for their livelihood.
Estimates range from 51 per .cent in
Madhya Pradesh to 69 per cent in Assam.
In urban areas, with the exception of
Haryana, Karnataka and Kerala, all major
states report a level of economic
dependency below 50 per cent for males.
The situation is more vulnerable for elderly
females in the urban areas. Their economic
dependency ranges form 52 per cent in
Himachal Pradesh to 72 per cent in Jammu
Kashmir. As stated earlier, widowhood
leads to major economic problems in old
age. Analysis of the plight of the fully
dependent elderly by widowhood status for
men and women shows a marked difference
In rural areas, 58 per cent of females and
45 per cent of males were fully dependent
whereas in urban areas, these percentages
were 64 and 46 respectively. There is a
marked difference between males and
females in this respect. The most
vulnerable group consists of elderly
females in urban areas; 64 per cent of them
are dependent on others for food, clothing
and health care. This is one of the reasons
why the elderly continue to work in old age
in spite of poor health. An assessment of
the situation in the major states (Table 9)
shows that in rural areas, only 5 states (out
of 15) reported a male dependency level
above 50 per cent. Ironically, all states
except Himachal Pradesh have reported
Population Ageing And Health In India
15
S Irudaya Rajan
Though every household in India may not
have an elderly member, some households
could have more than one elderly member.
Almost 58 percent of households had one
elderly member above 60 years of age, 39
percent of households had two elderly
members and 3 percent of households had
three or more elderly members. The pattern
is similar in both rural and urban areas. If
the households have more than two elderly
members, who are they and what is their
relationship to the head of the household?
Interestingly, many households do
accommodate elderly relatives such as
mother and father-in-law, uncles and
aunts. It is possible that some households
in which the head of the household is an
elderly member, has his parents (80+) with
them. This is a situation where four
generations live under one roof.
It is evident that a suitable policy needs to
be framed towards restoring familial care
of the elderly in view of the drastic social
changes that have taken place in the wake
of modernisation. It goes without saying
that prompt action for the provision of social
security to the vulnerable poor elderly is
called for before things worsen.
Alternatives such as old-age homes may
also be thought of with the support of non
governmental organisations and voluntary
associations.
VI. Dependency among the Elderly
The National Sample Survey in its 52nd
round (July 1995-June 1996) focused on
issues such as economic independence,
chronic ailments, retirement and
withdrawal from economic activity and
familial integration among the elderly 60
and above. This was a large-scale sample
survey conducted throughout the country.
The elderly covered in the sample
consisted of 16,777 males and 16,428
females (for details, see Table 8).
Using the raw data on economic
independence, this paper has attempted an
assessment of the level of poverty among
the Indian elderly according to sex, place
of residence and marital status by major
states. All the elderly in the sample were
asked to state their economic dependence,
which was coded into three categories: not
dependent, partially dependent and fully
dependent. We presume that fully
dependent elderly need economic support
in old age as they are below the poverty
line. They should be integrated into
various poverty alleviation and social
security programmes. Tables 9 and 10
provide some details.
Table 8: Dependency Status among the Indian Elderly
Total
Urban
Rural
Male
Female
Total
Male
Female
Total
Male
Female
Total
36.4
Not dependent
Partially dependent 18.6
45
Fully dependent
10491
No of Elderly
24.7
17.1
58.2
9954
30.7
17.9
51.4
20445
38.6
16
45.5
6286
22.4
13.4
64.2
6473
30.4
14.7
55
12759
37.2
17.6
45.2
16777
23.8
15.6
60.6
16428
30.6
16.6
52.8
33205
Note: Estimated by the author using the National Sample Survey data (52nd round).
Population Ageing And Health In India
14
S Irudaya Rajan
Table 9: Fully Dependent Elderly by Sex and Place of Residence in Major States
Male Female
Andhra Pradesh
46
64.9
50.7
Assam
69
Bihar
36.7
54.6
58
Gujarat
45.3
Haryana
54.1
65.9
Himachal Pradesh 36.3
37.7
61.6
Jammu Kashmir 37.7
Karnataka
50.4
58.8
Kerala
53.4
57.7
51.4
Madhya Pradesh 42.1
46.7
Maharashtra
52.3
49.4
Orissa
62.4
57.2
Punjab
67.9
Rajasthan
43.7
54.8
52.4
Tamil Nadu
42.1
Uttar Pradesh
39.7
54.9
67.1
West Bengal
49.8
58.2
45
India
Total
Urban
Rural
Total
55.3
58.6
45.1
51.8
60
37
48.4
54.9
55.8
46.7
49.6
55.6
62.4
49.6
46.8
47
58.2
51.4
Male Female
59.1
43.1
45.1
57.1
63.2
37.4
46.5
63.6
66.7
51.1
52.2
30
34.8
72.3
66.7
52.8
53.4
66.9
59.4
45.5
45.9
62.9
40.4
69.6
46.9
70.2
42.6
60
60.8
40.3
46.9
64.7
46.9
64.6
45.5
64.2
Total
51.5
50.9
49.9
55.4
59.1
40.6
51.4
59.9
61
52.2
54.4
55.9
58.5
52.1
50.4
56
55.5
55
Male
44.8
49.5
36.8
45.9
52.8
35.6
36.8
51.6
53.4
43.3
46.3
47.5
53.2
43.2
41.2
41.6
48.3
45.2
Female
62.2
66
56.5
60.7
58.2
39.3
64.7
62.4
61.4
53.9
57.3
64.1
68.8
56.9
57.1
57.8
65.8
60.6
Total
53.6
56.8
46.2
53.5
55.7
37.4
49.3
57.3
57.8
48.6
51.9
55.6
60.8
50.6
48.8
49.5
56.9
52.8
Note: Estimated by the author using the National Sample Survey data (52nd round).
In rural areas, 58 per cent of females and
45 per cent of males were fully dependent
whereas in urban areas, these percentages
were 64 and 46 respectively. There is a
marked difference between males and
females in this respect. The most
vulnerable group consists of elderly
females in urban areas; 64 per cent of them
are dependent on others for food, clothing
and health care. This is one of the reasons
why the elderly continue to work in old age
in spite of poor health. An assessment of
the situation in the major states (Table 9)
shows that in rural areas, only 5 states (out
of 15) reported a male dependency level
above 50 per cent. Ironically, all states
except Himachal Pradesh have reported
Population Ageing And Health In India
that more than half of their elderly women
depended on others for their livelihood.
Estimates range from 51 per .cent in
Madhya Pradesh to 69 per cent in Assam.
In urban areas, with the exception of
Haryana, Karnataka and Kerala, all major
states report a level of economic
dependency below 50 per cent for males.
The situation is more vulnerable for elderly
females in the urban areas. Their economic
dependency ranges form 52 per cent in
Himachal Pradesh to 72 per cent in Jammu
Kashmir. As stated earlier, widowhood
leads to major economic problems in old
age. Analysis of the plight of the fully
dependent elderly by widowhood status for
men and women shows a marked difference
15
S Irudaya Rajan____
between widowers and widows. This is
partly due to the elderly women’s
participation in household (invisible) work.
per cent and 5 per cent respectively for
urban areas.
State wise distribution of the elderly who
had difficulty in obtaining at least one
basic need is presented in Table 11. Among
rural females. Andhra Pradesh, Assam,
Bihar, Tamil Nadu and West Bengal
reported that more than 10 per cent of
elderly had problems in adequately
meeting at least one of their basic needs.
A few states such as Gujarat, Karnataka,
Kerala, Madhya Pradesh and Maharashtra
reported percentages between 5 and 10.
Rural females are at a disadvantage
compared to their urban counterparts.
Large variations existed between states
among rural females - from 3 per cent in
Punjab to 20 per cent in Assam. When we
assess the situation by widowhood status
of both men and women, the situation of
women is worse compared to the general
elderly: they are victims of both old age and
the status of widowhood.
The 52nd National Sample Survey also
assessed the problems faced by elderly men
and women in obtaining the basic
necessities of life such as food, clothing
and medical care. All the elderly were
asked: “Are your day-to-day requirements
on the following (food, clothing and
medicines) adequately met?" In rural
areas, around 3 per cent of the females had
difficulty in obtaining adequate food, 5 per
cent had difficulty in purchasing clothing
and 10 per cent had difficulty in
purchasing necessary medicines (Table
10). The proportions are lower for males
compared to females and lower in urban
areas compared to rural areas. Nine per
cent of elderly males and 11 per cent of
elderly females in rural areas faced
difficulties with regard to access to one of
the three basic needs. The figures were 4
Table 10: Basic Needs Unmet among the Indian Elderly
Urban.
Rural
Food
Clothing
Medicine
At least one
Male Female
2.9
3.3
4.1
4.9
10.2
8.9
9.2
10.6
Total
3.1
4.5
9.5
9.9
Male Female
1.4
1.6
1.9
2.3
3.8
4.6
4.1
4.8
Total
Total
1.5
2.1
4.2
4.5
Male
2.3
3.3
7
7.3
Female
2.7
3.9
8
8.3
Total
2.5
3.6
7.5
7.8
Note: Estimated by the author using the National Sample Survey data (52nd round).
Population Ageing And Health In India
16
S Irudaya Rajan
Table 11: Classification of the Indian Elderly by Sex and Place of Residence
on the basis of at least one Basic Need Unmet
Urban
Rural
Male Female
15.5
Andhra Pradesh
14.3
19.7
13.4
Assam
6.7
12.1
Bihar
8.2
Gujarat
8.1
4.7
Haryana
3.7
Himachal Pradesh 0.5
2.1
Jammu & Kashmir 1.2
1.4
6.7
8.8
Karnataka
3.4
6.8
Kerala
Madhya Pradesh
5.3
6.1
6.4
Maharashtra
6.6
Punjab
4.1
3.1
Rajasthan
3.2
3.6
8.1
13.4
Tamil Nadu
Uttar Pradesh
4.6
4.3
9.2
10.6
India
Total
14.9
16.2
9.2
8.2
4.2
1.3
1.3
7.9
5.5
5.7
6.5
3.6
3.4
10.5
4.5
9.9
Male Female
5.4
6.9
7.6
10.6
5.7
7.5
2.1
1.9
5.2
5.3
2.2
0
0.7
0
4.1
3.1
2.9
1.8
1.2
1.3
2.1
1.7
2.7
1.5
0.8
2.3
4.9
5.4
0.8
1.7
4.1
4.8
Total
Total
6.2
9.2
6.6
2.8
5.3
1
0.4
3.6
2.4
1.2
1.9
2.1
1.7
5.2
1.3
4.5
Male
11.6
12.8
6.5
5.3
4.4
0.5
1
5
9.4
3.9
4.2
3.1
2.3
6.5
3.6
7.3
Female
11.6
16.7
11
5.1
5
2.1
1
6.7
5.2
4.5
4.4
3
3.1
8.9
3.6
8.3
Total
11.6
14.6
8.6
5.2
4.7
1.3
1
5.9
4.3
4.2
4.3
3
2.7
7.6
3.69
7.8
Note: Estimated by the author using the National Sample Survey data (52nd round).
no valuable assets in their names (Table
12). They are the ones who need social as
sistance and the benefit of poverty allevia
tion programmes. Marked differences ex
ist between males and females and be
tween rural and urban areas and between
major states of India. Kerala ranks first with
76 per cent of its elderly women reporting
no financial asset in their name. No state
except Bihar and Gujarat has less than 50
per cent of elderly women reporting ‘no
assets’. On the other hand, all states ex
cept Kerala have reported a proportion
around 50 per cent as elderly without as
sets
To assess the levels of poverty and depen
dency among the elderly, data on owner
ship of assets and property have also been
used. The information collected is classi
fied into four major divisions: owning and
participating in financial assets, owning
but not participating in financial assets,
not owning but participating in financial
assets and neither owning nor managing
financial assets. The same question was
also canvassed to assess the ownership and
management of properties. According to
this information, around 60 per cent of
rural and urban females and around 30 per
cent of rural and urban males in India had
Population Ageing And Health In India
17
S Irudaya Rajan
Table 12: Percentage of Elderly with no Property by Sex and Place of Residence
in the Major States of India
Urban
Rural
Andhra Pradesh
Assam
Bihar
Gujarat
Haryana
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Orissa
Punjab
Rajasthan
Tamil Nadu
Uttar Pradesh
West Bengal
India
Male Female
33.2
64.3
9.2
45.8
14.7 43.8
17.6 47.7
18.6
62.5
22.8
59.3
22.4 52.3
19.2 49.9
19.7
56.9
14.6 46.2
20.9
62.4
13.2
57.5
24.7
56.4
12.2 46.8
11.5
57
50.2
16.6
Total
48.5
24.9
28.4
33.1
40.7
42.1
38.7
34.7
39.2
29.7
41
37
39.1
28.8
33.8
33
Male Female
35.6
70.5
15.9
50.5
14.6
41
14
41.7
19.2
56.4
32.5 67.8
31.5
55.1
22.1
57.7
24.5 58.4
50
20.6
64
18.5
14.5
50.5
32.6 64.5
14.2 47.9
56.7
19
22.2
54.3
Total
Total
54
32.6
27.4
28.4
38.3
50.7
44.7
39.2
41.3
36.1
41.1
34.3
48.4
31.5
37.4
38.5
Male
34.2
10.6
14.7
15.9
18.9
27.4
25.9
20.2
22.1
15.8
20
13.7
28.9
12.7
15.2
18.7
Female
67.1
46.9
43.1
44.8
59.8
63.3
53.4
52.5
57.6
47.1
63
54.7
61
47.1
56.8
51.8
Total
50.9
26.6
28.2
30.8
39.6
46.1
41.1
36.2
40.2
31.1
41.1
35.9
44.2
29.5
35.6
35.1
Note: Estimated by the author using the National Sample Survey data (52nd round).
This is also true in case of property
ownership. Almost half of the elderly
women in India in both rural and urban
areas have no property in their name. For
females, no difference exists between rural
and urban areas, whereas marked
difference exists for males between rural
and urban areas. Andhra Pradesh, Haryana
and Punjab report that 60 per cent of their
rural elderly had no property to fall back
on in their old age. A similar pattern exists
in urban areas.
ageing is accompanied by multiple
illnesses and physical ailments. Besides
physical illnesses, the aged are more likely
to be victims of poor mental health, which
arises from senility, neurosis and extent
of life satisfaction. Thus, the health status
of the aged should occupy a central place
in any study of the elderly population. In
most of the primary surveys, the Indian
elderly in general and the rural aged in
particular are assumed to have some health
problems.
Health Status of the Elderly
The Nandal, Khatri and Kadian (1987)
study found a majority of the elderly
suffering from diseases like cough (cough
includes tuberculosis of lungs, bronchitis,
asthma, and whooping cough as per the
International Classification of diseases),
VII.
Health problems are supposed to be the
major concern of a society as older people
are more prone to suffer from ill health than
younger age groups. It is often claimed that
Population Ageing And Health In India
18
S Irudaya Rajan
poor eyesight, anaemia and dental
problems. The proportion of the sick and
the bedridden among the elderly is found
to be increasing with advancing age; the
major physical disabilities being blindness
and deafness (Darshan, Sharma and Singh,
1987). Shah (1993) in his study of urban
elderly in Gujarat found deteriorating
physical conditions among two-thirds of
the elderly, consisting of poor vision,
hearing impairment, arthritis and loss of
memory. An interesting observation made
in this study relates to the sick elderly’s
preference for treatment by private doctors.
Besides physical ailments, psychiatric
morbidity is also prevalent among a large
proportion of elderly. An enquiry in this
direction by Gupta and Vohra (1987)
provides evidence of psychiatric morbidity
among the elderly. This study also draws a
distinction between functional and
organic disorders in old age. It is found
that functional disorders precede organic
disorders, which become frequent beyond
seventy. The First National Sample Survey
(NSS) conducted during the second half of
1980s, focussed on the elderly and
indicated that 45 per cent of the elderly
suffered from some chronic illness like pain
in the joints and cough. Other diseases
noted in the NSS survey included blood
pressure, heart disease, urinary problems
and diabetes. The major killers among the
elderly consisted of respiratory disorders
in rural areas and circulatory disorders in
urban areas. Another rural survey reported
that around 5 percent of the elderly were
bedridden and another 18.5 per cent had
only limited mobility. Given the prevalence
of ill health and disability among the
elderly, it was found that dissatisfaction
Population Ageing And Health In India
existed among the elderly with regard to
the provision of medical aid. The author also
referred to the fact that the sick elderly
lacked proper familial care while public
health services were insufficient to meet
the health needs of the elderly.
The National Sample Survey in its 52nd
round (July 1995-June 1996) focused on
issues such as economic independence,
chronic ailments, retirement and
withdrawal from economic activity and
familial integration among the elderly. This
formed a large-scale sample survey
conducted throughout the country. The
sample consisted of 17,171 male and
16,811 female elderly persons. Among
them, 20,950 lived in rural areas and
13,032 in urban areas. The following
section analyses the raw data of this NSS
round to assess the disease and disability
profile and the patterns on health
utilisation among the elderly across social
groups (SC/ST). The following issues are
analysed further:
(a) Self reported health
(b) Disability profile
(c) Disease profile
All the elderly were asked to state thenperception of their health as ‘good’ or ‘bad’.
About 70 percent of the elderly males and
females reported that their health status
was ‘good’. The difference between males
and females and places of residence (rural
or urban) is not significant. However, the
proportion of females reporting good health
was slightly higher than that of males in
urban areas whereas the trend was the
reverse in rural areas (Table 13).
19
S Irudaya Rajan
Table 13: Health, Disease and Disability profile among the Elderly in India, 1995-96
Rural
Male
Female
Urban
Total
Male
Female
Total
Total
Male
Female
Total
13032
17171
16811
33982
70.6
70.29
70.45
24.47
24.17
24.32
60.86
59.18
60.03
Sample Elderly
10737
10213
2095
0
6434
6598
Reported as Good Health (%)
70.05
68.53
69.31
71.53
73.02
72.28
Reported as No Disease (%)
20.92
20.98
20.95
30.39
29.11
29.74
Reported as No Disability (%)
59.33
57.45
58.41
63.41
61.87
62.63
Note: Based on the raw data of NSS 1995-96.t*
The proportion reporting good health
declined from 70 percent among those aged
60 and above to 68 percent among those
aged 70 and above and to 65 percent
among those aged 80 and above. In order
to ensure that the sample was not small.
the country has been divided into eight
regions to assess the self-perception of
health.
Table 14: Percentage of Elderly who reported having Good Health by
Regions of India, 1995-96
Urban
Rural
South
West
North West
North
East
North Hill
North East
Union Terriotiry
India
Male
70.66
72.76
72.68
71.38
65.65
69.16
65.45
69.7
70.05
Female
68.61
74.84
70.67
69.75
60.46
70.75
61.74
71.64
68.53
Total
Male Female Total
69.63 73.2
75.83 74.57
73.84 71.74 74.24 73.01
71.65 72.5
76.76 74.72
70.6 72.86 74.05 73.45
63.21 70.32 67.23 68.79
69.91 68.59 67.72 68.19
63.83 65.24 63.95 64.59
68.77 68.47
70.48 68.2
69.31 71.53 73.02 72.28
Total
Male Female Total
71.81 71.99 71.9
72.26 74.56 73.44
72.61 73.19 72.91
71.77 70.94 71.37
67.29 62.99 65.23
69.04 70.16 69.56
65.38 62.63 64.11
68.59 69.38 68.95
70.6 70.29 70.45
Note: East Region: Assam. Orissa. West Bengal;
North East Region: Arunachal Pradesh. Manipur. Meghalaya, Mizoram. Nagaland. Sikkim, Tripura;
North Hill Region: Himachal Pradesh. Jammu & Kashmir:
North West Region: Haryana. Punjab. Rajasthan:
North Region: Bihar, Madhya Pradesh. Uttar Pradesh. Andhra Pradesh. Karnataka, Kerala. Tamil Nadu:
Union Territories: Andaman & Nicobar Islands. Dadra & Nagar Haveli, Dtelhi, Lakshadweep.
Pondicherry. Daman & Diu. Chandigarh:
West Region: Goa. Gujarat. Maharashtra.
Population Ageing And Health In India
20
s Irudaya Rajan
The west region had the highest proportion
(73.4) of the elderly reporting good health,
followed by the north-west, south and north
regions. The lowest proportion was reported
from the north-east region (more details,
see Table 14). Similar patterns were
observed among ages 70 and 80 above.
Detailed analysis was undertaken with
respect to self-reported health among
scheduled castes and scheduled tribes
along with others. Compared to the general
elderly, the elderly belonging to the SCs
and STs reported poor health but the
differences were not very high. The only
exception was found in the case of urban
females. However, there were not much
differences between SCs and STs (Table 15).
problems, diabetics and cancer (Table 16).
Differences were observed among sex,
place of residence and socially vulnerable
groups such as SCs and STs. In the case of
joint pains, a common chronic disease
among the Indian elderly, women reported
a higher proportion compared to men, rural
areas reported more compared to urban
areas and among Scheduled Tribes,
followed by Scheduled Castes. On the other
hand, the incidence of cough was higher
among males than among females. People
most affected by cough consisted of
Scheduled Tribes, followed by Scheduled
Castes and general elderly as the lowest.
With ailments such as piles, heart diseases,
urinary problems and diabetics, the
incidence was higher among males
compared to females whereas in the case
of cancer, the reverse trend was noticed.
In general, except in the case of joint pain,
cough and piles, the incidence of all other
diseases was higher among scheduled
castes compared to those among scheduled
tribes.
Among the eight chronic diseases
canvassed in the National Sample Survey,
close to one-third of the elderly reported
suffering from pain in joints, followed by
cough (about 20 percent) and blood
pressure (about 10 percent). Less than five
percent of the elderly reported as suffering
from piles, heart diseases, urinary
Table 15 Percentage of Elderly who reported having good health by
Scheduled Caste and Tribes, 1995-96
Rural
ST
SC
Others
Male
70.35
68.72
70.4
Female
66.33
68.79
68.88
Urban.
Total
68.44
68.75
69.65
Male
69.53
71.43
71.65
Female
75.39
73.14
72.89
Total
Total
72.37
72.28
72.28
Male
70.2
69.51
70.93
Female
68
70.11
70.66
Total
69.15
69.8
70.79
Note: Based on the raw data of NSS 1995-96.
Population Ageing And Health In India
21
S Irudaya Rajan
Get'
09597 P°6
Table 16: Disease patterns among the Elderly by Scheduled Caste/Tribes, Others
Rural
Total
Urban
Male
Female
Total
Male
Female
Total
Male
Female
Total
25.13
21.88
24.58
22.35
21.92
21.15
23.81
21.9
22.9
20.41
19.64
16.02
15.77
17.71
15.82
18.17
18.69
15.92
24.28
21.22
20.94
21.14
20.64
18.78
22.78
20.94
19.86
3.29
2.14
2.97
2.42
2.53
2.48
2.88
2.33
2.73
1.78
2.46
2.58
1.89
2.97
2.41
1.83
2.71
2.49
3.02
2.23
2.81
2.32
2.67
2.45
2.69
2.44
2.63
40.25
38.5
38.23
40.64
38.52
38.81
40.43
38.51
38.51
28.7
35.6
32.74
35.33
37.94
35.46
31.91
36.76
34.13
38.18
37.65
35.9
39.66
38.34
37.32
38.89
37.99
36.61
6.46
7.31
7.1
6.76
6.56
7.24
6.6
6.95
7.17
13.31
17.97
17.79
14.2
19.2
19.03
13.74
18.58
18.42
7.69
10.45
11.64
8.13
10.39
12.47
7.9
10.42
12.06
1.94
2.89
2.28
2.06
2.78
2.04
2
2.84
2.16
2.37
5.58
6.14
2.52
5.71
5.37
2.44
5.65
5.75
2.01
3.68
3.92
2.15
3.67
3.52
2.08
3.68
3.72
2.26
3.54
2.97
2.35
2.29
2.28
2.3
2.93
2.63
1.18
3.57
3.39
2.21
2.4
2.71
1.68
2.99
3.04
2.07
3.55
3.15
2.32
2.32
2.47
2.19
2.95
2.81
1.68
1.3
2.13
1.78
1.09
2.11
1.73
1.2
2.12
3.25
5.02
6.93
4.73
4.69
6.49
3.97
4.86
6.7
1.96
2.4
4.17
2.32
2.18
4.05
2.13
2.29
4.11
0.19
0.33
0.31
0.21
0.05
0.21
0.2
0.19
0.26
0
0.45
0.25
0.32
0.57
0.41
0.15
0.51
0.33
0.16
0.36
0.29
0.23
0.21
0.3
0.19
0.29
0.29
1548
2148
7026
1405
2012
6767
2953
4160
13793
338
896
5195
317
875
5397
655
1771
10592
1886
3044
12221
1722
2887
12164
3608
5931
24385
Cough
ST
SC
Others
Piles
ST
SC
Others
Problems of joints
ST
SC
Others
High/Low BP
ST
SC
Others
Heart Disease
ST
SC
Others
Urinary Problems
ST
SC
Others
Diabetes
ST
SC
Others
Cancer
ST
SC
Others
Sample
ST
SC
Others
Note: Based on the raw data of NSS 1995-96.
Population Ageing And Health In India
22
S Irudaya Rajan
that they were not suffering from any
chronic disease. The proportion was about
20 percent in rural areas and 30 percent
in urban areas (Table 17). Not much
difference was observed between the sexes.
However, among the regions, the north
west reported the highest proportion of
elderly with no disease, followed by west
and south. The lowest proportion was
reported by states in the east region. Similar
patterns were observed among the elderly
above 70 and also above 80.
As disease patterns have serious
implications for health care expenditure,
the elderly are classified into four different
groups by sex, place of residence and
region. The four groups consist of the
following:
(a) Elderly with no disease
(b) Elderly with one disease
(c) Elderly with two diseases
(d) Elderly with three diseases
One-fourth of the elderly in India reported
Table 17: Disease Profile among the Elderly by Regions of India, 1995-96
Elderly reported as having No Disease
South
West
North West
North
East
North Hills
North East
Union Territory
India
Rural
Urban
Male
Female
Female
25.66
23.45
25.76
19.43
13.87
21.88
16.39
30.3
20.92
23.04 24.34 28.5
23.88 23.67 34.09
27.11 26.45 35.7
19.61 19.52 32.45
13.75 13.81 18.14
22.05 21.96 30.37
17.68 16.95 34.31
31.34 30.72 36.04
20.98 20.95 30.39
Total
Male
Total
Total
29.85 29.2
33.16 33.62
35.3 35.49
27.1
29.78
16.57 17.36
28.48 29.51
31.75 33.03
32.41 34.33
29.11 29.74
Female
Total
26.95 26.23
28.62 28.26
29.76 30.5
22.85 21.69
15.37
14.8
23.62 23.3
22.54 23.34
34.55 32.19
24.47 24.17
26.58
28.44
30.14
22.29
15.1
23.48
22.91
33.48
24.32
Male
Elderly reported as suffering from one Chronic Disease
South
West
North West
North
East
North Hills
North East
Union Territory
India
55.39
48.79
48.21
49.18
65.01
56.66
58.96
55.56
53.9
55.47
45.53
46.04
47.69
64.97
48.55
55.18
47.76
51.76
Population Ageing And Health In India
55.43
47.1
47.11
48.46
64.99
52.84
57.31
52.41
52.85
56.23
53.78
50.34
47.3
69.14
58.12
50.11
50.53
54.66
23
54.34
53.48
48.49
51.46
71.43
63.29
51.25
52.96
55.11
55.24
53.63
49.38
49.38
70.27
60.46
50.68
51.68
54.89
55.77 54.94 55.34
51.22 49.28 50.23
49.06 47.06 48.03
48.69 48.73 48.71
66.46 67.38 66.9
56.96 51.42 54.37
55.93 53.6 54.86
51.83 51.88 51.85
54.18 53.07 53.63
S Irudaya Rajan
Urban
Rural
Male
Female
Total
Male
Female
Total
Total
Male
Female
Total
20.99
16.66
15.51
19.15
29.45
22.98
21.92
23.04
20.64
16.47
17.18
18.72
30.96
22.93
21.6
27.5
20.81
16.56
16.37
18.94
30.17
22.96
21.78
25.07
20.15
19.43
19.8 21.87 23.08 22.48 20.8
Elderly reported as suffering from three Chronic Diseases
20.86
20.83
Elderly reported as suffering from two Chronic Diseases
South
West
North West
North
East
North Hills
North East
Union Territory
India
Sou tli
West
North West
North
East
North Hills
North East
Union Territory
India
20.4
14.4
14.9
18.45
27.86
22.42
24.17
21.21
19.51
13.5
15.56
18.15
28.3
20.67
22.71
19.4
19.95
13.93
15.24
18.3
28.07
21.6
23.54
20.48
21.71
19.05
16.42
21.13
32.39
25.13
17.61
23.67
21.92
19.79
19.47
20.19
35.41
32.28
19.95
29.64
21.82
19.42
18.01
20.66
33.89
28.37
18.78
26.49
2.71
1.12
1.56
1.52
5.03
3.13
2.48
2.3
2.31
1.2
1.07
1.26
4.8
1.53
2.29
0
2.51
1.16
1.31
1.39
4.92
2.38
2.39
1.43
4.27
4.01
3.15
3.89
6.6
4.71
3.39
4.55
4.13
4.37
2.39
3.54
7.08
6.33
2.72
7.66
4.2
4.19
2.75
3.72
6.84
5.44
3.05
6.01
3.41
2.53
2.2
2.14
5.58
3.45
2.79
3.99
3.16
2.7
1.61
1.89
5.65
2.47
2.46
6.25
3.28
2.61
1.9
2.02
5.61
2.99
2.64
5.01
2.41
2.01
2.21
4.29
4.3
4.3
3.12
2.91
3.01
Note: Based on the raw data of NSS 1995-96.
East Region: Assam, Orissa, West Bengal;
North East Region: Arunachal Pradesh, Manipur, Meghalaya, Mizoram. Nagaland. Sikkim, Tripura;
North Hill Region: Himachal Pradesh. Jammu & Kashmir;
North West Region: Haryana, Punjab, Rajasthan;
North Region: Bihar, Madhya Pradesh, Uttar Pradesh. Andhra Pradesh. Karnataka, Kerala. Tamil Nadu;
Union Territories:Andaman & Nicobar Islands, Dadra & Nagar Haveli, Delhi, Lakshadweep.
Pondicherry. Daman &Diu, Chandigarh;
West Region: Goa. Gujarat. Maharashtra.
One out of two elderly in India suffers from
at least one chronic disease which requires
life-long medication. The proportion is
slightly higher in urban areas compared to
rural areas. The Eastern region led all the
other regions in India with a higher
percentage of elderly (two out of three)
suffering from at least one chronic disease,
followed by the south; the lowest was in
north and north-west India. Similarly, one
out of five elderly reported suffering from
Population Ageing And Health In India
two chronic diseases canvassed in the NSS;
close to three percent suffers from three
chronic diseases.
The NSS probed into five types of
disabilities of the elderly. These were
visual impairment, hearing problem,
difficulty in walking (locomotor problem),
problems in speech and senility (Table 18).
Twenty-five percent of the elderly in India
suffered from visual impairment, followed
24
S Inidaya Rajan
by hearing difficulties (14 percent) and
locomotor disability and senility (each 11
percent). The prevalence rates of all the five
disabilities were higher in rural than in
urban areas. Except for visual impairment,
women were ahead in all the disabilities
compared to males. Between SCs and STs,
disabilities among scheduled tribes were
high compared to that among scheduled
castes. Compared to the general population
and scheduled caste, the scheduled tribes
reported the highest incidence of
disabilities.
About 60 pei sent of the elderly in India live
disability-free lives in old age. The highest
proportion of no disability was reported in
South India and the lowest in East India
(Table 19). It was slightly higher among
rural areas compared to that in urban areas.
Among the five disabilities under
investigation in the NSS survey, 40 percent
of the elderly reported suffering from at
least one disability and this was slightly
higher among females compared to males.
Sex differentials were reported for the
prevalence of two and three disabilities; 15
percent suffered from at least two
disabilities and another 6 percent suffered
from three disabilities.
Table 18: Disabilities among the Elderly by Social Groups in India, 1995-96
Rural
Urban
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
27.71
28.12
25.52
27.33
26.09
26.7
27.53
27.14
26.1
23.96
26
23.41
23.66
27.09
24.92
23.82
26.54
24.18
27.04
27.5
24.62
26.66
26.39
25.91
26.86
26.96
25.27
17.89
13.87
14.66
20
14.21
16.23
18.9
14.04
15.43
13.91
10.83
12.03
17.03
13.71
12.03
15.42
12.25
12.03
17.18
12.98
13.54
19.45
14.06
14.36
18.26
13.51
13.95
4.84
3.26
3.69
5.77
3.73
3.95
5.28
3.49
3.81
5.62
2.12
3.21
3.79
2.74
3.15
4.73
2.43
3.18
4.98
2.92
3.49
5.4
3.43
3.59
5.18
3.17
3.54
11.3
10.34
10.86
11.89
10.49
11.56
11.58
10.41
11.2
10.06
8.71
8.93
7.57
9.6
9.88
8.85
9.15
9.41
11.08
9.86
10.04
11.09
10.22
10.81
11.09
10.03
10.42
12.17
10.24
10.36
11.41
10.29
9.84
9.47
6.47
7.08
8.83
9.03
7.23
9.16
7.74
7.16
10.5
9.2
8.38
11.56
9.87
8.97
11
9.53
8.67
Visual
ST
SC
Others
Hearing
ST
SC
Others
Speech
ST
SC
Others
Locomotor
ST
SC
Others
Amnesia / Senility
ST
SC
Others
10.72
10.34
9.34
Note: Based on the raw data of NSS 1995-96.
Population Ageing And Health In India
25
S Irudaya Rajan
Table 19: Disability Profile among Elderly by Regions of India, 1995-96
Elderly reported as having No Disability
Rural
South
West
North - West
North
East
North Hills
North - East
Union Territory
India
Male
59.79
54.83
63.94
61.4
55.34
58.02
58.73
63.64
59.33
Female
59.33
55.75
59.82
58.46
51.5
60.18
56.25
53.73
57.45
Urban
Total
Male
59.56 65.77
55.31 63.81
61.84 64.71
59.99 61.54
53.54 59.84
59.04 65.45
57.65 62.08
59.64 63.25
58.41 63.41
Female
64.68
59.54
61.18
63.33
57.5
65.82
62.13
58.5
61.87
Total
Total
65.2
61.65
62.87
62.43
58.68
65.62
62.1
61.01
62.63
Male Female Total
62.49 61.84 62.16
59.19 57.54 58.35
64.25 60.39 62.26
61.44 59.81 60.65
56.92 53.75 55.4
59.55 61.28 60.36
59.88 58.61
59.3
63.35 57.5 60.68
60.86 59.18 60.03
Elderly reported as suffering from one Disability
South
West
North West
North
East
North Hills
North East
Union Territory
India
39.25
44.31
34.87
37.02
43.89
40.63
37.62
35.35
39.3
38.6 38.92 32.36
43.13 43.7 35.64
38.49 36.71 33.52
39.6 38.26 36.96
46.85 45.28 38.28
39.36 40.03 34.55
39.18 38.3 35.44
46.27 39.76 34.98
40.69 39.98 35.03
33.76 33.09
39.39 37.54
37.19 35.43
34.81 35.88
41.18 39.71
33.54 34.1
35.6 35.52
40.32 37.5
36.62 35.83
36.13 36.33 36.23
40.1
41.36 40.75
34.32 37.95 36.19
37
38.27 37.62
41.92 44.73 43.27
39.37 38.22 38.84
36.87 37.74 37.27
35.08 41.56 38.03
37.7 39.09 38.39
Elderly reported as suffering from two Disabilities
South
West
North West
North
East
North Hills
North East
Union Territory
India
14.69
17.41
13.71
16.8
18.32
14.67
15.45
13.13
16.08
15.5
17.01
13.87
18.8
20.77
14.4
19.82
31.34
17.49
Population Ageing And Health In India
15.1
11.35
17.21 12.49
13.79
11.9
17.76 13.97
19.47 14.13
14.54 12.57
14
17.35
20.48 13.43
16.77 12.74
26
10.72
14.62
13.82
16.03
16.09
12.03
12.7
19.37
13.84
11.02
13.56
12.9
15
15.1
12.32
13.35
16.23
13.3
13.18 13.26
15.02 15.88
12.98 13.85
16.06 18.03
16.85 19.02
14.24 13.93
14.95 16.96
13.35 21.88
14.83 16.05
13.22
15.46
13.43
17.02
17.89
14.1
15.87
17.24
15.44
S Irudaya Rajan
Male
Female
Total
Urban
Rural
Male
Total
Female
Total
Male
Female
Total
4.21
5.98
5.41
7.54
7
4.44
7.2
7.81
6.05
3.95
5.98
5.03
7.36
6.88
4.72
6.99
5.7
5.88
Elderly reported as suffering from three Disabilities
South
West
North West
North
East
North Hills
North East
Union Territory
India
4.25
6.98
5.34
7.49
7.44
5.57
6.84
5.05
6.38
5.04
6.55
5.51
8.12
8.45
4.29
8.38
11.94
6.84
4.65
6.76
5.42
7.79
7.92
4.97
7.51
7.83
6.61
2.98
4.92
3.56
6.37
5.54
2.62
6.77
3.53
4.59
3.27
5.35
5.28
6.02
4.56
5.06
5.44
6.72
4.82
3.13
5.14
4.45
6.19
5.05
3.72
6.11
5.04
4.7
3.68
5.98
4.62
7.19
6.77
4.96
6.82
3.93
5.71
Note:Based on the raw data of NSS 1995-96.
East Region: Assam. Orissa. West Bengal:
North East Region: Arunachal Pradesh. Manipur. Meghalaya. Mizoram, Nagaland, Sikkim. Tripura;
North Hill Region: Himachal Pradesh. Jammu & Kashmir;
North West Region: Haryana, Punjab. Rajasthan;
North Region: Bihar. Madhya Pradesh. Uttar Pradesh. Andhra Pradesh. Karnataka. Kerala. Tamil Nadu;
Union Territories: Andaman & Nicobar Islands. Dadra & Nagar Haveli, Delhi, Lakshadweep,
Pondicherry. Daman & Diu, Chandigarh;
West Region: Goa. Gujarat. Maharashtra.
during the year preceding the survey (Table
20). The proportion of the elderly who were
hospitalised was lower among SCs and STs
compared to the rest of the elderly. The
results, however, should not be taken at its
face value because most of the elderly from
poor households in India are not
hospitalised till the very last hours, as they
cannot afford the medical expenses. The
proportion of elderly ailing during the 15
days preceding the survey was reported to
be slightly higher than the proportion of
elderly hospitalised during the year
preceding the survey. Though the elderly
in India tend to suffer from many ailments
in the later years of life, they do not
undergo proper medical treatment due to
the absence of a comprehensive health
insurance scheme; this is particularly true
in the case of the poor elderly. One out of
every 10 elderly in India was ailing on the
In the 52nd round of NSS, a few more
interesting questions were put to all
household members about the morbidity
status and hospitalisation. The questions
were:
(i) Whether hospitalised during the
last one year?
(ii) Whether ailing during the last
15 days?
(iii) Whether ailing on the day before
the date of survey?
(iv) If yes to question (iii), whether
normal activity was disrupted?
The raw data relating to the above
questions were analysed wherever the
elderly had responded positively and those
relating to SC, STs and others were
compared. Close to 10 percent of the elderly
among STs and 12 percent among SCs
reported that they had been hospitalised
Population Ageing And Health In India
27
S Irudaya Rajan
reported as dead during the last one year;
among whom 755 were males and 528 were
females (Table 21). Among the elderly, 80
percent died at home and only 17 percent
died in the hospitals (9 percent in
government hospitals compared to 8
percent in private hospitals). Similarly,
close to 30 percent of the elderly did not
receive any medical attention before death.
A few were examined by medical
practitioners. One in three was reported to
have died of old age. More than 5 percent
of the elderly died due causes such as fever
heart failure and disorders of the
respiratory, circulatory and digestive
systems.
last day preceding the survey. If this
proportion is applied to India’s 80 million
elderly, it follows that close to 8 million
suffer from some ailment every day. About
5 percent of the elderly who were ailing on
the day preceding the survey, stated that
their usual activities were disrupted due
to their indisposition; they were thus
deprived of a day’s earnings.
In this same NSS round, information was
also elicited about deaths in the household
during the year. This information collected
included age at death, cause of death, place
of death and medical attention if any before
death. About 1283 elderly persons were
Table 20: Morbidity Particulars among the Elderly with social groups, 1995-96
Urban.
Rural
Male
Total
Female
Total
Male
Female
Total
Male
Female
Total
6.83
6.46
7.26
7.04
7.75
7.43
8.16
7.96
10.36
13.84
12.82
12.83
8.83
9.49
10.56
10.34
9.62
11.69
11.67
11.57
10.85
14.11
18.52
16.53
8.83
10.59
15.68
13.73
9.89
12.4
17.12
15.16
Whether Hospitalised
ST
SC
Others
Total
8.59
8.33
9.04
8.83
Whether ailing during the last 15 days preceding the survey
ST
SC
Others
Total
12.86
16.57
17.44
16.6
13.88
17.3
17.5
16.96
13.34
16.92
17.47
16.78
Whether ailing on the day preceding the
ST
SC
Others
Total
8.14
12.38
12.62
11.93
9.4
12.52
12.43
12.03
8.74
12.45
12.53
11.98
10.36
17.3
16.44
16.24
9.15
15.43
14.77
14.58
9.77
16.37
15.59
15.4
12.86
16.57
17.44
16.6
13.88
17.3
17.5
16.96
13.34
16.92
17.47
16.78
6.62
11.54
11.58
11.34
6.26
12.54
12.22
11.96
8.14
12.38
12.62
11.93
9.4
12.52
12.43
12.03
8.74
12.45
12.53
11.98
3.47
3.89
3.85
3.84
2.6
4.4
3.97
3.96
3.68
4.84
4.92
4.73
3.7
4.82
4.39
4.38
3.69
4.83
4.66
4.56
survey
5.92
13.5
12.88
12.6
If usual activity disrupted due to ailments, yes
ST
SC
Others
Total
3.68
4.84
4.92
4.73
3.7
4.82
4.39
4.38
3.69
4.83
4.66
4.56
1.78
4.91
4.08
4.08
Note: Based on the raw data of NSS 1995-96.
U
Population Ageing And Health In India
28
S Irudaya Rajan
Utilisation of Health Services:
The extent of utilisation of health services
is an index of accessibility and
affordability of the households, particularly
the poor households in which elderly live.
The frequent occurrence of illness among
the aged calls for regular utilisation of
health services provided by private and
public sectors as well as charitable
institutions. In the NSS survey, additional
data were collected on the use of health
services among the elderly who had
undergone medical treatment during the
365 days preceding the survey. About 4000
Table 21: Medical attention at death among the Elderly
60 - 69
70 - 79
so +
Total
31.47
11.75
22.11
10.36
24.3
21.9
13.54
25.73
12.42
26.19
14.75
10.03
21.83
14.45
38.94
23.83
11.76
23.15
12.07
29.03
18.92
15.94
5.98
2.19
6.97
6.57
4.98
20.72
0.2
0
0
0.2
1.2
6.77
8.96
37.02
11.74
6.09
3.61
5.42
3.84
3.61
16.03
0.45
0.23
0.23
0
0.45
5.42
5.87
64.31
7.08
2.65
1.18
4.13
4.42
1.77
9.73
0
0
0
0
0
2.36
2.06
37.15
12.15
5.14
2.41
5.69
5.06
3.66
16.2
0.23
0.08
0.08
0.08
0.62
5.14
6.07
73.31
2.79
12.95
8.57
2.19
79.46
1.13
8.13
9.26
1.81
89.68
0.59
4.13
4.13
0.88
79.76
1.76
9.01
7.49
1.68
Medical attention before Death
Government
Others
Registered Medical Practitioner
Other Medical Practitioner
No medical attention
Cause of death
Old age
Disorders of respiratory system
Diseases of circulatory system
Accidents & injuries
Fevers
Digestive disorders
Disorders of the nervous system
Other symptoms
Bleeding
Sepsis
Obstructed labour
Anaemia
Jaundice
Heart failure
Others
Place of Death
Home
During transport
Government Hospital
Private Hospital
Others
Note: Based on the raw data of NSS 1995-96.
Population Ageing And Health In India
29
S Irudaya Rajan
and 15 percent in special wards.
Regarding duration of stay as in-patients,
about 50 percent of them remained for a
week. However, 52 percent of them had
availed treatment before hospitalisation
and 67 percent continued their treatment
after discharge from the hospital.
elderly reported that they had been
hospitalised. Among them, 42 percent had
gone to government hospitals and 39
percent to private hospitals (Table 22).
About 45 percent of the elderly, who
utilised the services of government
hospitals, were admitted in free wards and
40 percent were admitted in the pay ward
Population Ageing And Health In India
30
S Irudaya Rajan
Table 22: Utilisation Pattern of Health Services among the Elderly
Percentage
Total
Male
Female
Total
Male
Female
Total
1099
69
10
963
208
122
15
2486
613
58
4
620
147
107
11
1560
1712
127
14
1583
355
229
26
4046
44.21
2.78
0.4
38.74
8.37
4.91
0.6
100
39.29
3.72
0.26
39.74
9.42
6.86
0.71
100
42.31
3.14
0.35
39.13
8.77
5.66
0.64
100
1129
964
394
665
658
239
1794
1622
633
45.4
38.76
15.84
42.57
42.13
15.3
44.31
40.06
15.63
1186
542
390
79
287
845
309
224
39
143
2031
851
614
118
430
47.75
21.82
15.7
3.18
11.55
54.17
19.81
14.36
2.5
9.17
50.22
21.04
15.18
2.92
10.63
2176
54.35
48.64
52.13
Type of hospital
Public Hospital
PHC
Public dispensary
Private hospital
Nursing home
Chari, institution
Others
Total
Type of ward
Free
Paying general
Paying special
Stay in hospital
One week
Two weeks
Three weeks
Four weeks
Above four weeks
Treatment undertaken before hospitalisation
Yes
1388
788
Treatment continued after discharge
Yes
1714
1080
2794
67.11
66.67
66.94
1096
736
1832
52.69
56.88
54.3
Hospital charges paid
Yes
Total Medical Expenditure during hospitalisation (in Rupees)
Below 500
501 - 1000
1001 - 2000
2001 - 3000
3001-4000
4001 - 5000
Above 5000
525
319
363
200
140
116
445
345
225
241
131
91
70
212
870
544
604
331
231
186
657
24.91
15.13
17.22
9.49
6.64
5.5
21.11
26.24
17.11
18.33
9.96
6.92
5.32
16.12
25.42
15.89
17.65
9.67
6.75
5.43
19.19
388
1140
35.42
28.93
32.91
If any loss in household income
Yes
752
Note: Based on the raw data of NSS 1995-96.
Population Ageing And Health In India
31
S Irudaya Rajan
08597
Close to 54 percent of those who were
hospitalised paid for their treatment.
Among them, about 55 percent of them paid
less than Rs. 1000 and close to 10 per cent
paid over Rs. 5000. In case of
hospitalisation of the elderly, about 33
percent of households lost income due to
absence from work. About 40 percent of
them spent from their savings to meet
hospital charges and another 27 percent
borrowed money for treatment.
Policy Prescriptions
Based on the above observations made on
the health status of India’s elderly, it can
be concluded that some definite health
intervention measures are necessary to
cater to specific diseases associated with
old age. This calls for the establishment of
special geriatric wards within public sector
health facilities and concessions in private
hospitals through identity cards for the
poor elderly. With the ongoing fertility
transition, the demand for maternal and
child health services are likely to fall
sharply and therefore the Medical Council
of India should have specially trained
personnel to treat geriatric disorders.
This vulnerable section of society like any
other economically backward section of the
population needs to be provided with
subsidised or concessional health care
facilities. There should be special wards for
treating the elderly in general hospitals
throughout the country. There should also
Population Ageing And Health In India
32
be separate counters for elderly patients so
that they do not have to stand or wait in
long lines along with other patients.
Our earlier studies, group discussions and
case studies clearly indicate that the
elderly in India mainly face three types of
handicaps relating to hearing, vision and
mobility. The majority among them suffer
from ailments relating to vision and
hearing. These handicaps can be rectified
through the use of spectacles and hearing
aids. For instance, Arvind Eye hospital in
Tamil Nadu provides free eye check up for
the elderly, performs free surgery and gives
them with eye glasses. If the government
is serious about helping the elderly, it
should provide a budgetary allocation for
the purpose so that they can enjoy their
later years and be an asset to the family as
well as to society. Non governmental
organisations such as Helpage India
should come forward in a big way to help
the elderly.
Most of India’s elderly being economically
dependent, the cost of treatment is often a
burden on the household. Therefore, many
of the elderly ignore their ailments unless
they become too acute. Thus, there is a
great need for an appropriate insurance
scheme for enabling the elderly to meet
their medical expenses. Evidently such
schemes should be made compulsory for
all workers gainfully employed during
their economically active years of life.
S Irudaya Rajan
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Centre For Enquiry Into Health And Allied Themes
Research Centre Of Anusandhan Trust
CEHAT, in Hindi means “Health”. CEHAT, the research
centre of Anusandhan Trust, stands for research, action,
service and advocacy in health and allied themes. Socially
relevant and rigorous academic health research and action
at CEHAT is for the well being of the disadvantaged masses,
for strengthening people's health movements and for realising
right to health care. Its institutional structure acts as an
interface between progressive people’s movements and
academia.
CEHAT’s objectives are to undertake socially relevant
research and advocacy projects on various socio-political
aspects of health; establish direct services and programmes
to demonstrate how health services can be made accessible
equitably and ethically; disseminate information through
databases and relevant publications, supported by a wellstocked and specialised libraiy and a documentation centre.
We are a multi disciplinary team with training and
experience in Medicine, Life Sciences, Economics, Social
Sciences, Social Work, Journalism and Law. CEHAT’s projects
are based on its ideological commitments and priorities, and
are focused on four broad themes, (1) Health Services and
Financing (2) Health Legislation, Ethics and Patients’ Rights,
(3) Women’s Health, (4) Investigation and Treatment of Psycho-
Social Trauma. An increasing part of this work is being done
collaboratively and in partnership with other organisations
and institutions.
Previous publications
Year of Publication.
1
Review of Health Care in India: Country Health report .................................
2005
2
Health and Health Care in Maharashtra: Health Status Report of
Maharashtra (in English and Hindi) ....................................................................
2005
3
Health Facilities in Jalna: A study of distribution, capacities and
services offered in a district in Maharashtra ..................................................... 2004
4
Health and Health Care Situation in Jalna, Yawatmal and Nandurbar....... 2004
This is one of background papers to the Establishing Health as a Human Right Project. It reflects
solely the views of the author. The views, analysis and conclusions are not intended to represent
the views of the organisation.
ISBN : 81-89042-44-0
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