Aging boom, no easy way out

If the country has been able to tackle the problem of child boom through family planning, why not curb the aged boom? The elderly population (above 60 years) in the country is about 100 millions now, and it is projected to increase to 175 million by 2026 and 323 million by 2050, constituting 20 percent of the country’s total population, according to the United Nations. The argument for checking the aged boom rises from a multidimensional incapacity- social, economic or governmental. Needs of the ageing population are often overlooked by policy- makers, hoping to reap benefits from the investment on the younger generation. This problem cannot be solved by merely making better allocations to the elderly because better medical and other facilities would reduce their suffering but increase their longevity.

The Government has the vision document and programmes though the implementation is slow due to resource constraints. The outlook on this unique social problem has changed with the Supreme Court’s landmark judgment, legalising passive euthanasia- permitting painless killing of a patient suffering from an incurable and painful disease or irreversible coma. One of the clauses in the Mental Health Care Bill 2016 decriminalises suicide, stating that a person who attempts suicide should be presumed to have severe stress, and shall not be punished. In view of the enormity of the problem and agony elderly people face, the Government may also legalise active euthanasia on a selective basis with adequate control. These elderly may be permitted to donate their organs for the welfare of others. This programme may be implemented similar to the family planning programme carried out in the country.  

Intergeneration ties, the hallmark of the traditional family system, are getting eroded as a result of limited number of children to take care of the elderly, migration for employment separating families, emergence of nuclear households and crumbling financial structure of families. The ongoing slow process of breakdown of the joint family system is posing challenging problems to older population and also to society. Above all, elderly women face agonising problems in society due to the general outlook and various customs.

In the ageing process, coping is a very important skill needed to move forward in life and not get stuck in the past. The old and the young should understand each other’s problems and adapt themselves to prevailing conditions. The responsibility for maintaining destitute elders rests with the working population. But the latter already has the responsibility of taking care of the child population. According to the Welfare Act of parents, it is the duty of children to maintain their parents, which is to provide for all basic necessities and requirements. Unfortunately, due to the increasing cost of health care, especially in case of acute health conditions and prolonged illness, the working population is not able to sustain the financial burden.

On the other hand, the social safety net or poverty alleviation programme can only help solve a negligent share of the problem, as even a modest subsidy or assistance would require a staggering expenditure. It will be much beyond the current level of Government income. Many customs and approach to life may have to change. Even in villages the poorest among the poor take loans beyond their capacity to repay, for organising the death ceremony of an elderly person in the family.  Persons with terminal diseases are kept alive for a long time with life supports due to family pressure, leading to shattering of the financial structure of the family.   Though the ageing of society is a welcome trend, it will cripple the economic development in the country.

OLD AGE BOOM AND EXPLODING PROBLEMS

The growth rate of older individuals is three times higher that of the population as a whole.   Old adults above 80 are more vulnerable. Their number has more than doubled in the last 60 years, and reached about 50 million now.   The country is grappling with non-communicable diseases (NCDs) - cardiovascular, cancer, chronic respiratory, diabetes and eye sight conditions- which increase with age.  Over 7 lakh in 60-69 age group die in India of coronary disease every year. Fuelling the growing burden of NCDs is an increase in major risk factors such as tobacco use, obesity, physical inactivity and alcohol consumption.

The prevalence of mental illness, another prominent NCD, is also rising. It is as high as 27 percent in southern states, manifesting in depression, anxiety, bipolar disorder, dementia and alcoholism. Almost one-half of older people have at least one chronic disease such as asthma, angina, hypertension, arthritis, depression or diabetes. Pain affects old people at least 25 percent of the time, increasing with the age. The key economic implication of the ageing population is the increase in health care costs.   Only about 10 percent of India’s population have some sort of medical insurance, and less than 11 percent of older Indians have a pension with limited benefits. Saving is difficult or impossible for a majority of Indians, and they find it extremely difficult or impossible to meet the cost of health care. But as the population ages, health generally declines requiring more medical attention, visits to doctor, surgery, physiotherapy, hospital stay  and prescribed medicines. There are also cases of cancer, Alzheimer’s and cardiovascular problem.

Old age death and frailty are linked, because half the deaths in old age are preceded by months and years of frailty. Individuals and society are not able to sustain consequences of such long illnesses. Many elderly dread to face such situations, and they are considered as social and economic burden. The Government is trying their best to improve medical facilities and also extend financial assistance to them.  But many critics point out that considering the enormity and complexity of the problem, such assistance is too meagre to meet the situation, and it may bring improvements in survival but not in poverty rates.

(Author is former advisor to Kerala Government and first director of National Transportation, Planning and Research Centre)