The ageing of populations is rapidly accelerating with increasing life expectancy worldwide. Ageing involves changes in physiological, pathological, social, and psychological conditions of the individuals; however, the resultant capacities and health needs of the elderly are not random. These are rooted throughout the life-course and can often be modified, highlighting the importance of a life-cycle approach. The aim of health care has changed enormously; joint family system has largely been replaced by independent living. This shift in family system can mainly be attributed to greater life expectancy, independence and self-esteem of the elderly on one hand, and on the other hand is the freedom of living/non-interference cherished by the younger generations. However, increasing life span is often accompanied by diseases, disorders and disabilities with their consequent loss of independence.
During the last few decades, major chunk of the disease burden has shifted to non-communicable diseases and resultant disabilities rather than pre-mature deaths caused by infectious diseases. Increasing life span and poor health care compound the degree of disability among the elderly and pose problems for the care givers. Meeting the specialised health care needs of the elderly with multi-morbidity is a great challenge being faced by the health-care systems across the globe. For the first time in history, majority of the individuals can expect to live beyond 60 years. Ageing population has, therefore, been a matter of great concern for the policy makers all over.
In the year 1901, India’s elderly population was just 12 million which rose to 19 million (1951), 77 million (2001), 104 million (2011) and it is anticipated to touch 137 million mark by 2021. Our country which houses the 2nd largest number of aged people in the world, has taken merely 25 years to double its elderly population.
|Population (in millions)||Male||Female||Total|
|India’s Total Population||623.3||587.6||1210.9|
|Population aged 60+||51.1||52.8||103.9|
|Elderly as % of Total Population||8.2||9.0||8.6|
(Source: Population Census 2011, SRS Report 2013)
Largely, the problems of elderly arise from inadequate income, lack of suitable employment opportunities, poor housing conditions, physical and psychosocial health issues, absence of social safety-nets, stresses and strains associated with changing family patterns and lack of appropriate post-retirement activities. Changes in socio-economic status adversely affect the elderly’s way of life. Therefore, appropriate ways and means of stress management need to be explored and implemented.
Age related physiological decline comprises changes in the normal body functions leading to poor mobility, failing vision, impaired hearing, eating/digestion problems, loss of memory coupled with inability to control certain physiological functions (particularly urinary- incontinence) and various chronic diseases/disorders. Rapid urbanisation and unhealthy lifestyle are the root cause of escalating incidence of age related chronic disease such as heart disease, cancer, diabetes etc. Economic dependency on children/relatives, loss of authority and lack of social recognition result in poor self-esteem of the elderly; and this situation is expected to worsen in the coming years.
For the elderly, appropriate nutrition is imperative for good health as it can affect the entire ageing process. Compared to the youngsters, elderly are more vulnerable since ageing is accompanied by diminished functional status including impaired muscle function, loss of bone mass, immune dysfunction, anaemia, reduced cognition, poor wound healing recovery and frequent morbidity/hospitalisation/surgery which can often result in mortality. With the changing scenario, elderly are usually left to fend for themselves which invariably affects their health and nutritional status. Due to reduced food intake and lack of dietary diversity, they commonly suffer from micronutrient deficiencies.
Despite multiple health problems, old-age should not imply dependence. Appropriate interventions including health promotion, disease prevention and primary to palliative care need to target the elderly so as to add healthy years to their lives! In 2002, WHO released a policy framework – Active Ageingwhich emphasizes the need for multi-sectoral actions to ensure that “older persons remain a resource to their families, communities and economies”.
The increasing proportion of elderly subject the welfare schemes and health-care systems as well as their families under pressure. The fact that more and more people will live longer, it will add to the existing burden of chronic diseases and disabilities – putting additional strain on the society. Therefore, the welfare policies/schemes and the health care systems need to be designed appropriately.
In India, Ministry of Social Justice and Empowerment in close collaboration with State Governments, Non-Governmental Organisations and civil societies develops and implements various programmes for the senior citizens. Under the Scheme Integrated Programme for Older Persons (IPOP), the Ministry runs several projects Maintenance of Old Age Homes and Respite Care Homes which include running of Multi Service Centres for Older Persons;
Maintenance of Mobile Medicare Units; running of Day Care Centres for Old Persons with Alzheimer’s/Dementia; multi facility care centre for older widows; physiotherapy clinics; Regional Resource and Training Centres and several other programmes to benefit the elderly.
The concept of Active and Healthy Ageing needs to be promoted, which includes preventive, promotive, curative and rehabilitative aspects of the elderly’s health!!
About the authors:
Dr Santosh Jain Passi – Public Health Nutrition Consultant; Former Director, Institute of Home Economics, University of Delhi
Akanksha Jain –Ph D Scholar, Amity University, Noida, Uttar Pradesh; Research Officer – Public Health Nutrition Division, LSTech Ventures Ltd, Gurgaon, Haryana, India
Views expressed in the article are author’s personal.