Are Old People a Global Burden?

ARE “OLD” PEOPLE A GLOBAL BURDEN?

Prof. Kalluri Subba Rao

The twenty first century offers a bright health for all. It holds the prospect not merely of longer life but superior quality of life with less disability and disease. The global population has perhaps never looked as healthy as it is today. All this has become possible because of the tremendous advances in Medicine and Medicare.

The next century faces a peculiar situation - the demographic ageing. The increase in ageing population is indeed a global phenomenon touching the shores of India as well. The population of our country, as per the 1991 census, was 844.3 million forming 16 percent of the global population. More important is the rate at which the over all population was increasing during the present century and also the percentage of elderly (above 60 years) in the population during that period. As can be seen, in 1901 India had about 12 million people above 60 years. This constituted 5.06 percentage of the entire population. By 1991, this figure of elderly people rose to about 57 million constituting 6.70 percent of the population. If one looks at the actual rate of increase in the population in each decade it is apparent that the highest rate of growth occurred since 1951 and the trend is still continuing. By 2001, India’s population is expected to be 986.1 million and the number of elderly persons aged 60 years is projected to touch 76 million by that time. Looking in a different way, in the year 2001 the number of people in the age group 15-64 would be 630 million and out of this 50 million would be above 65 years! Projections beyond 2016 made by the United Nations indicate that India will have 326 million persons 60 plus in 2050 and a great proportion of them actually beyond 65 years!.

The life expectancy of a baby born in India in the period 1970-75 was 49.7 years which means that anyone born during that period can be expected to live 49.7 years. This figure rose to 60.3 by the year 1991-95. A marginally higher figure holds good even for today. By the year 2020, life expectancy at birth in India will be close to 70 years.

A point to be noted is that once a person has lived long enough then the chances for that person to live longer are better! Thus if one comes across a seventy year old person the chances are that person is going to hit 80 as well! Indeed, we do see many grand old persons who have excelled in their professions and are guiding our society today. A few such names are mentioned below. This list is only a fragmentary example and there are many more like that including our honourable President and the Prime Minister.

Semmangudi Srinivas Iyer         Carnatic vocalist                       90
Dev Anand                               Film Actor                                75
Manna Dey                              Play singer                       75
Gangadhar Gadgil                     Marathi Writer                          75
Zohra Segal                              Stage/Film Actor                      86
B. C. Sanyal                             Artist                                        96
C. Gopalan                               Nutritionist                                80
B. Ramamurthi                          Neurosurgeon77
A. Venkoba Rao                      Medical Scientist                      75
M. S. Kanungo                         Scientist/Gerontologist             72

Thus, India is right in the middle of an extraordinary demographic transition from being a young country with high mortality and high fertility to a state of increasing population, life expectancy and ageing population. India is not alone in this transition. Many other developing countries are going through the same phenomenon. On the other hand, the so­ called developed countries seem to have passed through this phase of demographic ageing long time ago and are seeing now the effects of such transition. For example, in USA there are 33.6 million people over 65 years today, a number expected to more than double by 2030. The fast growing segment of the population seems to be those above 70 and 80! If this is what is going to happen in the developing countries, it is imperative that there is going to be an increasing global load of elderly people since majority of the global population resides in these so-called developing countries.

The primary reason for such demographic ageing is improved Medicare in all its aspects. Due to the phenomenal advances in medical and biological sciences, infant mortality has been substantially reduced. The general healthcare of the population has improved. People have become, over the years, nutrition and health conscious. There has been a general increase in the overall standard of living. What are the likely effects of people living longer on the society and country at large? An immediate impression that grips every one is that the ageing population might become a burden to the concerned country and the world at large.

One can analyse the situation carefully and see whether the impression is realistic or baseless. The impact of increase in ageing population has three dimensions – Socio-economical, Political and Medical.

Socio-economical: An elderly person beyond 65 years or more is likely to face, either himself or along with the spouse, a situation which can be described as lonely and no body to take care of them or to interact with, in view of the dwindling joint family system. If the economical resource is inadequate then the problem would be compounded. In such an event the elderly could cause strain to the society and the State. However, the elderly people could be looked upon as an asset to the society and the Government, if they are looked after properly both in terms of economics and health. This brings in the other two dimensions.

Political: For a number of reasons ageing has not become an issue of serious consideration for the Government in our country until recently. However, it has become now since the State has realized that unless some measures are taken the problem may go out of proportion.

Indeed the Govt. of India has announced its national policy recently. It seeks to assure
older persons that their concerns are national concerns and they will not live unprotected, ignored or marginalised. A brief version of the announced policy is given below.

National Policy for Older Persons (Highlights):­

The well being of older persons is the goal of the National policy, which will be achieved by securing them their place in society so that they live this phase of life with purpose, dignity and peace. The policy believes that action is necessary.

• To help the elderly, offer them protection from abuse and exploitation, and create opportunities for them to improve the quality of their lives.
• To ensure the rights of the elderly, giving them their share of development funds to ascertain that elderly women are not subject to the triple evil of age, widowhood and gender.
• To regard life as a continuum and the age after sixty another phase. As such, there should be opportunities to lead an active, creative and satisfying life.
• To create an age-integrated society in which there are strong bonds between the generations and conditions are suitable for the elderly to stay with their families.
• To acknowledge the potential of the elderly and to use them like other human resources.
• To empower the elderly so that they can take decisions concerning themselves, having regard to the fact that they constitute twelve per cent of the electorate.
• To provide more money for the well being of the elderly with contributions from the community and society.
• To do more for the rural old who constitute seventy five per cent of the aged population and are terribly neglected.

If this National Policy is implemented faithfully and in consultation with experts in various fields, then old age will cease to be considered synonymous with ill health and liability. On the other hand, the so-called ageing population, with their wisdom, experience and expertise would be an asset to the growth and development of a nation.

But the billion-rupee question is whether the Govt. would be able to implement the above policy at least to some extent. And if it does, what are the priorities and how to go about it. This brings in the third dimension of the ageing phenomenon.

Medical/Biological: - While it is true that the advances made in medical sciences resulted in improved longevity of people, medical research is still struggling to provide adequate coverage for old age dependent ramifications. As already mentioned, in the scenario of demographic ageing, that segment of population which is above 70 years would be bulging in the years to come. This means more and more people in the stages of “terminal ageing” would be seen in the society. Therefore, any Government or the society has to take two major precautions. One is to ensure that such terminally ageing individuals do not suffer from the ailments that are usually associated with that age. That means one should have a healthy ageing period devoid of major debilitations. Otherwise the whole purpose of prolonging the life span would be an unnecessary and meaningless exercise. Ageing per se need not become the cause of death but one could have a comfortable old age until death ensues due to the failure of a vital function. In other words, the morbidity period must be decreased to a minimum. How to achieve this?

From the available information, mainly there are five killer diseases that would inflict an ageing person. These, are Bronchitis and Asthma, Heart attack (cardiovascular problems), Paralysis, Cancer and TB of lungs. About 60 to 70% of the older people die due to these diseases while the rest of the percentage die due to a variety of other reasons. It is therefore important that the State should promote research and community activities leading towards prevention and better management of these diseases.

Fundamental research to understand the very basics of the ageing process at genetic level must be encouraged by the public funding agencies. There are many debilitative situations (e.g. neurodegenerative diseases, diabetes ophthalmic problems etc.,) that can arise in old age. These may not kill the person immediately but make the person invalid for creative and active work. Medical research to understand and better manage these situations must go at top gear. It is rather sad that a country like India with a population of about 70 million people above 60 years does not have even a single organisation/institute solely developed to ageing research. It may be mentioned here that United States has established a National Institute for ageing research almost 50 years ago!

Health care for the elderly is to be seen as a special subject and it must have its settings in rural ground. The health service providers require special training to handle the elderly. In the urban areas, both public and private efforts are needed to provide health care to the old both for the people who can afford to pay and for those who could not afford to pay as well. Every hospital, public and private, should have a geriatric ward manned by specially trained personnel.

Of the many points enunciated by the Indian Government policy for elderly, two deserve special and immediate attention (in the opinion of this author). These are

• To create an age-integrated society in which there are strong bonds between the generations and conditions are suitable for the elderly to stay with their families.
• To acknowledge the potential of the elderly and to use them like other human resources.

Our good old Indian joint family system has immense in-built mechanism to keep the elderly people engaged in active work and enjoy satisfaction in the nursing care they receive from youngsters. It also provides one of the most efficient systems of disseminating the knowledge and expertise from generation to generation. It is not to say that the joint family system does not have any disadvantages. May be there are some and most of them are economical in nature and the rest pertaining to human behaviour. It may be agreed that the classical type of joint family system may not be possible in the present day high-tech scenario. But the fast society also takes away some of the disadvantages that the joint family system of yester years used to have. It would therefore be advisable that the Government provides some incentive if the employees are living along with their retired parents.

Secondly, both private and public organizations should take use of the expertise and experience of the elderly. Some times what the elderly want is recognition and appreciation but not extra money. This aspect if implemented would strengthen the society and create a new order. It is only hoped that this segment of human resource with tremendous treasure of varied expertise and wisdom will be put to use for the development of our country.

To end this article, it would be fitting to quote Robert Browning who eloquently said, “Grow old along with me! The best is yet to be, the last of life for which the first was made”.

Acknowledgements: The data in the tables presented here are essentially based on the 1991 census and the ICMR information as presented by Sri. S. K. Sinha, at the recently held WHO and ICMR sponsored workshop (Research and Healthcare priorities in geriatric medicine and aging, New Delhi, March 16-­18, 1999), in a paper entitled “Demographic profile and projections for the future”.