1. Alterations of Intra and Extra Mitochondrial Enzyme in the Muscle Fibersof Rat Hind Limbs: Role of Exercise




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Socio-economic and Health Implications of Population Ageing in India
Soumitra Basu and Prabir Kumar Das*

Research Fellow, The Asiatic Society, Kolkata- 700 016

*Cultural Anthropologist, Calcutta Metropolitan Institute of Gerontology, Kolkata -700 010

ABSTRACT


Population ageing is one of the major challenges of the 21st century. This demographic shift has immensely affected the social fabric, cultural values and economic structure of the society to a great extent. India being an important member of the developing countries will have to bear its share more in the coming decades. This backdrop gives an immense scope to study socio-economic and health implications of population ageing in this context. The present paper makes an attempt to examine (i) demographic, (ii) health and (iii) psycho-social implications of population ageing in the Indian context. It also raises some important policy issues, which will create newer problems to the aged during the immediate as well as in distant future. Finally it has been found that the ageing process has been influenced by the socio-economic development of the society. So, if we are late in thinking about socio-economic implications of population ageing, there will be more issues and questions than answers. It is proper time to seek appropriate and positive solutions to meet the challenges of ageing for the next millennium.


Key Words: Socio-economic, Health, Population ageing

Population ageing is one of humanity’s greatest triumphs (WHO, 2002). It is also one of greatest challenges of the 21st century. It is a phenomenon characterized by the decline in fertility and continued increase in the levels of life expectancy. These two variables are producing fundamental changes in the age structure of the population and are a hallmark of the demographic transition. This transition outlines shift from high levels of mortality and fertility to low levels and is subsequently characterized by a rapid drop in mortality followed by somewhat slower decline in fertility.

However, social scenario of the world is changing rapidly and this change is going to drastically alter the face of the world in the next millennium. This alteration will be manifested with many societal problems in the global context. The steady and sustained growth of sixty plus population is one such global phenomenon. This demographic shift will affect the social and economic lives of human beings to a great extent. However, this alteration is not uniform. Within the same region demographic transition may vary from one country to another. Furthermore, the impact of this ageing process on social and economic lives of older peoples of different countries will be varied in nature, depending on their social fabric, cultural values and economic structure of the society. India being an important member of the developing nations will bear its share more in the coming decades.

The present paper attempts to probe the implications of the ageing process for the social and economic lives of human beings in the 21st century. Broadly the paper will highlight some implications of population ageing which will intensify and create newer problems to the aged vis-à-vis society during the immediate as well as distant future.

In India, studies on demographic aspects of ageing are not too few. Overall these demographic studies especially in the context of population ageing in India can be broadly grouped into a number of categories which are as follows – several indicators of population ageing (Guha Roy, 1985; Bose, 1988;Guha Roy 1999; Biswas, 1994; Vijaya Kumar, 1999;Bhaswar, 1999); population ageing in developed and developing countries (Bose and Gangrade, 1988); historical pattern of mortality and fertility declination in India (Goyal, 1997); comprehensive demographic account of the elderly in India (Rajan, Mishra and Sharma,1999;Karkal,1998); gender differentials in ageing and widowhood (Gulati and Rajan,1999); demographic determinants of ageing process (Gulati,1989); socio-demographic dimensions of population ageing in India (Pati and Jena,1989); demographic trends and socio-economic implications (surpal,1986); population ageing in the context of Asia (Dhar Chakraborty,2004) etc. These are a cross section of the literatures on population ageing, which have been mentioned here. However omission is unintentional.

Objectives

The present paper makes an attempt to examine (i) demographic, (ii) economic, (iii) health and (iv) psycho-social implications of population ageing in India. Along with this, the paper also highlights some important policy issues, which may create newer problems to the aged during the immediate as well as in distant future. The secondary data sources have been used for understanding the present problem.

Population Ageing in India

The world’s elderly population has been growing for centuries. What is new is the rapid pace of ageing. The Indian situation can be better understood in the context of worldwide trends in population ageing. The trend is built up on the basis of UN Population Projections (UN, 1988) (Table.1). The size of the elderly population of age 60 years and above will cross one billion mark in 2020. Share of the less developed countries will be more than 0.7 billion, which is 69.5 per cent. Out of the total share of the developing region, Asia (excluding Japan) will contribute 77 percent of the aged population; where as about 72 percent of the sub population of elderly in Asia will be contributed by China and India. A new kind of population problem, hitherto known only in developing countries, is thus imminent in these two most populous countries of the world (Guha Roy, 1985).

In India, since 1961 sharp decline in the overall death rate and also in mortality levels in the older age groups initiated a process of ageing. This has accelerated after 1971 when the fertility level also started declining. The elderly population from 12.06 million in 1901 to 19.61 million in 1951, an increase of about 63 percent. Between 1951 and 1971 the number of elderly increased by about 67 percent, reaching 32.70 million by 1971. During 1971-81, the increase in the aged population was about 32 percent as against the increase of 24.7 percent recorded for the total population during this period. During the decade 1981-91 the old age population increased by 13.5 million with a decadal growth rate of 31 percent. According to estimates made by the Technical Group on Population Projections, the likely number of the elderly by the year 2016 will be around 113 millions (Census of India, 1999). The data clearly reveal that the absolute number of elderly population (60 years and above) is increasing rapidly, and the population is beginning to age (Table.2). This consequence is also reflected in the age structure of aged population, which suggest an increasing trend in the proportion of old. The growth of old-old and very-old more or less remains same over time, but other age groups between 69 to 80 years shows an increasing trend over the decades (Table.3). In Indian context, men outnumber women. This phenomenon is also true in the young-old (60-70 years) age groups. But as age increases, the sex ratio is in favour of women in the old-old and very-old age groups (sex ratio is defined as the number of females per 1000 males) (Table 4). Practically all section of the world has experienced continuous improvements in life expectancy and India is not exception to this phenomenon. Another important feature that can be mentioned here is the men’s life expectancy, which is uniformly, lower than women’s (Table.5). The other consequence of such phenomenon is reflected in rural-urban living. India being an agrarian country, more than three fourth of the aged person are residents of rural areas (Table.6). As a consequence of which the effect of population ageing is more severe in the countryside than it is in the urban area. In the following section we discuss the perceptible changes.


Table 1 : Worldwide Trend of Population of 60 Years and Above : 1980-2020

Region / Country 1980 1990 2000 2010 2020

A. Population Aged 60 and Over (in Million)

World 381.2 484.7 608.7 754.2 1011.6

Developed 173.3 203.6 234.6 232.4 308.2 Developing 207.9 281.8 374.1 491.8 703.4 Africa 23.4 30.9 41.8 57.0 82.0 Latin America 23.4 31.7 41.9 56.4 80.7 Asia(excluding Japan) 160.0 218.2 290.0 377.7 539.9 China 73.6 101.2 131.7 167.9 238.9 India 44.6 60.2 81.4 107.0 149.7 B. Proportion of Aged 60 and Over Population (in Per cent) World 8.6 9.2 9.9 10.8 12.9 Developed 15.2 16.8 18.4 19.7 22.4 Developing 6.3 7.0 7.7 8.7 10.9 Africa 4.9 4.8 4.8 4.9 5.6 Latin America 6.5 7.0 7.7 8.8 11.0 Asia(excluding Japan) 6.5 7.4 8.5 9.8 12.8 China 7.4 9.0 10.5 12.4 16.6 India 6.5 7.3 8.4 9.9 12.6


Source : United Nations,World Demographic Estimate and Projections,1950-2025 United Nations, New York Population Aged 60 and Over (in Million)


Table 2: Increasing Trend in the Proportion of Aged (60 Years and Above) in India, 1961-2021


State / Union Year Territory 1961 1971 1981 1991 2001 2011 2021

India 5.63 5.97 6.28 6.58 7.08 8.18 9.87

Source : Census of India , 2001

Table 3 : Growth of Older Population in India, 1961-2001

Age Year Group 1961 1971 1981 1991 2001

60 - 69 65.12 65.37 64.13 62.82 63.58

70 - 79 24.83 24.85 26.31 25.93 26.31

80 - 89 7.92 7.68 7.86 9.06 9.15

90 - 99 1.74 1.71 1.39 1.92 1.97

100+ 0.40 0.4 0.31 0.27 0.29

Source : Census of India, 2001


Table 4 : Sex Ratio for the Elderly in India, 1961-2001


State/Union Age Year

Territory Group 1961 1971 1981 1991 2001


India 60-64 77 92 94 94 91

65-69 96 92 96 94 97

70+ 106 97 98 93 102

Source : Census of India, 2001


Table 5 : Life Expectancy at 60 + : India

Period 60 years 65 years 70 years

Male Female Male Female Male Female

1901-11 9.0 9.3 7.3 7.6 5.8 6.0 1911-21 9.0 9.5 7.3 7.7 5.8 6.2 1921-31 9.3 9.9 7.5 8.0 6.0 6.4 1931-41 10.0 10.6 8.0 8.6 6.3 6.8 1941-51 10.9 11.4 8.8 9.2 6.8 7.3 1951-61 12.3 12.8 9.8 10.3 7.6 8.0 1961-71 14.0 14.3 11.1 11.5 8.6 8.9 1971-81 16.1 16.1 12.8 13.0 9.7 9.9 1981-91 17.3 18.0 13.7 14.5 10.4 11.0 1991-2001 18.1 20.0 14.6 15.9 11.0 12.1

Source : Malaker and Guha Roy , 1986


Table 6: Trends in the Proportion of Aged in Urban and Rural Areas, India


State/Union Year

Territory 1961 1971 1981 1991 2001

India

Rural 5.83 6.21 7.21 7.15 7.10 Urban 4.74 4.98 5.37 5.79 5.95

Source : Census of India, 2001


Perceptible Changes

Economic Aspect

As the demographic transformation takes place in the new millennium, the impact on country’s economy will not be a one-way process. On the one hand it is likely that such a large number of aged population cannot be fruitfully accommodated within the present framework of the economy. But the services of such large number of aged population can also be channelized in the manner that will be beneficial to the economy. A nation wide survey reveals that as many as 70 percent of the aged had to depend on others for their daily maintenance. The situation is worse for elderly females (Table.7). In this context it is very much pertinent to know the economic support providers to those elderlies. About 75 percent is provided by their own children, a sizeable portion (14 to 16 percent) by spouse, 5 to 6 percent by grandchildren and the rest by the relatives or non- relations (Table.8). But for economically independent ones, about 95 percent have one or more dependents (Table.9). The analysis shows that the situation in so far as the elderlies are concerned has become a complicated system where care providing requires a closer look in relation with the economic situation.

Being an agrarian country, Census data reveal that out of the productive workers in the 60 years and above age group, about 80 percent of the males and 85 percent of the females are in agricultural sector, where as very few percentages are involved in household industry sector (Census, 2001). In both these categories females outnumber the males. In organized sector like service, manufacturing including professional and technical jobs, participation of elderly males and females are poor. The reason for such a differential phenomenon in rural and urban India could partly be explained by the sector and states of employment. In urban areas, a significant proportion of the working population is engaged in regular wage employment and in this category there is a fixed age of mandatory superannuation. People are provided with retirement benefits. On the other hand in rural areas, the scope of regular wage employment is limited. The rural people mainly engage themselves in the agriculture sector as self-employed. As there is no age limit for superannuation, people continue to work even offer the age of 60 years (Table.10).


Table 7 : Per 1000 Distribution of Aged Persons by State of Economic Dependence for each Sex



India State of Economic Dependence

Gender Not Partially Fully No Total

Dependent Dependent Dependent Response

on Others on Others

Rural

Male 485 180 313 22 1000

Female 121 146 706 27 1000

Person 301 163 511 25 1000

Urban

Male 515 169 297 19 1000 Female 115 110 757 18 1000 Person 311 139 532 18 1000

Source : National Sample Survey 52nd Round Survey


Table 8 : Per 1000 Distribution of Care Provider of Economically Dependent Aged


India Economic Care Provider

Gender Spouse Own Grand Others Total

Children Children

Rural

Male 113 766 50 71 1000 Female 159 717 52 72 1000 Person 142 735 52 71 1000

Urban

Male 105 792 54 49 1000 Female 182 695 56 67 1000 Person 156 728 55 61 1000

Source : National Sample Survey 52nd Round Survey, 1995-96


Table 9 : Per 1000 Distribution of Economically Independent Aged Persons by their Dependents

India Number of Dependents

Gender Nil 1 2 3 - 5 6 or above Total


Rural

Male 35 348 150 266 201 1000 Female 157 242 102 162 337 1000 Person 52 332 144 251 221 1000

Urban

Male 32 434 181 218 135 1000 Female 175 303 101 91 330 1000 Person 51 416 170 201 162 1000

Source : National Sample Survey 52nd Round Survey, 1995-96.


Table 10: Per 1000 Distribution of Usual (Principal) Activity Status of Aged


India Usual Activity Status Sex Self employed in Regular Casual Total

Agri- Non- Employees Labour

culture agriculture

Rural

Male 662 111 12 215 1000 Female 509 92 29 370 1000 Person 627 106 16 251 1000

Urban

Male 176 567 147 110 1000 Female 203 354 152 291 1000 Person 182 523 150 145 1000

Source : National Sample Survey 52nd Round Survey


A comparative outlook of young (15-59 years) and 60+ workforce participation reveals that the proportion of the elderly in service sector has almost reduced by half from 39 percent to 20 percent among elderly males and one third from 18 percent to 12 percent among the females. Surprisingly, those employed in agriculture goes up substantially higher among the 60+ age groups as compared to young age group; the rise is 59 percent to 78 percent for males and from 78 percent to 84 percent for females. Increasing participation of females in the workforce is the result of changing trends in value system. Moreover, the out migration of younger generation compelled the aged to work for self-maintenance (Vijayanunni, 1997).

A common but useful way of assessing the impact of age structure on economic well being can be better judged through dependency ratio (Kinsella, 1994). The elderly population in India is diverse in terms of their needs and abilities. As a consequence of this phenomenon, elderly will form a highly dependent group that could have an adverse effect on the economy at the national as well as at the State level. Generally, child, elderly and the total dependency ratio, are the three markers that leads to understand the overall dependency on bread earning groups.

Over the decades, the old age dependency is gradually increasing and the fall out is seen more in females (Table.11). This is due to less workforce participation of females. On the other hand, from a comparative outlook it is evident that child dependency is gradually decreasing, whereas elderly dependency is gradually increasing (Table.12). This has happened because of a continuous proportional decline in the population aged 0-14 years due to decline in fertility rates. Another important observation from demographic projection indicates that gradual decline in the birth rates will decrease the load of child rearing cost. Where as, increasing trend of life expectancy will increase the huge dependency load of elderly. This is an alarming demographic trend that requires a substantiative adjustment in the economic sphere of the government. In other words the productivity of the elderlies (60-70 years) need to be reassessed and as far as applicable the varied experience of the group should be reemployed for the overall benefit of the society and thus may minimized the adverse effect of such dependency syndrome.

Health Aspect

With the growing elderly population in this country, their health status is becoming a great concern. Geriatric treatments are not yet in the state of formative structure in India. The supply of health manpower and arrangement for basic medical infrastructure are utterly inadequate to cope with this growing population. With advancing years the elderly have a number of health problems; most of them are chronic in nature. However elderlies suffer not only from chronic ailment specific to old age, but also from ill-health accumulated over the life span that may manifest itself in old age in an aggravated form.


Table 11 : Old Age Dependency Ratio by Sex, India, 1961- 2001


Year Total Male Female

1961 10.93 10.91 10.94

1971 11.47 11.39 11.57 1981 12.04 11.84 12.24 1991 12.26 12.16 12.23 2001 12.59 11.72 12.05

Source : Census of India, 2001

Old Age Dependency Ratio = Number of Persons 60

Persons in the Age Group 15-59


Table 12: Dependency Ratio and Indices of Ageing, India, 1951- 2001


Year Dependency Ratio

Child Elderly Total Index of Ageing

1951 68.49 9.8 78.29 14.31 1961 76.97 10.93 87.90 13.72 1971 80.82 11.47 92.29 14.2 1981 73.64 12.04 85.68 16.18 1991 61.43 12.26 73.69 18.42 2001 50.94 12.59 63.53 24.72

Source : Census of India , 2001

On the basis of existing evidences from causes of death in India, it appears that for the age group 65-69 years about 38 percent of the deaths in urban areas occur due to disease of the circulatory system followed by 20-22 percent of these by symptom, signs and ill-defined conditions where as about 8 to 10 percent of the deaths occur due to infectious and parasitic diseases. For the age group 70 years and above those three groups of diseases are the major causes of deaths. Next comes nutritional, metabolic, gastro-intestinal and genitor-urinary disorders (Table.13). The prevalence of chronic diseases among the aged in general seem to be very high. It is higher in urban areas (55 percent) than in the rural areas (52 percent). Elderly peoples are suffering from chronic disorders, joint problems, cough and cold, hypertension, diabetes and heart diseases. ‘Problem of joint’ and ‘cough’ happened to be the most severe chronic diseases for the aged. Greater prevalence of blood pressure, heart disease and diabetes in the urban areas compared to that in rural areas reflects the disparity in development (Table.14). Thus the health experiences of the aged population in India are consistent with the Theory of Epidemiologic Transition, which suggests that health problems shift from communicable and infectious diseases to chronic and degenerative diseases with improvement in socio-economic level (Omran, 1971).

Disability is viewed as largely the result of cumulative experience over life cycle with disease and injury. With the advancement of chronological age, elderly peoples are suffering from four major components of impairments, such as hearing, loss of vision, locomotors problem and loss of memory. The age of onset of impairment, according to the National Sample Survey Organization (NSSO of 1991) was 60 years or above for 54 percent (locomotors disability) to 69 percent (visual impairment) of the elderly persons. Visual impairment is one of the most common non-lethal conditions among the elderly. Elderly women suffer more than men in the impairment of vision probably due to more nutritional deficiency (restrictions to dietary intake due to widowhood) and Vitamin A deficiency in particular. Besides, it is evident that elderly females suffer more from locomotors problems, which is an obvious consequence after menopause. Loss of hearing appears at later old age. The major contributing factors in urban areas being the noises created above the permissible limit by vehicular traffic, factories and excessive use of electronic gadgets (Table.15).

Table 13 : Percentage Distribution of Medically Certified Death for Aged Persons by Sex according to the Major Cause Groups for Urban Areas, 1993


Cause of Death 65 - 69 70+

Male Female Male Female

Infectious and Parasitic Diseases 13.2 9.6 9.3 6.5

Neoplasms 5.3 6.9 4.1 3.8

Endocrine Nutritional and Metabolic

Diseases and Immunity Disorders 4.9 6.5 4.1 4.5

Diseases of Blood and Blood

Forming Organs 1.5 1.8 1.4 1.9

Mental Disorders 0.2 0.1 0.1 0.1

Diseases of the Nervous System

and Sense Organs 1.9 2.3 1.9 1.9

Disease of the Circulatory System 38.3 36.6 36.9 36.9

Disease of the Respiratory System 8.2 7.1 9.7 10.2

Disease of the Digestive System 5.1 3.5 3.2 2.4

Disease of the Genito-Urinary System 1.8 1.7 1.7 1.2

Disease of the Skin and Subcutaneous

Tissue 0.2 0.3 0.2 0.2 Disease of the Musculo-Skeletal

System and Connective Tissue 0.1 0.3 0.1 0.1

Symptoms Signs and Ill-defined

Conditions 15.7 19.5 24.1 27.3

Injury and Poisoning 3.5 3.3 2.9 2.6

Other Causes 0.1 0.5 0.3 0.4

All Causes 100.0 100.0 100.0 100.0

Source : Census of India, 2001


Table 14: Per 1000 Distribution of Aged Persons having Chronic Diseases by Gender


India Rural Urban

Type of Chronic Disease Male Female Male Female

Cough 250 1958 179 142

Piles 33 16 32 18

Problems of Joints 363 404 285 393

High / Low Blood Pressure 108 105 200 251

HeartDisease 34 27 68 53

Urinary Problem 38 23 49 24

Diabetes 36 28 85 66

Cancer 2 3 2 4

Any of the Above 527 514 528 560

Source : National Sample Survey 52nd Round Survey, 1995-96

Note : Multiple Responses Occurred


Table 15 : Per 1000 Distribution of Aged Persons having Type of Physical Disability by Sex


India Rural Urban

Type of Physical Disability Male Female Male Female

Visual 249 291 225 260

Hearing 139 156 111 132

Speech 32 38 29 3

Locomotor 107 115 80 94 Amnesia / Senility 96 113 61 80 Any Disability 380 425 333 367

Source : National Sample Survey 52nd Round Survey

Note : Multiple Responses Occurred


Social Aspect

The family is the key unit that provides social and economic support to the individual at different stages of life. In India, still now the family structure is horizontal with children and fewer generations above. The extended family system is the dominant form of family. Very high percentages of the aged person are still living in family with spouse and sons or kin. In such a system, the aged who have lost their spouses, depend on their children for living, a true reflection of Indian tradition. The rural-urban difference is negligible in this respect. Very few percentage of the aged have no surviving children (Table.16). Regarding living arrangement, one distressing observation is that while majority of the aged males are living with their spouses, majority of their counterparts are living either alone or with their surviving children or live with other relations and non-relations. This pattern is observable due to the impact of the higher incidence of widowhood generated by difference in age at marriage and longer life expectancy of elderly females (Table.17). The other important phenomenon is the care-giving role of the family. But this role also has undergone many a changes due to the impact of urbanization, industrialization, modernization and even globalization. The consequence of which is the relinquishment of traditional role and status by the elderlies. Thus the family can neither fulfill their needs nor is to give them physical, material and emotional supports. But still then aged prefer to secure a tender healing touch from the member of the family particularly in their twilight years.

Table 16 : Per 1000 Distribution of Aged Persons by Type of Living Arrangement by Gender, India

Living Arrangement Rural Urban

Male Female Male Female

Alone 25 61 30 60 With Spouse Only 137 77 103 57 With Spouse & Other Members 613 313 648 297 With Children 179 481 178 512 With Other Relations

& Non-relations 38 59 35 65 No Response 8 9 6 9 Total 1000 1000 1000 1000

Source : National Sample Survey 52nd Round Survey

Table 17 : Percentage Distribution of Aged 60+ by Marital Satus, Sex, India 1961-2001


Year Never Married Married Widowed Divorced

Seperated

Male Female Male Female Male Female Male Female

1961 2.86 0.41 69.06 23.72 27.47 75.36 0.57 0.45 1971 2.43 0.37 74.67 30.04 22.37 69.17 0.46 0.37 1981 1.95 0.36 78.19 34.89 19.4 64.33 0.39 0.40 1991 3.45 1.39 80.7 44.16 15.47 54.04 0.32 0.40 2001 NA NA NA NA NA NA NA NA

Source : Census of India, 2001

Implications and Consequences of Transition

The ageing process has already begun in India. The above discussion clearly depicts that in India, population ageing and its character are undergoing a significant change. In this section, the paper will highlight some aspects of implications and consequences of gradual demographic and subsequent transitions in India.

Demography

 The process of population ageing is a by-product of fertility and mortality declines. It is neither amenable to change nor it can be modified or altered and hence ageing of population will continue in future years to come.

 Number of aged persons will increase in a rapid manner, which will encompass a larger proportion of the total population. As a result they will survive in an ageing society.

 In the near future, their percentage will be more in the age group of 60-80 years of age.

 The index of ageing which is another indicator of population ageing is expected to pick up faster within the next thirty years.

 Sex ratio will increase over the decades, which makes an imbalance among the old. There is likely to be a preponderance of females in the old-old age group.

 Increased trend of urbanization will compel the elderly population to concentrate more in urban areas.

 Literacy rate of the elderly population will increase. The rate will increase more within urban elderly females.

 Increasing trend of life expectancy of females will compel them to spend their twilight years of life in bitter ashes of widowhood.

 In India, the regional and cultural difference of population ageing is to be reckoned.
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