“A human being is a part of the whole, called by us ‘universe; a part of limited in time and space. He experiences himself, his thoughts and feelings as something separated from the rest – a kind of optical delusion of his consciousness.) Albert Einstein
“The death of an elderly man is like burning a library.” A proverb
Introduction – “Age is nothing but a number.” Not very long ago, retirement meant end of active life and wait for death, whenever it comes. So during the interim period, one should lead a sedentary life, most of the time be spent on reflection and meditation.
Not anymore – The mindset of old people is tuned to what Abraham Lincoln had said, “… In the end, it is not the years in your life that count. It is the life in your years.” Or what Mark twain commented, “Age is an issue of mind over matter. If you do not mind, it does not matter.” Now there are no restrictions how a senior citizen should behave, act or think. The gap between generations has almost disappeared. Internet and social media have played a big role in making the free flow of ideas between people of all ages.
At present, as far as possible, Many old people refuse to retire in earlier traditional way, as it led to boredom, total dependence on sons, depleting funds, loneliness. Today with increased awareness, longevity and better health-care, most of the senior citizens after spending their prime time in job requirements and familial responsibilities, now look forward to pursue their hobbies holidaying, travelling or work which really interests them. They are careful to keep themselves emotionally, financially and health-wise fit enough to enjoy their retired life. There are so many opportunities for them to keep themselves occupied meaningfully, only they have to keep pace with the changing times.
Psychologist Gitanjali Sharma says very correctly, “The mind does not age like the body. In mind everybody is as old as one feels.” Failing energies with aging compels one to dependence – whether one likes it or not. That day comes in every body’s life, when he/she is compelled to depend on younger ones, even for fulfilling their daily needs. There is a saying – Old age is very bitter -“Tulsi wa fal kaun hai, pakat hi karuwaen”. Living with no hope of better health or better future itself, is very sad and painful. Indian scriptures have permitted voluntary death in old age, especially when one’s body is incapable of carrying out basic human activities for survival.
Issue – In modern societies such elderly people are usually neglected or treated well because of lack of time, patience and resources. Instances of parental abuse are increasing. Together with child abuse and spousal violence, neglect of elderly has been a hidden social problem an unholy trinity of domestic violence since long. The issue of neglecting elders encompasses physical as well as financial exploitation of the 60+ people. Dr. Buston wrote an article, “Granny-battering in the August Medical Journal 1975, “It is about time that all of us realized that elderly people too are at times deliberately battered”.
Gaps in present understanding of elder issues – There are many gaps in the present understanding of elder issues all-over the world. It is a complex problem. Youth are also too busy in their present world and have little apprehension of old people’s problems. Lack of sensitivity aggravates the problems more.
Old age becomes a source of many physical and mental worries for themselves as well as their near and dear ones. People do not know how extensive it is, what are the endangering factors, or what are the policies and interventions that would be effective to prevent or reduce these problems. Until and unless we understand the issue of elders abuse better. Any one of us could end up being a victim or a perpetrator.
Proper elderly care requires various measures ranging from better support of caregivers; more training and incentives to for those paid or unpaid – who take up the responsibility of helping elderly people; to legislation and provide the legal instruments for better protection to them. There should be better public awareness and education about Geriatric Psychiatry to know the common causes and signs of elder abuse or to be aware of the existence of Elder Protection Team and how to make a report.
Difficulties in old age – The reasons behind the difficulties old persons have to face are indifferent family response, slow interventions and intra-familial pressures. Even in many well-off families, youth misbehave with elderly. There are many cases reported in newspapers when the old parents are often considered a burden by married children. They are abandoned, compelled into destitution and isolation or even eliminated. In order to preserve or save family honour and reputation, many senior citizens bear it silently, deny or cover-up the ill-treatment they get from their own children. There is a large number of elderly persons, whose sons/daughters are settled abroad. It is not always possible for young sons/daughters to reach to their parents immediately. So much and so disgusted are some senior citizens, that they pre-book for their funeral services.
Usually, the main trouble of elderly arises because of dementia which means a loss of memory. With them it is “a progressive loss of comprehension, judgment, insight, speech and physical function. Psychological and behavioural changes in elders make them dependent and vulnerable. Increasing burden and stress of modern life makes the service giver (family members, paid caregivers, friends and professional health-care workers) agitated and aggressive, which starts from verbal abuse and neglect. The vulnerability and weakness with growing age tends to shake old persons’ self-confidence forever.
Euthanasia, both active and passive (Ichcha mrityu or freedom to die) – Many older people think that it seems to be cruel to keep a person alive even in vegetative stage, when medical opinion is as certain as can be, that there is no chance of recovery, for both – the patient and his family. Such people, who choose to die peacefully should be allowed to do so. In the past Supreme Court has acknowledged that the right to dignity in life extends to the right to a dignified death. Active euthanasia means assist in patients immediate death through painless injection. Passive means withdrawing life-support. There must be strict safeguards to ensure that the provision is not misused by people who may benefit from the death of the patient.
Senior citizens in India – Elderly population is in increase in India. India will soon become one of the countries in the world having largest number of older people. Medical science has improved public health and quality of life, reduced old-age suffering and improved average life span. Still there are many physical and mental problems. A Sample Registration System Report says (TOI, p.13, 2.4.2012). Nearly 7.5% of India’s population is currently above 60 years. A majority of them are in rural areas. In urban areas too, better education, health facilities and awareness has increased the life expectancy. (A Sample Registration System Report quoted from TOI, p.13, 2.4.2012).
Importance of Family for well-being of elders – One of the salient feature of Indian culture is to revere and take care of the elders in their old age. Family has been the mainstay of social support. Traditional and conservative society view is that it is the duty of parents to take care of their children till they mature enough to meet the challenges and get settled in life. Similarly sons/daughters are obliged to take care of their old parents when their energies fail. Offering Prayers or performing rituals for dead have no meaning, if one does not look after well one’s own parents/grand-parents while they are alive. The National Policy on Older Persons also recognizes the importance of family for the well-being of older persons.
Elder’s Abuse – Elder abuse is a complex, poorly understood problem. It, along with child abuse, sexual abuse forms a trinity of domestic violence. The issue of elder abuse encompasses physical, psychological, sexual abuse, neglect as well as financial exploitation of senior citizens. They are discriminated and marginalized by the mainstream of society. In 1975, G.R. Busrston attracted the attention of people towards the problems of elders in his article ‘Granny battering, published in the British Medical Journal (August issue) –“It is about time that all of us realized that elderly people too are, at times, deliberately battered.”
A study on abuse of India’s elderly, conducted across 20 cities and over 5,500 people has found that ill-treatment of elders is on rise.
- “Even in this age and time, 58% of older persons in India are living with the family. The findings of this report also confirm confidence in the ability of the family to care for its elder members.” (Quoted from TOI, p11, 29 Sept, 2012)
- Almost 1 in 3 (32%) have faced abuse. (TOI, 29 Sept. 2012, p.1) The study revealed that Indian sons (56%) and their wives (23%) were found to be the primary abuser. They are not treating their aged parents well. Then comes the neighbors, living in nearby places, especially in multi-storied flats, shrewd friends and members of extended families. There are more than 50% cases which remain unreported in order to uphold family honor.
- Out of total older men who faced difficulty 47% cases were reported and 53% did not report.
States with high abuse rates are Madhya Pradesh (77.12%), Assam 60%, UP 52%, Gujrat 43% and AP 42.86%., West Bengal 40.93%. People in Rajasthan are most well-behaved with the elderly in their family. States with low abuse rates are Rajasthan 2%, HP 3%, Kerala 11%, Maharashtra 39%, and Delhi 30% and TN 27.56%. In Delhi, out of 84% cases of those who felt abused by their sons or their wives, 69% felt disrespected. 76%of those abused did not report it.
What can be done to give relief to elderly people – Measures needed to be taken to control elder abuse –
- To promote family values,
- Sensitize the young on the necessities of older people and promote in them desirability of meeting familial obligations.
- The most effective measure is through sensitizing children and strengthening inter-generation bonding.
- Increased economic independence.
- Initiate state policies to encourage young generation to co-reside with their parents by providing tax relief, allowing rebates for medical expenditures and giving preference in allotment of houses.
- Short term staying facilities for older persons, so that family can get some relief when oldies go out.
- There should be nation-wide programs in schools and colleges for sensitizing children and young adults towards the aging and the aged,
- Sensitization of healthcare workers to recognize and develop a protocol for treating,
- Develop a robust social security system that not only ensures income security to the older persons, but also gives them opportunities for income generation.
- It is one of the primary ethical duty of any welfare government and its institutions to provide comfortable environment for elderly and terminally ill persons or to ease their anxiety, stress, or pain and other problems, physical, psychological and spiritual by opening healthcare centers in each and every local area, to take care, genuinely and compassionately, of their day today physical, medical and mental necessities.
- Government should build flats for senior citizens specially designed keeping in view the special needs of old-age – from grab rails in bathrooms and corridors to anti-skid flooring, arthritis friendly taps, wheelchair friendly lifts and flooring etc. It will give them secure atmosphere and live independently with dignity.
As a welfare state, UK is one of the foremost nation in the world for providing best possible care to its elderly people as well. It has developed many effective and efficient support systems for elderly and terminally ill patients – thanks to Mac Millon’s institution, being the major force behind it. palliative care is not an essential part of the treatment regimen. In India, most patients cannot afford institutionalized care (such as in hospice).
Geriatric and palliative care in India – At least 1.2 million disabled people in India are living in households consisting only of persons with disability. Life is a challenge for them. There are 24.9 cr total households in 2011 out of which households with one or more disabled person is 2.1 crore and disabled persons living on their own are 11.8 lakh. (TOI Report, Aug 29, 2014, P. 9)
Cases of old parents being abandoned or abused is on increase across the country, a survey (across 12 cities, 1200 senior citizens surveyed across 12 cities) was conducted. It pointed out that 60% of senior citizen’s experienced (mostly verbal, rather than physical) abuse. Generally women are more vulnerable than men, report suggests. Most of them do not know how to deal with the abuse.
Common forms of abuse, which are on rise, are verbal abuse, disrespect, and neglect. Common reasons are emotional dependence on children, economic dependence of elders and changing ethos. Now elders lack confidence in any person be it their own off-springs, close relatives, friends/neighbors or any governmental (be it police, helpline etc.) or non-governmental organizations. Fear of retaliation and their vulnerability are the reasons behind this kind of distrust. Also elderly persons believe in maintaining family honour and confidentiality of a family matter and become silent sufferers as many of them live with their abusers i.e. their own children.
Unfortunately palliative care is not in the priority list of health schemes of the government. Doctors are too busy battling disease rather than caring about offering pain relief or emotional balm. Of the 9 million estimated deaths every year, almost 6 million are said to need palliative care. This includes almost all cases of cancer (80% of the 1 million new cases in India come for treatment at advanced stage.) Then there are conditions – AIDS, muscular dystrophy, dementia, multi-organ failure, Alzheimer’s, Parkinson’s diseases, end-stage renal disease, heart diseases, those who are permanently bedridden and people with neurological problems.
The demand for palliative care is expected to explode with increasing life span and shift from acute to chronic illness. With it increases the need to improve the quality of life of patients and their families facing problems associated with life-threatening-illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual.
How to deal – There is a strong need to give elderly persons proper protection It requires –
- Economic independence for elderly people,
- Sensitizing youth,
- Strengthening intergenerational bonding
- Developing groups of elderly for assistance, intervention
Sensitize the Youth of the day – Instead of running after blindly for name, fame or money, they should feel that it is the time for them to pay-back for whatever they love and care they got from their parents till now. Youth of the day have more education facility, more exposure and more talented and capable to do wonderful work in technological field than previous generations. But most of them neither have time nor tolerance for older people. There is a need to sensitize people about elders.
The focus should be on propagating and inculcating family values so that the needs of the elderly are met by family members to the maximum extent possible. Future of humanity lies in resurrection of family values like sharing vision, caring, loyalty and discipline.
Developing an effective legal reporting and redressal-system – Realizing the need Government of India has enacted Maintenance and Welfare of Parents and Senior citizens Act 2007 has been. It aims “to provide for more effective provisions for maintenance and welfare of parents and senior citizens guaranteed and recognized under the Constitution and for matters connected there with or incidental thereto.”
The Act outlines the legal options available to elders.
- Parents and grandparents who cannot maintain themselves can demand maintenance under the Act.
- Maintenance include food, clothing, residence, medical attendance and treatment.
- Maximum maintenance cannot exceed Rs. 10,000/- per month.
- The state government can designate a social welfare officer to ensure the senior citizen gets maintenance.
- If children/relatives fail to pay maintenance within three months, the tribunal can impose a fine and even imprison them, the tribunal can impose a fine and even imprison them till the fine and even imprison them till the fine is paid.
- If senior citizen is abandoned, children/relatives can be imprisoned for up-to three months or fined up-to Rs.5,000, or both.
Proper training to care-takers – The vice chairman, medical board, research, at the institute of Mental Health has advised that there should be better support of care-givers, more training and incentives for those who take care of their elderly, legislate to provide legal instruments to better protect the elderly. There should be better public awareness and education. (firstname.lastname@example.org,)
- Need of trained care-taker/institutional help – It has been observed that within a family presence of domestic help lessens the burden of family members and reduces the burden and stress of care-giver and minimizes the chances of elder abuse as the presence of “non-family member” within household places a restraining hand.
Winding up – As is evident, in India elderly population is in increase. It will soon become one of the countries in the world having largest number of older people. Medical science has improved public health and quality of life, reduced old-age suffering and improved average life span. Age longevity Old age still becomes a source of many physical and mental worries.
Growing awareness about the agonies of old people – Recently, welfare of senior citizens has assumed significance. Age longevity has given rise to new set of problems. Failing energies as one gets older every year, needs support of youth at every step, no matter what is ones bank-balance. The responsibility of looking after old parents falls on already aged and weakened shoulders. As age of the sons and daughters advances, even their own shoulders are not strong enough to bear the burden and solve all the problems of elders.
Collapse of family as a social institution, while aping the west is causing severe problems. Innovations in medical science have solved many problems, but simultaneously it has forced a person to live unnaturally, just for the fact that they are still alive. It is very difficult for them to lead a quality of life. Sometimes family has to sell homes, beg and borrow to look-after terminally ill patient.
New support systems – Many new kind of support systems have come up like – Night shelters, old-age homes or other senior living projects etc. but they are only transitory measures. Living away from a loving family is really harsh. However while coping demands of a fast-paced life, when it becomes difficult the youth to shoulder the burden of oldies, old age homes are an alternative for elderly people. The continuously growing number of old persons has given rise to the number of old age homes as well. Some offers short stay facilities where the elderly can be kept while family members are out of town. Some provide pay and stay facilities to live securely. The concept of retirement homes in particular areas have been gaining ground. There are some specialized apartments which give elders a sense of community as they live away from their families in a multistoried flats.
Senior citizens not only require protection from the younger generation, but also love and care. They hardly have anybody to talk freely or share their emotions with. The younger generation does not have time or patience to listen the same story again and again.
Distances, a problem for younger generation – Some educated and aware old people realize the difficulties their children face in coming immediately every time, they face an emergency. There young sons/daughters also have their own liabilities – familial as well at their workplace. But many old ones take it to their heart. They keep on brooding and many of them become the victim of depression. It is more practical for senior citizens to be in close touch with the relatives, friends and colleagues of their own age living in their local area, so that they get required assistance immediately when-ever needed.
- Weaknesses of Indian bureaucracy
- Dalit Assertion
- Factors, that changed caste-system into casteism
- Development Administration
- Wisdom/Enlightenment and empowerment
- Rights and duties
- Role of Bureaucracy in good governance
- India – Unity in Diversity
- Fusion of many cultures in India
- Theory of biological Evolution
- Dalit Assertion, A Journey from ‘Shudras’to Outcastes, to’Panchamas’ and to ‘Dalits’
- Untouchables (“Dalits” of modern India) in Ancient India