Ageing is a series of process that begins with life and continues throughout the life cycle. It presents both challenges and opportunities. Elderly or old age consists of ages nearing or surpassing the average life span of human beings. The boundary of old age cannot be defined exactly because it does not have the same meaning in all societies. According to the Indian law, a senior citizen means any person being a citizen of India, who has attained the age of sixty years or above.
Demographic Transition in Kerala
Demographic transition is a change from high fertility and mortality to low fertility and mortality. The indications of this transition are reflected in the current demographic trends of Kerala. The notable achievements made by the State in the demographic variables have raised concerns also. The change in fertility and mortality rate has brought significant changes in the age composition of the population. The demographic trend shows that Kerala is currently passing through the most critical stage of demographic transition as a result of fertility and mortality changes, particularly steep in the 70s and 80s and the consequent age structural transition. One of the important consequences of the demographic transition is population aging. The term aging of a population refers to a relative increase in the number of aged persons. It is evident that changes in fertility and mortality have brought positive changes in the number of older persons. The move in the age composition in favour of old age has implications on Kerala's socio-economic situation.
Status in India and Kerala
In traditional Indian culture and social arrangements, the social security system provided for families was prevalent; the elders were respected and obeyed in their household, neighbourhood, and community. However, this has almost eroded with the emergent nuclear family with very poor arrangements for taking care of the old. This is accentuated by the fact that a large number of the able bodied and young have gone out for jobs (especially to Gulf Countries), leaving the old to fend for themselves. Also, many of the women who were traditionally the care givers in the family are also now working and need to combine outside work with care of the elderly.
The traditional social arrangement is seen to be slowly deteriorating in both urban and rural settings. According to Population Census 2011, there are nearly 10.4 crore elderly persons (aged 60 years or above) in India; 5.3 crore females and 5.1 crore males. Both the share and size of elderly population is increasing over time. From 5.6 per cent in 1961, the proportion has increased to 8.6 per cent in 2011. For males, it was marginally lower at 8.2 per cent, while for females it was 9.0 per cent. As regards rural and urban areas, 71 per cent of elderly population resides in rural areas while 29 per cent is in urban areas. The life expectancy at birth during 2009-13 was 69.3 for females as against 65.8 years for males.
Kerala is aging faster than the rest of India. Its 60 plus population, 5.1 per cent of the total in 1961, was just below the national 5.6 per cent. Since 1980, Kerala has overtaken the rest and the 2001 comparison is 10.5 per cent to 7.5; by 2011, almost 13 per cent of the population is already past 60 years. According to a study (Centre for Development Studies, 2013 “A survey on ageing scenario in Kerala”), the State's elderly population is growing at a perpetual rate of 2.3 per cent. The growth rate is high among the elderly aged 70 or 80 and above. Currently 42 lakh people of Kerala are 60 and above; 13 per cent of them are 80 years and over, the fastest growing group among the old. Women outnumber men among the 60 plus and among them, majority are widows. Kerala has got the highest life expectancy at birth. The life expectancy at birth in Kerala is 71.8 years and 77.8 years for males and females respectively as per the SRS Report 2009-13. Generally, life expectancy among women is higher than men (for all-India also); however, it is much higher in Kerala and men marry women a few years younger which explains the high proportion of widows among the old. NSS Survey 2015 on morbidity indicates that 65 per cent old are morbid.
In Kerala, the culture of sending elderly persons to Old Age Home is fast developing. Majority of old age people in Kerala are widows. In 1991, among the old age people in the range of 60-69, 53.8 per cent are widows and among those above 70 years it comes to 69.20 per cent. By 2025, about 20 per cent of our population would be elderly and the demand on the social security system would be really enormous. So, it is very important to remember that social security to the senior citizens is not charity instead it is their basic human right. The age composition of Kerala's Senior Citizens is given in Table 4.1.10.
| Age composition | Total | Men | Women |
| Total population | 33,406,061 | 16,027,412 | 17,378,649 |
| Total old age population | 4,193,393 | 1,853,595 | 2,309,798 |
| 60-69 | 2,416,805 (58%) | 1,114,368 (60%) | 1,272,437 (55%) |
| 70-79 | 1,234,739 (29%) | 534,879 (29%) | 699,860 (30%) |
| 80+ | 541,849 (13%) | 204,348 (11%) | 337,501 (15%) |
| Source: Census of India, 2011 | |||
The marital status of Kerala's Senior Citizens is given in Table 4.1.11.
| Total | Men | Women | |
| Never married | 2.6 | 1.8 | 3.3 |
| Currently married | 60.8 | 88.9 | 37.8 |
| Widowed | 35.7 | 8.8 | 57.0 |
| Others | 0.9 | 0.5 | 1.9 |
| Without partner | 39.2 | 11.1 | 62.2 |
| Source: Census of India, 2011 | |||
The total figures for currently married is misleading because among the currently married which is 60.8 per cent persons, men constitute 88.9 per cent and women only 37.8 per cent. This means that for an overwhelming majority of men (88.9 per cent) their wives are alive at older ages while for only 37.8 per cent women, their husbands are living. Men marry wives several years younger and when they enter 60, their wives will be much younger (may be in their late fifties). Thus, at 80, while only 17 per cent men are widowed, as many as 84.2 per cent women are widowed (not shown in the Table 4.1.11).
Kerala Disability Census 2015
Senior Citizens as per Census 2011 in Kerala are 41,93,393. However in 2015, according to the disability survey there were 8,217,434 households with a population of 34,254,086 of which senior family members is 4,233,474 constituting 12.36 per cent of total family members. There were 1,934,758 male and 2,298,716 female senior members. Most common disability among the aged persons was loco motor disability and visual disability as per Census 2011. Persons suffering from Alzheimer have numbered 35041. In Kerala, number of senior citizens having disabilities and living in institutions is 4,260 of which 2,352 is female and 1908 is male. In this, 80 plus population constitute 570 numbers. Number of households where all members are Senior members was 432,953 which is 5.27 per cent of total families/households. The number of senior female members is 2,298,716 which is 54.3 per cent and the number of senior male members is 1,934,758 which is 45.7 per cent.
Increasing Old Age Dependency
The ratio of the dependent population to that of the working age population is defined as the dependency ratio and is an important indicator of the economic burden carried by each worker. Old age dependency is the ratio of persons aged 60 years and above to the working age population. The ‘Old' Dependency Ratio of India as per 2011 census is 142 and in Kerala it is 196 due to higher life expectancy at birth. The old age dependency ratio shows an increasing trend in Kerala and is highest among Indian States (Elderly in India 2016, Ministry of Statistics and Programme Implementation, GOI). The dependency ratio increases, implies obviously that the proportion of elderly in the total population increases as a proportion to the working population.
Senior Citizens as Experienced Human Resource
The retirement age for the State Government service is 56 years and in most of the public sector undertakings it is 60. Ageing lowers working life of persons. In Kerala, the retired Government staff get pension which helps them to lead a comfortable life. Committed deployment of this experienced manpower has the potential to enhance production. Elderly when employed meaningfully and kept busy, tend to live healthier and longer. Employment keeps the elderly busy, entertained as well as providing them with the feeling of social relevance. But for those people who have no such job or other unorganised sector workers, there is no pension and retirement. Some category of the people get only a nominal amount as pension and it will not help even to cover their medical requirements. In developed countries, the social security system is very strong and therefore not much to worry for them in the old age.
Nutritional Considerations for the Elderly
The number of individuals aged 60 years or older is escalating and too often this is also a group most vulnerable to many health risks from a nutrient poor diet. A significant number of elderly fail to get the amount and types of food necessary to meet essential energy and nutrient needs. Ageing population in developing countries is currently facing malnutrition due to social and demographic changes and at the same time it is being observed that their diets are becoming higher in fats, animal products, refined foods and are low in fiber, contributing to rapidly increasing prevalence of obesity and type 2 diabetes. Dietary interventions in the elderly are therefore particularly challenging, because of the paucity of data on which accurate recommendations for age related changes in nutrient requirements could be based.
Health
There is no one who would not grow old. Every being on the earth inevitably follows the cycle, determined by nature that takes him/her through multi-phases of childhood, adolescence, adulthood and maturity. Each stage has its own strength, its set of responsibilities and its particular problems. Generally, with the advancement of age, the entire scenario undergoes a drastic change. Responsibilities are passed on to the next generation and the potency slowly fades out- giving rise to a monotony and dullness, leading gradually to a complicated set of problems that hinder effectiveness. These problems are what precisely cast a dooming effect on the health of an individual.
Kerala is considered to have the best health care system in India. But Kerala is also known for its highest morbidity. The 71st Round of National Sample Survey on Morbidity (January to June 2015) shows that while a total of 89 persons out of 1,000 persons surveyed reported ill during a 15 days period of survey all over India, the number reported from Kerala was 310 out of 1,000. Among the 60+ this was 276 for India and 646 for Kerala. Kerala has the largest incidence of Non Communicable Diseases (NCDs) in India. The State is considered to be the diabetes capital of India. The Registrar General of India's Report on Medical Certification of Cause of Death 2013 shows that while in India only 3 per cent people died due to diabetes in 2013, it was 10.2 per cent for Kerala. The cases of hypertension and cardio vascular diseases are not different. These may be treated as the factors reducing life span and affecting quality of life. While these are general problems affecting all age groups in Kerala, it disproportionately affects the old who are a more vulnerable group in matters of health.
Government's Role in Welfare of Aged
Since independence, the Government has been committed to supporting the old people in our society with certain interventionist welfare methods. The year 1999 was declared by the UN as the International Year of Older Persons. The Government of India approved the National Policy for Older Persons on January 13, 1999 to accelerate welfare measures and empower the elderly in ways beneficial to them. Maintenance and Welfare of Parents and Senior Citizens Act, 2007 provides legal sanctions to the rights of the elderly. In addition constitutional provisions for old age security, old age pension, establishing old age homes, expanding geriatric services, liberalising housing policy for elders have also been undertaken.
State Old Age Policy 2013
Kerala was one of the earlier States to have introduced a policy for senior citizens. The first policy document emerged in 2006. Later, Government reviewed the Old Age Policy 2006 and came out with a new State Old Age Policy 2013. The aim of the policy was to ensure maximum welfare facilities to all aged people in the State. The State government will register police case against those who exploit the age old.
National Policy on Senior Citizens 2011
National policy recognizes the rich experience of old persons and hence rightly considers them as important human resource, assures dignified life in their last phase, assures physical and financial security, health care, shelter and acknowledges the need for affirmative action by the government, especially for the elder women and rural poor. The policy envisaged State support to ensure financial and food security, health care, shelter and other needs of older persons, equitable share in development, protection against abuse and exploitation, and availability of services to improve the quality of life.
The Maintenance and Welfare of Parents and Senior Citizens Act, 2007
The Maintenance and Welfare of Parents and Senior Citizens Act, 2007 was enacted in December 2007, inter alia, to ensure need based maintenance for parents and senior citizens and their welfare. The Act provides for Maintenance of Parents/senior citizens by children/relatives made obligatory and justiciable through Tribunals, Revocation of transfer of property by senior citizens in case of negligence by relatives, Penal provision for abandonment of senior citizens,
Establishment of Old Age Homes for Indigent Senior Citizens, Protection of life and property of senior citizens, Adequate medical facilities for Senior Citizens etc.
Kerala Maintenance and Welfare of Senior Citizens Rules 2008
Under these Rules the senior citizens or parents who are unable to maintain himself/herself apply for maintenance to the Maintenance Tribunal. The Revenue Divisional Officer (RDO) is appointed as Presiding Officers of Maintenance Tribunal under the Act for each Sub-division. District Collectors are appointed as Presiding Officers of Appellate Tribunal for each District. District Welfare Officers are designated as Maintenance Officers for each District.
Ministry of Social Justice and Empowerment
The Ministry of Social Justice and Empowerment, as the name suggests, is to ensure equitable treatment to such sections of society which suffer social inequalities, exploitation, discrimination and injustice. The Social Defense Division of the Ministry mainly caters to the requirements of Senior Citizens, besides victims of alcoholism and substance abuse, Transgender Persons and Beggars/Destitute. The Ministry develops and implements Acts, Policies and Programmes for welfare of Senior Citizens in collaboration with State Governments/Union Territory Administrations to ensure that Senior Citizens may lead a secured, dignified and productive life.
Vayoshreshta Samman Award for the Aged
October 1st every year is celebrated all over the world as International Day of the Elderly and as part of this Ministry of Social Justice and Empowerment has been celebrating the occasion every year by organizing a series of programmes and facilitating distinguished senior citizens, organizations and Panchayaths with the Vayoshreshtha Samman. This is to recognize the services rendered by the older senior citizens, to sensitize the society about the problems and needs of the older persons and to reiterate the Government's commitment towards the cause of the elderly. Total of 10 awards are given therein for various categories. Institutions which study about problems of old age, Associations providing welfare services to old age, people above 90 years of age who continue social work, especially among the old age, best mothers who tried hard to bring up their children to a secure position;, brave old age people, old age people who got national/international awards in field of cultural activities, best Panchayats working for welfare of old age, old age people working in the field of sports, and old age people working for economic prosperity, can apply for concerned awards.
Social Security Schemes for Elderly
The policies and programs for the old age people aim at their welfare and maintenance, especially for senior citizens, by supporting old-age homes, day care centers, mobile medical care units, etc.
Rashtriya Vayoshri Yojana – A Central Scheme for Providing Physical Aids and Assisted Living Devices to Senior Citizens
This Central Government scheme provides physical aids and assisted living devices for such senior citizens suffering from age related disabilities/infirmities, who belong to BPL category. The Scheme aims to address following types of disability/infirmity low vision, hearing impairment, loss of teeth and locomotor disability. Types of physical aids and assisted-living devices to be provided under the scheme are walking sticks, elbow crutches, walkers/crutches, tripods/quadpods, spectacles, hearing aids, artificial dentures and, wheelchair, etc.
Integrated Programme for Older Persons – A Central Sector Scheme to Improve the Quality of Life of the Older Persons
The main objective of the scheme is to improve the quality of life of the older persons by providing basic amenities like shelter, food, medical care and entertainment opportunities and by encouraging productive and active ageing through providing support to Government/Non-Governmental Organizations/Panchayati Raj Institutions/local bodies and the Community at large. Assistance under the scheme will be given to the Panchayati Raj Institutions/local bodies and eligible Non-Governmental Voluntary Organizations.
Age Friendly Panchayat
The age friendly Panchayat implemented by Social Justice Department of Kerala is a new initiative associated with State Old Age Policy, 2013. Converting all the Panchayats in the State into age-friendly Panchayats for ensuring good health, participation and assuring quality of life to the Senior Citizens is the objective of the programme.
Vayomithram
Kerala Social Security Mission is implementing the Vayomithram project which provides health care and support to elderly above the age of 65 years residing at Corporation/Municipal Areas in the State. The Vayomithram project mainly provides free medicines through mobile clinics, palliative care and help desk to the old age. The project is implemented as a joint initiative with LSGD in the area (Municipality/Corporation). Vayomithram provides medicines free of cost by conducting mobile clinics in ward basis in the area. There are no economic criteria for availing the service. Each mobile unit comprises Medical Officer, Staff Nurse and Junior Public Health Nurse. Palliative care service is provided for the bed ridden patients in the project area. Special trained nurses and JPHN's are available for the service. Vayomithram co-ordinators provide help desk service to the needy old age in the area. The old age can avail help from the vayomithram office. In addition to this special medical camp, special entertainment programmes like Sallapam, Snehayathra were conducted mainly for the destitute in old age home and Vayomithram beneficiaries., Sponsorship programmes were conducted with the help of NGOs as also special day programmes., Counseling service was provided by Vayomithram co-ordinators with reference of doctors from mobile clinics and active involvement of Vayomithram in social issues related to old age in the area. Kerala Social Security Mission is implementing this programme in 6 Municipal Corporations and 70 Municipalities of all the 14 districts. In the financial year 2016-17, 38 new Vayomithram units have been started in Municipalities across the State. In 2016-17, the number of beneficiaries was 175,865.
Vayo Amrutham
Evolution of finite health care protocols had added years to life thus resulting in increased old age population. The nuclear family in the present society has paved the way to a larger number of old age homes. Old age people are very often forced to be isolated from nuclear families. The old age population then has to live in social isolation along with physical and mental health probelms. The Social Justice Department with the support of Indian System of Medicine department has implemented this new initiative in 15 old age homes for the treatment of inmates who are suffering from health problems. Majority of cases treated are in health ailments like diabetes, asthma, skin diseases, arthritis, eye and ear diseases, etc. Health care also includes palliative care for bedridden and counseling. As part of this scheme, Ayurvedic treatment is being provided to the Inmates inmates belonging to all the government old age homes functioning under Social Justice Department. The inmate will be provided with the service of a medical officer and an attender.
Mandahasam
Mandahasam is an initiative by Social Justice Department for giving free tooth set for the senior citizens. The scheme aims to reduce nutritional, physical and mental problems faced by the elderly people after losing their teeth. The department would prepare a list of dental colleges and dental treatment centres from where the beneficiaries could avail treatment. It would also ensure the quality of artificial tooth and quality treatment by setting standards and norms. Senior citizens who fall in BPL category would be eligible for the benefit under this scheme. One beneficiary would get maximum financial assistance of 5,000 for fixing the teeth.
Sayamprabha Home – Comprehensive Scheme for Senior Citizens
Sayamprabha Home project is a new initiative of Social Justice Department that provides day care facilities in co-operation with LSGD institutions. These day care centres will provide the most required services and help on a barrier free platform in their age of need. These day care facilities will offer an opportunity for the senior citizens to mingle with their own age group and provide solace to elderly who suffer loneliness during daytime. As an initial phase 70 such day care centres have been identified by LSGD institutions which will provide counseling programmes and yoga meditation programmes to the Senior Citizens.
Assistance to Local Self Government Institutions to Start Old Age Homes and Day Care Centers
As part of implementing State's Old Age Policy, the Government has proposed to support Local Self Governments for starting old age homes/day care centres by providing 2 lakh for each institution for meeting the administrative expenses. The running of Institution will be entrusted to Kudumbasree and LSG will provide infrastructure and maintenance. For this purpose, concerned local bodies will constitute a Monitoring Committee. The Department will provide the recurring expenditure as per the approved norms. The role of LSG in this Plan is to provide land and building, infrastructure, day-to-day maintenance and identify and engage local Kudumbasree members for the functioning of the home.
Old Age Home and Day Care Centre
These institutions are maintained for the care and protection of senior citizens having nobody to look after. The persons seeking admission in these institutions shall submit their application to the Superintendent of the institution. Confirmation of the admission shall be made after getting the enquiry report of the District Probation Officer. Total number of such old age home is 15 and sanctioned bed strength is 1125.
National Old Age Pension Scheme
The Indira Gandhi National Old Age Pension Scheme (IGNOAPS) is a non-contributory old age pension scheme that covers Indians who are 60 years and above and live below the poverty line. All individuals above the age of 60 who live below the poverty line are eligible to apply for IGNOAPS. All IGNOAPS beneficiaries aged 60–79 receive a monthly pension of 1,100. Those 80 years and above receive a monthly pension amount of 1,500. As a part of decentralisation through the Indian Constitutional Amendment Act 1993, the implementation of Indira Gandhi National Old age pension, which was handled by the Revenue Department of State Government, has been transferred to Local Self Government Institutions. At present the local bodies have been entrusted with the task of receiving the application, processing, granting and distribution of the pension.
Reservation in Public Transport System
Ministry of Shipping, Road Transport and Highways provides reservation of two seats for senior citizens in front row of the buses of the State Road Transport Undertakings. A person of 65 years and above is eligible for reservation of two seats in State buses in Kerala. The Ministry of Railways provides separate ticket counters for senior citizens at various Passenger Reservation System centres if the average demand per shift is more than 120 tickets. Besides this, there is also provision of lower berth to male passengers of 60 years and above and female passengers of 45 years and above, 40 per cent and 50 per cent concession in rail fare for male passengers aged 60 years and above and female passengers aged 58 years and above respectively and wheel chairs at stations for old age passengers.
Outlook
Kerala today has a very large population of old people. These demographic shifts are taking place alongside many other rapid social and economic changes that are transforming the lives of older people. In this scenario it is necessary to re-look at all the policy formulations and its implementation with a practical approach keeping in mind the needs and rights of old people. In coming years the major challenge before the State is provision of employment opportunities, social security and pension for the aged.