chapter 3 demography of elderly population in...
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Chapter 3
DEMOGRAPHY OF ELDERLY POPULATION IN INDIA
The ageing of a population is an obvious consequence of the
process of demographic transition. Being ahead in this process, the
developed regions of the world have experienced its consequences and
the developing world is well on its way to facing a similar scene.
Developing countries have more elderly persons in absolute terms
because of their large population base. A recent emphasis on studies
pertaining to the elderly in the developing world is due to their increasing
numbers and deteriorating conditions. While their increasing number is
attributed to demographic transition, their deteriorating condition is
considered as the end result of the fast eroding traditional family system
in the wake of rapid modernization and urbanization. As neither of the
circumstances is avoidable, the reason seems to be the lack of adequate
preparedness. However, the available studies have addressed multiple
dimensions of the situation of the elderly by projecting their future size
and composition, assessing their needs and difficulties with regard to
health, social adjustment in old age etc.
The projected increase in both the absolute and relative size of
the elderly population in many Third world countries is a subject of
growing concern for social policy (World Bank 2001, United Nations
2002). These increases are the result of changing fertility and mortality
regimes over the last 40 years. Reduction in mortality means a longer
life span for individuals. Population ageing involves a shift from high
mortality/high fertility to low mortality/low fertility and consequently
an increased proportion of older people in the total population.
Population ageing had far-reaching effects, especially in
developing countries. It was fertility decline that caused shrinkage of
the younger population while the older population increased. In
Europe or developed countries this happened very slowly, since
decline in fertility was spread over a century or so.
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The changing proportions of the aged have been accompanied
by steady decline in the proportions of children. Over the half century
the proportion of children (0-14 years) dropped worldwide from 34.3
percent in 1950 to 30 percent in 2000. In the MDRs the proportion of
persons aged 60 years and above is slightly higher than the proportion
of children below 15 years of age. Age distribution changes have been
very slow in the LDRs and Asia. Substantial changes are, however
expected to occur in the next 50 years. (United Nations, 2002)
The number of elderly in the developing countries has been
growing at a phenomenal rate. The two major population giants of
Asia are India and China, because they are sharing a significant
proportion of this growing elderly population. The Indian aged
population is currently the second largest in the world to that of china
with 100 million of the aged. The absolute number of the over 60
population in India will increase from 77 million 2001 to 137 million
by 2021. Hence, there arises a need to understand the socio-economic
as well as demographic dynamics of the elderly population in general
(Irudaya Rajan, Sharma and Mishra, 2003). In the present chapter, we
have analysed the different aspects of ageing in India using NSSO
surveys for different years, Census of India, Sample registration
system etc.
POPULATION AGEING IN INDIA
The UN defines a country as “Ageing” or “Greying Nation” where
the proportion of people over 60 reaches 7 percent to total population.
By 2011 India has exceeded that proportion (8.0 percent) and is
expected to reach 12.6 percent in 2025. In order to study the
implications of an ageing population in India, the changing Indian
demographic configuration needs to be highlighted first. Here, we have
analysed the following for this purpose.
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Size and Growth of Elderly Population
In India, as a result of the change in the age composition of the
population over time, there has been a progressive increase in both
the number and proportion of aged people. The Indian population has
increased from 361 million in 1951 to 1.027 billion in 2001 and
further to 1.21 billion in 2011. Simultaneously, the number of older
people has increased from 19 million (i.e. 4 percent of total
population) to 77 million and further to roughly 93 million (i.e. 7.5
percent of the total) during the same time span (Registrar General of
India, SRS Statistical Report 2011).
Table 3.1 shows that percentage share of elderly population in
total population by sex in India. According to Census of India, there
has been a steady rise in the share of elderly population (aged 60
years or above) in the total population over the decades. The
proportion of elderly people in the population of India rose from 5.6
percent in 1961 to 7.5 percent in 2001. According to SRS statistical
report, in 2011 it rose further to 8.0 percent.
Table 3.1 Percentage share of elderly population
(aged 60 years and above) in total population by sex in India
Years Male Female Total Rural Urban
1961 5.5 5.8 5.6 5.8 4.7
1971 5.9 6.0 6.0 6.2 5.0
1981 6.4 6.6 6.5 6.8 5.4
1991 6.7 6.8 6.8 7.1 5.7
2001 7.1 7.8 7.5 7.7 6.7
2011 7.7 8.4 8.0 8.1 7.9
2004-05 6.9 7.5 7.2 7.3 7.0
2007-08 7.3 7.7 7.5 7.6 7.2
Source: Census of India for 1961-2001, NSSO Survey 2004-05 and 2007-08, SRS (Sample Registration System) Statistical Report 2011
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For males the rise was more modest from 5.5 percent to 7.1
percent, while for females there had been a steep rise from 5.8 percent to
7.8 percent during five decadal Censuses from 1961 to 2001. In 2011,
the elderly population accounted for 8.0 percent of total population. For
males it was marginally lower at 7.7 percent while for females it was 8.4
percent. According to NSSO surveys, the proportion of elderly in the
population of India rose from 7.2 percent in 2004-05 to 7.5 percent in
2007-08. The proportion of elderly males rose from 6.9 percent in 2004-
05 to 7.3 percent in 2007-08, while on the other hand the proportion of
elderly female rose from 7.5 percent to 7.7 percent during the
corresponding period (Figure 3.1). In rural areas the proportion of elderly
population rose from 5.8 percent in 1961 to 8.1 percent in 2011 and on
the other hand in urban areas it rose from 4.7 percent to 7.9 percent
during the corresponding period. According to NSSO surveys the
proportion of elderly population in rural areas was 7.3 percent during
2004-05 and increased up to 7.6 percent in 2007-08. While on the other
hand in urban areas the proportion of elderly population rose from 7.0
percent to 7.2 percent during the corresponding period. It has been
observed that the percentage share of elderly to total population
remained higher in rural areas than in urban areas.
Distribution of population of India by broad age groups has
been depicted in Table 3.2.
Table 3.2 Percent distribution of population by broad age groups, India Since 1951
Years Age Groups
0-14 15-59 60+ Total
1951 38.4 56.1 5.5 100.0
1961 41.1 53.3 5.6 100.0
1971 42.0 52.0 6.0 100.0
1981 39.7 53.9 6.4 100.0
1991 37.6 55.7 6.7 100.0
2001 35.3 56.9 7.5 100.0
2011 29.5 62.5 8.0 100.0
Source: Census of India for 1951-2001, SRS (Sample Registration System) Statistical Report 2011
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Dividing the total population into three major age groups (i.e.
age in years 0-14, 15-59 and 60 and above) it has been observed
that the proportion of population in the younger age-groups (0-14
years) has dropped sharply after 1971, and accordingly the
proportion of population in the working-age-group (15-59 years) and
the aged (60 years and above) has shown a tendency to increase.
The proportion of population in the 0-14 age group which was 41.1
percent in 1971 dropped to about 35.3 percent in 2001 and further
to 29.5 in 2011 (SRS Statistical Report, 2011). While the proportion
of elderly population (60 years and above) which was about 5.5
percent during 1971 rose sharply to 7.5 percent in 2001. According
to SRS, Statistical Report, it further rose to 8.0 in 2011. In other
words, the process of ageing of population has already begun in
India (Figure 3.2).
In India, as a result of the change in the age composition of
the population over time, there has been a progressive increase, in
the number and proportion of aged people. Table 3.3 shows
distribution of elderly population to total population in India by
age-groups during the period 1961-2001.
In absolute terms elderly population (60+) increased from
mere 25 million in 1961 to 43 million in 1981 and further to 77
million in 2001 (i.e. more than thrice). The proportion of the
population who are aged 60 or over has been increasing
consistently over the last century, particularly after 1951. The
proportion of elderly persons in the total population of India rose
from 5.6 percent in 1961 to 6.49 percent in 1981 and further to
7.5 percent in 2001.
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Table 3.3 Numbers and Proportion of Elderly in the Indian Population by Age-Groups, 1961-2001
Number (in millions) Percentage (%)
1961 1971 1981 1991 2001 1961 1971 1981 1991 2001
60+ 25 33 43 57 77 5.6 6 6.49 6.76 7.5
70+ 9 11 15 21 29 2 2.1 2.33 2.51 2.9
80+ 2 3 4 6 8 0.6 0.6 0.62 0.76 0.8
90+ 0.5 0.7 0.7 1 n.a. 0.1 0.1 0.1 0.2 n.a.
100+ 0.01 0.01 0.01 0.01 n.a. 0.02 0.02 0.02 0.02 n.a.
Source: Census of India for the period 1961-2001
This was true to other age cohorts too. The elderly
population aged 70 and above was 29 million in 2001 while it was
only 9 million in 1961 and 21 million in 1991. Beside the
proportion of elderly above 70 in the total population increased
from 2 percent in 1961 to 2.9 percent in 2001.
The elderly population aged 80 years and above was 2 million
in 1961 and rose up to 8 million in year 2001. The proportion of
elderly with age 80 years and above rose from 0.6 percent in 1961
to 0.8 percent in 2001. The absolute share of the elderly, with age
90 years and above, rose from 0.5 million in 1961 to 1 million in
1991. Their proportion became double during the corresponding
period (from 0.1 percent in 1961 to 0.2 percent in 1991) (Figure
3.3).
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The gender-wise distribution of aged (60+) in total population for
different states has also been shown in Table 3.4. Two interesting
observations have been observed, first regarding inter-state variation
in size distribution of the elderly population, it has been observed that
the share of aged population in most of the states exceed than all-
India level (8.0 percent). This was particularly true for Kerala,
Himachal Pradesh, Maharashtra, Punjab, Tamil Nadu, Orissa and
Karnataka. Among the states the proportion of elderly in total
population was more than 8 percent in Maharashtra, Tamil Nadu,
Punjab, Himachal Pradesh. In Kerala the proportion of elderly in total
population of the state was highest (12.6 percent) in year 2011.
Secondly, regarding feminization of the elderly population it has been
found that elderly female outnumbered elderly male in almost every
state except Bihar, Haryana, Punjab and Uttar Pradesh.
Table 3.4 Size of elderly population (aged 60+) and their share in total population in major states of India in 2011
All India and selected major states
Proportion of elderly in total population of State
Male Female Total
Andhra Pradesh 8.3 9.4 8.8
Bihar 7.2 6.7 7.0
Gujarat 7.6 9.0 8.3
Haryana 6.6 7.6 7.1
Himachal Pradesh 10.4 10.3 10.4
Karnataka 7.9 8.9 8.4
Kerala 11.8 13.3 12.6
Madhya Pradesh 6.8 7.4 7.1
Maharashtra 8.8 9.7 9.3
Orissa 9.1 9.5 9.3
Punjab 9.1 10.0 9.5
Rajasthan 6.6 7.9 7.2
Tamil Nadu 10.2 10.9 10.5
Uttar Pradesh 6.6 7.1 6.8
West Bengal 8.2 8.2 8.2
All India 7.7 8.4 8.0
Source: SRS Bulletin (Sample Registration System) October, 2012, Registrar General of India, New Delhi
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In India, as a result of the change in the age composition of the
population over time, there has been a progressive increase in both
the number and proportion of aged people. The proportion of the
population aged 60 years or more has been increasing over the last
century, particularly after 1951. The decadal growth rate of India’s
elderly population and of the general population, for the period 1951
to 2001 has been depicted in Table 3.5. It shows once again that the
aged population in India has grown very steadily since 1951 at a
much faster rate as compared to that of general population all
through during 1951 to 2001 and more so during the period 1961 to
1981. A decadal growth rate of 23.9 percent recorded for the elderly
population during 1951-1961, increased to more than 33 percent
during the decades 1961-71 and 1971-81 as against around 25
percent decadal growth in general population during the period.
During period 1981-1991 decadal growth rate of elderly population
declined to 29.7 percent and further to 25.2 percent during 1991-
2001 as against 23.87 percent growth in general population during
period 1981-1991 and 21.54 percent during 1991-2001 (Figure 3.4).
Table 3.5 Decadal Growth in elderly population vis-à-vis that of general population in India
Period Percentage change in general population
Percentage change in elderly population
1951-1961 + 21.64 + 23.9
1961-1971 +24.80 +33.7
1971-1981 +24.66 +33.0
1981-1991 +23.87 +29.7
1991-2001 +21.54 +25.2
Source: Census of India for 1951-2001
However, since then there has been a steady decline in the
decadal growth rate of aged population although it has outpaced the
growth of general population.
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The Trend in the Sex Ratio of the Elderly Population
The progressive increase in the proportion of females to males in
the elderly population is also evident in the trend in the sex ratio of
elderly population aged 60 years or over. Table 3.6 depicts the Trend
in Sex Ratio (females per 1000 males) for elderly and the general
population according to Census of India. The sex ratio among elderly
people was as high as 1028 in 1951 but subsequently dropped to
about 938 in 1971, but has finally increased again to about 972 in
2001 (Figure 3.5). It has been found that there was relatively higher
ratio of females to males in elderly population than in the general
population for all the years since independence.
Table 3.6 Trend in Sex ratio (Number of Females per 1000 males) for elderly and the general population.
Years Sex Ratio of Elderly
population Sex Ratio of General
population
1951 1028 946
1961 1000 941
1971 938 930
1981 960 934
1991 930 927
2001 972 933
Source: Census of India for 1951-2001
Table 3.7 depicts the Trend in Sex Ratio for elderly according to
different NSS estimates. The NSS estimates showed a rising trend in sex
ratio for elderly during the period 1993-94 to 1995-96 but declined
between 1995-96 and 2004. Sex ratio was 984 during 1993-94 and
increased upto 1023 during 1995-96 and further declined to 999 in 2004.
Table 3.7 Trend in Sex ratio (Number of Females per 1000 males) for elderly (NSS Surveys)
Period Sex Ratio of Elderly population
NSS 43rd Round (1987-88) 983
NSS 50th Round (1993-94) 984
NSS 52nd Round (1995-96) 1023
NSS 60th Round (Jan.-June, 2004) 999
Source: Various rounds of NSS Surveys.
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FACTORS RESPONSIBLE FOR AGIENG OF POPULATION IN INDIA
The changes in the age structure which occurred in the
developing countries, leading to the ageing of the population, are
primarily because of the long term downward trend in the birth rates
in these economically advanced countries. Secondly, there is
substantial improvement in life expectancy throughout the world. This
is particularly due to a reduction in child mortality which reflects
improvement in public health and medical advances in the prevention
of many fatal infectious diseases in childhood. Since the mortality
level of the developed countries was already low and the expectation of
life at birth was very high, further improvement in mortality condition
in these countries affected the older age groups and led to a further
ageing of the population. On the other hand, the age structure of the
developing countries has remained virtually unchanged because their
birth rates have remained more or less at high levels, though their
death rates have been declining since the 1950s. These developing
countries have also started experiencing the fall in their birth rates
since the last two to three decades. The relatively faster decline in
birth rates than in the death rates in the developing countries like
India is however a recent phenomenon.
Total Fertility Rate, Crude Birth Rate and Crude Death Rate
Fertility decline has been the primary determinant of population
ageing (United Nations 2002). Table 3.8 depicts the crude birth rate
and total fertility by residence in India. Total Fertility Rate declined
from 4.5 percent in 1981 to 2.4 percent in 2011. Rural-urban
differences have been observed in fertility rates. Rural areas have
shown higher fertility rates as compared to that of urban areas for all
the years.
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Table 3.8 Crude Birth Rate (CBR), Crude Death Rate (CDR) and Total Fertility Rate (TFR) by residence over time in India
Year Crude Birth Rate (CBR)
Crude Death Rate (CDR)
Total Fertility Rate (TFR)
Rural Urban Total Rural Urban Total Rural Urban Total
1981 35.6 27.0 33.9 13.7 7.8 12.5 4.8 3.3 4.5
1982 35.5 27.6 33.8 13.1 7.4 11.9 4.9 3.4 4.5
1983 35.3 28.3 33.7 13.1 7.9 11.9 4.9 3.4 4.5
1984 35.3 29.4 33.9 13.8 8.6 12.6 4.8 3.5 4.5
1985 34.3 28.1 32.9 13.0 7.8 11.8 4.6 3.3 4.3
1986 34.2 27.1 32.6 12.2 7.6 11.1 4.5 3.1 4.2
1987 33.7 27.4 32.2 12.0 7.4 10.9 4.4 3.2 4.1
1988 33.1 26.3 31.5 12.0 7.7 11.0 4.3 3.1 4.0
1989 32.2 25.2 30.6 11.1 7.2 10.3 4.2 2.8 3.9
1990 31.7 24.7 30.2 10.5 6.8 9.7 4.1 2.8 3.8
1991 30.9 24.3 29.5 10.6 7.1 9.8 3.9 2.7 3.6
1992 30.9 23.1 29.2 10.9 7.0 10.1 3.9 2.6 3.6
1993 30.4 23.7 28.7 10.6 5.8 9.3 3.8 2.8 3.5
1994 30.5 23.1 28.7 10.1 6.7 9.3 3.8 2.7 3.5
1995 30.0 22.7 28.3 9.8 6.6 9.0 3.9 2.6 3.5
1996 29.3 21.6 27.5 9.7 6.5 9.0 3.7 2.4 3.4
1997 28.9 21.5 27.2 9.6 6.5 8.9 3.6 2.4 3.3
1998 28.0 21.1 26.5 9.7 6.6 9.0 3.5 2.4 3.2
1999 27.6 20.8 26.1 9.4 6.3 8.7 3.5 2.3 3.2
2000 27.6 20.7 25.8 9.3 6.3 8.5 3.5 2.3 3.2
2001 27.1 20.3 25.4 9.1 6.3 8.4 3.4 2.3 3.1
2002 26.6 20.0 25.0 8.7 6.1 8.1 3.3 2.2 3.0
2003 26.4 19.8 24.8 8.7 6.0 8.0 3.2 2.2 3.0
2004 25.9 19.0 24.1 8.2 5.8 7.5 3.3 2.1 2.9
2005 25.6 19.1 23.8 8.1 6.0 7.6 3.2 2.1 2.9
2006 25.2 18.8 23.5 8.1 6.0 7.5 3.1 2.0 2.8
2007 24.7 18.6 23.1 8.0 6.0 7.4 3.0 2.0 2.7
2008 24.4 18.5 22.8 8.0 5.9 7.4 2.9 2.0 2.6
2009 24.1 18.3 22.5 7.8 5.8 7.3 2.9 2.0 2.6
2010 23.7 18.0 22.1 7.7 5.8 7.2 2.8 1.9 2.5
2011 23.3 17.6 21.8 7.6 5.7 7.1 2.7 1.9 2.4
Note: Estimates of vital rates at the National Level upto 1995 do not include Mizoram as the SRS was not operational in Mizoram till 1995.
Source: SRS, Registrar General, Vol. 46 No. 1 January 2012, India & SRS-2010 (April, 2012), SRS Statistical Report 2011
Crude Death Rate (CDR) is another important measure as it, in
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combination with the crude birth rate determines population growth
rate. It is the number of deaths in a year per 1000 population of the mid-
year population. It registered a decline from 12.5 deaths per 1000
population in 1981 to 7.1 deaths per 1000 population in 2011 i.e. a
decline of 43.2 per cent. The maximum decline in CDR was observed
during the first period 1981-90. On comparing the CDR in rural and
urban areas, it has been found that though the CDR declined in both
rural and urban areas but still a big difference existed between them
(Table 3.8). The CDR decline was higher in rural areas as compared to
the urban areas. Better control of famines, better management of natural
disasters, better medical facilities, improvement in public health and
sanitation, decline of major killer diseases like cholera, tuberculosis etc,
better control of epidemics, spread of education and immunization
programmes have helped to bring down the crude death rate in India.
Life Expectancy
With the rapid advancement in medical science and technology
it has now become easier to control various dreaded diseases which
were the cause of high mortality earlier. This has resulted in a steady
increase in the expected length of life or life expectancy at birth or life
expectancy at age 0. Due to various biological factors, generally
women live longer than men but still because of some social factors
adverse to women, India is one of the few countries of the world where
life expectancy at birth was slightly in favour of males till about 1980.
However, because of improvement in the various socio-economic
conditions since then, women’s life expectancy is now higher than
men’s in India as observed in most of the other countries of the world.
It can be interpreted as the ageing transition is a structural shift
in the age composition from a conical shaped age pyramid with a wide
base and rapidly narrowing off towards its apex, characterising high
fertility and mortality conditions in pre-transitional stages, towards a
barrel shaped age pyramid resting on a relatively shortened base and
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slowly tapering off towards its apex, characterising low fertility and
mortality conditions in the advanced stages of demographic
advancement (Gulati 1989).
Table 3.9 Life expectancy at selected ages by sex over time in India
At age
(years)
Period Male Female Total
0 1970-75
1976-80
1981-85
1986-90
1991-95
1996-00
2001-05
2002-06
50.5
52.5
55.4
57.7
59.7
61.0
62.3
62.6
49.0
52.1
55.7
58.1
60.9
62.7
63.9
64.2
49.7
52.3
55.5
57.7
60.3
61.9
63.2
63.4
60 1970-75
1976-80
1981-85
1986-90
1991-95
1996-00
2001-05
2002-06
13.4
14.1
14.6
14.7
15.3
15.8
16.4
16.7
14.3
15.9
16.4
16.1
17.1
17.8
18.7
18.9
13.8
15.0
15.4
15.4
16.2
16.9
17.7
17.9
70 1970-75
1976-80
1981-85
1986-90
1991-95
1996-00
2001-05
2002-06
8.6
9.6
9.7
9.4
10.0
10.4
10.9
10.9
9.2
10.9
11.0
10.1
11.0
11.7
12.3
12.4
8.9
10.2
10.2
9.9
10.6
11.1
11.7
11.8
Source: Sample Registration System (SRS) Office of the Registrar General, India.
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Table 3.9 gives the figures for life expectancy at selected ages by
sex over time in India. Life expectancy at birth rose steadily and by
1990 had reached 60 years (61 for females and 60 for males). The life
expectancy at birth for females has been rising continuously. Earlier
in 1970-75 it was 49 years for females and 51 years for males and
during 2002-06, it was 64 years for females and 63 years for males. It
has been found that life expectancy was higher among urban people
than among the rural people. In 2002-06 it was 69 years in urban
areas and 62 years in rural areas (Figure 3.6).
Life expectancy at higher ages like 60 years, 70 and above
calculates the average remaining length of life for those who have
already attained the specified age. Life expectancy at age 60 was found
to be about 14 years for the period 1970-75 which increased to 18
years, for the period 2002-06. For males it rose from 13 years to 17
years and for females from 14 years to 19 years during the
corresponding period. At age 70, life expectancy in India was found to
be less than 12 years (11 for males and 12 for females) during the
period 2002-06.
Table 3.10 shows the expectation of life at birth and at age 60
for major states of India by sex for the period 1996-00 and 1997-01.
Among the major states of India, while the expectation at birth was
highest in Kerala (70.8 for males and 76.2 for females) for the period
1997-01 followed by Punjab (67.2 for males and 69.3 for females), but
if we look at life expectation at age 60 Punjab stood at top (20.2 for
males and 21.2 for females). In terms of male expectation of life at age
60 for the period 1997-01, Punjab was followed by Haryana (19.0)
whereas in female life expectancy at 60, Kerala (20.6) followed Punjab.
Demographically disadvantaged states such as Bihar, Madhya
Pradesh and Orissa had lowest life expectancy at birth but for Bihar,
life expectancy at age 60 was higher than Maharashtra, Tamil Nadu
and Gujarat.
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Table 3.10 Expectation of life at birth and at age 60 for major states of India by sex, 1996-00 & 1997-01
States 1996-00 1997-01
At birth At age 60 At birth At age 60
Male Female Male Female Male Female Male Female
Andhra Pradesh 61.7 64.3 15.9 16.8 61.9 64.4 15.9 16.9
Bihar 60.9 59.1 16.4 16.6 61.1 59.3 16.7 16.9
Gujarat 62.1 64.0 15.2 16.8 62.3 64.2 15.3 16.8
Haryana 64.4 65.1 19.0 19.5 64.6 65.2 19.0 19.6
Himachal Pradesh 65.4 66.0 17.5 17.1 65.5 66.1 17.7 17.3
Karnataka 62.5 65.8 15.9 17.7 62.6 66.0 16.0 18.0
Kerala 70.7 76.1 18.6 20.5 70.8 76.2 18.8 20.6
Madhya Pradesh 56.6 56.3 14.8 15.3 56.7 56.4 14.9 15.6
Maharashtra 64.7 67.2 16.5 17.4 64.8 67.3 16.7 17.5
Orissa 57.8 58.0 15.4 15.3 58.0 58.2 15.6 15.5
Punjab 67.1 69.2 20.2 21.3 67.2 69.3 20.2 21.2
Rajasthan 60.1 61.1 15.3 17.1 60.3 61.3 15.4 17.2
Tamil Nadu 63.9 65.9 15.8 16.2 64.1 66.1 15.9 16.5
Uttar Pradesh 59.1 57.9 15.1 16.3 59.2 58.1 15.2 16.5
West Bengal 63.0 64.5 15.7 16.9 63.2 64.6 16.0 17.0
Source: Sample Registration System (SRS) Office of the Registrar General, India.
An important feature of population ageing is therefore the
greater longevity of women than men, a differential which has
increased during the latter half of the twentieth century. The
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female/male discrepancy in life expectation increased during 1991-2001
and is expected to continue. The reason for this differential decline was
not yet very clear, particularly in view of the fact that status of women
was very low which was reflected in the neglect of their health and well-
being at all ages in the developing counties like India. However, the
improvement in life expectancy was particularly due to a reduction in
child mortality which reflected improvements in public health and
medical advances in the prevention of many fatal infectious diseases in
childhood. Increase in the life expectancy of older people reflected
improvement in the quality of life in the later part of the twentieth
century and to a limited extent some of the achievements of medical
science, although we are not yet successful in combating some of the
illnesses that are major causes of death among the elderly such as heart
attacks, lung cancer, stroke and circulatory diseases. These are major
causes of death for both men and women in the older ages, but they do
not become as important for women until later in the age curve. Thus
these factors differentially affect the sexes within the same age cohort
and contribute to the increasing longevity of women to men.
Age-Specific Death Rate
The age specific death rates in the older age groups by sex give
an idea about the health status of the elderly persons, in the Indian
society. Table 3.11 depicts Age-specific death rate (per 1000) of elderly
population by sex in India. The age specific death rate gives the
number of deaths, during a given time period, of persons of a
particular age group per 1000 persons in that age group.
There was sharp rise in age-specific death rate with age from 20
(per 1000) for persons in the age group 60-64 years to 74 among those
aged 75-79 years and 168 for persons aged 85+. Also for all the broad
age-groups, the rates for males were invariably more than that
forfemales. This progressive advantage in favour of women in the
elderly population is primarily due to the increasingly lower mortality
64
rates of women at middle to late ages compared with men (Figure 3.7).
Table 3.11 Age-specific death rate (per 1000) of elderly population by sex and residence in India, 2011
Age group Male Female Total
60-64 23.8 16.1 20.1
65-69 40.1 26.7 33.2
70-74 58.1 42.5 49.9
75-79 81.5 66.4 73.6
80-84 115.9 95.1 104.8
85+ 183.6 154.8 167.6
Source: SRS (Sample Registration System) Statistical Report 2011
Table 3.12 shows the Age-specific death rate (per 1000) for
broad age-groups of elderly population in states of India. Among
states the age-specific death rate among elderly was relatively lower in
Himachal Pradesh, Kerala, Punjab and highest in Andhra Pradesh,
Bihar, Maharashtra, Orissa, Madhya Pradesh etc.
Table 3.12 Age-Specific death rate (per 1000) for broad age-groups
of elderly population in states of India 2011
State Broad age groups (years) for elderly population
60-64 65-69 70-74 75-79 80-84 85+
Andhra Pradesh 22.8 34.3 53.3 68.1 90.7 125.2
Bihar 20.4 33.9 56.8 73.6 106.9 168.8
Gujarat 18.7 29.8 50.5 54.8 98.3 150.4
Haryana 19.2 32.3 47.0 59.7 70.3 198.9
Himachal Pradesh 14.5 28.6 37.8 66.7 105.8 116.2
Karnataka 18.8 31.8 44.8 83.0 108.1 169.0
Kerala 15.1 21.2 36.0 67.1 97.6 202.7
Madhya Pradesh 24.6 35.6 71.7 87.0 146.3 159.3
Maharashtra 20.5 28.4 45.2 73.1 98.4 159.1
Orissa 22.0 32.2 50.6 74.2 115.5 186.5
Punjab 16.5 22.7 39.8 58.8 91.2 169.3
Rajasthan 17.1 29.1 45.9 62.8 101.2 187.2
Tamil Nadu 19.0 31.8 48.3 69.6 97.2 155.6
Uttar Pradesh 22.4 41.4 48.7 23.1 124.2 167.2
West Bengal 19.3 32.0 48.6 70.3 101.9 172.4
India 20.1 33.2 49.9 73.6 104.8 167.6
Source: SRS (Sample Registration System) Statistical Report 2011
65
66
Thus the improvement in life expectancy and decline in age-
specific death rate among the elderly are particularly due to the
improvements in public health and medical advances in the prevention
of many fatal infectious diseases and both are the major causes for the
increase in elderly population. Increases in the life expectancy of older
people reflect some of the achievements of medical science.
SOCIO-ECONOMIC AND HEALTH CONDITION OF ELDERLY IN INDIA
Old age is the later part of life, which is characterised by
deterioration in physical capacities. The deterioration brings changes
in the person’s active participation in different areas of life, role
playing and role performance and from economic self sufficiency to
dependence. As a person moves along the life cycle to the higher age
group a general change occurs in his or her living environment. This is
mainly because as the age goes up the ability of the individual to
convert their endowments into output declines. The elderly person
looses out their life time amenities as they passes through a lean
period of their life (Bagchi, 2003).
Socio-Economic Condition of Elderly
This section examines the socio-economic conditions of the
elderly population in India. The socio-economic conditions of elderly in
India, covering marital status, literacy level, dependency ratio, living
arrangements, and economic status have been discussed as below:
Marital status
Marital status of the elderly assumes special significance in the
context of care in old age as it is known that those who are married
fair better in all economic and social aspects than those who are
single. A major concern related to the increasing proportion of the
elderly women, especially widows in the population. Two reasons are
given for the marked gender disparities in widowhood in India (i)
longer life span of women compared to that of men and (ii) the general
67
tendency in India for women to marry men older than themselves
(Gulati and Irudaya Rajan 1999). Also widowed men are much more
likely to remarry and thus restore their earlier status. Though the
relationship between the well being of the elderly and their marital
status cannot be spelt out precisely, any change in the marital status
of the elderly deserves careful examination.
Table 3.13: Marital Status of the elderly in India (in percentages)
Marital Status Rural Urban
Male Female Total Male Female Total
Never married 1.65 0.55 1.10 1.74 1.19 1.46
Currently married 78.57 39.06 58.96 82.27 38.64 59.97
Widowed 19.43 59.85 39.49 15.85 59.71 38.27
Divorced/Separated 0.36 0.54 0.45 0.14 0.47 0.31
Source: NSSO 60th round (Jan-Jun, 2004)
Table 3.13 shows that widowhood and living without spouse is
one of the real challenges for the elderly in India. About 40 percent of
the elderly spent their life without spouses. This incidence of
widowhood was around 60 percent among females in both rural as
well as urban areas. On the other hand, incidence of widowhood
among males was only 15.85 in urban areas and 19.43 percent in
rural areas. This is mainly because the life expectancy is relatively
higher among females compared to that of males.
Table 3.14 shows the marital status of the elderly in Indian
states. Here we take a logistic position that those unmarried,
separated and widowed are of same category with almost identical
position in the society, as long as quality of life is concerned. The
widowhood seems to be chronic problem among the elderly in India
especially among elderly women. Almost in all states more than sixty
percent of women were living without spouse despite significant
spatial difference that exists in India while prevalence of widowhood
68
among men was as low as twenty percent in most of Indian states. The
trend of high incidence of loss of spouse was making life insecure for
the elderly especially that of women in India in their life (Figure 3.8).
Table 3.14: The marital status of the elderly in Indian states (Percentage of unmarried/widowed among aged)
All India and selected major states Male Female
Andhra Pradesh 18.55 70.54
Bihar 21.84 49.20
Gujarat 22.79 61.62
Haryana 19.67 41.17
Himachal Pradesh 22.27 63.37
Karnataka 16.73 73.58
Kerala 14.29 66.16
Madhya Pradesh 22.69 56.42
Maharashtra 15.65 58.91
Orissa 13.12 59.94
Punjab 21.95 46.03
Rajasthan 21.72 57.64
Tamil Nadu 18.24 68.79
Uttar Pradesh 29.42 54.61
West Bengal 17.31 71.27
All India 20.55 61.05
Source: NSSO 60th round (Jan-June, 2004)
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70
Literacy Level
Education, in its broadest sense is a means of transference of
knowledge and information among the members of a society, which in
turn helps develop secular and individualistic ideas. Education
increases the ability of an individual to think rationally and logically.
It is an important determinant of various demographic decisions of
individuals. It has been found that the levels of birth rate, death rate
and infant mortality rate are higher in the states where female literacy
rates are lower. The formal education system is not only helps the
individual acquire skills in reading, writing and calculating to be able
to meet the requirements of the employment sector in later life, but
equally importantly enables the development of rationality. Despite
the spread of education over time, however, its benefits have not
reached the elderly population. There is a huge gap between the
literacy level of the elderly males and females as well as of general
overall population.
Table 3.15: Percentage of literates among elderly persons in India
Years Rural Urban Total
Male Female Total Male Female Total Male Female Total
Census
1991
34 18 21 66 3 49 41 13 27
Census
2001
45 13 29 75 42 58 53 20 36
NSSO
Survey
2007-08
44 13 28 77 44 61 52 21 36
Source: Census of India 1991, 2001 & NSSO Survey 2007-08
Table 3.15 tells us about the percent of literates among elderly
in India. It has been found that percentage of literate elderly males
was 41 in 1991 and on the other side among their female
counterparts, it was only 13 percent. In 2001, it was 53 percent for
males and 20 percent for females. The proportion of literates among
elderly persons has increased from 27 percent in 1991 to 36 percent
in 2001 (Figure 3.9).
71
72
According to NSSO Survey for 2007-08 only 52 percent of
elderly males and 21 percent of elderly females (aged 60 years or
above) were literate. It has been observed that the literacy rate among
both elderly males and females have improved over time in both rural
and urban areas and the literacy rate among males was more than
their female counterparts.
Old Age Dependency Ratio
The total dependency ratio is often used as an indicator of
the economic potential, the principal argument being that a low
dependency implies more workers and the need to divert fewer
resources to dependent populations. It has also been argued that
the shift in the age composition of the population (in favour of
ageing of population) is likely to damage the economy. As older
people consume a higher proportion of the national budget for
health, social services and social security, these become somewhat
self-evident aspects, particularly in the developed countries. For
example, for the USA it is estimated that per capita costs for
elderly persons are approximately three times those incurred by
youth. Comparable figures for the developing world indicate that
the costs of elderly people are 1.5 times higher than for young
people (Johnson, 1993).
The old-age dependency ratio measures the responsibility of
the aged to the working-age population. In India, generally,
persons aged 15 to 59 years are supposed to form the population
of working ages and at age 60, people generally retire or withdraw
themselves from work. Thus old age dependency ratio is obtained
by dividing the population aged 60 or more by the population of
working ages.
73
Table 3.16: Old age dependency ratio by sex and Residence, India 1961-2001
Year Male Female Total Rural Urban
1961 10.9 10.9 10.9 11.4 8.7
1971 11.4 11.6 11.5 12.2 8.9
1981* 11.8 12.2 12.0 13.0 9.2
1991** 12.2 12.2 12.2 13.2 9.7
2001# 12.4 13.8 13.1 14.1 10.8
Source: Census of India 1961-2001
* Excludes figures for Assam in 1981 where the Census was not conducted
** Excludes Jammu & Kashmir where the Census 1991 was not conducted
# Excludes 3 sub-divisions of Senapati district of Manipur
Table 3.16 shows the old-age dependency ratio by sex in India.
The movement of the ratio overtime indicates an ever-rising trend in
this ratio which rose from 10.9 percent in 1961 to 12.0 percent in
1981 and further to 13.1 percent in 2001. Among the males, old-age
dependency ratio was 10.9 percent in 1961 and rose to 11.8 percent
in 1981 and further to 12.4 percent in 2001. On the other side among
the females, it was 10.9 percent and rose to 12.2 percent in 1981 and
further to 13.8 percent in 2001. It has been found that the female old-
age dependency ratio as well as the gap between female and male old-
age dependency ratio are rising over time (Figure 3.10). This is a
matter of great concern. It has been observed that there was a
considerable difference between the dependency ratio of rural and
urban areas. In rural areas, it rose from 11.4 percent in 1961 to 14.1
percent in 2001 while in the urban areas it rose from 8.7 percent in
1961 to 10.8 percent in 2001. This is due to the fact that the working
age population was highly concentrated in the urban areas.
74
75
Living arrangements among elderly
The conventional living pattern of the elderly has drastically
changed, following the reduction in fertility and the increase in life
expectancy particularly at older ages. In India, the traditional practice
has been for people to live together with children in old age. Living
with children need not necessarily with the intention of receiving care
and support, but often the rest of the family also benefit from the
arrangements for example, when the younger women of the household
go to work, their children are often taken care of by the grandparents.
In fact, the United Nations (2003) in its announcement of theme for
international day for older persons depicts healthy older persons as a
resource for their families, societies and the economy of their
respective countries.
Living arrangement is an important component in dealing the
welfare of any specific group. The elderly persons, being less able to be
independent, need the care and support of others in several respects.
Taking care of the elderly refers mainly to the emotional support; on
the other hand support given to the elderly refers to the financial and
material support. The former type of support is expected from the
families or intimate relatives; whereas the latter is supposed to be a
joint effort of the immediate family and society. The care and support
enjoyed by the elderly is linked to their residence in other words the
living arrangements.
The distribution per 1000 of aged persons by type of living
arrangements for each sex in rural and urban India has been shown
in Table 3.17. The results of NSS 60th Round show that about 4 to 5
percent were living with other relations and non-relations, about 57
percent of the aged were living with their spouses and another 32
percent were living without their spouses and with their children.
Moreover, 4 to 5 percent were still living alone.
76
Table 3.17: Distribution per 1000 of aged persons by type of living arrangement for each sex (India)
Rural Urban
Living Arrangements
Male Female Total Male Female Total
Living alone 28 (25)
76 (61)
53 (43)
21 (30)
65 (60)
43 (45)
With spouse only
162 (137)
87 (77)
125 (107)
133 (103)
75 (57)
104 (80)
With spouse, children and grand children
597 (613)
284 (313)
442 (462)
649 (648)
294 (297)
468 (469)
With spouse (2+3)
759 (750)
371 (390)
567 (569)
782 (751)
369 (354)
572 (549)
With children 168 (179)
475 (481)
320 (331)
154 (178)
482 (512)
322 (349)
With other relations and
non relations
27 (38)
56 (59)
42 (48)
29 (35)
67 (65)
49 (51)
Total (include n.r.)
1000 1000 1000 1000 1000 1000
Note: Figures in Parentheses give the corresponding estimates obtained from
NSSO 52nd round (1995-96)
Source: NSSO 60th round (Jan-Jun, 2004)
However figures reflects that the living arrangements of the aged
has not changed much between 1995-96 and 2004, as the proportion
of the aged living alone remained almost the same. During this period,
the proportion of the aged who lived with their spouses only had
however, risen in urban areas as well as in rural areas. The proportion
of aged persons especially females living with their children reflect the
gradual breakdown of the extended or joint family system in India in
both rural and urban areas.
77
Economic Condition
Inadequate financial resources are mentioned as one of the
major problems of the Indian elderly. The financial inadequacy seems
to be of higher degree among the elderly women compared to their
male counterparts. Another major problem is related to the loss of
economic independence with the increase in age. The elderly continue
to work though their working hours decrease with increasing age.
Financial problems are more common among widows and among the
elderly who live in nuclear families. Economic insecurity is considered
to be the sole concern of the elderly in barely sustainable households
in India. The major sources of worry for the elderly are stress and
economic dependence. For understanding their economic dependence
it is important to analyse gainful employment among elderly.
The financial and economic well being of the elderly is closely
linked to their level of education and past work status. Under usual
circumstances, most of the elderly in the formal sector would have
retired from the labour force. However, given the Indian situation
where the unorganized sector accounts for a larger share of the work
force and where rural labour is predominantly in agriculture or allied
activities, there is no question of formal retirement for the elderly. In
fact, being economically active is probably a positive feature of the
aged population in India since it helps to keep at bay many of the age
related health problems that arise from a feeling of being unwanted,
isolated and useless.
Table 3.18: Status of gainful employment among the elderly (in percentages)
Status of
gainful
employment
Rural Urban Total
Male Female Total Male Female Total Male Female Total
economically active
59.3 16.7 38.2 33.0 8.0 20.0 53.1 14.6 33.8
economically
non active
40.7 83.3 61.8 67.0 92.0 79.8 46.9 85.4 66.2
Source: NSSO 60th round (Jan-Jun, 2004)
78
79
Table 3.18 shows the status of gainful employment among the elderly
sex-wise. It is clear from this table that majority were not productively
employed in the work force. In India only 33.8 percent were engaged
in the productive work while it was significantly higher in the case of
males 53.1 percent and only 14.6 percent in case of females. The
difference was mainly due to the fact that an elderly woman generally
engages in the household duties that are out of the purview of
economic activities. The elderly in the rural areas were more engaged
in the economic activity (38.2 percent) than their urban counterparts
(20.0 percent) as they are forced to work by the conditions of the
deprivation in which they live (Figure 3.11).
Table 3.19 depicts the status of gainful employment among the
elderly in Indian states. The state wise estimates of economically gainful
workers among the elderly almost show a similar pattern as observed in
the national scenario. There was a significant fell in work participation in
higher age groups. At all India level figures shows that in the case of
males it fall down from 53.1 percent to 15.28 percent as the age group
from 60-79 category to the eighty plus years of the category. In the case
of females the figure fell further down from 14.6 percent to 2.43 percent
in these two age groups. In Punjab state, in the case of males
corresponding figures were 50.42 percent and 10.55 percent respectively
in these two age groups. In case of females the figures were 5.62 percent
and zero percent respectively in these two age groups. Moreover these
figures were below all India level for both male and female.
One of the critical issue raised in the high levels of work
participation is that for poor elderly there is only one retirement, not
from work, but from the world” (Irudaya Rajan, Mishra, and Sharma
1999). The high levels of work participation among the elderly shows
that majority of them are working to avoid the economic and social
crisis, that, they faced both within and outside family set up. In most
of the cases they are compelled by the situation of their life that put
them in the labor force in the later years of life.
80
Table 3.19: Status of gainful employment among the elderly in Indian states (in percentages)
All India and selected
major states
60-79 80+
Male Female Male Female
Andhra Pradesh 49.88 17.54 5.68 3.83
Bihar 70.78 13.74 27.71 0.00
Gujarat 54.88 15.07 9.01 1.90
Haryana 44.11 6.26 2.99 0.00
Himachal Pradesh 68.65 34.74 34.90 18.00
Karnataka 57.36 18.32 18.23 0.60
Kerala 44.25 11.94 12.59 2.55
Madhya Pradesh 63.64 24.08 8.29 0.63
Maharashtra 49.71 21.80 13.71 0.50
Orissa 57.01 10.14 20.05 0.00
Punjab 50.42 5.62 10.55 0.00
Rajasthan 58.72 13.38 11.05 1.39
Tamil Nadu 51.50 24.49 14.56 1.01
Uttar Pradesh 67.71 11.55 22.47 4.47
West Bengal 49.74 6.10 13.78 3.92
All India 53.1 14.6 15.28 2.43
Source: NSSO 60th round (Jan-Jun, 2004)
Further the problems of day-to-day maintenance of livelihood of
the elderly can be revealed by looking at their economic dependence/
81
independence. Table 3.20 reveals the state of economic independence
(i.e. day-to-day maintenance of livelihood) for each sex of the elderly in
rural and urban sectors of India.
Table 3.20: Distribution per 1000 of aged persons by state of Economic Independence of each sex in India
State of
Economic Independence
Rural Urban
Male Female Total Male Female Total
Not dependent on others
513 (485)
139 (121)
327 (301)
555 (515)
170 (115)
359 (311)
Partially dependent on
others
152 (180)
124 (146)
138 (163)
134 (169)
95 (110)
114 (139)
Fully dependent on others
320 (313)
720 (706)
519 (511)
301 (297)
721 (757)
516 (532)
Total (include n.r.) 1000 1000 1000 1000 1000 1000
Note: Figures in Parentheses give the corresponding estimates obtained from NSSO 52nd round (1995-96)
Source: NSSO 60th round (Jan-Jun, 2004)
According to NSS 60th round 65 percent of the aged had to
depend on others for their daily maintenance in both rural and urban
areas. The situation of elderly females was worse. Among the elderly
females about 85 percent were economically dependent either fully or
partially. Males were in much better condition than females.
Compared to estimates obtained from NSS 52nd round (1995-96), the
economic condition of the aged persons has improved in general and
also both among male and female in rural as well as urban areas. The
economic condition of elderly has improved more in the urban sector
compared to that of the rural sector.
Table 3.21 shows the assessment of the level of poverty among
Indian elderly according to sex, by major states of India. All the
elderly were categorized here in three categories: not dependent,
partially dependent and fully dependent; we presume that fully
dependent the elderly need economic help in old age as they are
below the poverty line.
82
Table 3.21: Dependency status among the elderly by sex and place of residence in India (state wise)
All India and selected major states
Male Female Total
Andhra Pradesh 44.8 62.2 53.6
Bihar 36.8 56.5 46.2
Gujarat 45.9 60.7 53.5
Haryana 52.8 58.2 55.7
Himachal Pradesh 35.6 39.3 37.4
Karnataka 51.6 62.4 57.3
Kerala 53.4 61.4 57.8
Madhya Pradesh 43.3 53.9 48.6
Maharashtra 46.3 57.3 51.9
Orissa 47.5 64.1 55.6
Punjab 53.2 68.8 60.8
Rajasthan 43.2 56.9 50.6
Tamil Nadu 41.2 57.1 48.8
Uttar Pradesh 41.6 57.8 49.5
West Bengal 48.3 65.8 56.9
All India 45.2 60.6 52.8
Source: NSSO 60th round (Jan-Jun, 2004)
It has been observed, a large proportion of the elderly were
economically dependent on others for their livelihood in most of the
states. It is therefore, pertinent to know about the persons who are
providing economic support to these elderly. Table 3.22 depicts the
distribution per 1000 of economically dependent aged persons by
category of persons supporting the aged for each sex in India.
According to NSSO 60th round, a majority (about 76 to 78 percent)
had to depend on their children and a sizable proportion (13 to 15
percent) on their spouses for their economic support. Only 3 percent
were supported by their grandchildren and the rest (6 percent) had to
depend on ‘others’, including non-relations.
83
Table 3.22: Distribution per 1000 of economically dependent aged persons by category of persons supporting the aged
for each sex in India
Category of persons
supporting
Rural Urban
Male Female Total Male Female Total
Spouse 70
(113)
159
(159)
127
(142)
60
(105)
192
(182)
148
(156)
Own children 850
(766)
746
(717)
784
(735)
865
(792)
710
(695)
762
(728)
Grand children 22
(50)
31
(52)
28
(52)
18
(54)
30
(56)
26
(55)
Others 57
(71)
63
(72)
61
(71)
57
(49)
68
(67)
64
(61)
Total
(include n.r.)
1000 1000 1000 1000 1000 1000
Note: Figures in Parentheses give the corresponding estimates obtained from NSSO 52nd round (1995-96)
Source: NSSO 60th round (Jan-Jun, 2004)
Between the years 1995-96 and 2004, the distribution of the
aged who were economically dependent changed in respect of the
category of persons supporting them for their livelihood. The pattern
of change is not similar for males and females, but is so for the elderly
living in the rural and urban areas. In the inter-survey periods, the
proportion of the aged males and females depending on their children
for economic support has increased in both rural and urban areas
and more so in the rural areas. On the other hand, the proportion of
those depending on their spouse decreased, in general, among the
males but marginally increased among the aged females in the urban
areas. The proportion in this category however did not show any
change between the periods in the rural areas.
84
Health Condition of Elderly
The process of biological ageing brings with it several
accompanying health problems or diseases. It is obvious that people
become more and more susceptible to chronic diseases, physical
disabilities and mental incapacities in their old age. The decline in the
efficient functioning of the various organ systems of the body
including the immune system renders the elderly particularly
vulnerable to several diseases. As age advances, due to deteriorating
physiological conditions, the body becomes more prone to illness. The
illness of the elderly are multiple and chronic in nature. Some of the
health problems of the elderly can be attributed to social values also.
The idea that old age is an age of ailments and physical problems is
deeply rooted in the Indian mind, and many of the sufferings and
physical troubles within curable limitations are accepted as natural
and inevitable by the elderly.
The perception about one’s health is an important factor in
getting an idea about a person’s actual health condition. A person
may be considered as being in good health if he feels so. Moreover, it
reflects the mental health of that person. Table 3.23 depicts the
distribution of aged persons (per 1000) by own perception about their
health. It has been observed that as high as 55 to 63 percent of the
aged with sickness felt that they were in a good or fair condition of
health. The proportion among the aged without sickness was 77 to 78
percent. Possibly they considered their sickness as a problem of
ageing. Among the aged, the males seemed to be feeling that they had
a better health condition even with sickness compared their female
counterparts. As against this, about 13 to 17 percent of the aged who
were not even sick considered themselves as having a poor state of
health. Rural aged seemed to be feeling that they had a better health
condition even with sickness as compared to the urban aged.
85
Table 3.23: Proportion (per 1000) of aged persons according to their own perception about Health (India)
Own perception about current state of health
Aged persons with sickness
Aged persons without sickness
male female person male female person
Rural
excellent/very good 19 14 17 81 43 62
good/fair 580 525 553 772 770 771
poor 401 460 429 147 187 167
all aged 1000 1000 1000 1000 1000 1000
Urban
excellent/very good 31 19 24 114 72 92
good/fair 641 620 631 775 780 778
poor 327 360 345 111 148 130
all aged 1000 1000 1000 1000 1000 1000
Note: The proportions have been adjusted excluding the ‘not reported cases’.
Source: NSSO 60th round (Jan-Jun, 2004)
Table-3.24 shows the prevalence of chronic disease among the
elderly in India. It has been found that heart disease is the major
chronic problem among both elderly male and elderly female.
Prevalence of heart diseases among elderly males and females was
much higher in urban areas than in rural areas. Among elderly males,
most common problem was urinary problem. On the other side more
elderly females reported to suffer from problem of joints.
86
Table 3.24: Number of person aged 60 years and above reporting a chronic disease (per 1000 persons) by sex (India)
Type of chronic disease
Rural Urban
Male Female Person Male Female Person
Whooping Cough 8 6 7 4 2 3
Ulcer 37 54 44 30 24 27
Problem of joints 30 40 34 26 45 35
Hypertension 23 53 36 50 59 54
Heart disease 95 59 80 165 162 164
Urinary Problem 78 28 57 89 33 63
Diabetes 30 52 40 68 36 53
Cancer 18 36 26 25 25 25
Source: NSSO 60th round (Jan-Jun, 2004)
Ability to move is an important indicator of physical condition of
health of aged persons. It also indicates their dependence on others
for movement and performing their daily routine. Table 3.25 gives
information regarding the proportion (number per 1000) of the aged
persons who cannot move around and are confined to their home or
who cannot move at all and are confined to bed.
Table 3.25: Proportion (per 1000) of aged persons who cannot move and are confined to bed or home in India
age-groups (years) rural urban
male female person male female person
60-64 27 34 31 33 34 33
64-69 51 50 51 34 63 50
70-74 79 132 105 77 116 97
75-79 117 163 139 113 185 147
80& above 220 326 269 239 323 283
all aged 67 88 77 68 100 84
Source: NSSO 60th round (Jan-Jun, 2004)
87
About 8 percent of the aged persons were either confined to
their home or bed. With the increasing age the proportion of aged
persons reporting confinement to their home or bed was found to
increase in both rural and urban areas, being as high as 27 for
persons aged 80 and above. In both rural and urban areas the
incidence of confinement is seen to be higher among female than
among male.
On the whole, we can conclude that due to the ongoing
demographic transition, India faces major age structure changes with
an accelerating growth in the aged (60+) population. The cause of this
change is decline in fertility reinforced by continued decline in
mortality levels. The increase of demographic ageing process in our
country has a series of socio-economic problems as well as health
problems. There are several problems of elderly which are – loneliness,
economic dependency, poor health, malnutrition etc.
The elderly population (60+) increased sharply during 1991-
2001. In India, as a result of the change in the age composition of the
population over time, there has been a progressive increase in both
the number and proportion of aged people. The proportion of elderly
female to elderly males has been found higher than in the general
population for all the years since independence. The improvement in
life expectancy and decline in age-specific death rate among the
elderly are particularly due to the improvements in public health and
medical advances in the prevention of many fatal infectious diseases
and both are the major cause for the increase in elderly population.
Widowhood and living without spouse is one of the real challenges for
the elderly in India. Among the elderly people only two categories,
namely those who live with spouse, children and grandchildren and
those who live with children and grandchildren but without spouse,
are predominant among the Indian elderly. In India only one third of
the elderly are engaged in the productive work while it is significantly
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higher in the case of men than in case of women. Elderly females were
more economically dependent either fully or partially. Males were in
much better condition than females. Since age is associated with
increase in physical illness and disability, ageing becomes an essential
part of the health care delivery system. Therefore in-depth studies
through multidisciplinary assessment on issues like socio-economic
problems, health, and psychological stress and social security needs
of the elderly should be done nationwide.
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