Health Care Challenges of Indian Older Adults with Special Reference to Mental Health: An Overview

Review Article

Austin Palliat Care. 2016; 1(1): 1005.

Health Care Challenges of Indian Older Adults with Special Reference to Mental Health: An Overview

Tiwari SC* and Pandey NM

Department of Geriatric Mental Health, King George’s Medical University, India

*Corresponding author: Tiwari SC, Department of Geriatric Mental Health, King George’s Medical University, UP, Lucknow, India

Received: April 21, 2016; Accepted: June 07, 2016; Published: June 09, 2016


The growth rate of Indian older adults (aged 60 years and above) is comparatively faster than other parts of the World. In 1991, the population of this segment of society was 56.7 million, which doubled in 2011 i.e. 103 million and is expected to triple in the next four decades i.e., 316 million. Increased life expectancy, reduced mortality rate and longevity are definite achievements for any country but simultaneously, they become a challenge if proper health care, support and management cannot be ascertained. With advancement in age, a person faces decline in anatomical, biological and functional strength which makes them more vulnerable to the development of disease and disabilities. Moreover, changing familial and social matrices threat their overall health, especially, psychological and mental health status. Studies report that a large segment of this population suffer from health related problems. Care of older adults has enormous challenges, including individual, familial and social trials which need to be worked out immediately. The article provides an evidence based summary regarding health care challenges and practical strategies to manage the same.

Keywords: Older adults; Health care; Physical and mental health; Disabilities; Challenges; Opportunities


India, one of the largest democracies of the world with 28 States and 6 Union Territories, is the second largest populous country after China and is facing a transitional phase. The changing demographic scenario and population projections indicate that the growth rate of Indian older adults is comparatively faster than in the other regions of the World. It also indicates that the rate of mortality in India is on a decline. Currently, the population of older adults (aged 60 years and above) in the country is growing at a fast pace. Projections reveal that by 2050 this segment of population will be similar in proportion to the world older adult population. According to 2011 census older adults share 8.6% [1] of the total population. Within two decades, the population of older adults has doubled in the country i.e. from 56.7 million in 1991 to 103 million in 2011 [1] and is expected to triple in the next four decades i.e., 316 million [2].

Life expectancy at birth has risen from 49.7 (male=50.5, female=49.0) years in 1970-75 to over 63.5 (male=62.6, female=64.2) in 2002-2006 [3,4] and 67.1 in year 2012 [5], and it has expanded the absolute number and proportion of older. These changes affected the dependency ratio and it is indicated that Old Dependency Ratio (ODR) is on an increase, i.e. from 122 in 1991 to 142 in 2011 [1]. Population ageing cannot be perceived just as an achievement but also as one of the greatest challenges for the country. Adding years to life does not always as certain wellness, prosperity and quality of life. Isolation, exclusion and marginalization are also experienced by this segment of the population. Some of these usual factors, not only undermine the status of older persons in the society, but also threaten their overall health, especially mental health and quality of life. This aspect puts an excessive burden on social, economic and health care demands in the society, especially in developing countries like India. Thus, planning, developing and promoting health care services and assuring wellness and quality of life for older adults are the prime concerns. But, before making plans, one needs to chalk out an overview on the subject so that they may be made and implemented in a righteous manner. Let us have an outline regarding psycho-social and health related issues of Indian older adults in the country.

Psycho-Social Changes and Status of Indian Older Adults

After independence, many changes have been observed in the Indian psycho-social milieu. Urbanization, industrialization, and many more modern establishments have come into existence. Even the villages and remote areas of the country have got influenced. Bonding at different levels of familial and social milieu have gradually been transformed, which have eroded the traditional Indian values to some extent and the country which was initially praised for its cultural values and institutions like marriage, peer group, reference group etc. became feeble. Economic values have become stronger, and it has given birth to individualism, autonomy and the desire to live independently in the younger generation. This has directly affected the living arrangements of the older adults. These psychosocial and cultural changes in India have also given rise to many other issues.

For better positions and opportunities as well as monetary benefits, the younger generation is moving away and the older adults are left behind at their ancestral places with little or no personal, personnel, emotional, economic, social support and care [6]. Indian studies have reported that individuals in nuclear families are more susceptible for developing psychological problems than those in joint families [7-9]. Moreover, in the present day society, it is evident that interpersonal relationships are developed on the basis of economic value of an individual which often affect the mental health of older adults in a negative manner. Dutifulness, care and respect for older adults are at times seen as an outdated tradition. And sometimes they suffer with the feeling of loneliness. Loneliness has been found to be a major threat for old age and may be considered as a disease [10]. The article further quotes loneliness to be more dangerous than smoking. It adversely affects the immune and cardiovascular systems [11-13].

Unfortunately, nowadays, feeling of loneliness is being generally experienced by Indian older adults. Traditionally, families have been the primary source of support for them. They have been living with their children/grandchildren in joint set ups and were positioned as the key persons in the family. The conventional Indian joint families were instrumental in safeguarding the socio-economic status of older adults. Rapid changes in the social scenario have given birth to nuclear families and thus, older adults are likely to be exposed to emotional, physical and financial insecurities. It ultimately affects their overall health and quality of life. In the name of modernization, conventional living patterns have moved out to such an extent that the Government of India has taken an initiative by introducing an act in 2007 i.e. ‘The Maintenance and Welfare of Parents and Senior Citizen Act, 2007’.

Health Status in Indian Older Adults

Older adults often confront a variety of health related problems. Physiological, biological, anatomical, and other sensory changes apart from their respective social statuses make the elderly more susceptible to developing multiple problems. The decline associated with anatomical, biological and functional strength exposes them to disease and disabilities. Generally, they deal with multiple and chronic diseases. Problems related to major organ systems like- cardiovascular (heart and arteries), respiratory (lungs and musculoskeletal), gastrointestinal, genitourinary, endocrinological, nervous, musculoskeletal, immunological, special senses (eye, ear, nose, throat) adversely affect the health of older adults. Some of the health problems of older adults are attributed to psycho-social milieu too.

Disability in older adults

An individual who is restricted to perform an activity in the manner which is considered normal for a human being is referred to as a disability. It may be in the form of either mental or physical disability viz. lack of ability to work in a proper manner, visual impairment, hearing, speech or movement related difficulties. There are a very few studies, which have looked into the disability patterns of Indian older adults. According to the National Sample Survey Organization (NSSO) [14] there are five types of disabilities in older adults i) visual impairment, ii) hearing problem/impairment, iii) difficulty in walking (loco-motoric problems), iv) problems in speech and v) senility. Twenty-five percent of the elderly in India suffer from visual impairment, followed by hearing difficulties (14%) and locomotor disability and senility (each 11%). Occurrence of physical disability was found to be more in rural older adults than urban. Further, the 58th round NSSO data reveals that more than ¼th of Indian older adults are disabled and the highest disability was found to be prevalent in the oldest old (75 yrs & >=61%) followed by 70-74 years (51%), 65-70 years (42%) and 60-64 years (36%) (NSSO, 2003) [15].

Physical health problems in older adults

In old age, gradual decline in functional reserves of different organs, immune system and harmful impacts of noxious environment etc. as well as physiological and biological limitations make the older adults more susceptible for developing physical illnesses. National Sample Survey Organization (NSSO), 2006 [16] clearly indicates that this segment of the population experiences a greater burden of ailments than the younger population. The older adults often suffer from cardiovascular illness, circulatory diseases, and cancers, while the non-elderly face a higher risk of mortality from infectious and parasitic diseases [17-19]. Realizing the need for collecting data in relation to comprehensive morbidity profile of elderly WHO and Govt. carried out a multi centric survey at 10 centres of India during 2002-03 and revealed high prevalence of physical morbidity [20]. According to this report hypertension, cataract, osteoarthritis, chronic obstructive pulmonary disease, Ischemic Heart Disease (IHD), diabetes mellitus, benign prostatic hypertrophy, upper and lower gastrointestinal dyspepsia/ and constipation, depression were the common diseases amongst elderly. The overall prevalence of various morbidities is shown in Table 1.

Citation: Tiwari SC and Pandey NM. Health Care Challenges of Indian Older Adults with Special Reference to Mental Health: An Overview. Austin Palliat Care. 2016; 1(1): 1005.