The Elderly Are Left Out in the New India

New America Media, News Feature, Sandip Roy* //Photographs: Bishan Samaddar, Posted: Jan 04, 2010

Editor's Note: India's aging population has reached 80 million, but the country lacks the infrastructure to cater to this new demographic. This is the first in a series of reports by NAM editor Sandip Roy, whose reporting was supported by a fellowship from the South Asian Journalists Association.

NEW DELHI - If you are looking for the new India, Khan Market is your place. Even in the middle of a weekday afternoon, it’s bustling with college students and young professionals crowding around its creperies and coffee bars. The magazine stall stocks GQ and Marie Claire and People – with Indians on the cover. But right in front of it is a donation box. The sign reads “Donate – Older Persons Need Your Help.”

“We have expressions in India like, 'I was thinking about you, you are going to live a hundred years,'” says Himanshu Rath, who runs Agewell Foundation, which puts those donation boxes all over New Delhi. “But in spite of that, because of economic changes, old people are being made to feel redundant.”

As Indians boast about their rising GDP, seniors are increasingly feeling left out of the picture. The irony is that while the new India (and its markets) is obsessed with youth, old India is growing rapidly. Over 80 million people are over 60 in India today. By 2050, a quarter of the population will be over 60. “The biggest increase has been in the category of 80-plus,” says Matthew Cherian, CEO of HelpAge India, a nonprofit organization that voices the needs of India’s “gray” population.

India’s own prime minister, Dr. Manmohan Singh, is pushing 80. So is the just-retired leader of the opposition. The well-being of senior citizens is written into Article 41 of the Indian constitution. There’s even been a National Policy on Older Persons for 10 years. But that’s on paper.

An inter-ministerial committee was set up to implement the national policy. It has met only four times in the last 10 years, according to Cherian from HelpAge.

“We are not keeping pace with anything,” says Dr. A. B. Dey, head of geriatric services at the All India Institute of Medical Sciences (AIIMS) in New Delhi. “We are supposed to have two national institutes of aging and programs in every state. But things are slow.”

Dr. Ira Ray, additional director general of health services with the Government of India, helped start many of the government’s programs for seniors. She says that like all countries, India had to juggle its priorities. “The big emphasis was on infant mortality and family welfare. Then were the programs to eliminate infectious diseases. So geriatric services always had lower priority,” says Dr. Ray. “After all, the kitty of resources is the same.”

But as life spans have increased there are more detected cases of Alzheimer’s and related dementia. “We didn’t have words for it,” says Cherian. “In the villages of Haryana people would say they had turned into vegetables. They would lie on their charpoy [rope beds] and just wither away.”

Most old age homes in India do not accept patients with dementia. Hospitals don’t know how to care for them. “It’s a hidden problem,” says Prem Kumar Raja, secretary of Nightingales Medical Trust, which provides medical services for seniors in Bangalore. “People don’t like to talk about it.” Nightingales has a dementia day care center and hopes to open a comprehensive dementia care center in 2010. It will be the first in the country. Raja estimates there are 3 million people with dementia in India right now--30,000 in Bangalore alone.

Of course India is not alone in the developing world in grappling with a growing graying population. China has 160 million seniors. “But China has the money to photocopy the American model,” says Dr. Dey at AIIMS. China’s older population is increasing by 8 million every year, says Wang Xiao Yan, director of Community Alliance in Beijing. It has about 40,000 nursing homes with 2 million beds. India, says Dr. Dey, lags far behind.

Economists have warned against a “gray crisis” looming in many countries because they have fewer and fewer young workers to support a growing number of seniors. But that is not yet such a problem in India, says Sarah Lamb, professor of anthropology at Brandeis University and author of "Aging and the Indian Diaspora." India, unlike Japan or Italy, still has a fairly high fertility rate. “Times are changing but there is still not a shortage of family members to look after the elderly,” says Lamb. “There’s really only been a modest increase of elderly living alone.”

Lamb says even those who have moved into old-age homes are learning to adapt the ancient Hindu concepts of renouncing life and moving to the forest to these times. “Some say the old age home is the modern forest. It helps us cut the ties of maya [illusion],” says Lamb.But Dr. Dey at AIIMS says the Hindu concept of rebirth can also be an obstacle. He says religions like Christianity and Judaism give importance to every part of life including old age. “Here you can offer the best care to a sick old person, and he will say, 'why prolong this life? Didn’t the Bhagavad Gita say that it’s a rotten body and the soul needs a new home?'”

The problem for India is not that there are 80 million older people. The real issue is a lack of infrastructure and financial security for a huge number of elders. There are 22 million widows in India, a number larger than the population of New York. “The problem is not about widowhood,” says Ruprekha Chowdhury who is doing her dissertation on old age homes in Bengal. “The problem is they have no savings.”

According to a 1996 survey, 64 percent of elderly women depend on others for food, clothing and shelter. “Widowhood, age and gender--it’s a triple disadvantage,” says Indrani Chakravarty, director of Calcutta Metropolitan Institute of Gerontology. She runs a day care center for poor elders. A handful of men come to the center, but at lunch time the room is a sea of women in white saris. Many of them have walked for an hour through slushy roads to get there.

“At least the doctor comes once a week here. We get medicines. Umbrellas in the rain. Blankets,” says Shanti Mistry who has been coming to the center for seven years. She has acute spondylosis. “If people looked after us at home we would not come.”Even middle-class elders often do not have money saved up for old age. Pensions are few.

Health insurance is not common. Migration, whether to the west or to big cities, and smaller families mean there are fewer children around. Cities aren’t age-friendly. There might be wheelchair ramps but no rails to hold on to. “Aging came to India before development,” says Indira Jai Prakash, a gerontologist in Bangalore. “In Western countries, they developed first and then longevity came.”

But the biggest issue is that most older people are not really prepared to enter this new world of old age. “They didn’t see their parents live to be 75,” says Himanshu Rath at the Agewell Foundation. “You could say this is the first real generation of old people.”

And they need to step up and demand their rights. So is it time for an AARP in India? “That’s still a ways away,” says Rath. “Old people still deny themselves. You ask your father for Rs 3000 to buy jeans and he will give you the money. You ask him to buy himself two undershirts and he will say no need. That attitude needs to change first.”

Sandip Roy is an editor with New America Media and host of its radio show UpFront on KALW 91.7 FM. He is a commentator on NPR’s Morning Edition and writes regularly for ethnic and mainstream media publications such as the San Francisco Chronicle, California Magazine, India Currents, India Abroad, and others. He traveled to India on a World Affairs Journalism Fellowship administered by the International Center for Journalists. The fellowship is sponsored by the Ethics and Excellence in Journalism Foundation.