1. Introduction
'A chip off the old block' is a popular saying in English, which implies a continuity of values and actions passed on from one generation to the next without any conscious effort. As such, this statement normally represents a positive passing on/down of values. Today, however, the chip is the symbol of technology, and has been the trigger for revolutionary and radical shifts in traditional, social, political and economic spheres worldwide. Traditions and values have all been affected, and so has the passing down of norms. Slowly but surely, a new order seems to be emerging that has more of the 'chip' and less of the 'old block'!
This chapter attempts to analyze the situation of the aged in this rapidly changing scenario. Every single human being has been touched by the impact of technology, directly or subtly. Ageing by itself is an evolutionary process, and in the largely traditional societies of the Asian and Pacific region, the impact of the emerging scenario on the position of the aged and the process of ageing, has been mixed. Currently, what are the major issues and concerns in the life of the aged? What are the implications for the future? What could be the impact on society, and, indirectly on social planners and planning? These are some of the issues that this chapter would like to address. These issues have been viewed in the context and framework of the Life Span Perspective.
2. Societal Changes and their Impact on the Status of the Ageing
The aged in Asian traditions have always occupied a position of respect to the point of reverence. Respect for age is a deeply embedded cultural value, and possibly derives its strength from the ancient religious and secular texts for which the Indian subcontinent, in particular, has always been known. The well-known Indian epics, the Ramayana and the Mahabharatha, as well as the ancient secular literature, contain illustrations and examples of the Ashrama theory (Life Span or Cycle), which was a strong influence on people living in those ancient times in areas which are presently known as India, Sri Lanka, Nepal, Pakistan, and subsequently through the spread of Buddhism from India to other Asian countries such as China, Thailand, Cambodia and Japan. The Ashrama theory, though ancient in origin, is a fairly visionary attempt at profiling the passages, or life stages, of a human being. Human development was seen, not only in terms of distinct stages of life, but it also considered the individual life cycle as whole and sequential.
In brief, the Ashrama theory delineated four distinct stages or phases of human life and development. These stages included distinct roles and expectations related to a particular phase or stage. The first stage that every individual had to go through was the Brahmcharya stage - a stage of learning skills and unquestioned devotion to the gurus (teachers). This period lasted roughly for the first 25 years of life. This stage was followed by the Grihasthashram, roughly coinciding with the domestic phase, wherein individuals are enjoined to perform the duties of a householder which are raising and maintaining a family and all that this entails. This period lasts from age 26 to age 50. Vanaprastha represented a stage of gradual withdrawal, without reducing responsibilities. This period is the stage of the aged, and would be roughly between 51 and 75 years. The last stage, Sanyasa, is one of total renunciation of all attachments and submission of oneself to the pursuit of spiritual freedom. Essentially this stage represents retirement from the mundane and routine activities of life. The third and fourth stages could be combined to represent the present day retirement phase (over 65 ). These stages are not rigid or mandatory or even obligatory on the part of any individual, but they have been suggested as a means of ensuring a smoother passage, and one that is known, accepted and practiced by the members of the society.
The ancient traditions have also exhorted the individual to look after the old, the infirm, and the elderly, as well as the disadvantaged. All this was contained under the aegis of the joint or extended family system, and since agriculture remained the main occupation, filial loyalties were strongly encouraged. In fact, in most societies of the ESCAP region, family obligations were readily accepted, and the aged parents lived in their own homes with their grown up son(s). The father continued as the head of the household until his death or disability. After the death of the father, the eldest son assumed his mantle by default. Under this system, the mother held the position of senior female and enjoyed the authority and respect of the family. Such situations were common in earlier times, but they are presently only seen on a very small scale in villages in some Asian countries.
Industrialization, urbanization and the introduction of the chip have brought with them radical changes, not only in occupational patterns, but also in population dynamics (which continue to this day, especially in the developing countries of the Asian region). Migration cleaves traditional family structures and functions. These changes have a tremendous impact on the disadvantaged and the aged in traditional Asian societies. There is a definite weakening of the traditional and joint or extended family structures, especially in the loss of family support for the elderly. Radical changes have also occurred in the size, composition and living arrangements of families, ownership of property, and the focus of power. The pattern of inter-and intra-generational support and relationships between members of the extended family have also dramatically altered during the last four decades and these changes can be witnessed in the increasing trend towards the nuclear family, the erosion of traditional kinship ties, and the weakening of the family as a support system.
3.Health and Nutrition Status
There is a paucity of empirical literature on the health and nutrition status of the population which is over 65 in Asian countries. However, an attempt will be made here to draw inferences, wherever possible, based on information derived from broad indicators of health of the elderly in these countries. Some of these indicators are life expectancy and mortality rates, availability of services, and access to overall assistance.
The size of the elderly population is significant, and considering that the two Asian giants, China and India, are located in this region, it is not surprising that they account for more than half of the elderly population in the less developed regions (see annexures 1 and 2). Older women have a higher survival rate than men during this century due to an increase in women's life expectancy and an overall reduction in their mortality. Although the population of the elderly has grown in the last four or five decades, there has been very little concomitant increase in the availability of health services and other forms of medical assistance or an increase in awareness among the old about their health and nutrition needs.
The elderly invariably suffer from diseases of the respiratory system, symptoms of ill-defined arthritis and rheumatism, hypertension, congestive heart failure and diabetes. In the lower economic strata, a substantial number of old persons suffer from various disabilities like blindness, deafness, paralysis of lower limbs, infirmity, etc.
In a recent inter-disciplinary study conducted in the slum settlements of Bombay, India, it was found that the old in slums have no access to health facilities, and they find it very difficult to commute. Besides, community-based health care services for the aged in slums do not exist (Gore, Siva Raju, Anand, 1995, personal communication). The preliminary findings indicate that during sickness, the elderly depend on their traditional belief system for the diagnosis as well as mechanisms of healing, instead of taking advantage of the advanced medical system available in the neighbourhood. Here it could be a combination of poverty, ignorance on the part of the elderly, or sheer indifference by the family members, caught up in their own battle for survival.
It is difficult to identify which diseases are age-related and which are lifestyle-related, contagious, or due to the environment. This does not mean that the elderly can look forward to leading a life totally free from disease or disability, but it does mean that what needs to be done is to treat the disease and not ageing. Just because a person is old does not mean that she/he should expect to be 'naturally' predisposed towards diseases or less capable of benefiting from appropriate medical treatment.
The nutritional deficiency problems amongst the aged in developing countries may be due more to poverty and related problems. In fact, considering the links between economics and nutritional status, one is tempted to generalize this as a fact.
4. Disability amongst the Aged
Ageing is characterized by a general reduction in functional capacities as well as structural changes in the body. For instance, there is a gradual increase in body weight and a degeneration of the elastic tissues of the skin, resulting in wrinkling. Other changes are related to a reduction in hearing, vision, muscle and bladder control. Amongst the major problems are those related to reduced efficiency of the heart and blood circulation, and those affecting learning and memory. A decline in physiological functioning also seems to herald a change for the worse in psychological functioning and in the overall mental health of the elderly. Thus, raised blood pressure, cerebrovascular and cardiovascular disorders, and lowered functional capacity, are related to slower reaction time in many activities. There is less mobility and ability to respond to various stimuli. This change is visible in the inability of the elderly to sustain participation in group activities or conversations in particular.
Disability in the aged, as well as the disabilities accompanying ageing have not been recognized as problems, and have scarcely received any attention. This is strange considering that The World Programme of Action Concerning Disabled Persons (1983-1992) laid out three goals: prevention, rehabilitation and equalization of opportunities, and most countries in the Asian and Pacific region have a national programme on disability prevention or a firmly established disability prevention and rehabilitation component as a part of general health services. Considering the attention paid to the disabilities of the aged, very little data are available on this from these countries. Bangladesh reports a high incidence of blindness among those over 65 (41.6 per cent), of which 42.7 per cent are female, compared to 39.2 per cent for males. Prolonged illness and old age was found more among women (32.9 per cent) than men (26.8 per cent) (WHO, SEARO, 1995).
Low-cost functional appliances for those who are orthopaedically disabled have been tried in India and Myanmar. India has also started using indigenous intraocular lenses for the visually disabled. However, in most cases, rehabilitation programmes are primarily functional and symbolic, and do not have strong linkages and organized infrastructure. They are, at best, ad hoc. Ageing and disability become further compounded with the lack of community-based outreach services for the elderly in rural areas and the slums of the fast-growing urban agglomerates in developing countries.
Physical disability in the aged often gives rise to profound anxiety and a sense of apathy and helplessness. This situation is indeed very difficult, since the aged in such conditions invariably tend to be withdrawn, negative and inflexible. In such cases, the role of the family is crucial and calls for greater sensitivity and tolerance. It is also observed that women resist, more than men, in receiving and accepting any kind of correctional help or support. This tends to alienate and push the elderly, especially women, into a cycle of depression and social isolation.
5. Educational Attainment and Literacy among the Aged
Educational attainment is sometimes used as an indicator of economic and health status amongst the elderly. Higher educational attainment allows young individuals to prepare for the economics of old age by enhancing their ability to accumulate resources (OECD, 1989). This, at least from a theoretical perspective, reduces potential levels of individual and societal dependence.
In the countries of the ESCAP region, accurate data related to literacy and educational attainment of the aged are not available for several countries. As is evident, most of the present-day elderly lived the bulk of their lives prior to the accelerated pace of socioeconomic reforms and changes brought about by the introduction of technology. Also, they lived in times when everyone was contented with the immediate. Judging by the efforts currently being made in all these countries to increase levels of literacy, it is expected that there will be more literate elderly by the year 2000.
Gender differences in literacy in the aged are striking. Older women have lower rates of literacy than men. In China in 1990, only 11 per cent of women aged 60 and above could read and write, compared with half of all men in the same age group. Projections for five Asian countries from 1980 to 2020 (Christenson and Hermalin, 1991), suggest that gender differences among the elderly in literacy and primary education will diminish but not disappear entirely. Disparities at the secondary and higher educational levels might persist, and therefore the improvement would be gradual.
As one might expect, literacy levels in the rural areas are definitely lower than in the urban areas, across all age ranges, and the gap typically widens with increasing age. It is interesting to note that in every country in this region there is a serious and determined national effort to make the population completely literate. This does not necessarily mean that the aged will catch up with the young, but it would definitely make the aged less dependent, and would widen the scope of their experiences.
An important feature of Asian society is the preservation and continuation of tradition and heritage, which in several instances have been passed from generation to generation orally. The aged could use literacy to communicate with the young, and hopefully reduce the communication gap.
6. Housing and Shelter for the Aged
Housing in the urban context has always been a problem. To think in terms of subsidized housing, wherein the government is the main provider, does call for a review of the present housing situation and the resources needed to provide the same. As is observed in the Asia and Pacific region, except for Australia, Japan (to some extent), Singapore, Israel and Malaysia, very little importance has been given to the housing situation of, and for, the aged. While it is a fact that other countries have the family-based approach to shelter and housing, it is presumed that this arrangement is satisfactory to all concerned. This is probably one reason (though in the developing countries there could be several others), why the policy planners do not give attention to this aspect of welfare measures for the aged. It must be noted here that the term 'housing', does not refer to special housing, but to a friendly, informal neighbourhood 'drop-in' place, with simple amenities -- essentially a place providing contact for the elderly.
Institutions, wherever they exist, have to be designed with the problems of the aged in mind. The design should be functional and simple in arrangement, with safety devices, orthopaedic support, and simple easy-to-operate gadgets, which would ease their day-to-day activities, without straining their physical and mental faculties. All this might not be very easy to provide in urban areas, considering the price of the land and infrastructure, but certainly, innovative approaches and linkages with present infrastructure might help. This is a challenge to urban planners as well as social policy makers.
7. Economic Independence amongst the Aged
The proportion of the elderly workers in professional and technical, as well as administrative positions, has been gradually rising in most of the developing countries of the Asia and Pacific region, though in Japan, 33 per cent of elderly workers were in the agricultural sector in 1990, and the 1982 census data from China revealed that more than 80 per cent of workers in the agricultural sector were 55 and above. The disadvantage of the elderly in agriculture (still the predominant sector in the Asia and Pacific region) is that the elderly by and large are deprived of any tangible savings. Throughout their life, they work under fairly stressful conditions, until age no longer permits, and after that they find themselves marginalized and without much economic support.
In the urban areas, it is still not very clear if the employment agencies have a separate arrangement to tap this resource, but it is quite interesting to note that the concentration of workers in professional and technical occupations often declines with age, and then rises among the elderly (U.S. Bureau of the Census, 1993). Could this be due to the use of the 'old and experienced' and the tenacity of the elderly? It becomes clear that economic independence among the elderly is enjoyed by the very few, and even those who do get their pension often find it difficult to maintain themselves on a fixed income, especially during inflationary and other volatile conditions.
The question of economic independence or access to regular income, in the case of women, is one of immense concern, particularly in the rural sector. Women by and large have been concentrating on household work, and have never thought of savings. However, this situation is also changing as more and more women understand the need to provide an economic buffer for themselves to meet any eventuality. Schemes designed by government welfare agencies focusing on women exclusively are evolving, notably in India, though in terms of the magnitude and complexity of the situation, there is still a lot to be done.
8. Leisure and Recreation among the Aged
Leisure for most people means activities which are not related to their regular, routine work, but which give them the maximum amount of personal pleasure. Traditionally, the elderly (men as well as women) spent their sunset years interacting with their grandchildren, and generally participating in simple household chores. Of course leisure time and related activities are also dependent on the position and activities of the elderly before they retired from an active to a more passive stage of life. Very few seem to take an independent attitude to life, and still fewer have cultivated a meaningful hobby, or had the time and inclination to do so.
Many elderly feel frustrated and regret not having cultivated a hobby or activity. Many criticize the attitudes of the present generation and some just wait for death to close in on them. This scenario seems to be the norm for many elderly, whether in urban or rural settings, although there are quite a few who have planned for their old age and look forward to growing old and accept their problems and handicaps gracefully. The preceding insights have been based primarily on informal conversations the author undertook during the writing of this paper with elderly men and women who come from several different locales and from a fairly broad spectrum of economic positions.
It has been found that the various leisure time activities resorted to by the educated elderly include walking, reading the newspaper thoroughly, listening to the radio (and presently surfing through the plethora of television channels), reading books, and organizing religious activities. Soodan (1975) found a direct relation between educational attainment and free-time activity, and whereas the majority of women had not completely given up their domestic role, the majority of the men had begun to involve themselves in household chores. It would be interesting to know from the elderly about the manner in which they would like to spend their leisure time, since it is hard to come by such information for the region as a whole.
9. Personal Safety and Protection
The elderly, particularly those who find it difficult to commute and indeed walk, constantly worry about avoiding accidents and physical activities that might cause them pain, and thus in turn, impose more difficulties on their families. This concern is common to all the elderly, regardless of economic status. The difficulties the elderly face in the poorer sections of the society because of their lack of amenities are quite serious. Physical hazards like slippery floors, a lack door of handles and railings on stairs, a complete lack of privacy, and the absence of any safety regulations increases the elderly's risk of accidents. Public facilities should have specific arrangements for the elderly, with the accent on safety. In the case of the institutions for the elderly, there should be specific arrangements for physical and emotional protection.
10. Social Perception of the Ageing
The term 'aged' not only describes individuals, it is also used as a collective noun. Once individuals are identified as 'old', they are seen exclusively as old. Alternative words are used to soften the negative connotations associated with the word 'old'. These alternatives include 'elderly', 'senior citizens', 'elders' or 'pensioners'. The word 'old' may be used to describe persons who are 60 and above. This category includes healthy, physically active, and capable functioning individuals, as well as persons who are sick, dependent, unable to function, and who require care. Placing these two types in the same category, although not fair, has become the norm in various societies. In literature, particularly in children's literature, old women are often portrayed as witches, and are usually ugly, wicked and frightening. In the Asian context, while there are such frightening references to older women, by and large, the older woman is often portrayed as a wife of a sage and a 'Big Mother', with all the characteristics of humility, nurturance and so on.
In the face of such culturally contradictory historical perceptions of old persons, and the contradictory tensions and ambiguities embedded in the concept of ageing, the currently available gerontological literature is inadequate and inconsistent. Generally, American researchers present a more optimistic view, suggesting that ageing does not necessarily mean withdrawal, decline, and depression, but rather it entails a reconstruction of life through personal revitalization and resocialization. However, the view that ageing provides an extended vacation from learning and development is not really applicable to the Asian continent because various subcultures have their own perception in regard to old age, the aged and ageing.
The concrete problems commonly ascribed to older persons are, in fact, less important than the perceptions others hold about them. It appears that the specific concrete problems encountered by the elderly may be the result of others' misconceptions. For example, the perception of the aged who fall ill and recover is radically different from the perception of younger persons who fall ill and recover. The general perception that members of the society have about the elderly varies between inclusion and segregation. One perception includes the aged. They are seen as indistinguishable from the rest of the community. The other equally prominent view is the opposite -- that is that the aged are to be separated from the society in which they were once an integral and sustaining part. The attitude of the society towards the aged ranges from integration to segregation and from involvement to disengagement
Another perception which affects attitudes towards the elderly is the dichotomy between humanization and dehumanization. Under humanization, the aged are viewed as complete human beings, with clear-cut social identities and defined social roles. With dehumanization, they are viewed as culturally vague entities, lacking some of the properties of human beings. Thus, under integration and humanization, the aged are not only integrated into their familial and social environment, but are viewed as acceptable human beings. Ideally, this is the most desirable social pattern. This pattern is visible to a large extent in rural and other less developed areas in the Asian region (Kendig and others, 1992).
In urban areas, the attitude towards the aged is definitely changing. The importance given to material benefits far outweighs that of caring for and protecting the old and giving them the importance they deserve in society. The demands and pressures in urban areas such as limited dwelling space in households, commuting, and increasing competition fueled by consumerism, are fast changing the attitude of the younger generation towards the older generation. The young may not have the urge to include the old in their conversations or discuss their problems and difficulties with them. Nor are the young keen to allow the old to make any decisions on their behalf. This is more likely when the older person is not economically self-sufficient and/or has a level of employment far removed from what it was in the past. Thus, the social and psychological, and with it the emotional distances between generations, widen.
The opposite could be true in some families. Some societies pay high respect to elders, treating them as the repository of knowledge, skills, wisdom and tradition, and sustaining and nurturing the elderly. In fact, having an elderly person in the house made that person indispensable to family, friends and neighbourhood. In such situations, it is usual to find that the elderly, control and direct resources. But, as more and more practical knowledge is being stored and accessed through information technology, the role of the aged has considerably diminished. This fact becomes evident as one notices the attitude towards separation and the institutionalization of aged. There is a definite increase in the number of residential institutions for the aged, indicating (especially in the Asian context where filial ties have always been important), a lack of family support and the apparent indifference to those values which were important in earlier generations.
The evaluation of living conditions in these institutions for the aged is outside the purview of this paper. However, observations suggest that institutionalization has always implied that rejection by the family and depression in the aged is the normal outcome of such separation. This is not to suggest that this fallout is always a response to institutionalization. There are other reasons, too, like the traditional practices in some societies (notably Indian), in which the parents can live with a son's family, but not with the married daughter's family. Also, mother-in-law and daughter-in-law conflicts may push the aged into such shelters. However, the institutionalization of the aged should be the last resort, and definitely not result in social isolation and separation from the family.
11. Self-perception of the Aged
Satisfaction with the past seems to be an important ingredient in being satisfied with present life. Some researchers have stressed this factor as critical and one which contributes substantially to the sense of well-being and happiness in old age. Satisfaction with life has been found to be a major indicator of successful ageing in the Indian population. Satisfaction with the present also appears to be determined by one's values, and the importance attached to achievement. Researchers asked several elderly persons what they valued as far as their day-to-day lives were concerned. They mentioned position, wealth (movable and immovable), helpfulness, creativity, character, independence or autonomy, ego, integrity, a peaceful and quiet life and a reputation in a special area or field, as some important values. Of these expressed values, the ones that correlated positively with life satisfaction and were highly significant include: personal creativity, ego, integrity and independence or autonomy of the individual. Status, power and wealth were positively correlated, but were not significant (Ramamurti and Jamuna, 1993).
What happens to the person as she/he grows older becomes important. A feeling of satisfaction with life becomes a significant ingredient for a general sense of well-being (Neugarten 1982). Researchers who have studied satisfaction with and towards life in detail, have stressed the importance of this factor. Growth and change are inevitable and inexorable, and like all life experiences, the roots of attitudinal and behavioural expressions in old age towards oneself and others are laid down in the earlier stages of life itself. Another interesting classification based on the responses of people to the ageing process has been provided by Susan Prichard (1962). According to her, there are five categories of older persons:
The loss of status and decision making was felt more by those old persons who surrendered their property in favour of the younger members of the family and who have no control and access to sources of income. The loss of status and a decision-making role was experienced more by ageing women than by men. The perception of the aged towards such inter-generational changes was not very encouraging. It was found that most of the aged were of the view that the younger generation did not pay respect to the elderly and they perceived this would have a negative impact on the bonds of inter-generational togetherness in the future (Soodan, 1975).
However, the perceptions of pensioners about their role and respect from family members was quite positive. By and large, it was found that the pensioners received due respect from the family members, and preferred living with their adult children as a desirable choice (Desai and Naik, 1971).
12. Integration of the Aged in the Family
The countries in the ESCAP region are known for their traditional belief in the strength of the family and the values that it engenders. In effect, this means that the family can be tapped for help and support for the aged. The problem of old age is essentially a social problem due to the rising proportion of the aged in the population, and the declining roles and status of the aged in the industrial society. In the pre-industrialized society, the old were involved in productive activities and were specialists in societies dominated by agriculture and handicrafts. Work in the economies of formerly developing countries in Asia depended directly or indirectly on physical health, and hence the elderly remained largely independent.
The elderly often owned the land, and until recently, there was no procedure of mandatory retirement at a set age. Thus, people continued with their set occupations if they were able to do so.
In pre-industrial societies, emphasis was placed on investment in children. Parents reared their children and in turn expected their children to perform their duty and care for them in old age. It was considered the duty of children to provide financial, physical and other types of security to parents in their old age. However, much of this is changing quickly as nuclear families are replacing the joint families of older times. Nuclear families are on the increase in most parts of Asia. Many factors have contributed to the separation of the aged from their families, including migration of the young seeking employment opportunities in the cities and even outside the country; the rising cost of living; the erosion of human values, and the increasing emphasis on individuality. Although the deteriorating situation of the aged in urban areas in Asian countries could be viewed as an emerging trend, younger people do not want to be branded as abusers of the aged.
To a large extent, the older people in urban areas still enjoy a fairly high status in their families and are generally well-respected by their children. Desai and Naik (1971) reported that in Greater Bombay, the advice of the elderly was usually taken in all family affairs. Recent studies (Ramamurthi and Jamuna, 1993), indicated that the sentimental attachment between children and their parents and commitment to care of the elderly is a key element in Indian culture. Sometimes if the economic status of adult children is not good, it is suggested that the state should extend some support to strengthen the care for the elderly within the family.
13. The Community, the State, the Workplace and Ageing
In general, in Asian societies, the elderly remain integrated with the family and the community. Even the electronic media support this approach. In some countries, certain legislation and constitutional provisions, coupled with old age schemes, foster the integration of the aged within their society. The Hindu Adoption and Maintenance Act (1956) for example, binds Hindus to maintain their aged or infirm parents for a lifetime. Section 22 of this Act states that each person who has a claim on the property of a person, has the duty to maintain him or her. In addition to this, as per the Directive Principle of the Constitution of the State Policy, senior citizens can expect appropriate measures for their welfare and economic support through their work, to ensure a minimum standard of livelihood and public assistance, in case they are unemployed, sick or disabled.
Old age pension schemes are also operative in the organized sector for employees in Asian countries. Recently, in India, an old age pension exclusively based on age and not on employment status, was announced for the disadvantaged sections of society. Other Asian countries, like Thailand, Nepal and Sri Lanka have yet to evolve such a scheme. Admittedly, the net amount of pension is meager and it is rather difficult to meet the needs of the old, but at least a beginning has been made. Currently, only a very small percentage of the aged work in the organized sector and are entitled to all the benefits of a pension or a lump sum payment when they retire from work (Chowdhery Pal, 1993). Because of the rising cost of living, particularly in urban areas, retirees with old age pensions cannot manage without additional economic help and support of their children. Women in old age are by and large dependent on their children, as very few of the females falling into the 60 plus age group work in the formal sector. In Bangladesh, for instance, only the elite, such as persons retired from the military, government and the industrial sectors (which form a negligible proportion of the total aged population), get the benefits of a pension. Almost 85 per cent of the population which live in rural areas have no such provision. Though the elderly in rural areas are reported to have high status (Ibrahim, 1985).
In Nepal, the Provident Fund Scheme is restricted to civil servants only, though a few select manufacturing establishments are attempting greater involvement in developing programmes for the aged. Nepal has no statutory programmes for the aged. In 1980, the Federal Ministry of Health and Social Welfare prepared an action plan for the aged in Pakistan for the first time. It aimed at providing a reasonable living standard for aged citizens. Unfortunately most of the provisions could not be implemented due to financial constraints as per the plan period of 1988-93. There are a few `homes for the aged' in the cities, and in the future there are plans to provide travel facilities on trains and buses, day care facilities, and a stipend for those families who lose their breadwinner. In Sri Lanka, the status of the aged is more or less the same as in India, Pakistan and Nepal. Some ad hoc, voluntary, and limited arrangements exist for the care of the aged, as well as a policy of free medical treatment. This is a definite advantage to the elderly.
China has fairly well-established and organized care for their elderly. Their respect for the aged can be gauged by the fact that most of the country's top leaders are over 70, including the present president. China has four types of programmes which concern the elderly. They are: (1) income security, (2) medical care, (3) educational services, and (4) leisure activities. Besides these, China also provides day care centres for the elderly. To meet the emotional needs of the elderly and of children, day care centres and orphanages for children have been encouraged to interact with day care centres for the elderly. Such arrangements work positively to alleviate aged persons' feelings of loneliness and deprivation.
As regards the situation of the aged in other countries of the ESCAP region like Malaysia, Singapore, Thailand, Australia and Japan, families and the state have intervened to provide facilities for the elderly population.
In Malaysia, the elderly population has received a great deal of attention, although the problem is not so alarming. There is, however, no specific policy geared to meet the needs of the aged. However, the needs of the aged are put on a par with those of persons with disabilities and other disadvantaged groups in the country. The official stance in Malaysia is to provide welfare and support to the aged through the family and the community. Institutional facilities are used as the last resort. In addition, this progressive country provides tax rebates for the medical care of elderly members living in the family. Malaysia also has several income and other welfare security schemes, in addition to providing for the new elderly destitutes and establishing village welfare homes and cottages to help the rural elderly.
Thailand, steeped in benign Buddhist traditions, depends heavily on the family system to provide the bulk of support for the elderly. Government and private schemes and services in Thailand, however, are limited in number and scope. In 1982, the Thai Government set up a national committee to devise a long-term plan for the elderly. This plan (1982-2000) includes the provision of health services, education, security, and employment. It is a comprehensive scheme that intends to cover the social, cultural, and all welfare aspects related to the elderly.
Thailand, Malaysia and Pakistan have designated one day a year to the aged to create and sustain awareness in their citizens about their needs and the services available to them, and to acknowledge the contribution of their elders.
Sri Lanka gives priority in housing programmes to the homeless poor and the disabled amongst the elderly. Countries like Nepal, Bangladesh, Pakistan, and India have no specific provisions for housing the elderly. This can be a great incentive for promoting the integration of the aged with family, particularly, in urban areas, where housing is a problem.
It would be worthwhile to understand the situation of the aged in developed countries of the region such as Australia, Hong Kong, Japan and Singapore. The Australian elders and their needs have been dealt with through a unique arrangement of resources centred on the old age pension scheme. This arrangement effectively deals with poverty and meets basic needs, but restricts income to a moderate level. This system is further supplemented by high rates of outright home ownership and by occupational superannuation and small amounts of other savings or assets. Family care for the elderly does not receive much attention in Australia.
Hong Kong, on the other hand, focused on community care of the elderly, and organized their plans around: i) special security benefits, ii) public housing for the elderly, iii) community support services, and iv) community education for their elders.
Japan, the most developed country in the region, endorses family care for its elderly population. Japan spends a substantial amount on medical care, with the largest portion allotted to the aged. The government is trying hard to promote home care services as a part of its efforts to prepare for the increasing elderly population. It is also trying ways to offset increasing medical expenditure by transferring institutional care of the elderly to home care. Such home care is usually undertaken by the females of the society (wives, daughters or daughters-in-law).
In spite of difficulties in modern times, the Japanese consider it important to care for the elderly within the family and the community. The Japanese also promote this attitude with the younger generation. The policy of lifetime employment, which is the norm in many companies, is a very significant component of the organized sector, and it instills a sense of security for the employed (and by extension for their families), as well as ensuring loyalty to the employer.
Singapore is one of the few countries in the world that has definite programmes for its elderly and this bears a closer look. The essential policy of the government is to maintain the elderly within the family. Among its long-term plans for the elderly are preventive measures that may slow down pathological degenerative conditions and thus reduce the risk of disease and disability. The Singapore Government has demonstrated in its policy, the need to support and enforce a viable socioeconomic infrastructure for the integration of the elderly within the community. Thus, in Singapore, community-based services like family housing, together with training in the use of equipment which facilitates routine activities, are some of the programmes for the elderly. There is also provision for service-givers and, if needed, domiciliary medical care for the weak and bed-ridden, as well as the terminally ill. It should be noted here that preventive programmes begin in youth and place emphasis on the practice of healthy life styles.
To summarize, each country in the ESCAP region has programmes for its elderly, ranging from very progressive to tentative and symbolic. What this underscores, is that societies in the region have started to look at this issue with the seriousness it deserves. It can be argued that in developing countries there are other major issues, and the provision for the aged might impinge on other welfare programmes. It is quite clear that the elders are an important resource and should be included in all welfare programmes. Private initiatives in these areas are strongly recommended and the corporate sector should include more meaningful support for the aged.
14. Emerging Issues
As is evident, the Asian scenario is changing fast, and is keeping up with trends worldwide, at least in terms of the introduction of modern elements and technology within its social purview. Some of the emerging issues pertaining to ageing and social change are highlighted here.
14.1 The elderly population - size, growth rate and implications
The elderly population has been growing, but what is new and significant, is the rapid pace at which this segment is growing, particularly in the Asian region. In Asia, the aged population is increasing at a faster rate than Europe and North America. Thus, for Asian societies, these issues related to the aged need the immediate attention of planners and welfare agencies. (See annexures 1 and 2.) Issues related to health care costs and maintenance of infrastructure, either specialized or integrated with the existing facilities, and utilizing existing resources, should be the concern of planners, policy makers, the government and the community.
14.2 Healthy life expectancy
As individuals live longer, the quality of that longer life becomes a central issue. People do contemplate questions like, are we living healthier as well as longer lives, or are we spending an increasing portion of our older years with disabilities, mental disorders, or ill health? (WHO, Manila, 1995). The meaning of healthy life expectancy is normally taken as expectancy without limitation of functions, sometimes called 'active life expectancy' or 'disability-free life expectancy'. Healthy life expectancy does not mean complete absence of disease. In fact, very many elderly may live and function close to normal lives with long-term chronic diseases such as diabetes or hypertension. Healthy life expectancy is likely to be an important measure of health and development of societies in the future.
14.3 Urbanization and the rural aged
The aggregate trend towards urbanization is very strong in Asia and the Pacific. Young people migrate from rural areas to urban areas for want of jobs; thus, disproportionately the 'elderly' are found in villages, and with most infrastructural development focused in urban centres, the delivery of health services to the rural elderly should become an important concern. However, for the elderly living in urban areas, the challenge is to meet their structural, emotional and social needs, and concerns.
14.4 Elderly women widows
In developing countries, the difference in life expectancy between the sexes is marginal. As a result, elderly women do not outnumber elderly men to the extent seen in developed nations. The diversity of developing countries does produce divergent trends, and, while India, Bangladesh, and Egypt report more men than women in most older age groups, in China the number of females in the higher age groups is rising. This difference could have important implications in the socio-cultural, financial and the general quality of life of elderly women, as most of them may be non-pensioners, or with nominal skills and levels of education.
Another issue which should be of concern is that the percentage of elderly women widows is higher than men. While the widowhood rates rise with age for both sexes, men tend to remarry more than women. In some countries like Indonesia, the Republic of Korea and Japan the number of aged widowed women is greater than the total number of men of a particular age. Widowhood triggers a series of adjustments in lifestyle, including changes in living arrangements and personal relationships, and since women have to face this situation more than men, there is a definite need to arrange family counseling services, and counseling services for elderly women. In the case of destitute elderly women, whether to create institutional infrastructure, or to explore community-based integration programmes are issues that need to be examined in the context of each society's culture, tradition and changing urban scenario.
14.5 Reduction in family support
A 1984 World Health Organization survey of persons 60 and older in Malaysia, the Philippines, Fiji, and the Republic of Korea revealed that from 72 to 79 per cent of respondents lived with their adult children (Andrews and others.,1986). This means that the elderly may live in a kind of a symbiotic relationship with family; sharing, contributing and receiving. Similar conditions were also observed in countries as diverse as India, Indonesia, Singapore, and the Ivory Coast during the mid-1970s (Martin, 1988; Kinsella, 1992).
However, the situation in the 1990s is changing and certainly different. The chances of two or three generation households are remote, though on the positive side it may be said that the young do continue to support elderly parents and seek their blessings, advice and support. Baby-sitting grandchildren, housekeeping and sharing of experience are often valued. It is only when the elderly suffer from chronic disability and a diminished capacity for self-reliance, that their adult children may find it difficult, especially in the urban areas.
It has been observed that youth's support for the elderly is declining, and presently it is women who provide the bulk of family care. Can urbanization foster the value of reciprocal care and not succumb to the pressures of rapidly changing situations? This will be the cultural challenge for Asian countries.
14.6 Reduction in economically gainful activities
In developing countries where pension and retirement support cover a limited section of the population, and that too is in the organized sector, it is not surprising that the elderly and those who have had to make way for the young, find themselves in a difficult situation. The avenues for employment and economic activities for the aged, are more or less closed, and in the developing countries, almost non-existent. While in the rural areas one might find the elderly continuing to work, their urban counterparts have no options whatsoever.
The present situation for elderly women is also quite poor, except may be in the agricultural and the non-formal sector, but this position will change especially in the urban areas as more and more women are employed and develop skills and enterpreneurship.
While the retirement age can be made flexible, instead of linking it with chronological age, what can also be done is for the government and the private sector to reserve certain categories of jobs and activities exclusively for the elderly, otherwise the sight of the elderly sitting out their sunset years would be a common sight, and admittedly not a pleasant one at that.
14.7 Reduction in socio-cultural interactions
This aspect of the elderly is really one of immense concern, since the elderly become alienated as soon as they retire, become disabled, or their role in the household is diminished. As those social interactions which were and are the life blood of every human activity become diminished in the case of the elderly, this is the time that the old really begin to perceive and hold strong negative opinions about themselves, and their usefulness to the society. One can very well imagine if this sizable and growing section of the population were to subscribe to such large-scale cynicism, the consequences could be quite detrimental to the growth of the society as a whole.
However, in Asian cultures and particularly in India, communes and organizations especially organized and based on spiritual and revitalizing values exist. They have been able to attract and hold the elderly in a very positive manner. These communes also have residential arrangements and hold regular congregations, which enables both social and emotional fulfillment.
14.8 Rights of the elderly
It is quite surprising that while rights for every section of society exist, hardly anyone or any organization talks about the rights of the elderly. Considering what has already been discussed, and the implications in refusing to give a serious look at the issues that bedevil the aged and the ageing process, it is time that society accepts that the elderly too have rights, and their contribution should be recognized by everyone, and these rights range from the fundamental to the really human.
15. Conclusions
from A Light in the Attic
by Shel Silverstein.
Ageing seems to be purely physiological, at least in its obvious manifestations, and is a process that every living being has to, and will, definitely experience. However, what has been discussed so far is an attempt to understand this process and all the trauma and stigma that seems to be attached to the aged and the process of ageing. It appears that as one studies this issue, ageing is what happens to your neighbour, and when age creeps up on oneself, then all the doubts and self recriminations crop up. How strange are human beings and how inadequate they can be in not recognizing that rearing children is a definite investment for the future, but, how equally satisfying and stimulating would it be for grown ups to rear the already-grown up?
To conclude, technology and modernization has certainly contributed to enhancing the overall quality of life and also to prolonging the life span. The quality of life, however, is dependent on some cultural and traditional values, like the role of the family as a unit that takes care, supports and sustains the individual and everyone within it. Asian societies are fortunate that these values are deeply embedded, and Asian youth, in particular, still respect these values. Hence, it is definitely feasible to evolve an Asian pattern of treating the elderly that combines the best of the West, while drawing from the wellsprings of eastern values and thoughts that go back a very, very long way.
Andrews, G.R., A. Esterman, A. Braumack-Mayer and C. Rungie. 1986. Aging in the Western Pacific. World Health Organization, Regional Office for the Western Pacific, Manila.
Arshat, H., P.C. Tan and T.N. Peng. 1989. The Aging of Population in Malaysia. Economic and Social Commission for Asia and the Pacific, Bangkok, Thailand, Asian Population Studies Series No. 96. United Nations, New York.
Chowdhrey, Pal D. 1992. Aging and the aged - A source book. Inter India Publications.
Christenson, B. and A. Hermalin. 1991. 'Comparative analysis of the changing educational composition of the elderly population in five Asian countries : A preliminary report." Comparative Study of the Elderly in Asia, Research Report No. 91-11, Population Studies Center, University of Michigan, Ann Arbor.
Desai, K.G and R.D. Naik. 1971. Problems of Retired People in Greater Bombay, Tata Institute of Social Sciences, Bombay.
Gore, M.S., Sivaraju and Anand. 1995. Aging in the slum settlements of Bombay ( A study in progress - personal communication), Tata Institute of Social Sciences, Bombay.
Ibrahim, M. 1985. (Unpublished paper). Tradition and modern development in Bangladesh Society. Institute of Geriatric Medicine, Dhaka.
Kendig, H., A. Hashimoto and L.C. Coppard (eds.). 1992. Family Support for the Elderly - The International Experience, Oxford University Press. (Published on behalf of The World Health Organization), Oxford.
Kinsella, K. 1988. Aging in the Third World. Washington, D.C., U.S. Government Printing Office, U.S. Bureau of the Census (International Reports, Series P-95, No. 79).
Martin, L.G. 1988. 'The aging of Asia'. Journal of Gerontology Social Sciences, 43, 99- 113.
Neugarten, B. 1982. Age or Need? Sage Publications, Beverly Hills.
Organization for Economic Cooperation and Development (OECD). 1989. Employment Outlook, July, Paris.
Ramamurti, P.V. and D. Jamuna. 1993. 'Psychological dimensions of aging in India', The Indian Journal of Social Science, vol. 6 No. 4, Sage Publications, New Delhi/London.
Soodan, K.S. 1975. Aging in India, Minerva Associates, Calcutta.
U.S. Bureau of the Census. 1992. International Population Reports, p. 25, 92-3, An Aging World II. US Government Printing Office, Washington D.C.
World Health Organization. 1995. Health Situation in the South East Asia Region, 1991-93, Regional Office for South East Asia, New Delhi.
World Health Organization. 1995. New Horizons in Health, Regional Office for the Western Pacific, Manila.