GOLDEN YEARS HORIZON:

Crafting a Future for Aging Generations

INTRODUCTION: The older people in a society are a valuable resource. It's

normal to get older, and getting older can bring both good and bad things.
Census 2011 data shows that 8.6% of India's population, or 104 million people
aged 60 and up, live in cities. Men are more common than women among
adults (60+).

Because people are living longer and mixed families are breaking up, seniors
are forced to be alone and ignored. A healthy lifestyle should include regular
exercise, a well-balanced diet, and a promise to stay away from drugs, alcohol,
and other substances that are addicting. A cheerful attitude and good mental
health can improve the quality of life that comes with getting older.

When the National Policy on Older Persons was made in 1999, it called for

The Welfare of Parents and Senior Citizens Act (2007) and the National Policy
for Senior Citizens (2011) of the Indian Government spell out how to meet the
needs of seniors. As part of the Ayushman Bharat programme, the National
Programme for Health Care of the Elderly and Health and Wellness Centres
give people over 65 expert care in basic healthcare settings.

What are "super-agers"? They are a new group of older people that doctors
have just recently discovered. This saying refers to people in their 70s and 80s
who are mentally or physically as smart as their friends their age. Because the
world's population is getting older so quickly, by 2030, 34 countries will have
more than 20% of their people over the age of 65. Recently, long-term studies
on "super agers" from all over the world have focused on the habits, practises,
and health signs of people younger than 90 years old. Researchers are interested
in studying older people who are healthy as well as those who have dementia or
cognitive decline. While more research is being done on mental health, family
history, and general health, it is very important to create and focus on integrated
care approaches that are based in the community, fit the needs of senior
citizens, and have strong coordination and long-term care systems. This is true
for all cultures, but especially for those with populations that are getting older
or super-aging.

Health Care: There are a few important things about India's older people. The
old, who make up 7.5% of the population, live in towns two-thirds of the time,
and more than half of them have a low socioeconomic level (SES). In India,
60% of the elderly are dependant on others, often because they are widowed,
divorced, or separated, and 70% of the elderly are women. People over 65 who
live alone are more likely to be women (2.4%) than men (1.42% vs. 3.49%).
Because of this, most old people live in rural places, are poor, and rely on their
families.

The National Sample Survey Organisation describes disabilities as "illness,

sickness, injury, and poisoning." Looking at morbidity trends by age makes it
clear that older people have more illnesses than younger people, no matter what
gender they are or where they live. People who are not elderly are more likely
to die from infectious and viral diseases, while older people are more likely to
have heart disease, circulation problems, and cancer. Chronic
noncommunicable diseases (NCDs), most of which are caused by bad living
choices, are becoming more common in wealthy countries where the
population is changing. The change in diseases from infectious to
noncommunicable has not happened at the same time as India's fast population
growth, though. Figure 15-1 shows that over 65s in India are more likely to get
chronic illnesses than acute illnesses. Along with communicable diseases,
noncommunicable diseases (NCDs) are on the rise, especially metabolic,
cardiovascular, and degenerative diseases. Heart disease is one of the most
common chronic diseases in older people. Others include chronic asthma,
anaemia, high blood pressure, chest pain, kidney problems, stomach problems,
vision problems, diabetes, arthritis, and depression. Also, the pretty high
number of illnesses among the old caused by re-emerging infectious diseases
varies a lot depending on their gender, where they live, and their social status.
As the population ages, it is expected that NCD-related disability will rise and
make up a bigger share of the national disability total. That being said, the fact
that most of the above studies uses self-reported statistics is a very big problem.
Since autopsies and doctor checks of patients are not common, this leaves a big
hole in the information about the problems that older people face. To find out
more about the patterns of health problems that affect older people, more than
just polls are needed.

India's older citizens have a wide range of illnesses, which puts extra strain on
the country's public healthcare system. Before making our mental model of
Indian seniors' health, we looked at the country's health state as a whole. It was
found that "health care, far from helping people get out of poverty, has become
an important cause of household poverty and debt; the average national health
indicators, though showing improvements in the last ten years, hide vast
regional and social disparities." This means that while some rich people have
great health, others have "the worst imaginable conditions." We found a number
of problems that older people face, such as disordered growth, family
nuclearization and dependence, loss of earning potential, and more. because of
the damage done by past wrongs based on race, religion, and gender. Overall,
we found that the senior population (and the subpopulations that make up this
population) doesn't get the right treatment for their problems (access), and even
when care is physically available, people don't get it because it's too expensive
(affordability).
So, the goal of this chapter is to group and describe specific problems with
access and cost, along with the possible reasons for those problems. These
problems need to be taken into account when India's future health laws are
being made and put into action. When we look for places where there are still
gaps in the data, we try to find them. All of the researchers did a literature
review, talking to experts in health systems research, government policy
clearinghouses, academic journal articles, books, and programme
documentation, such as reports, presentations, and papers from both
government and non-government organisations. The co-authors put together a
league table of all the available information, such as studies, papers, and policy
reports. They then looked into the most important results and issues related to
access and cost. We talk about our findings in parts with names. Then, we talk
about possible future policy paths for a system of national health care that are
important for the health of older

SOCIAL SUPPORT AND LONELINESS:

A global study found that India has the third-highest rate of loneliness among
older people and the second-largest population that is getting older in the world.
In line with a

According to a study by PAN Healthcare, more than 64% of older people in

India feel lonely. The problem is worse in cities. What makes it so likely for
most older people in India to feel lonely? Some of the reasons for this are more
people getting widowed or living alone without their families, more
technological barriers, retirement from work and not having any exciting things
to do, movement problems, and less contact with younger people. 5.7% of older
people in India live alone and don't have any family or friends to help them.
Loneliness and social isolation affect people from all walks of life, from the
poor and elderly to the rich and living in cities. Concerns about how it might
hurt the health and quality of life of older people make it an important issue for
them. It is thought that loneliness, along with higher levels of stress, anxiety,
and sadness, is one of the main reasons why older people are more likely to
develop dementia and other cognitive problems.

A new study from Meerut's Lala Lajpat Rai Medical College says that old
people who live alone and don't connect with other people are more likely to
get sick, which makes them feel stressed and hopeless. When it comes to their
lives, older people who are busy and social tend to have better ones. It was also
found that older women were more likely to feel lonely than older men, even in
homes with lots of people. India clearly needs to do a better job of making sure
that older people who live alone or are lonely can get long-term care and
psycho-geriatric treatments. The government should start programmes to
improve the mental and physical health of the elderly, but families should also
do more to help their older members. Divorce, being abused, or not getting
attention from close family members are the main reasons why older people
feel sad and alone.

According to new study that used statistics from the first wave

As part of the Longitudinal Ageing Study in India (LASI) from 2017 to 2018,
20.5% of

Indians over the age of 45 reported feeling moderately lonely, and 13.3% said
they felt very lonely. 18.3% of people over 65 from one rural and one urban site
in India (n = 1001 at baseline) who took part in a study by the 10/66 Dementia
Research Group said they felt lonely. So, it looks like Indian seniors are having
a hard time with loneliness. More research needs to be done to fully understand
loneliness in places like India, where the population is mostly young now but is
expected to age quickly. Loneliness has been linked to cognitive decline,
dementia, poor physical functioning, and disability in older people [25,26]. It's
interesting to note that study shows these relationships may work both ways,
with worsening physical and mental health leading to more loneliness
[27,28,29]. There is proof that this link may go both ways, similar to how being
alone makes you more likely to become depressed. A study by Cohen-
Mansfield et al. found that poor health, low functional status, bad mental
health, and cognitive problems are all major causes of loneliness in older
people.

It has been found that older people who are lonely are more likely to develop
dementia, cognitive loss, poor physical performance, and disability [25,26]. It's
interesting to note that study shows these relationships may work both ways,
with worsening physical and mental health leading to more loneliness
[27,28,29]. There is proof that this link may go both ways, similar to how being
alone makes you more likely to become depressed. A study by Cohen-
Mansfield et al. found that poor health, low functional status, bad mental
health, and cognitive problems are all major causes of loneliness in older
people.

FINANCIAL CONDITION:

In India, the situation for the elderly (people aged 60 and up) is much worse
because they often don't have any source of income and depend on family
members to take care of them and keep them alive. When they die, their sons
and daughters often get the money they used to buy a house or flat, but
sometimes they are kicked out. As cities and technology have grown, nuclear
families have broken up. This means that older parents have to live in small
spaces with their children, which is not at all comfortable. A lot of the time,
people spend their last years in misery because they can't see how they will pay
their bills in the future. India has one of the worst social security systems in the
world, so there isn't much care for the old there. Only a little more than 70% of
people are in some way covered by social security. Being able to support
yourself financially is the best way to tell how healthy an old community is.
Only 26.3% of people are financially independent, and 20.3% are only slightly
dependent on others. However, 53.4% of older people, or the bulk, count on
their children for all of their money. Another problem is that there aren't enough
senior living choices that aren't too expensive for people to live on their own.
For the average middle-class Indian, the price of the flashy ones is too high.

Care for the elderly is different in each state. Most of the time, the State
payments that are given out through different programmes are very poor. As
many as 17 states offer benefits for the elderly that are less than Rs 1,000 per
month with only a small amount of money from their budgets. There are big
differences between states when it comes to this issue. As life expectancy rises
and fertility falls, the population continues to age. Different states in India are
also going through different fertility changes. The state with the most older
people is Kerala (16.5%), and the state with the next most is Tamil Nadu
(13.6%). A big part of the people living in Himachal Pradesh (13.1%), Punjab
(12.6%), and Andhra Pradesh (12.4%) in 2021 would be over 65. But the
number of seniors in Assam (8.2%), Uttar Pradesh (8.1%), and Bihar (7.7%),
on the other hand, is not as high. The number of old people in Kerala is
expected to reach 20.8% of the total population by 2036, which is almost one in
four people. India's elderly population lacks respect and has a number of
disabilities because they don't get enough food and medical care. For the
elderly, the state needs to give them a bigger old age income. Also, there is a
need for senior living that is easier to get to so that people can live on their
own. People over the age of 65 want better medical care. Many older people
who are still able to work should be given the chance to do something else.
This will help lower the number of mental health problems. To help older
people stay financially stable, income tax deductions and higher savings
interest rates should be made available. It is very important to add more
programmes that help seniors move by train and air so that their lives are more
interesting and varied.

There are three stages of how dependent on others older people are financially:
completely independent, somewhat dependent, and completely dependent.
Assam has the highest rate of country men who are fully dependent on their
jobs (42%), while Nagaland has the lowest rate (4%). Manipur had the fewest
women who were fully dependent on their own income (24%), while Delhi had
the most (100%) among rural women. Men living in cities in Himachal Pradesh
were found to be the most financially independent (82%), while men living in
rural areas in Arunachal Pradesh and Assam were the least financially
independent (28%). Women were both the most and least financially
independent in Meghalaya, the state where the study took place.

The AYUSHMAN Bharat only partly meets the need for all older people to
have access to health insurance. Social workers have to visit lonely and sad
people and help them with everyday things like cooking, bathing, and working
out. Some really great work is done by NGOs like HelpAge India. That being
said, the expectations are very high.

When it comes to technological innovation, some people find it hard to

because of their health problems or physical limits, older people and new ideas
go hand in hand. For example, almost one-fourth of older people have trouble
reading because of a health problem. An older person may not be able to use
the tablet or the small screen on their cell phone because of mental or physical
limits. Similarly, older people just don't know how to use a computer or the
Internet. Seniors gain confidence and technology skills by being taught and
getting help.

Adopting new technologies can be hard for older people for a number of
different reasons. Physical problems that make it hard to use new technologies:
many seniors have health problems that make it hard for them to use modern
technologies. About two out of five adults have a "physical or health condition
that makes reading difficult" or a "inability, debilitated, or persistent illness that
keeps them from fully participating in many regular daily activities." It's just
plain weird that this group of people is more unlike seniors, who can physically
use the internet (66% vs. 49%), have home broadband (38% vs. 53%), and own
most of the important digital devices. Most adults feel like they need help with
new, complicated technology. 77% of people who answered said they would
need someone to help them learn how to use a new technology device like a
cell phone or computer. Only 18% said they would be fine using one on their
own. Even more, 56% of seniors who use the internet but don't use long-
distance social networking sites like Facebook or Twitter would need help if
they wanted to use them to talk to family or friends. Skepticism about the
benefits of technology: older adults are split on whether or not not having
access to the internet hurts them. 25% of these non-clients totally agree with the
idea that "people who don't have access to the internet are really at risk because
of all the information they might miss." This is also thought by 50% of them.
But 35% of these older people who don't use the internet don't think they're
missing a big chance to get important information, and 18% of them strongly
disagree.

That older people can stay free while their loved ones are sure they are safe and
sound will require technology. As India's economy grows, more money should
be put into technology that helps the elderly, and more programmes should be
started to teach older people about technology. The government should also
make policies that support these efforts.

Intergenerational Relationships:

It can be hard to understand each other when they were raised in different times
because their worldviews and beliefs can be very different. Because of this
understanding gap, it's important to find ways for younger and older groups to
connect with each other. This is not as true in eastern countries where joint
families are still very popular. It is much easier for grandkids to understand and
relate to the point of view of an older family member. This understanding not
only helps little kids see their world better, but it's also a key part of how they
learn to get along with others. Because of this, living with your grandparents is
not necessary in Indian society. Because of their knowledge, care, and
guidance, older people make children much more aware of the good things
around them. Making them understand how our society has lost a lot because
our value systems have changed over time is helpful. But things could easily
turn around if young people took on the responsibility of bringing back the
virtues of honesty, hard work, and caring for nature. One of the benefits of
living with grandparents and having grandparents close by is that kids learn that
the world is a good place to live and are taught good values that make it even
better. Those over 65 have a good chance to find meaning in their life.

CONCLUSION: In the upcoming decades, there will be an

unprecedented load on morbidity and mortality across the nation due to the expansion of the
senior population. As we've mentioned, societal barriers influenced by gender and other axes
of social inequality (religion, caste, financial position, stigma) are major obstacles to senior
Indians' access to health care. Physical obstacles include restricted mobility, a decline in
social participation, and the health system's constrained accessibility. Constraints on health
affordability include caps on income, employment, and assets, as well as restrictions on the
financial protection provided for medical expenses under the Indian health system.Primary
and secondary prevention, as well as health promotion, have been highlighted in
recommendations made under the UHC framework with the aim of fostering conditions that
support healthy lifestyles, early detection, regular screening among the elderly, and averting
institutionalisation. A concurrent program of focused study on how different UHC
components influence and may better serve the expanding demographic of Indian elders is
necessary to guarantee that their requirements are satisfied.