 Abstract In any society the elderly are the most vulnerable and high risk groups in terms of health status. After a certain age, health problems begin to crop up leading to losing control over one’s body and mind even not recognizing own family owing to Alzheimer. It is then children began to see their parents as a burden. It is these parents who at times wander out of their homes or are thrown out. Some leave their old parents or grandparents in old-age homes and don’t even come to visit them. They are prone to several ailments with increase in their age. Some of these ailments may be chronic. But the physical and financial resources for treatment of such diseases are limited with regard to older persons. Keeping in view of this, the present study analyzes the chronic ailments by which the senior citizens (old age people) suffering and their source for treatment. For the present study random sampling method is applied for the selection of the sample. The study also discusses the old age population trends at global, national and state level. Introduction Every society uses age categories to divide this ongoing process into stages or segments of life. These life stages are socially constructed rather than inevitable. Age, too, is a production of social category. At any point of life span, age simultaneously denotes not only a number and a mixture of physical characteristics but also a set of social constructs, defined’ by the norms specific to a given society at a specific point in history. Think about childhood, for example. When you were growing up, childhood was a distinct period of life with particular activities designed especially for your age group: television programmes, movies, school, music etc. Thus, a specific period of life is it infancy, childhood, adolescence, adulthood, middle age or old age is influenced by the structural entities of a given society. Therefore, ageing is not to be considered the mere product of biological function rather a consequence of socio-cultural factors. Moreover, what is important about ageing, then, is how a society uses it to put people into categories. As a classificatory tool, age is important in three ways. First, like sex, age is an ascribed status or characteristic, which is, based on attributes over which we have little or no control. Second, unlike sex, a specific age is always transitional - constantly moving from one age to another, beginning life at zero and ending with a certain number at death that is regulated by societal expectations of age-appropriate behaviour. These transitions also assume that conformity is rewarded whereas deviance is punished. Third, although in every society some age groups are more powerful, rich and respectable than others; the unique aspect of ageing is that everyone can expect to occupy various positions throughout life on the basis of his or her age. The equation is very simple - all of us, at certain time, were powerless infants, and in course of time, the power and influence change as we move from one age category to another. Thus, the definition of ageing is socially caused. Changing Position of Senior Citizens and their Needs India is passing through a phase of rapid socio-economic transformation. As a result, the joint-family system is gradually breaking down giving way to nuclear family. Forces of modernization, technological changes and mobility have introduced changes in the life-style and values of the people that have adversely affected traditional respects as well as attitude of empathy and care for the aged. Migration of the younger people from rural areas to the cities and towns worsens the situation of the old who either stay behind, leading a life of isolation or moving along with sons and daughters to towns or lead their life in cramped situation. Even increasing literacy amongst women accompanied by their employment outside the home in offices and in factories also leaves no time for those women to take care of the old at home. Besides, there is now greater investment by the family on education and upbringing of children. The high cost of living and changing priorities affect the intra-family distribution of income in favour of the younger generation. The old people have been at the receiving end of these socio-economic changes. As a result, in modern societies the social position of the older is much more insecure than was the case in many earlier cultures, where old age often brought prestige, wealth and power. Not only did older people usually have a secure position in the community but also they retained important duties within the family. Much of this has disappeared in modern societies today. In the past, the old age people were never a burden to the family. An old man continued to work in the farm or home till late in his life. The old women nursed their grand children and provided native medicine to the sick in the family. The wisdom and experience of the old was an asset to the community. It compensated the lack of literacy, training and the devices of storing and retrieving of knowledge. The young learnt trade and skill by imitating the old age people and the experienced. Naturally, therefore, age received its due recognition and honour. But then things have changed from bad to worse in the recent past as far as the aged is concerned. Nowadays, the elderly are not given the same respect as they used to get before. They are not shown adequate care and attention by their family members partly due to the limited resources and partly due to growth of individualism in modern industrial life. All these aspects lead to greater alienation and isolation of the aged from the rest of his/ her family and society at large. It is of course true that the aged in India is not as handicapped as the aged in some parts of the Western world. However, it is beyond doubt that the aged in India now have a feeling of being neglected, if not being led down or despise. The main aim of the present study is to make a bird’s eye view of the health related problems of the vulnerable elderly like widowed females, poor and middle class urban elderly, disabled, fragile older persons. Objectives of the Study 1. To examine the most common chronic diseases by which senior citizens were suffering. 2. To analyze the physical and financial sources of treatment of sample elderly. Methodology In Anantapur district there are five revenue divisions. From each division 18 senior citizens were selected by random sampling method. With regard to urban areas the sample of 30 senior citizens were selected from three municipalities namely, Hindupur, Guntakal and Dharmavaram. So the total sample constitutes 180 senior citizens. Review of Literature Sarmah(2014) studied the nutritional status in relation to ageing among three communities living under similar ecological conditions of Lakhimpur district of Assam. Nutritional status was assessed from Body Mass Index calculated from weight and stature of individuals. Females were found to be more prone to malnourishment than males. Prevalence of malnutrition was also found to increase with increase in age. Reddy (2014) in their study showed that the epidemiology of nutritional status of rural elderly is being important tool to plan the health actions. The authors estimates that the nutritional status and prevalence of non communicable diseases among the rural elderly. The study shows that out of the 571 elderly persons 297 (52.1%) were males and 274(47.9%) were females. Mean age for the entire study population was 69.8 +7.8 years. The mean weight of the studied elderly persons was 46.2+10.1 Kgs. Nearly half of the elderly 236 (41.3%) were undernourished (BMI<18.5), 297 (52.0%) were in normal nutrition or overweight 38 (6.6%). Majority of the elderly people were suffered with one or more chronic diseases. Mainly visual defects 400 (70.0%) followed by musculoskeletal system disorders 197 (34.5%), anemia 122 (21.3%) and hearing defects 118 (20.8%). Nayak (2014) in their study made a focus on socio-economic profile of the elderly population of India. This study is based on census years. Size and growth elderly population, sex ratio, dependency ratio, economic solvency, have been analysed. There has been a steady rise in the share of elderly population in the total population over the decades. The study has found that higher ratio female to males, dependency ratio increased; per capita expenditure of urban elderly persons was more than rural elderly persons. The government should spread pension scheme for all elderly person who have no income source. The government should provide free medical treatment, transportation and other required services to elderly persons. The government should establish separate department for senior citizens. Joseph et.al (2014) conducted a study in Chandigarh. As per the study more than half of the participants expressed a moderate psychological wellbeing as per test scores. This study has revealed that majority of the inhabitants in this old age home settings were literate, married with urban background. More than half of the participants expressed a moderate psychological wellbeing as per test scores. Furthermore, it corroborates the findings of previous studies-social support is essential for ensuring psychological wellbeing among older adults than the area of caring. The results of the study further corroborate the findings of previous studies i.e. social support is essential for ensuring psychological wellbeing among older adults irrespective of area of caring. Sachin (2015) considers that the senior citizens constitute a precious reservoir of human resource as they are gifted with knowledge of various sorts, varied experiences and deep insights. According to author, the elderly may be formally retired, yet an overwhelming majority of them are physically fit and mentally alert. The author opines that given an appropriate opportunity, they are in a position to make significant contribution to the socio-economic development of their nation. Global Trends A notable aspect of the global ageing process is the progressive demographic ageing of the older population itself. For most nations, regardless of their geographic location or developmental stage, the 80 or over age group is growing faster than any younger segment of the older population. At the global level, the average annual growth rate of persons aged 80 years or over (3.8 per cent) is currently twice as high as the growth rate of the population over 60 years of age (1.9per cent). Currently, six countries account for 54 per cent of the total number aged 80 years or over. They are China, with the largest number (12 million), United States of America (9 million), India (6 million), Japan (5 million), Germany (3 million) and Russian Federation (3 million). In 2050, six countries will have more than 10 million people aged 80 years or over: China (99 million), India (48 million), United Sates of America (30 million), Japan (17 million), Brazil (10 million) and Indonesia (10 million). Together they will account for 57 per cent of all those 80 or over in the world. Elderly Population in India The growth in elderly population is due to the longevity of life achieved because of economic well-being, better medicines and medical facilities and reduction in fertility rates. In India, the decadal growth in general population has shown a decreasing trend since 1961 and so is the growth in elderly population till 2001. In the last one decade, however, that is between 2001 and 2011, the growth in elderly population has shot up to 36 per cent while the same was 25 per cent in the earlier decade. The general population has grown by merely 18 per cent vis-a-vis 22 per cent in earlier decade. It is observed that in India, the growth in elderly population has always been more than the growth in general population. Very high growth rate in elderly population vis-a-vis of general population was observed earlier also in the two decades between 1961 and 1981. Table 1 gives the details of age wise population of senior citizen’s in India as per 2011 census.  It is evident from table 1 that the share of old age people in total population of the country stood 8.58 per cent. The share of female aged among total females is 8.98 per cent. In case of males the share is slightly lower than female aged people (8.19 per cent). Among the senior citizens the per cent of older males and females is decreasing with an increase in the age group except 80 and above years. To be precise 36.27 per cent of senior citizens were in the age group of 60 to 64 years. Here, the percent of males is higher (36.62 per cent) than the females (35.93 per cent). Around 25.47 per cent of senior citizens are in the age group of 65 to 69 years. They are followed by the age group of 70 to 74 years with 18.50 per cent. The senior citizens in the age group of 80 and above years are outnumbering the age group of 75 to 79 years. The share of 80 and above years constitutes 10.87 per cent of total senior citizens. On the other hand the share of 75 to 79 years age group stood at 8.89 per cent. Table 2 furnishes the details of age wise population of senior citizen’s in Andhra Pradesh state as per 2011 census.  As per table 2 the share of senior citizens in total population of the State is higher than the national level. The share of senior citizens in total population of the Andhra Pradesh State stood 10.38 per cent. Unlike, at national level the male senior citizens outnumbering the females in the state. The share of male senior citizens among total male population is 9.79 per cent. In case of females the share is slightly lower than male senior citizens (9.20 per cent). Within the male senior citizen age groups the per cent of is decreasing with an increase in the age groups except 80 and above years. To be precise 39.21 per cent of senior citizens were in the age group of 60 to 64 years. Among them the males constitute 38.65 per cent and the females constitute 38.03 per cent. Around 25.93 per cent of senior citizens are in the age group of 65 to 69 years. They are followed by the age group of 70 to 74 years with 17.54 per cent. The senior citizens in the age group of 80 and above years are outnumbering the age group of 75 to 79 years. The share of 80 and above years constitutes 9.79 per cent of total senior citizens. On the other hand the share of 75 to 79 years age group stood at 7.54 per cent. Health Conditions of Elderly The hardest part of being old is declining health and lack of finances, threat of dependence, and the loss of beloved ones. The existing health care systems are not sufficient to meet the physical and health needs of the ageing population such as old age security, establishing old age homes, expanding geriatric services and liberalizing the welfare policy for older persons. Social and psychological factors play a major role in determining the health status of the Indian elder. The chronic ailments by which sample senior citizens suffering is presented in table 3.  As per table 3 the commonest health problems of elderly were found to be visual impairment (79.44 per cent), Arthritis (70.56 per cent) and Osteoporosis (45 per cent). Obesity is an important senior health risk factor for heart disease, diabetes, and cancer- all chronic condition that impact quality of life. As the numbers on the scale increase, so does the risk for disease. The obesity rate is high (51.11 per cent) and it is as low as 23.33 per cent among rural senior citizens. According to the CDC, heart disease remains the leading killer of senior citizens accounting for 489,722 deaths in 2014. As a chronic condition, heart disease affects 38.89percent of urban and 32.22 percent of sample rural older people. The study shows that 51.11 percent of people in urban areas and 12.11 per cent in rural areas are living with diabetes, a significant senior health risk. The risk of Dementia and TB is high is in urban areas than rural areas. But the risk of cancer is high in rural areas than in urban areas. Source of Treatment The source of treatment for illness as declared by sample respondent senior citizens is presented in table 4.  According to table 4 preponderant majority i.e. 45 per cent of sample respondents were visiting government hospital for treatment. In this regard, the rural older persons are ahead with 56.67 per cent as the government hospital is the major available health facility in rural areas. With regard to private hospital treatment, the urban senior citizens top the list with 52.22 per cent. The visitors to private hospital in rural areas sharply declined to 20 per cent. Around 18.89 per cent of sample senior citizens were visiting private clinics for treatment of various ailments. Decision Making on Visiting of Hospital Generally, most of the older persons are financially and physically dependents, they can’t visit hospital on their own. Someone in the family has to support them. Table 5 gives the details of decision making on the visit of hospital by sample respondent senior citizens.  It is welcome move to note that 44.44 per cent of senior citizens reported that they are visiting the hospital on their own decision. In this regard, there are no major differences between rural and older population. With regard to 37.78 per cent of senior citizens the decision to visit the hospital is taking by their life partners. Children are the final decision makers in sending their parents to hospital in case of 12.22 per cent of sample respondents. Others like grand children, daughter-in-law, relative etc were the decision makers in sending 5.56 per cent of sample older citizens to visit the hospital. Expenditure for Treatment As the old age persons often suffer from various chronic ailments, the expenditure for treatment of such diseases will be high. With little or no income sources it may not possible for all old age persons to bear such huge expenses. Table 6 gives all such details.  It is evident from table 6 that majority of old age persons were not self sufficient to bear the expenditure on treatment. Only 28.33 per cent of sample respondent senior citizens were bearing their treatment expenditure. Around 33.33 per cent of senior citizens were depending on children for treatment expenses. The treatment expenses of 27.22 per cent of senior citizens were incurring by their spouse. Others like donors, relatives, leaders bearing the treatment expenses of 11.11 per cent of total sample. There are no wider variations among rural and urban senior citizens in this regard.
Findings
Suggestions
Conclusion With an increase in the age of senior citizens, there is a corresponding decrease in the percentage of such elderly population at all India level as well as Andhra Pradesh. The most common health problems facing by old age people in the study area is Cataract and Arthritis. The incidence of Diabetes, Asthma, TB, Dementia and Obesity is higher among urban populace than the rural areas. For the treatment of several diseases more than half of rural senior citizens were visiting government hospitals. The medical expenses were borne by the old age people in both rural and urban areas in the study area. References
Dr. D. Sreenivasa Reddy Teaching Personnel in Social Work, Department of Rural Development and Social Work, Sri Krishnadevaraya University, Anantapuramu, A.P. |
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