Simi Mehta, Anshula Mehta, Sunidhi Agarwal, Ritika Gupta, Malcolm Antony

Owing to fertility rates reducing and life expectancy increasing, the number of people involved in caring for the elderly has drastically reduced. Researchers of gerontology have noticed a sharp increase in the demand for paid caregivers for the elderly, which shines a light on questions regarding responsibility and care or neglect of senior citizens and the discrimination they face. To discuss this important and often overlooked subject, the Gender Impact Studies Center, Impact and Policy Research Institute, organized a #WebPolicyTalk on “Who Cares for the Elderly? Gendered Intersectionalities in Geriatric Care,” under The State of Gender Equality #GenderGaps series.

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Professor Vibhuti Patel, a prominent economist, and feminist, and the chair of this discussion, introduced the subject and the speaker of the panel Dr. Anagha Tendulkar, Head and Associate Professor at the Department of Sociology at the Sophia College, Mumbai.

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Demographic, Social, and Cultural Background

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Dr Anagha Tendulkar, Associate Professor and Head of the Department of Sociology, Sophia College, Mumbai, began by defining ageing as a universal process that implies changes in a person’s mental and physical state as they grow older along with a gradual impact on their life and lifestyle. In the context of academic discourse, ageing can be approached chronologically, physiologically, psychologically, and sociologically. However, our understanding of the concept of ageing is very limited, Dr Tendulkar believes. The chronological parameter is the most widely used especially in India, but it is a very limited and empirical one.

Demographic or population aging, on the other hand, according to the World Health Organisation, is defined as the increasing population of older people within the total population. According to demographic trends, the whole population of the world is aging, with the oldest region being Europe, and the youngest being Africa.

While India is known to be the country with a very large youth population, demographic trends reveal that we are heard towards a ‘grey revolution.’ The population of citizens over 60 years of age has increased steadily, from 55.6 Million (6.7%) in 1991 to 104 Million (8.6%) in 2011. By 2026, the number of senior citizens in India is projected to be 173 Million. This rapid growth is concerning because this puts pressure on the availability of caregiving and healthcare facilities, which are already in a frayed state.

Gender-based Differences

One also finds that the population of aged women is slightly higher than that of men. The concerns related to this pertain to patriarchal social structures, more enforced in the older generations, owing to which most old women do not know how to manage their assets, bank accounts, and so on. Another pertinent question in this context is the understanding of the process of aging across gender groups, including men and women, and also members of the LGBTQ+ community, who are the least represented in these studies.

Sociologists have identified multiple gender differentials in the process of ageing. The pace, nature, and quality of ageing vary across the gender spectrum. These variations mark the inequalities owing to various factors such as marital status, gender of children, caste, class, religion, and so on that translate into the availability or lack of availability of access to opportunities, spaces, resources, etc.

The study of the process of ageing in men mostly revolves around physical health and the phase of retirement. Documentation on the process of ageing of LGBTQ+ individuals mostly comes from European and North American studies. However, these are limited, and the studies mainly revolve around health, housing, and social care.

The grey revolution in India has unfortunately been marked by a large number of missing elderly persons and a large number of invisible groups. This implies a decline in familial obligations and reliance on care facilities which are often overwhelmed.

In India, the family and community are still the primary caregivers to the elderly. Governmental and non-governmental agencies are secondary. While many old-age homes do exist, decent ones at reasonable costs are still a dream. “Many women’s old age homes are still called widow’s homes. There are cultural nuances that need to be repaired before understanding ageing within Indian society,” Dr Tendulkar notes.

While senior citizens associations do exist, they are largely dominated by elderly men, which means elderly women’s issues go unnoticed.

Another cultural nuance that Dr Tendular notes is that while patriarchal values are still strongly instilled in the elderly, there is also a gradual feminization of ageing. However, for elderly women, in particular, ageing means de-empowerment.

Ageing needs to be considered in several intersectional ways, Dr Tendulkar remarks. Much of Indian society is still ruthlessly insensitive towards the layers of marginalization that elderly women face.

“Gerontological care must be emphasized, which will automatically reduce the burdens of geriatric care,” Dr. Tendulkar concludes.

A Research and Public Policy Perspective

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Professor Vina Vaswani, Director of the Centre for Ethics, and Professor, Department of Forensic Medicine and Toxicology, Yenepoya (Deemed to be) University, Mangalore, started by noting the various forms of ageism faced by the elderly population in daily life.

According to the 2011 census, 15 million elderly people in India live alone, and nearly3/4th of them are elderly women.

Highlighting the intersectionality of understanding aging, referring to the Crenshaw study, Prof Vaswani noted that various socio-cultural factors such as gender, race, sexual orientation, wealth, caste, religion, etc. can oppress or enable mobility. These intersect social identities which have a direct role in the way one is treated.

Women are at the forefront of all kinds of caregiving. However, this doesn’t reciprocate to elderly women receiving the same amount of care. Elderly women receive lesser informal care compared to elderly men owing to patriarchal social structures. Moreover, research that can account for this is also scanty.

Policy needs to take into consideration the various aspects of caregiving in order to improve facilities and caregivers must be listened to better. The people for whom policies are being made must be involved in the decision process, Prof Vaswani concludes.

HealthCare of the Elderly

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Dr. Anand P Ambali, Professor, Department of Medicine and Geriatric Clinic at Shri B.M Patil Medical College Hospital and Research Centre, Vijaypura, reiterated that women are most present in both formal and informal caregiving, but receive the least care.

Negligence of the health of the elderly, especially elderly women is prevalent, but especially so for the economically weaker sections who neglect to provide healthcare due to financial constraints.

Elderly women are at higher risk for mental illnesses such as depression, due to loneliness and isolation. Moreover, negligence of preexisting prevalent conditions such as diabetes leads to its aggravation, and diabetes-induced vision issues, etc.

Exclusive health screening for elderly women must be implemented in order to avoid health aggravations, Dr. Ambali suggested.

Social and Economic Systems

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Professor Urmi Nanda Biswas, Professor at the Department of Psychology, M.S University of Baroda, Vadodara, highlighted the reality of gender equity and intersectionalities in the elderly, supported by her academic work. While women occupy 70% of the healthcare workforce, only 25% of leadership positions in the healthcare industry are occupied by women. A majority of caregivers especially for the elderly are still considered informal and are usually underpaid. It is also common for them to be harassed in various ways.

Social structures must be improved with regards to elderly care and insurance providing for the elderly and their health concerns must be better organized, Prof Biswas notes.

A Mental Health Perspective

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Mr. Sailesh Mishra, Founder President of the Silver Innings and Founder, A1 Snehanjali – Assisted Living Elder Care Home, Mumbai, highlights that as women are relied upon for caregiving, their health and capabilities are taken for granted. Mental health policies specifically catering to women and elderly women is the need of the hour, Mr. Mishra concluded

Question and Answer

Prof Patel took to answering questions from the audience. On what we can learn from global policies and practices, Prof Patel answered that Scandinavian countries have provided a great example by implementing paid caregiving work and care banks.

Self-help groups of senior citizen women must be encouraged in order to protect their interests and voice out their grievances.

The globalization of economic structures has contributed to the reduction of public-sector spending, and currently, only 1.2% of the annual GDP is spent on healthcare infrastructures. Geriatric care is the most neglected out of all of the provided services.

Increased migration out of India means elderly family members are left to care for themselves. Social welfare and protection are of the utmost importance, and taking cues from Scandinavian social welfare structures would be greatly beneficial, Prof Patel concludes.

Dr. Arjun Kumar thanked all of the speakers for their insightful discussions and concluded the session.

Acknowledgement: Malcolm Antony is a Research Intern at IMPRI

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