Review Paper
Aging of Women in India: The Experience of Older
Women in Formal Care Homes
Khyati
Singh[*]
Assistant
Teacher, Shri D.R.H Arya Kanya
Inter College, Sitapur, (U.P.) India.
Corresponding
Author: Khyati Singh Key
words: Aging,
Family, Older, Challenges, Physical Education. The population expansion in the nation is increasing the
number of aging females in formal care homes. The feminization of ageing is
a process that has begun in India but is not occurring uniformly throughout
India. Older women are more likely to be widowed, poor and suffer
vulnerability to adverse outcomes like poor health. With the changing
social landscape of India, middle income older women are increasingly
opting for ‘pay and stay homes’ an emerging type of old age home in India. The
review paper explores the conditions of older women such as their living
environment, condition of these homes and quality of life they are provided
with. The social, physical, emotional and cultural dimensions of
their lives along with mental wellbeing and how to overcome with the
temporary psychological disorders, how
these foster homes compete with their day today activities without
interfering into cultural differences and maintains a communication with
their families and other social engagements. The paper researches the insights into these kinship
care centers by being transparent as the facilities provided by them, their
current status, caregivers and the other staff and most importantly the
experiences of the residents.
ARTICLE DETAILS ABSTRACT
1.
Background of the Study
The population of India is rapidly aging causing a huge shift in the
country’s demographic landscape. The gearing up population confronts
politicians, healthcare professionals, and society as a whole with
possibilities as well as difficulties brought about by the demographic
transition. The aging population (65 & above) should be provided with a
complete set of instructions due to the dynamic swapping in the demography of
the nation and needs a solid mechanism to support their overall wellbeing.
1.1 Demographic
Trends
India’s aging population is expanding at
an unprecedented rate. According to the Census of India, the proportion of
individuals aged 60 and above increased from 7.5% in 2001 to 8.6% in 2011, and
it is projected to reach 19.5% by 2050. This demographic shift is primarily
driven by declining fertility rates, improved healthcare, and increased life
expectancy. The average life expectancy at birth has risen from 49.7 years in
1970-75 to 69.7 years in 2015-20. While these trends are indicative of
progress, they also pose significant challenges for the nation’s social and
economic fabric.
1.2 Socio-Economic
Implications
The aging
population has profound socio-economic implications. On the economic front, an
increasing number of retirees relative to the working-age population could
strain pension systems and social security frameworks. Currently, a large
proportion of the elderly in India are not being benefitted by formal pension
schemes, relying instead on familial support and personal savings. This lack of
financial security poses a risk of increased poverty among the elderly,
especially as traditional family structures evolve and urbanization continues (Armstrong, 2005).
Healthcare
systems also face mounting pressure as they adapt to the needs of an aging
population. The elderly are more prone to chronic illnesses such as diabetes,
cardiovascular diseases, and arthritis, which require ongoing medical attention
and resources. The cost of healthcare for older adults is significantly higher
due to the complexity and chronic nature of their health issues. This scenario
demands a strategic enhancement of healthcare infrastructure and services
tailored to geriatric care, including preventive, curative and palliative
measures.
1.3 Gender
Disparities in Aging
Gender
disparities significantly impact the experience of aging in India, with older
women facing distinct challenges compared to their male counterparts. Women
generally have a higher life expectancy than men, resulting in a larger
population of elderly women. However, this longevity often comes with a higher
burden of morbidity and disability. Many older women have experienced lifelong
gender discrimination, leading to worst health outcomes, limited access to
education and employment, and financial dependency. Widowhood is another
critical issue affecting older women in India. Cultural norms and social
practices often marginalize widows, stripping them of social status and
economic support. Many widows face isolation, neglect, and even abuse,
exacerbating their vulnerability. The combination of these factors underscores
the need for gender-sensitive policies and programs that address the unique
needs of older women.
1.4 Health
and Well-Being of the Elderly
The health
and well-being of the elderly in India are influenced by a variety of factors,
including nutrition, physical activity, mental health, and access to healthcare
services. Malnutrition is a prevalent issue among the elderly, stemming from
factors such as poverty, lack of access to nutritious food, and physiological
changes associated with aging. Ensuring adequate nutrition through community
programs and healthcare interventions is essential for improving their quality
of life. Physical activity plays a crucial role in maintaining health and
preventing disease among older adults. However, many elderly individuals,
particularly women, have limited opportunities for physical exercise due to
safety concerns, lack of facilities, and socio-cultural barriers. Promoting
age-friendly environments that encourage physical activity can significantly
benefit their physical and mental health (Barnett,
2006). Mental health is another critical component of overall
well-being. Depression, anxiety, and cognitive decline are common among the
elderly, yet mental health services are often inadequate or inaccessible.
Social isolation and loneliness exacerbate these issues, highlighting the need
for comprehensive mental health support systems and community engagement
initiatives.
1.5 Social
Support and Caregiving
Traditionally,
family has been the primary source of support and caregiving for the elderly in
India. However, rapid urbanization, migration, and changing family structures
are altering the dynamics of familial support. Many elderly individuals,
especially in urban areas, live alone or with only their spouse, increasing
their reliance on formal care services. The emergence of formal care homes and
assisted living facilities reflects this shift, but these institutions face
challenges such as resource constraints, staffing issues, and varying quality
of care. The role of caregivers, whether family members or
professional staff, is pivotal in ensuring the well-being of the elderly.
Caregiving is often physically and emotionally demanding, with significant
implications for the caregiver’s health and financial stability. Supporting
caregivers through training, financial aid, and respite care services is
crucial for sustaining the caregiving system.
1.6 Policy
and Legislative Framework
India has
implemented various policies and programs to address the needs of its aging
population. The National Policy on Older Persons (NPOP) and the Maintenance and
Welfare of Parents and Senior Citizens Act, 2007, aim to ensure the welfare of
the elderly by promoting their health, security, and participation in society.
These policies advocate for the creation of age-friendly infrastructure,
provision of healthcare services and protection of elderly rights (Bartky, 1998). However, the implementation of these
policies faces challenges, including inadequate funding, lack of awareness, and
insufficient coordination among stakeholders. Strengthening the policy framework
through better enforcement, increased budget allocation and public-private
partnerships can enhance the effectiveness of these initiatives. The aging population in India represents a
significant demographic shift with wide-ranging socio-economic implications.
Addressing the challenges faced by the elderly, particularly older women,
requires a multi-faceted approach that encompasses healthcare, social support,
financial security, and gender-sensitive policies. As India continues to age,
it is imperative to build a robust support system that ensures the dignity,
health, and well-being of its elderly citizens. By prioritizing the needs of
this growing demographic, India can transform the challenges of aging into
opportunities for inclusive growth and social cohesion.
2.
Specific Challenges Faced by
Older Women in India
As the
population of older adults in India grows, understanding the unique challenges
faced by older women becomes increasingly important. These challenges are
multifaceted, encompassing health, economic security, social status, and access
to services. Addressing these issues requires a nuanced approach that considers
the specific needs and vulnerabilities of older women.
2.1 Health-Related
Challenges
Older women
in India face numerous health-related challenges that are often exacerbated by
lifelong gender disparities. Women generally have a longer life expectancy than
men, but this longevity often comes with a higher burden of chronic illnesses
and disabilities. Conditions such as osteoporosis, arthritis, cardiovascular
diseases, and diabetes are common among older women. These health issues are
compounded by limited access to healthcare services, particularly in rural
areas where healthcare infrastructure is often inadequate. Malnutrition is another
significant concern. Many older women suffer from malnutrition due to factors
such as poverty, lack of access to nutritious food, and social norms that
prioritize the nutritional needs of other family members over their own. This
can lead to weakened immune systems, increased susceptibility to infections,
and overall poor health outcomes (Bernard, 2000).
Mental health is also a critical aspect of well-being for older women.
Depression, anxiety, and loneliness are prevalent among this demographic, often
linked to social isolation, bereavement, and the stresses of aging. Mental
health services are frequently inaccessible or inadequate, particularly in
rural areas, leaving many women without the support they need.
2.2 Economic
Security
Economic
insecurity is a significant challenge for older women in India. Many have spent
their lives in unpaid domestic roles or informal employment, resulting in a
lack of savings and pension benefits. The absence of a stable income makes them
financially dependent on family members, which can be precarious if family
support is not available or reliable. Widowhood exacerbates economic
vulnerabilities. Widows often face social stigma and discrimination, which can
limit their access to property, financial resources, and social support.
Without a husband, many women lose their primary source of income and may lack
the skills or opportunities to become economically self-sufficient. This
economic dependency can lead to poverty and marginalization.
2.3 Social
Status and Isolation
Older women
in India often experience a decline in social status and increased isolation as
they age. Traditional gender roles and cultural norms can contribute to the
marginalization of elderly women, especially widows. Social exclusion can lead
to loneliness, depression, and a sense of worthlessness (Butler, 1990). The breakdown of joint family systems, driven
by urbanization and migration, has further isolated older women. While
traditionally, elderly family members would live with and be cared for by their
extended family, the shift towards nuclear families has left many older women
living alone or in old age homes. This separation from family and community can
lead to emotional distress and a loss of social support.
2.4 Access to
Services
Access to essential
services is a major challenge for older women in India. Healthcare, social
services, and legal support are often difficult to access due to financial
constraints, lack of information, and mobility issues. Rural areas, in
particular, suffer from a dearth of adequate services, leaving many older women
without necessary care and support. Legal issues, such as property rights and
inheritance, also pose challenges. Many older women are unaware of their legal
rights or lack the means to enforce them. Inheritance disputes and property
grabbing by relatives are common, further jeopardizing their economic security
and well-being.
2.5 Gender-Sensitive
Policies and Interventions
Addressing
the challenges faced by older women requires gender-sensitive policies and
interventions. This includes ensuring access to comprehensive healthcare
services, providing economic support through pensions and social security, and
creating programs that address social isolation and mental health. Legal
frameworks must be strengthened to protect the rights of older women,
particularly in areas related to property and inheritance. Public awareness
campaigns can help combat the stigma and discrimination faced by elderly women,
promoting greater social inclusion (Cumming,
1961).
Community-based
initiatives can play a crucial role in supporting older women. Programs that
encourage social engagement, provide caregiver support, and promote
intergenerational bonding can help mitigate the impacts of isolation and
enhance the quality of life for older women. The specific challenges faced by
older women in India are complex and multifaceted, requiring a comprehensive
and nuanced approach to address them effectively. By focusing on health,
economic security, social inclusion, and access to services, policymakers and
society can work towards creating an environment where older women can live
with dignity, security, and well-being.
3.
Research Objectives
· To traverse the milieu
of aging female population in formal care homes in India.
· To assess the quality of
care provided to older women in these settings.
4. Literature Review
According
to Kalavar (2011), The
feminization of aging is a process that has begun in India but is not occurring
uniformly throughout India. Older women are more likely to be widowed, poor,
and suffer vulnerability to adverse outcomes like poor health. With the
changing social landscape of India, middle-income older women are increasingly
opting for ‘pay and stay homes’, an emerging type of old age home in India.
Majority of the 97 women residents of ‘pay and stay’ homes reported being
widowed (68%), and 25% were childless. Childlessness and widowhood were
important considerations in the decision to relocate to an old age home. Older
women reported higher degrees of psychological closeness and contact with
daughters than sons, and the overall social network size was small. High
prevalence of diabetes rates among older women carries implications for
potential functional disability. Strong advocacy measures for empowering older
women in India should be a priority policy directive.
According to Singh (2020), The
Indian joint family was a well-developed system to take care of the needy in
the family. The social fabric has changed with globalization leading to
migration and breaking up of joint families into nuclear families. The women of
the family are among the worst to be impacted. As the nurturer before she
realizes she is already past her prime and unlike the west where the parents
are left alone by their children quite early in their life thus leaving them
with sufficient time and energy to decide the route of their life, in India, it
is yet not so. The paper proposes to trace the problems faced by the elderly
especially the women in the Indian society. The paper shares with its readers
some of the practices adopted within India and abroad to engage the elderly
women actively so that they become productive citizens of the society.
According to Kaushik
(2021), Population aging is considered as a mark of success of human
civilization achieved through medical advancement and public health initiatives
containing mortality rates and increasing longevity. And aging is more
peculiarly a female experience. World over, societies and nations are aging
fast, and “feminization of aging” is becoming a reality. However, for most
females, old age is not a cherished stage of life. For more than three-fourths
of elderly women in the world, old age is illustrated by increased morbidity,
disability, dependence, despair, depression, and marginalization. India is a
home to nearly 90 million elderly women. Aged ladies who have lived 50–60 years
of their life in poverty, illiteracy, chronic malnutrition, learnt
helplessness, devoid of skills, their old age is invariably portrayed by
loneliness, alienation, powerlessness, without assets and resources,
marginalization, and social exclusion. This paper chalks out the causal factors
of the vulnerabilities faced by elderly women in India at the biological,
social, and psychological levels. It also captures the efforts and
interventions geared toward ameliorating their sufferings and empowering them.
These interventions are undertaken by civil society organizations and
government agencies. The paper also identifies the gaps in services and
provides suggestive measures so that the elderly ladies can live the last years
of their lives with health, dignity, independence, fulfillment,
productivity, and happiness.
According to Nair et al. (2021),
Aging is an inevitable physiological process. A significant increase has been
noted in the elderly population over the years. Aging population face
challenges with physical health conditions, but also mental health problems.
Care of the elderly is influenced by health conditions, health services, as
well socio-cultural factors. Gender plays an important role in the aging
process with significant differences noted in the aging process, variations in
health conditions as well care received. The current review addresses the role
of gender in the aging process and its influence in the prevalence, clinical
presentation and course of various mental and physical health conditions in the
elderly. The review identifies gaps in understanding the gender perspectives
related to long-term elderly care, legal and financial issues. The review emphasizes
the necessity to address the gender perspective in aging to adequately meet the
health demands of the elderly.
According to Bandyopadhyay
(2023), There is a growing recognition of the
importance of subjective definitions of successful aging from a clinical and
policy perspective, and for their social and cultural relevance. However, the
voices of older Indians remain largely underrepresented in the emerging body of
qualitative literature on successful aging. Given this gap, and India’s
burgeoning older population, the present study set out to examine their
subjective perception of successful aging. Using convenience sampling, data was
collected from older men and women (N = 63, M
Age = 71.21) living in the community, and in old age homes in Delhi
NCR, through face-to-face interviews and focus group discussions. Reflexive
thematic analysis resulted in four primary themes and eight sub-themes -
Successful Aging as Personal Well-being, Tensions between Agency and Fatalism,
comprising three sub-themes viz. the person as an active agent, co-existence of
agency and fatalism, and negotiating with the invisible powers; Linked Lives
comprising two sub-themes viz. the aging parent and the adult child, and
spousal interrelationship; and The Social and Built Environment comprising
three sub-themes, viz. complexity of social life: the health interface, social
life in the neighbourhood, and the good house. These findings
provide a culture-specific view of successful aging in the Indian context, and
reveals the multifaceted conceptualization of successful aging of older
Indians - one that encompasses various bio psychosocial components.
According to Thampi
et al. (2024), As global population ages, “Aging in
Place” is prioritized as the top aging strategy for many of the older adults
worldwide. India, being a nation that is expected to hold the maximum share of
the older adult population in the near future, has a huge responsibility vested
in it to take care of the needs of older adults. The social structure of the
nation has emphasized the importance of older adults to age in place,
experiencing all the independence and autonomy at their own dwelling places for
as long as possible. This study aims to provide a profound understanding of the
meaning, attitude, and perceptions of older adults toward aging in place. Using
a qualitative research design, in-depth interviews were conducted among 15
community-dwelling older adults who chose aging in place in Kerala, India.
Following the interviews, thematic network analysis was done, inspired by
Jennifer Attride-Stirling. Three global themes were
derived, which include the older adults’ perspectives on (1) determinants of
aging in place, (2) challenges of aging in place, and (3) strategies for
successful aging in place. The study evokes in-depth exploration of the
experiences of older adults aging in place, which inform future evidence-based
practices and policy-level implications.
According to Capistrant
et al. (2015), Family members have long provided care for aging and older
adults at home, especially in low and middle-income countries. However, many of
the deep-rooted cultural cornerstones of caregiving have not been explored in
the context of India’s current myriad rapid demographic and epidemiologic
transitions. 30 semi-structured, in-depth qualitative interviews of older adult
caregivers (aged 60+) were conducted in Jodhpur, the 2nd largest city in
Rajasthan state. Caregivers were identified through key informants and sampled
purposively, stratified by type of care needed (cognitive impairment/dementia,
physical health condition, healthy/normal aging). Analysis was both deductive
(based on care demands, caregiving role and responsibilities) and inductive
(based on new themes that emerged from the interviews and not originally
included in the guide). Common cultural explanations for taking on care roles included
feeling compelled to care for one’s family, akin to but distinct from filial
piety (respect for elders and parents). Cultural gender norms remained
important, but not sole motivators of care expectations. A key reward for care
providers was the hope that providing their loved one care would result in this
being their last re-birth, or offer them a better birth or life in the next
life. Caregiving appeared distinct from seva, a Hindu
concept of selfless service. Cultural explanations for caregiving in this
sample of Indian caregivers included concepts not typically seen in either
Western or East Asian caregiving research. There may be different and greater
subjective rewards of caregiving than typically included in Western caregiving
stress models.
5. Demographics and Health
Status of Older Women in India
The demographic
landscape of India is undergoing a profound transformation, marked by a
significant increase in the population of older adults. Among this aging
population, older women constitute a particularly vulnerable group, facing
unique health challenges and socio-economic disadvantages. This essay provides
a comprehensive analysis of the demographics and health status of older women
in India, highlighting key trends, health issues, and the socio-economic
context that shapes their well-being (Desai,
1955).
5.1 Demographic Trends
India is experiencing a
demographic shift with a growing proportion of its population entering old age.
According to the Census of India, the population of individuals aged 60 and
above is projected to reach 19.5% by 2050, up from 8.6% in 2011. This trend is
driven by declining fertility rates, improved healthcare, and increased life
expectancy, which has risen from 49.7 years in 1970-75 to approximately 70
years today. Women, in particular, have a higher life expectancy than men,
leading to a larger population of older women (Fonner,
1972). This demographic shift has significant implications for the
country’s social and economic fabric. The increasing number of older adults, particularly
women, requires a reassessment of social policies, healthcare infrastructure,
and support systems to address their specific needs. Older women often outlive
their spouses and may face the challenges of aging alone, necessitating
targeted interventions to ensure their well-being.
5.2 Health Challenges
Older women
in India faces a range of health challenges that are
exacerbated by their gender and socio-economic status. These challenges can be
broadly categorized into physical health issues, mental health concerns, and
accessibility to healthcare services.
5.3 Physical Health
Issues
Chronic illness is
prevalent among older women in India. Common conditions include cardiovascular
diseases, diabetes, hypertension, arthritis, and osteoporosis. These diseases
often require long-term management and can significantly impact the quality of
life. Arthritis and osteoporosis, for instance, lead to reduced mobility and
increased risk of fractures, which can further limit an individual’s ability to
perform daily activities and maintain independence. Additionally, sensory
impairments such as vision and hearing loss are common in older age. These
impairments can lead to social isolation and increase the risk of accidents and
falls. Regular health check-ups and timely medical interventions are crucial
for managing these conditions, but access to healthcare services remains a
significant barrier.
5.4 Mental Health
Concerns
Mental health is a
critical component of overall well-being, yet it is often overlooked in older
adults. Depression, anxiety, and cognitive decline, including dementia, are
prevalent among older women. The social isolation resulting from the loss of a
spouse, children moving away, and reduced social networks can exacerbate these
mental health issues. Additionally, older women who have spent their lives in
caregiving roles may struggle with a loss of purpose and identity as they age. Stigma
surrounding mental health in India further complicates the issue, often
preventing individuals from seeking help. There is a pressing need for mental
health services tailored to the elderly, including counseling, support groups,
and community-based interventions to address these concerns.
5.5 Accessibility to
Healthcare Services
Access to
healthcare services is a significant challenge for older women in India,
particularly those living in rural areas. Healthcare infrastructure in rural
regions is often inadequate, with a shortage of medical facilities, healthcare
professionals, and essential medicines. Older women, who may have mobility
issues or lack financial resources, find it particularly difficult to access
the care they need. In urban areas, while healthcare services are more readily
available, affordability remains a barrier. Many older women do not have health
insurance and must pay out-of-pocket for medical expenses. This financial
burden can lead to delayed treatment and exacerbation of health conditions.
5.6 Socio-Economic
Context
The socio-economic
context of older women in India is characterized by financial insecurity,
social isolation, and inadequate social support systems. Many older women have
spent their lives in unpaid domestic roles or informal employment, resulting in
a lack of savings and pension benefits. Financial dependency on family members
is common, but as family structures change, with younger generations moving
away for work, this support is not always reliable.
5.7 Financial Insecurity
Financial insecurity is
a major concern for older women in India. The lack of a stable income or pension
makes them vulnerable to poverty. Widowhood, which is common among older women,
exacerbates this vulnerability. Many widows face social stigma and
discrimination, which can limit their access to financial resources and social
support. Without a husband or children to provide for them, many older women
live in poverty, struggling to meet their basic needs.
5.8 Social Isolation
Social isolation is
another significant issue. Traditional joint family systems, which provided
social and emotional support to older adults, are becoming less common due to
urbanization and migration. As a result, many older women live alone or in old
age homes, away from their families. This isolation can lead to loneliness,
depression, and a decline in physical health.
5.9 Inadequate Social
Support Systems
The current social
support systems for older adults in India are inadequate to meet the growing
needs of this demographic. Government programs and policies, such as the
National Policy on Older Persons and the Maintenance and Welfare of Parents and
Senior Citizens Act, aim to provide support to the elderly, but their
implementation is often inconsistent. There is a need for more robust social
support systems that can address the diverse needs of older women, including
financial assistance, healthcare services, and social engagement opportunities
(Gee, 1987).
5.10 Gender-Sensitive
Policies and Interventions
To address the unique
challenges faced by older women in India, there is a need for gender-sensitive
policies and interventions. This includes ensuring access to comprehensive
healthcare services, providing economic support through pensions and social
security, and creating programs that address social isolation and mental
health.
5.11 Healthcare Services
Improving access to
healthcare services for older women requires both policy and infrastructure
changes. Mobile health units and telemedicine can help reach those in rural
areas, while subsidies and insurance schemes can make healthcare more
affordable. Training healthcare providers to address the specific needs of
older women is also crucial.
5.12 Economic Support
Economic support through
pensions and social security can significantly improve the quality of life for
older women. Expanding existing pension schemes and creating new ones that
include informal workers can help ensure financial security. Additionally,
providing financial literacy programs can help older women manage their
resources more effectively.
5.13 Social Engagement
Programs that promote
social engagement can help reduce isolation and improve mental health.
Community centers, senior citizen clubs, and intergenerational programs can
provide opportunities for older women to stay active and connected. Encouraging
volunteerism and creating spaces where older women can share their skills and
experiences can also foster a sense of purpose and belonging.
The demographics and
health status of older women in India highlight the need for comprehensive and
gender-sensitive approaches to support this growing population. Addressing
their physical health issues, mental health concerns, and socio-economic
challenges requires a multi-faceted strategy that includes improving healthcare
access, providing financial security, and promoting social engagement. By
recognizing and addressing the unique needs of older women, India can ensure a
better quality of life for its aging population, fostering a society that
values and supports its elderly citizens.
6. Conclusion
India is experiencing a
demographic change towards an ageing population, which provides a unique set of
issues, particularly for older women who are current residents of institutional
care homes. The findings of this research shed light on the myriad of
challenges that these women confront, which include problems ranging from
threats to their health and social isolation to economic difficulties and
cultural prejudices.
It is common for elderly
women who reside in formal care homes to struggle with major health problems. A
significant number of women suffer from chronic diseases, such as diabetes,
hypertension, and arthritis, which need ongoing medical attention and care.
Unfortunately, many nursing homes lack specialist, geriatric care and mental
health treatments because their health care infrastructure is inadequate. This
deficiency not only makes existing physical health problems worse, but it also
plays a role in the development of mental health disorders, such as anxiety and
depression.
The growing number of
elderly women in India, especially those who reside in official care homes,
brings to light the need of adopting an approach to elder care that is both
all-encompassing and humane. We have the ability to greatly improve their
quality of life by proactively addressing the health, social, economic, and
cultural difficulties that they are confronted with. The improvement of
healthcare services, the promotion of social involvement, the guarantee of
economic stability, and the adoption of techniques that are culturally
sensitive are all essential steps toward achieving this objective.
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