quality of life Uncategorized

What is the right ‘old age’?

Elderline, longevity, happy ageing and quality of life

Thanks for reading and subscribing to the Silver Angels Newsletter. I cover news focused on the Silver Economy, with a focus on research, media, entrepreneurship and impact. In this newsletter, I attempt to expand the language around ageing in the context of developments over the last three decades, and why retirement age doesn’t define old age.

Let’s dive in!

📣 Language of ageing

The wellbeing of senior citizens is part of the Constitution of India, under Article 41. India came up with its first ever policy centered around well-being of older persons in 1999, also declared the year of older persons by the UN. This policy laid out strategies to improve the quality of life of senior citizens through interventions in areas of financial security, healthcare and nutrition, shelter, continuous education, protection of life and property, and welfare of the programs to the most vulnerable among the older persons. In 2011, a national policy on senior citizens that integrated various services and benefits (pension, travel concession, etc.) to improve access and provisions for seniors was published. Drawing from active international efforts in the space, the policy advocated for dignified life for older adults through ageing-in-place services, financial support for assisted living facilities (old age homes), protection against abuse and neglect, and much more.’

The UN declared 2021-2030 as a decade for healthy ageing, defined as “the process of developing and maintaining the functional ability that enables wellbeing in older age”. It identified four areas for action – age-friendly environments, combatting ageism, integrated care, and long-term care – and this was followed by the WHO’s 2016 global strategy, which lays out an action plan to meet these goals centered around ageing and health. These and many other developments around the world have helped evolve the language around ageing over the past two decades– positive ageing, productive ageing, healthy ageing, happy ageing, active ageing, better ageing – into something more nuanced, relevant and futuristic.

One of the interesting aspects of studying ageing is the evolving language and context of usage, and how it impacts the way we frame a problem or an opportunity. The intergenerational changes further alter the perception around ageing, and strengthen the movement away from the binary of working and retired lives, which is largely a creation of formal workforce arrangements.

In the Indian context, a senior citizen is somebody over the age of 60 and thus acquires special rights under law, is eligible to avail certain entitlements and concessions, and gets credits in the Indian government tax system. A senior citizen dependent is also a tax-saver for a family, as highlighted in the article. Simply put, the definition of a senior citizen influences the financial and non-financial aspects of the elderly in India, and it is all the more relevant in the case of those dependent on the government for basic needs and protection. It is estimated that old age pension covered 28 million individuals across the country in 2019-20, the largest of the three major disbursements under the National Social Assistance Protection (NSAP).

🎈 Age in the context of longevity

Imagine this. The average lifespan of general population in India (longevity) has increased from 62 years in 2000 to almost 70 years in 2018. That is a rise of 8 additional years post the age of 60, termed as the cutoff age for senior citizen qualification!

In short what we have is a single standard cutoff age for a moving average for a population demographic with multiple indices around general wellbeing. You are more likely to see an active 75 year old Indian person raring to make her next youtube video than you did three decades ago.

Now, let us look at a few other countries.

Senior citizens in South Korea are those with a chronological age of 65 years while in the US, it could vary for different provisions and benefits. The federal health insurance (Medicare) kicks in at the age of 65 while getting policies around driving licenses vary from one state to the other, between 64 and 80. Taking a completely different view, Denmark categorizes people between 60 and 80 years into the third age group and those over 80 years into the fourth age group. The paper Think Tank – The 3rd Age from a reputed Danish think tank articulates 7 key challenges and 33 recommendations to develop what it terms as a good life for the third age group. A joint committe of the Japanese geriatrics and gerentology societies proposed to increase the age of elderly to 75 years and above considering those between 65 and 75 years continue to be active and feel uncomfortable being treated as elderly.

In short, there is no universal senior citizen and old age is not defined by one number.

⚡ Marketplace to improve Quality of Life?

It is well identified that a lot of factors contribute to increased life expectancy among general populations including sustained investment in health, education and so on. A developing and emerging country like India measures its progress over time by the improvement in access to basic and essential needs (food, shelter and clothing) of a larger population and improvement in overall standard of living (rights, life expectancy, safety, income equality, environment conditions, etc.). While standard of living comparisons help benchmark globally, they do not necessarily reveal the quality of life among those living longer.

It has been observed that subjective wellbeing is crucial for later life satisfaction and is an important determinant of quality of life. Aside from meeting basic needs, financial security, continuing participation in societal activities, better geriatric care, availability of supportive and assistive devices, better living arrangements and general life satisfaction play a crucial role in enhancing the quality of life among older adults.

Looking at the eldercare market from the perspective of quality of life improvements can help build a vibrant silver economy and a marketplace of reliable services spread across various needs. Affordability and access to such services are going to be key to ensure such improvements reach the next half billion.

Here are three such opportunity areas –

  1. The Alzheimer’s and Related Disorders Society of India (ARDSI)’s 2018 Dementia India Strategy Report estimates 14.3 million Indians with dementia by 2030 and the cost of care to touch 0.5% of the GDP. Given elderly are particularly vulnerable for dementia and other chronic conditions, this space needs better attention given its impact on the quality of life.
  2. In a previous article, I touched upon the transition from one-size-fits-all approach of old age homes to various formats of care and living arrangements, and in another article, about the growing ageing-in-place services in India. These efforts help improve the quality of life of older adults while presenting a clear opportunity for the future.
  3. While the shortage of doctors and nurses in India is well covered, the estimates around demand for caregivers for an ageing population is not fully understood. With global shortage of caregivers for elders, investments in this space can result in disproportionate improvements in quality of life. According to official estimates, Israel, a country of around 9 million, is home to 15000 Indians out of which 13500 are registered caregivers. While the Government, through industry partnerships, has developed certain standards for this industry, this is an area with immense opportunity to create jobs.

🖨 Mainstreamed

Articles from mainstream newspapers and magazines that touch upon the Silver Economy in India, and our short take.

Launch of Elderline by Government of India

The dedicated number 14567, along the lines of similar efforts in the past for children, is operational in UP, MP, Rajasthan, TN, Karnataka & Telengana through public-private partnerships. The service will be rolled out in other states over time and in the first three weeks, received 475 actionable calls seeking emotional support, information on pension, old age homes and other issues.

Eldercare while working from home, blog post in People Matters

“It is much more common and comfortable for people to talk about their children at work than it is to talk about aging and/or ill parents. So you cannot assume that your boss or peers know or understand your situation. Eldercare is also highly unpredictable and can therefore be highly disruptive to your workday. So tell your coworkers about your caregiving status and ask for their compassion during this time.”

These lines resonate across offices everywhere and drive the benefits programs in even the most progressive organizations, undermining the role of employees in the wellbeing of their parents/elders in the family.

Zero-sum game of caregiving by Rahul Desai in Firstpost

In this interesting personal journey, the author ventures into the world of caregiving through characters in three movies, and looks at his future self as possibly being one (or not) for his parents. I will also add the Netflix show, The Kominsky Method, to the mix of movies covered in the article – Solos, The Father, and Dick Johnson Is Dead.

Medical emergencies and lonelineness by Anubhuti Matta in Forbes

Emoha Eldercare, a Gurgaon-based eldercare company with 3500 members, launched a bike-based first responder to attend to accidents, perform CPR and offer first-aid. The company claims to have saved 40 lives through this service, and has also launched active ageing programs online to keep elders engaged.

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