This is a case stdy research conducted in Chamaraja nagar Town

1. Emerging Health issues of Elderly Citizens
Case Studies Conducted in Chamarajanagar Town
Manjunath,
Faculty
Department of Social Work
Post Graduate Satellite Centre
University of Mysore
Chamaraja Nagar
b4umanja@gmail.com
INTRODUCTION
Old age is a life stage in the life of every living being. Human
beings are no exceptions to this.
There is no United Nations standard numerical criterion, but
the UN agreed cutoff is 60+ years when referring to the
elderly population. In India, the elderly account for 7% of the
total population, of which two-thirds live in villages and
nearly half of them in poor conditions. Increasing life span
and poor health care add to the degree of disability among the
elderly and compound the problems of care giving.
Change in socio-economic status adversely affects the
individual's way of life after retirement. A feeling of low self-worth
may be felt due to the loss of earning power and social
recognition.
The elderly population in India is continuously increasing and
also the problems faced by these people are increasing
simultaneously.
The phenomenon of population ageing is becoming a major
concern for the policy makers all over the world, for both
developed and developing countries, during last two decades.
But the problems arising out of it will have varied implications
for underdeveloped, developing and developed countries.
Ageing of population is affected due to downward trends in
fertility and mortality i.e. due to low birth rates coupled with
long life expectancies.
In India the size of the elderly population, i.e. persons above
the age of 60 years is fast growing although it constituted only
7.4% of total population at the turn of the new millennium.
For a developing country like India, this may pose mounting
pressures on various socio economic fronts including pension
outlays, health care expenditures, fiscal discipline, savings
levels etc. Again this segment of population faces multiple
medical and psychological problems.
There is an emerging need to pay greater attention to ageing-related
issues and to promote holistic policies and programs
for dealing with the ageing society.
PLACE OF STUDY
Chamarajanagar is a town in the southern end of Karnataka,
a state in India. It was carved out of the original larger
Mysore in the year 1998. It is the third least populous district in
Karnataka (out of 30), after Kodagu and Bangalore Rural It is
also the headquarters of the Chamarajanagar
district of Karnataka. It is named after Chamaraja Wodeyar
IX (1774 - 1796), king of Mysore, who was born in the town. It
is also one of the less developed towns in Karnataka, even
though it is situated on the interstate that links Tamilnadu and
Kerala.
THEORITICAL BACKGROUND
The world’s population is ageing. Almost 700 million people
are now over 60. In 2050, for the first time in human history,
there will be more persons over 60 than children in the world -
more than one in five of the world’s population will be aged
60 or older. Women already outnumber men among those
aged 60 or older, and are twice as numerous among those aged
80 or over.
A 2011 report to the UN Secretary-General examines the
human rights challenges and trends presented by population
ageing faster than at any other time in history.
Whilst the report stresses that persons over 60 face diverse
challenges depending on their context, nonetheless, there are a
number of clearly identifiable challenges which require
strategies at the national and global levels. All of these
questions should be viewed through a human rights prism, in
developed and developing countries alike.

2. India is in a phase of demographic transition. As per the 1991
census, the population of the elderly in India was 57 million as
compared with 20 million in 1951. There has been a sharp
increase in the number of elderly persons between 1991 and
2001 and it has been projected that by the year 2050, the
number of elderly people would rise to about 324 million.
Over the past decades, India's health program and policies
have been focusing on issues like population stabilization and
disease control. However, the current statistics for the elderly
in India gives a prelude to a new set of medical, social, and
economic problems that could arise if a timely initiative in this
direction is not taken by the state in general and program
managers and policy makers in particulars. There is a need to
highlight the medical and socio-economic problems that are
being faced by the elderly people in India, and strategies for
bringing about an improvement in their quality of life also
need to be explored.
SOCIO-DEMOGRAPHIC PROFILE OF THE ELDERLY
According to recent statistics related to elderly people in India,
in the year 2001, it was observed that 75% of elderly persons
were living in rural areas. About 48.2% of elderly persons
were women, out of whom 55% were widows. A total of 73%
of elderly persons were illiterate and dependent on physical
labor. One-third was reported to be living below the poverty
line, i.e., 66% of older persons were in a vulnerable situation
without adequate food, clothing, or shelter. About 90% of the
elderly were from the unorganized sector, i.e., they have no
regular source of income. The number of centenarians in India
is about 2, 00,000 and India is one of the few countries in the
world in which the sex ratio of the aged favors males. This
could be attributed to various reasons such as under-reporting
of females, especially widows and higher female mortality in
different age groups.
PHYSIOLOGICAL AND SOCIO-ECONOMIC PROBLEMS
FACED BY ELDERLY CITIZEN
In India, the elderly people suffer from dual medical
problems, i.e., both communicable as well as non–
communicable diseases. A decline in immunity as well as age-related
physiological changes leads to an increased burden of
communicable diseases in the elderly. The prevalence of
tuberculosis is higher among the elderly than younger
individuals.
According to Government of India statistics, cardiovascular
disorders account for one-third of elderly mortality.
Respiratory disorders account for 10% mortality while
infections including tuberculosis account for another 10%.
Neoplasm accounts for 6% and accidents, poisoning, and
violence constitute less than 4% of elderly mortality with
more or less similar rates for nutritional, metabolic,
gastrointestinal, and genito-urinary infections.
Indian Council of Medical Research (ICMR) report on the
chronic morbidity profile in the elderly states that hearing
impairment is the most common morbidity followed by visual
impairment.
The elderly are also prone to abuse in their families or in
institutional settings. This includes physical abuse (infliction
of pain or injury), psychological or emotional abuse (infliction
of mental anguish and illegal exploitation), and sexual abuse.
STRATEGIES TO IMPROVE THE QUALITY-OF-LIFE OF
THE ELDERLY: THE ROLE OF THE HEALTH CARE
SYSTEM.
With a brief overview of the health and socio-economic
challenges that are being faced by the elderly population in
India, the following strategies may be explored by the
program managers of the public health care system to bring
about improvement in the quality-of-life of the geriatric
population.
At present, most of the geriatric outpatient department (OPD)
services are available at tertiary care hospitals. Also, most of
the government facilities such as day care centers, old age
residential homes, and counseling and recreational facilities
are urban based
Ensuring good quality geriatric health care services at the
primary level would greatly help in improving the utilization
rates of the available health services. Health care services
should be based on the “felt needs” of the elderly population.
The Maintenance and Welfare of Parents and senior citizen
Act (Senior Citizen act) is enacted to provide some speedy and
inexpensive remedy to get maintenance. The Bill provides for
a) Appropriate mechanism to be set up to provide based
maintenance to the parents and senior citizens.
b) Providing better Medical facility to them.
c) Formulation of suitable mechanism for protection of
life and property of older persons.
d) Setting up of old age homes in each district.
e) The family life is very necessary for senior citizens
and for parents to lead a life security, care and
dignity.

3. Capacity building may be done for different groups of
health personnel. Training of Medical Officers Besides
this, an entirely distinct team of health providers known
as “Community Geriatric Health Workers” may be trained
to provide home care to the disabled elderly population.
This strategy has been demonstrated to be successful in a
community based project in Cochin, known as “Urban
Community Dementia Services” wherein these health
workers provide home-based care as well as care in day
care centers.
Also, capacity building of the community leaders is essential
for the success of community-based geriatric and
rehabilitative health services. Community leaders can play an
important role in identifying the felt needs of the elderly and
in resource generation.
Among the secondary level health facilities, which mainly
include the district hospitals, sub-district, and medium-size
private hospitals, it is seen that India has about 12,000
hospitals with 7 lakh beds. Most of these beds are under the
public sector. The need of the hour is to set up geriatric wards
that would fulfill the specific needs of the geriatric population
by provision of distinct OPD services. Providing screening
services as well as curative and rehabilitative services and
convalescent homes to provide long-term care, which may be
a part of designated hospitals, is also a priority.
At the tertiary care level, which comprises of super specialty
and medical college hospitals, there needs to be provision of
geriatric wards and separate OPDs.
Elderly patients from poor and low income facilities should be
supplied with free or reasonably priced treatment through
public-private partnership.
The Central and State governments have already made efforts
to tackle the problem of economic insecurity by launching
policies such as the National Policy on Older Persons,
National Old Age Pension Program, Annapurna Program, etc.
However, the benefits of these programs have been questioned
several times in terms of the meager budget, improper
identification of beneficiaries, lengthy procedures, and
irregular payment.
REVIEW OF LITERATURE
For the purpose of the study the researcher have
reviewed the following literatures to get in depth and
comprehensive knowledge and theoretical background about
aging or the problems associated with the aged persons in the
district in particular and aged population in India in general.
The researcher also gone through various journal and articles
related to the topic. The books, articles and journals reviewed
are stated below including several web pages and web link of
different governmental and nongovernmental, national and
international service, voluntary and nonprofit organizations.
In Indian Journal of Community Medicine, Mr. Ashok.
K and M Padma in their article “Health and Social
Problems of the Elderly: A Cross-Sectional Study in
Udupi Taluk, Karnataka “absorbed the following.
Among the respondents 35.7% of the respondents were
aware of the government welfare schemes for the
elderly and only 14.6% (31) had utilized the geriatric
welfare services in their study. Three-fourths of the
population studied was not eligible for these schemes
because of having male children or property.
It was observed that 68.5% of the respondents had
friends and social contacts outside the home. In case of
a conflict with family members, nearly half of the
respondents (45%) preferred to sleep in order to get
over it, 33% preferred to discuss it with others, and
20% preferred to find a solution.
It was observed in our study that around 52% of the
respondents felt that old age affected their role in the
family. A total of 35% of the respondents felt they were
not consulted by the family members for making
decisions. They felt they were ignored by family
members because of their physical illness and
economic dependence. In spite of being unhappy due to
these problems, they still preferred their home to an old
age home for their residence
THE OBJECTIVES OF THE STUDY
The objectives of the study are as follows.
1. To understand the Health status/condition of the
aged people in the town.
2. To ascertain the family members’ attitude
towards the elders in their family.
3. To ascertain the public participation of the
elderly.
4. To assess the extent of economic dependency of
the elderly people.

4. 5. To ascertain the impact Social Status (caste,
religion, income level) on the wellbeing of the
elderly citizens( Socio-cultural barriers for the
wellbeing of the aged citizens)
6. To throw light on the current challenges faced by
the elderly citizens in the town.
RESEARCH METHODOLOGY
For the purpose of the study, the researcher has
adapted the case study method as this method is more relevant
in this context. The researcher have conducted ten (10) case
studies district hospital in the town including government
hospital, and selected households. The rationale behind
selection of case study method is that focus can be put on
specific interesting cases completely. Out of 10 cases that
were being carried out, two best cases were being selected for
the study.
CASE STUDY NO 1
Name: Ramanna Age: 60 years.(Name changed)
Mr. Puttanna is a farmer aged about 60 years residing at
Bagadi village of Chamaraja Nagar dist. Though he is
suffering from prolonged leg injury, he is living happily with
his wife. His home is near to the town, so they fully depend on
this hospital fir any kind health related problems.
Economically he is independent as they have a piece of land
and he and his wife are getting old age pension (OAP) and 30
kilograms of rice from the government at cheapest rate. He
also holds a job card under MGNREGA and he gets more than
100 days of work in a year at the wage rate of Rs. 190 per day.
When asked for his social/public participation, he shared with
the researcher that though they are economically independent,
they are being neglected by the neighbors and others around
them in the matter of participation in social and religious
celebrations. He told that he is being refused and neglected.
Few years ago, people used to come to him and seek
suggestions for almost all social and religious occasions like
to determine the date and time of the celebration. But these
days he is being ignored for none other reason but for their old
age. It is the result of the social stigma among the people
about the old age and senility.
Coming to the attitudes of the family members, though they
are given food in time by the daughter in law and all other
services and facilities are also provided but not by heart but by
the societal compulsion. He shared that though there were
many quarrels between his son and his wife regarding his stay
with them.
Compared to the attitude of their kith and kins other people
treat them better and respect them earlier.
Finally he is being asked to compare his experiences before
and after his 60 years of age, he told that though he and his
wife are economically self reliant in the eyes of the family
members and the society he is unproductive and use for
nothing on them , they think that he is a burden.
CASE STUDY NO 2
Name: Kalamma Age: 75 years (Name changed)
Mrs. Mallamma , a 75 year old woman basically from
Basavan Palya of Chamaraja Nagar Dist, around 10 km from
here.
She is suffering from Diabetes and visits district hospital
regularly for medical checkup and treatment. She lost her
husband about 15 years ago and presently she is with her only
son and his wife. There are no hospitals a=or clinics near to
her village. Either she should come to Chamaraja Nagar or
Yelanduru.
She says that I eyes of the neighbors she is happy and she is
being taken care of well but in reality, she narrates that,
though her son shows a little love and affection where as her
daughter in law doesn’t want to serve her. Though she serves
food, provides hot water, washes her clothes take her to
hospital and other necessary services to her, it is because of
the request by her husband and society as a whole.
Even though she gets old age pension, it is not really
benefiting her in any way. She has to bring vegetables and
other glossary to home rather than spending for her. She says
that to get three meals she has tolerate all these exploitative
situations.
In the village, among the community Mallama is well known
women for hard work and the way she is used to take care of
his son. She used to work hard in the paddy fields earning
handful of wages required to take care of her family. But
today she is unable to enjoy her old age. She doesn’t have
relative except her nephew in the nearby village. Even she is
being kept away from her grandchildren, stating false
statements about her illness to the children.
Pertaining to her involvement in the social and religious
occasions she is the most ignored person. During any kind of
family occasions like marriages, and festival celebrations, she

5. is being asked to stay back in the home take care of the live
stocks and other properties.
She says that her son and his wife think that Mallamma is an
Headache for them and burden on them and curse on her and
request the god to give her the death soon.
FINDINGS
1. Elderly citizen are economically independent in the
matter food clothes and shelter because of the social
security measures and schemes of the governments
like OAP, Anna Bhagya, Bhagyalakshmi Scheme etc.
2. Though physically well, these two cases are suffering
from isolation and discrimination by the family
members.
3. They are supposed to enjoy their old age with the
grandchildren but in these cases this privilege is
being denied.
4. Compared to the physiological illness they are much
affected by the mental harassment and isolation and
denied of participating in the religious ceremonies.
5. Male aged citizens are lass denied and ignored than
that of the female aged persons.
6. Mere passing of laws does not ensure the fair
treatment and wellbeing of the senior citizens.
Handful of awareness programs have to be
introduced to create a kind of obligation among the
younger generations.
7. Like physical health, mental health is also equally
important to live a happier and productive life.
8. Abuse, neglect and ill treatment or mistreatment of
the elderly people by the family members and
neighbors. Especially physical and emotional abuse.
9. Discrimination on the basis of ageing is often
combined with other forms of discrimination on the
grounds of gender, race and ethnicity, religion
disability, health or social and economic conditions.
10. Misconception about the old age or ageing plays a
crucial role in making the elderly citizens corner
stones.
11. The elderly citizens are being suppressed. They are
being kept in dark, away from the mainstream of the
community. Even they are not allowed to decide
what they want to eat.
SUGGESTIONS
1. Providing easy access for the aged citizens to the
government schemes and programs so that there may
not be involvement of mediators.
2. Dependency on the family members should be
minimized by increasing the amount old age pension,
widow pension, disability benefits etc.
3. Financial burden can be reduced to make them self
reliant in the matter of food, shelter and clothes.
4. Rural based recreational programs should be
formulated, implemented and monitored.
5. Aging is a multidisciplinary field. Capacity building
training programs should be arranged/conducted for
the rural health workers including community health
workers, social workers, doctors’ nurses etc.
CONLUSION
As people enter old age, they face challenges rather than
enjoying their old age. Ageism, which involves stereotyping
and discrimination against the elderly, leads to misconceptions
about their abilities. Although elderly poverty has been
improving, many older people may be detrimentally affected.
Dependent on care givers, which increases their risk of elderly
abuse
Effective and efficient programs and policies must be framed
and executed at grassroots level to safeguard the interest of the
elderly citizens. It’s the bound duty of every human being to
take care of their aged parents to be happy in their old age.
Unless and until we create awareness among the individuals,
societies and communities its difficult to see every senior
citizen happy in their old age, even though a handful of
legislations, policies and programs are available in India to
protect the and safeguard the interest of the Elderly citizens.
REFERENCES
1. Goel PK, Garg SK, Singh JV, Bhatnagar M, Chopra H,
Bajpai SK. Unmet needs of the elderly in a rural population of
Meerut. Indian J Community Med. 1999; 28:165–6.
2. Ahluwalia N. Aging, nutrition and Immune function. J Nutr
Health Aging. 2004; 8:2–6. [PubMed: 14730362].
3. Singh P, Umesh K, Dey AB. Prevalence of overweight and
obesity among elderly patients attending a geriatric clinic in a
tertiary care hospital in Delhi, India. Indian J Med Sci.2004;
58:162–3. [PubMed: 15122053]

6. 4. Leena Myrtle Gomaz, Geriatric Nursing, Jaypee Brothers
Medical Publication (p) Ltd, 2009, ISBN-10 8184486278
5. Indian Journal of Community Medicine, Geriatric health in
India: concerns and Solutions, Indian Association of
Preventive and Social medicine, Oct 2008
6. Shekar K and others, Handbook of Psychiatric Social Work,
NIMHANS, Banglore, P-59-70, 2007.

7. 4. Leena Myrtle Gomaz, Geriatric Nursing, Jaypee Brothers
Medical Publication (p) Ltd, 2009, ISBN-10 8184486278
5. Indian Journal of Community Medicine, Geriatric health in
India: concerns and Solutions, Indian Association of
Preventive and Social medicine, Oct 2008
6. Shekar K and others, Handbook of Psychiatric Social Work,
NIMHANS, Banglore, P-59-70, 2007.