The World Health Organization (1948) adopted a comprehensive and widely accepted view of health, defining it as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

The traditional biomedical model holds that illness can be fully accounted for by biological variables only, and even the most complex illness phenomenon can be reduced to certain measurable physiological abnormalities. Although this approach is certainly a cut above the ancient view of health that explained illness as resulting from demonic & spiritual activity, it greatly undermines the influence of other social and psychological factors on health and illness; failing to adequately define the reality of illness in human experience. It takes a reductionist stand, and a dualistic view for mind-body relations, disregarding the continuum of health (DiMatteo & Martin, 2007).

In furtherance to the biomedical model, the biopsychosocial model necessitated the inclusion of psychological and social factors alongside biological factors in understanding health and illness. This model takes on a more holistic view of health by incorporating the meaning a person attaches to his/her illness, the individuals’ unique response style (often learned through patterns of family and culture), his or her social expectations about illness, person’s psychological state, as well as the present social context of the illness (DiMatteo & Martin, 2007).

How to cite this article: Jaggi, P. and Saleem, Z. (2020). Ageing Population of Urban India & Psychological Well-being Issues. Int. J. Soc. Sci., 9(03): 169-184.

Source of Support: None; Conflict of Interest: None

Health can be categorized into 3 broad components, namely – physical health, mental health & social health. Physical health includes physical fitness, hygiene, nutrition, and sleep. Mental health includes dimensions of intrapersonal attitudes, growth, development and self-acclimatization, integration, autonomy, accurate perceptions, and environmental mastery. Jourard & Landsman (1980) proposed that positive self-concept, capability to show sensitivity & concern about others and the natural world, openness to original ideas, creativity, pragmatic self-perception, capability to work gainfully, and capability to love others, are components of a positive mental health. There are five components of social health and well- being, namely – social integration, social contribution, social coherence, social actualisation and social acceptance (Keyes, 1998).

Wellbeing is a complex, highly subjective and multi-dimensional construct, often defined in terms of its elements. Diener & Suh (1997) believed that subjective wellbeing consists of three interrelated components: life satisfaction, pleasant affect, and unpleasant affect. Affect refers to pleasant and unpleasant moods and emotions, whereas life satisfaction refers to a cognitive sense of satisfaction with life. Martin Seligman, the undeniable leader of the positive psychology movement, outlines the following elements of wellbeing which act as building blocks of a flourishing life: Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment (PERMA) (Seligman, 2013). Furthermore, wellbeing or so to say subjective wellbeing canopies concepts of happiness, satisfaction with life, and health.

Emotional wellbeing involves an individual being insightful and aware of affirmed happiness and satisfaction with life. It encapsulates frequent positive affect, rare negative affect, life satisfaction and happiness (Ryff & Keyes, 1995). Psychological wellbeing is best characterised by self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life, and personal growth. The concepts of social wellbeing and social health overlap to a great extent.

Rise in the elderly population can be attributed partly to advancements in public health and medical technologies, along with improvements in living conditions increasing longevity and lowering mortality rates. The average life span of human beings has increased manifold in the past few decades. However, in this era of globalization and technology, ethics of care and compassion are overpowered by self-interest. The increasingly detrimental social milieu of the elderly has resulted in the need for various legal policies and laws to protect this tenuous population group. This is an unprecedented phenomenon in India, which for centuries had emphasized greatly on collectivism, and catering to the needs of its elderly.

Groundswell in the number and proportion of older persons, as the baby boomers reach their senior years and as longevity increases, is a worldwide phenomenon often metaphorically termed as ‘The Silver Tsunami’. Population ageing has implications for nearly all sectors of society ranging from labour and financial markets, demand for housing, transportation and social protection to family structures and intergenerational ties.

Ageing is a complex developmental process that is, as yet, poorly understood.

Jeffrey S. Akman (2009) defined ageing in the terms of chronological age and functional age. Chronological age (how old a person is) is commonly used to define an age band of older adults. The start of the period of later life is not fixed and in many Western societies 60–65 years is looked upon as the threshold of old age. The reason for this is possibly related to societal norms (e.g. retirement age) and to the age at which degenerative changes of ageing become noticeable. A person’s functional age depends on their performance in relation to age-graded norms. Thus, a person might have a chronological age of 70 but have a functional age of 50 for reaction time and of 60 for speed of information processing. The related term of biological age may be used to relate individual function to age-based norms of physiological functions and, similarly, social age may be used to refer to societal norms of how people should behave at particular ages.

From a physical perspective, ageing involves a loss of resilience or reserved capacity to respond to stressors, and this acquired vulnerability usually means that ageing is associated with some greater susceptibility to illness as well as some decline in function over time.

Normal ageing refers to growing old with a manifest illness, whether physical or mental. This is not entirely uncommon for someone in their 70s. Pathological or sick ageing refers to a process of ageing where there is clear evidence for physical or mental pathology (Baltes, 1991). Finally, optimal ageing implies ageing under the best personal and environmental conditions and is a primary research motivation for many gerontologists.

The current retirement age for most government workers in India is 60. However, due to ageing population and increasing pressure on pension funding, many countries have begun raising the pensionable retirement age.

The condition of successful ageing if conducive to the experience of optimal health and wellbeing; moreover, they all are interwoven in terms of physical, psychological, social, cultural and spiritual aspects.

The biological theories of ageing can be subsumed under two broad categories – Programmed theory & Error Accumulation Theory. The programmed theories imply that ageing follows a biological timetable, perhaps a continuation of the one that regulates childhood growth and development. This regulation would depend on changes in gene expression that affect the systems responsible for maintenance, repair and defence responses. This segment constitutes of the theory of programmed longevity (ageing results from sequential switching on and off of certain genes), endocrine theory (ageing is controlled by hormones that act as biological clocks), Immunological Theory (immune functioning deteriorates as body ages leading to increased vulnerability to infectious disease and thus ageing and death). The damage or error theories explains ageing as the result of environmental assaults to living organisms that induce cumulative damage at various levels. Error accumulation theory includes wear and tear theory (ageing is a consequence of wearing out of vital parts of cells and tissues due to repeated use), rate of living theory (the greater an organism’s rate of oxygen based metabolism, the shorter its life span), cross-linking theory (ageing results from an accumulation of cross-linked proteins that damage cells & tissues and thus slow down bodily processes), free radicals theory (superoxide and other free radicals cause damage to the macromolecular components of the cell, giving rise to accumulated damage; as a result cells, and eventually organs stop functioning), somatic DNA damage theory (ageing results from damage to the genetic integrity of the body’s cells) (Jin, 2010).

The activity theory of ageingprovides that there is a positive relationship between a person’s level of activity and life satisfaction, which further reinforces a positive self-concept and improves adjustment in later life (Havighurst, 1961). Further study of the activity theory revealed that it is also important to take into consideration the type and quality of activity. For example, sustained intimate interpersonal and informal activities are projected to be more beneficial as they increase opportunities for reinforcement of person’s self-concept. Additionally, a sense of subjective well-being can result from an individual solely having a perception of being socially integrated, independent of the actual level of social integration. On the contrary, engaging in in activity that is not meaningful to the participant can actually lead to negative consequences.

The activity theory finds its’ roots in the symbolic interactionist theory which holds that a person’s identity or self-concept is defined in part by interactions with others and in part by the environment. These interactions impact not only one’s behaviour and thought patterns, but also the ageing process. The ageing person may experience loss of personal identity & wellbeing, low self-esteem, shame or isolation when social withdrawal or role loss occurs by retirement, widowhood or loss of ability to participate in past activities. To age successfully one must continue to be active throughout middle age and beyond, and actively take on productive roles in society, like volunteering, membership in organisations & social groups; to replace past roles lost as a consequence of ageing.

A major fallback of the activity theory is that it does not take into consideration the influence of other factors such as personality traits, socioeconomic status, and lifestyle characteristics, whilst mapping the relationship between activity and life satisfaction. Public health professionals are one of the major proponents of activity theory, considering their role in prescribing health-promoting activities specifically targeted to improve health and can have a significant impact on wellbeing beyond that of life satisfaction.

James Dowd’s (1975) exchange theory of ageingaddresses a perceived loss of status and power associated with ageing. In actuality it is derived from a larger theoretical base known as social exchange theory. The social exchange theory propagates that the social status of a person is determined by the ratio of rewards to costs associated with interaction with that person. Rewards can be actual or perceived, often taking the form of currency, information, goods, services, respect, power, social support, social acceptance, social approval, etc. This theory is based on the assumption that a person’s behaviour is in part determined by the person’s desire for personal benefit or reward; activities or interactions that are positively reinforced will continue while activities that do not yield sufficient benefit or rewards will be discontinued. Dowd’s theory vis a vis ageing, proposes that ageing individuals in industrialized nations lose power and social status as a result of decreasing value of exchangeable good and services. According to Dowd, as ageing people gradually lose control over finances, knowledge, and other resources owing to factors such as retirement, technological developments, and changes in health status, their ability to remain socially and financially viable is inhibited. As a result, their bargaining power is diminished, compelling them to comply with the wishes of others to offer in the exchange. The exchange relationship between younger persons and elderly decreases, making interactions and exchange more costly for younger persons, following the decline in resources of exchange available to the elderly. However, this theory does not address the impact of the context in which the exchange occurs, or how the value or reward may change over time or in a given situation.

Erik. H. Erikson (1968) propounded the psychosocial theory of development wherein each stage is tied to specific, basic social institutions, is associated with a particular strength, and awakens a specific sense of estrangement which can become the basis of psychopathology. Stages of a person’s life from birth to death are formed by the interaction of social influences with a physically and psychologically maturing organism. Initial stages counter infancy, early childhood, play age, school age, adolescence and young adulthood. Stages more pertinent to ageing include – adulthood, old age and very old age (Erikson, 1968).

Adulthood is characterised by – the dichotomy between generativity and stagnation, concern with what is generated such as progeny, products, ideas etc., and the establishment of guidelines for the upcoming generations. The primary social institution of adulthood is the family household, with divided labour & shared household duties. The virtue of care develops, and is expressed by wanting to take care of those needing it, and to share one’s knowledge and experience with them; this is accomplished through childrearing, teaching, demonstrating and supervising. When the potential enrichment to be found in generativity fails, the consequences are often seen in the estrangements of the next generation.

The old age stage of the epigenetic process of development is labelled as ‘Integrity vs. Despair’. Integrity can be described as a state wherein individuals come to perceive that their life has some order and meaning withing a larger order, apropos their successes and failures of existence, accomplishments, ideas and so on. The individual preserves a personal style of life and defends it from potential threats. The counterpart of integrity is a feeling despair vis a vis vicissitudes of individual life cycle, social and historical conditions, and the nakedness of existence in the face of death. The virtue of wisdom develops out of the encounter of integrity and despair, allowing one to maintain and convey the integrity of one’s lifetime of experiences, despite the gradual physical decline of the body. Wise individuals can represent to younger generations a style of life characterized by a feeling of wholeness & completeness, alleviating feelings of helplessness & dependence that often mark the end of life.

The very old age is characterised by a chasm between despair and gerotranscendence (Erikson & Erikson, 1997). Individuals who make it to 90 and beyond typically experience the loss of friends, family and even children. The despair faced by them revolves around their present reality, and not reminiscing about one’s life. At such an age, most individuals lose trust in their capabilities; subsequently their purpose in life and autonomy are dulled. Likewise, their identity may become unclear once again, leading them to become isolated and self-absorbed. However, some very old people hold a special place in their families and/or communities, and may withdraw only by choice, in order to contemplate and be at peace with their life; or in other words, have a last dance with life.

Professor Margaret Baltes and her colleagues at the Free University of Berlin in Germany developed the model of selection, optimization and compensation to illustrate the phenomenon of successful ageing (Baltes & Carstensen, 2003). In this model it is proposed that those who age successfully make concentrated endeavours in selected life areas that are significant to them, optimally use the resources that facilitate success in the preferred areas, and make up for losses required for success in these areas in order to accommodate to increasing biological, psychological, and socioeconomic constraints associated with ageing. Well-adjusted older adults carefully choose a limited number of valuable goals that provide them a purpose in life. They then use techniques and aids to help them overcome obstacles such as physical decline and illness, psychological limitations such as memory issues, and socio-economic constraints such as declining finances to allow them to achieve those valued goals. For example, in a 7-year longitudinal study of over 900 older adults living in Chicago, Boyle et al. (2010) found that those with a high score on a purpose in life inventory were at lower risk of developing Alzheimer’s disease and mild cognitive impairment and therefore had a better quality of life (Boyle, Buchman, Barnes, & Bennett, 2010).

Thiele & Whelan (2006) concluded in their wide-ranging analysis that the role of grandparent is usually important and fulfilling, likely because it offers an outlet for individuals to fulfil their generativity needs. Neugarten and Weinstein (1964) identified 5 types of grandparental roles. Firstly, there were those who took on a formal role and were engaged with the grandchildren not in childcare but lovingly and emotionally. The second role was simply fun-seeking, and for the grandchildren these grandparents served as playmates. The third type of role is that of a distant figure who had little interaction with grandchildren was the third type of grandparental position. The fourth role-type was that of parental surrogate, and these grandparents assume the role of parent to the grandchildren in order to allow the mother to work outside the home. The ultimate grandparental function was that of a family knowledge repository that occupied within the extended family a powerful patriarchal or matriarchal position. Where grandparents follow principles, which are supportive to the parents and grandchildren, they contribute to resilience in the family. Wherever they take on positions that greatly increase demands on parents and grandchildren without offering support, they indirectly contribute to the development of maladjustment (Neugarten & Weinstein, 1964).

The death of a loved one is one of the most stressful and emotionally devastating event a person can experience. Bereavement is the fact of loss through death, and is usually accompanied by overwhelming grief and mourning. Bereavement can bring changes in a person’s physiological and psychological health and wellbeing, as well as, social status and interpersonal relationships; it may also hamper one’s agility to cope with circumstances. The death of spouse has especially multitudinous implications in old age. Loneliness, depression, decreased psychological wellbeing, lower levels of social support, decreases in morale, difficulties with new roles and responsibilities, challenges to a sense of personal identity, and physical health problems are all associated with bereavement in elderly men and women (DiMatteo & Martin, 2007).

Carol Ryff (1989) and colleagues provided six factors that represent resources for effective living and resilience. The first being self acceptance which is expressed through having a positive attitude towards oneself, acceptance of strengths and weaknesses, and positive feelings about life. Personal growth is indicative of a person’s feeling of continued development and effectiveness, along with an openness to new experiences. To ensure wellbeing a person must also have a meaningful purpose in life which is characterised by personal goals and beliefs, that direct one’s life. Environmental mastery refers to a feeling of competence which is reflected in one’s ability to create a personally suitable living situation, and condition necessary for a successful life. Autonomy is a critical element of wellbeing and resilience; autonomous people are self-directed, work independently and resist negative social pressures. Lastly, having positive relations that are warm, satisfying and supportive, as well as being capable of empathy and intimacy are crucial in ensuring wellbeing and resilience in old age.

Remarriage among the elderly is an increasingly prevalent phenomenon. The prospect of remarriage is different for elderly than it is for young or middle-aged persons as they have distinctive needs and circumstances. Older person may appear selfish, disrespectful, and untrue to their previous spouse and family due the stereotypes and taboos attached to old age. Moreover, children tend to perceive parents only in the limited role of a parent who is self-sacrificing & asexual; hence, it is difficult for them to comprehend the fact that they have sexual and companionship needs and may get very lonely without a partner. This difficulty in accepting a new family member is coupled with the strong tradition of filial responsibility that leads them to perceive remarrying parents as an evidence of the children’s failure in providing for their parents; they may resist the marriage out of their own guilt (Katschke-Jennings & Healey, 1988). However, while remarriage can redress loneliness, it can cause potential legal complications for adult children in property distribution and rights. Worries about what society will think and even what their adult children’s in-laws will think, coupled with the children’s fears of loss of inheritance or assets sometimes leads to strong family disapproval. Further legal implications related to pension and health care makes elderly remarriage a convoluted pursuit; augmenting the older person’s crippling loneliness and well-being. Fortunately, in recent years, children are becoming increasingly open to the idea, and even actively coming forward to find partners for their parents. In some cases, the children live in another city or work full-time and are not able to care for their parent, and would like them to find a partner.

Globally, the population aged 65 and over is growing faster than all other age groups. The World Population Prospects: The 2019 Revision, revealed that by 2050, the global population of older persons is projected to more than double its size in 2015, reaching nearly 2.1 billion and one in six people in the world will be over age 65 (16%), up from one in 11 in 2019 (9%). By 2050, one in four persons living in Europe and Northern America could be aged 65 or over. Globally, for the first time in history in 2018, children under five years of age were outnumbered by persons aged 65 years or above. The number of persons aged 80 years or over is projected to triple, from 143 million in 2019 to 426 million in 2050. The global population of older persons is projected to more than double its size in 2015 by 2050, reaching nearly 2.1 billion. Between 2000 and 2015, population of persons aged 60 years or over increased by 68% in urban areas, compared to a 25% increase in rural areas, at a global level. In the years 2010-2015 women accounted for 54 per cent of the global population aged 60 years or over. As a result, the share of older persons in the total population is increasing virtually everywhere. Population ageing, although a global phenomenon, is disproportionate in developed and developing countries. By 2050, 44 per cent of the world’s population is estimated to live in relatively aged countries, with at least 20 per cent of the population aged 60 years or over.

1/8^th of the Worlds Elderly Population lives in India. According to the State of World Population 2019 report by the United Nations Population Fund (UNFPA), six per cent of India’s population was of the age 65 and above. The elderly population of India is projected to increase to about 300 million by 2050. India has thus acquired the label of “an ageing nation” with 7.7% of its population being more than 60 years old (Premchand, 2016). The All India Senior Citizen’s Confederation (AISCONN) revealed that the life expectancy of those above the age of 70 years has increased by 18%; however, this rise does not necessarily reflect improved quality of life. Reports of the Ministry of Statistics indicate that the old age dependency ration - measure of the pressure on the economically productive section of the population, hiked from 10.9% in 1961 to 14.2 & in 2011. Although 41.6% of the elderly population still works, very few feel financially secure. Delhi (NCR), the capital of India, has a total population of over 2 crores, of which 8% are above the age of 60, that is, over 12 lakh elderly people. Old age becomes ever more distressing to the portion of this population that had migrated from other parts of the country, and have trouble assimilating to the changed environment.

The demographic landscape is transitioning as a result of soar in the population of baby boomers coming to age. This spurt in the elderly population poses serious structural threats to the fiscal sustainability and public finance of a nation, in the way that decrease in government’s ability to collect tax revenue due to shrink in tax-paying working population is paralleled by increase in governmental expenditures of age related programs, particularly healthcare expenditure, pension. Diminishing productivity is corresponded with a reduction in economic growth which is the foundation of economic and social development, and reduction in national revenues and savings; generating negative impacts on economic sustainability. A country can be at risk of insufficient social development and economic in-sustainability, owing to sluggish economic growth. Yoshino and Miyamoto (2017) evidenced that population ageing weakens the effectiveness of traditional macroeconomic – fiscal and monetary policies. Effectiveness of fiscal policy – which relies heavily on tax collection, is diminished as a result of lower total labour supple in the economy. As retirees’ pension benefits are financed by active tax payers, overall burden per worker is substantially raised with a decreasing working population. With regard to monetary policy, a ratio of population directly affected by the monetary policy shock decreases as the consumption behaviour of the aged is not affected by change in interest or inflation rates due to their limited income and fixed spending behaviour. Population ageing has serious economic implications, it is imperative to develop more structured responses and reforms to address such challenges (Yoshino & Miyamoto, 2017).

Adopted in 2002, The Madrid Plan of Action (MIPAA) offers a bold new agenda for handling the issue of ageing in the 21^st-century. Three of its’ major focal points are: older persons and development; advancing health and well-being into old age; and ensuring enabling and supportive environments. It serves as a resource for policymaking, suggesting ways for Governments, non-governmental organizations, and other actors to reorient the ways in which their societies perceive, interact with and care for their older citizens. The Madrid Plan of Action also represents the first time 159 governments agreed to link questions of ageing to other frameworks for social and economic development and human rights. It also calls for governments to include older people in the development of the policy development process. Furthermore, the MIPAA is not legally binding and its implementation is voluntary.

Broadly, the central themes and objectives of the International Plan of Action on Ageing, 2002 incapsulate inter alia, the recognition of the unique situation and circumstances of ageing in indigenous persons, harnessing of scientific research and expertise focusing on the multi-faceted implications of ageing, support and social protection of older persons including preventive and rehabilitative health care, facilitating partnership among various societal and governmental structures and the elderly, commitment to gender equality among older persons, elimination of all forms of violence and discrimination against older persons, achievement of secure ageing and full realization of all human rights and fundamental freedoms of all older persons.

The socioeconomic problems of the elderly are aggravated by lack of social security and subpar facilities for health care, recreation and rehabilitation. In most developing countries, pension and social security are enjoyed by those who have worked in the public sector, to the exclusion of others; as a result, a vast number of the aged population especially those from rural areas are left to fend for themselves during such a vulnerable period of their life. Economic policies must be generated to safeguard the socioeconomic security of this silent majority.

Crime statistics have traditionally suggested that people aged 60 or over are less likely to be the victims of violent crime compared to the rest of the population. However, most victimisation surveys exclude certain groups such as those residing in care homes and hospitals. In addition, research usually examines a fairly narrow range of violence and abuse, not accounting for sexual violence and violence that leads to fatality. Skewed statistics can also be accounted for by instances of elderly violence and abuse that are often disregarded by police forces, health professionals and other key agencies because of ageist assumptions about older people being at low risk for violence. This results in missed opportunities to identify and prevent violence against older people. Thus, further research in law, criminology and gerontology must counter in these variables, so as to provide results reflective of the true scenario of the elderly and facilitate further policy making.

The institutional care system for the elderly is still in its nascent phase in India, confined to the developed metropolitans and affordable by those who are well off. Even now, elderly care is predominantly dependent on community care and family care. However, rapid modernisation, breakdown of joint family system, and migration of the young working population to urban areas has further dilapidated elderly care. Health care providers like nurses, assisted living care takers, and old age home employees and volunteers are often under trained and may end up negatively impacting the health and wellbeing of the older persons under their care. Moreover, the elderly are most adversely affected by poor infrastructure (roads and housing), inefficient health care system and dearth of human and technical resources vis a vis hospitals and other institutions. The operation of the philosophical fair innings argument often provides grounds that legitimate giving lower priority to policies that primarily benefit the elderly.

Research carried out by Agewell Foundation India on 50,000 older persons regarding legal provisions & practices evidenced that 14.05% did not opt for legal justice as they could not afford high fees of lawyers owing to their weak financial condition and dependence. Furthermore, lack of awareness regarding legal laws and provisions made for the welfare and empowerment of older persons is another ingredient of elderly injustice. Only 9990 out of 50,000 older persons admitted that they were aware of some elderly friendly legal provisions available in the country. Further analysis revealed that only 7.06% of elderly women and 16.7% elderly men had some knowledge of the Maintenance & Welfare of Parents & Senior Citizens Act, 2007.

Additionally, in spite of being aware of the legal provisions many old age parents may hesitate to use these provisions due to social sanction and guilt attached to acting against your own loved ones.