Introduction

Today one in nine persons in the world is aged 60 years or over. This ratio is predicted to increase to
one in five by the year 2050(1.United Nations Population Fund (UNFPA) and Helpage
International, 2012. ). In 1950, there were 205 million persons aged 60 years or over in the world.
By 2012, the number of older persons increased to almost 810 million (United Nations Population
Fund (UNFPA) and Helpage International, 2012, pg. 13). India is no exception to this transition in
demographics. According to projections constructed by the United Nations Population Division, the
share of Indians aged 60 and over will increase from 8% today to 19% by 2050.(2. Arokiasamy, et.
al. 2011). According to the3 global age watch index (2013), 8% of the Indian population is above
60 years of age, that translates to 100.2 million people over the age of 60. In India The life
expectancy at birth was 64.2 for females and 62.6 for males during 2002-2006. At age 60 remaining
length of life was found to be about 18 years on average; 16.7 for males, 18.9 for females and that
at age 70 it was less than 12 years; 10.9 for males and 12.4 for females.(4.Central Statistics Office
Ministry of Statistics & Programme Implementation Government of India, 2011). This phenomenon
of rapid graying of the world population brings forth an array of challenges especially for a
developing country like India. One of the major challenges of the 21st century is ensuring healthy
and productive aging, and empowering the elderly so that they can live a life of respect and dignity,
be independent and can exercise control over their own lives. The challenges are not limited to
provision of health care services or financial support; but also ensuring that elderly are, and feel,
that they are a productive unit of society, the creation of a society for all ages, ensuring that aging
becomes a phase of life that is celebrated and not dreaded.

Defining elderly

The definition of elderly is arbitrary and there is not any physiological basis for the cut-off of 60.
Chronological age is a social construct and not a biological one. Age is a multi-faceted concept, the
meaning attached old age differs from country to country. In the developed nations chronological
age of 60-65 is taken as a standard definition of old age. In contrast, in many of the developing
nations old age is considered a point after which active contribution of the concerned individual is
not possible (5.Gorman, 2000). A study by 6.Glascock (1980) categorized the definitions of old age
in three types. First, chronology; second, change in social role (i.e. change in work patterns, adult
status of children and menopause) and third, change in capabilities (i.e. caducity and change in
physical and mental characteristics). According to Glascock's (1980) cultural analysis of old age,
the predominant way of defining old age is a change in social roles, in spite of this, the western
standard of 60 years is considered the norm when referring to the elderly. Another important facet
of the concept of old age is, the self- definition of old age. It was found that as people enter old age,
their self-definitions of old age shift from multi-faceted, to ones largely focused on health status
(Brubaker, 1975, Johnson, 1976 and Freund, 1997).

What is empowerment?

Empowerment can be defined as a multi-faceted social process that helps people achieve control of
their own lives. It can have sociological, psychological, economical, health related or social
dimensions. (Page and Czuba, 1999). The precise definition of empowerment depends on the
project and the context of the project and the people involved (Bailey, 1992) . The basic questions,
that this paper intends to answer are; What is the need to empower the elderly? and What are the
barriers to empowerment of the elderly? Particularly from the weaker section. This particular paper
discusses the need to work upon psychosocial, financial and health related variables of
empowerment. The main focus of the paper is on psychosocial dimension of empowerment. The
paper also discusses the psychological implications of physical and financial limitations.

Need for empowerment.
Why do we need to empower the elderly? The clichd answer to this particular question is that one
day we will also get old. Beside this obvious fact, there are more reasons to focus on the
empowerment of the elderly, and particularly in the present scenario where we are witnessing a
decline of the traditional family unit. Many of the the sections and sub-sections of the society have
had people champion the cause of their emancipation, but elderly by large have been a neglected
group. This is a sad truth, considering that by 2050 twenty-two percent of the world population will
be above the age of 60 and in India this proportion will be 19% of the total population. This 19% of
population will have their own unique set of problems and challenges. The current Indian society is
grossly underprepared to face these challenges. There is a serious lack of understanding of geriatric
problems and also a lack of geriatric care infrastructure. The society at large also doesn't hold
favourable view of the elderly. Elderly are usually perceived to be a burden and are susceptible to
many prejudices and stereotypes which affect their self-concept, self-esteem and self- efficacy, and
by large their interaction with the society. Limitations in the financial, psychological and health
sphere contribute to the feelings of helplessness and, a lack of control over their own lives. The
efforts towards empowerment should not solely focus on provision of financial help or health care
facilities but also on creating an elderly friendly society. The most challenging and one of the most
important goal hence is fostering equity between the elderly and the young. The challenge is to
create a society where the elderly feel equally respected and valued. The succeding sections
elaborate on these challenges and need of empowerment in three spheres viz. Financial, health and
psychosocial.

Financial empowerment of the elderly
For many individuals, the defining event of crossing the age of 60 is retirement. The financial
limitations post retirement can be seen as one the biggest consequence of retirement. Unfortunately,
financial realties or rather limitations are the usual painful reminders of the 'aged' status of a person.
Most of the people in India will never retire in the conventional sense of the term because the
economic realities will force them to work till some sort of disability fires them from their job
(National Policy On Senior citizens, 2011) As people age, their health care expenditure also rises
thus increasing the burden on the already truncated income. Most of the elderly are either partially
or fully dependent on others
According to a recent estimate 65% of the elderly population in India has to depend on others for
their sustainance. Among the elderly, females are in a much worse position, only 14 to17 % in rural
and urban areas respectively, are economically independent. Males seem to be in a much better
position as compared to females 51% of males in rural areas reported that they are independent
whereas 56% of urban males reported that they are independent. Out of these economically
independent men it was found that around 90% of them had someone dependent on their income(
Central Statistics Office Ministry of Statistics & Programme Implementation Government of India,
2011). In India nearly 40% of people above the age of 60 were found to be working (Census, 2001).
It has been observed that in developed countries this ratio is a little more than 20%. Which is due to
the fact that elderly are sufficiently covered by the social security net,( Central Statistics Office
Ministry of Statistics & Programme Implementation Government of India, 2011) which is often not
the case with developing countries like India.

Its reported, that in India almost one third of population above 60 is below the poverty line(The
Ministry of Social Justice and Empowerment, 1999). Most of the people in this group don't own
any productive assests and have little to no savings. Another important fact to be considered is that
in India almost 90% of the workforce works in the unorganized sector, which means that most of
these people retire with no financial security in the form of pensions or other post-retirement
benefits. For people from weaker sections old age comes with different set of challenges. Financial
limitation of old age is a compound of increasing expenditure on health, and physical deterioration
which diminishes both ability and opportunities of gainful employment. Financial limitations also
give rise to a host of other mental, physical, emotional and behavioral problems. It has generally
been found that poverty is both, a cause and an effect of poor mental health(Langner & Michael,
1963). In a meta-analysis of articles on poverty and mental illness in developing countries by Patel
and Klienman(2003) it was reported that there is a strong association between indicators of
poverty and metal disorders. It was also reported that factors such as hopelessness, rapid social
change and risk of physical abuse and illness make them a highly vulnerable group. Old people
from the weaker sections are a high risk group; problems associated with their age, and their
economic status makes them highly likely to suffer from mental disorders.

Financial dependency of the elderly in many cases limits their life choices to a large extend and
they have to live in accord with the norms of the person they are dependent on, this causes them to
loose control over their own lives. Financial dependency among the elderly also brings along with it
a feeling of uselessness and reinforces the stereotype of elderly being a burden. In cases where the
elderly live with their children, income of the family; in case of elderly from the weaker sections, is
hardly able to provide adequate financial security. Old people are usually considered to be an
unproductive unit of the family who put undue strain on the limited family resources. This state of
financial dependency is also a source of constant insecurity and stress among the elderly.

Social security schemes of the government provide inadequate financial support to the elderly.
There are very few, and ineffective schemes of government for financial help of the elderly. There is
only one pension scheme of the government, the Indira Gandhi National Old Age pension Scheme
which provides elderly below the poverty line with 1000 rupees of pension per month(National
Policy On Senior citizens, 2011). Policies or programmes to encourage saving for old age among
weaker sections are non-existent. The only existing act that focuses on old age financial
preparedness is the Employees Provident Fund and Miscellaneous Provisions Act (EPFMP), which
covers only 11% of the working Indian population and does not cover people working in the
informal sectors, to which most of the people from the weaker sections belong. There is a great
need for government to encourage long term saving and provide mechanisms for long term saving,
so that, the elderly can live a life of economic security, independence and respect.

Psychosocial empowerment

The concept of old age is a social construct, and just like many social groups old people also are
victims of stereotypes and prejudices. Stereotypes are fixed, and overgeneralized view of a group or
a category of people (Cardwell, 1996). Elderly are not just the victims of their physical limitations
but also of the limits which society puts on them. Old people are often seen as dependent, helpless,
unproductive and demanding rather than deserving. Just like sexism and racism these stereotypes
about old people are reflected in the discriminatory behavior of people towards them. This
discrimination; based on stereotypes and prejudices about elderly is known as agesim. Agesim
discriminates, restricts and dehumanizes individuals based on their age. Agesim has developed
because of the tendency of our society as a whole to view old people as inferior to young people, in
other words agesim is a consequence of our youth centric society.

Agesim stems from the stereotypes and prejudices about old people. Elderly are usually percieved
to be rigid and inflexible. In a study it was found that many people believe that elderly are set in
their ways and they find it difficult to change or to understand the viewpoint of others (Hummert,
1990). This negative stereotype of the elderly hampers their interaction with the younger
generation. Elderly, because of the physical, financial and socio-cultural limitations are usually
isolated from the mainstream society. The negative stereotype of rigidity of the elderly further
hampers their interaction with the younger generation. which causes old people to loose track of the
recent normative changes in the society and hence hampers their ability to understand and adapt.
The elderly are rigid, not because of their inherent rigidity but because of the lack of information
and understanding of the new norms, thus rigidity in elderly can be seen as arising from a cycle
initiated by the stereotype of rigidity. This stereotype of rigidity also effects the perception of old
people in family and in the workplace. Example, A study by Hayward et al. (1997) reported that 30
% of managers percieved that elderly employees were difficult to train. Another negative stereotype
of the elderly is the stereotype of elderly being despondent (Hummert, 1990). They are viewed as
being useless and are considered a burden to the society. The picture usually associated with a old
person, is of a pitiful, sad and neglected individual who is dependent on his/her children for
survival. This negative stereotype not only affects the view of the society towards the elderly but
also the self-perception of the old people. Old people internalise this stereotype and behave in a
stereotype consistent manner. This causes them to form a negative view of self which leads to low
self-esteem and low levels of self-efficacy among the elderly. They start viewing themselves as
useless, which has adverse effects on all domains of their life ranging from their health to their
relationships. To study the effect of age-related stereotypes on cognition, a study by Levy (1996)
used the subliminal priming procedure to see whether the performance of old people in a memory
task is affected by the activation of the elderly stereotype. Groups of elderly were exposed to
positive-age stereotypes and negative age stereotypes.It was found that the group exposed to
negative-age stereotypes performed much worse compared to the group exposed to positive-age
stereotypes on four memory tasks. In an another study; examining age-related stereotype's influence
on walking of the elderly, it was found that participants who were exposed to positive aging
stereotypes showed a signicant increase in swing time and gait speed.(Swing time is the time a
person takes to lift the foot off the ground; greater swing time indicates better balance) (Hausdorff,
Levy, & Wei, 1999). Negative age related stereotypes also have an affect on the health of the
elderly. It was reported that in medical settings, the health problems of elderly are not taken very
seriously because their signs of illness are usually dismissed as being a general consequence of old
age(Hummert, 1999;Kemper, 1994;Ryan, Meredith, and Shantz, 1994.) This health related
stereotype of the elderly not only taints the views of medical care personnel, but also the elderly's
view of normal ageing, they may not seek treatment for their ailments because of their own
stereotypes about ageing. As illustrated from the examples above the stereotypes of elderly not only
shape the society's view of the elderly, but also the elderly's view of themselves. Internalizing of the
old age stereotype begins in childhood because of the information present in the environment.
(DePallo et al., 1995). When people reach old age these age-related stereotypes which have been
reinforced for many years become self stereotypes(Snyder & Miene, 1994). In a study of implicit
attitudes it was found that old people had a negative view of old age and elderly, which was
almost similar to the view that young people had of elderly (Nosek et al., 2002b). Self
stereotypes of ageing may be aquired in two stages. First, when an individual reaches the age that
is formally defined by institutions(eg. Retirement age of 60) or informally defined by the society
as old age, as a consequence the concerned individual transitions to the elderly group. This change
in group membership is imposed and artificial rather than willingly accepted by the target (Sherif,
1953). In this stage the transition of ageing stereotypes to self stereotypes is caused by other
people's perception of an individuals' group membership. The second stage is the identification
stage, where an individual starts identifying himself as being part of the aged group. At this point
there is an acceptance of ones aged status (Hyman, 1942). This acceptance and realization of one's
aged status is facilitated by cues from the environment (eg. Expectations of people, changing social
roles, the image of aging in media) and also the physical changes that accompany old age (eg.
Wrinkels, menopause in case of woman, lose in dexterity of the limbs, weakning eyesight).

The stereotypes of the elderly affect the viewpoint of society regarding them and thus the
interaction and behavior towards the elderly, it also imposes artificial limitations on the elderly. For
empowerment to be possible in true sense of the word an understanding of age-related stereotypes
and their effects is required. There is also a greater need for sensetization of the younger generation,
Also there is a need for encouraging interaction between old people and the young generation. So
that young people can have a better understanding of old people. This will not only help the elderly
but also the younger generation because one day they also have to face old age.

Another problem which the elderly face is the problem of isolation and loneliness. Isolation and
lolniness are two related but different concepts. social isolation is an objective measure of social
interaction (number of personal contacts) and is sometimes referred to as aloneness or solitude (Hall
and Havens, 1999). Social isolation can be objectively measured by observing an individuals social
interaction and network. Loneliness on the other hand is subjective, loneliness is a person's
perception of the adequacy of his social relationships, in terms of quality or quantity. Feeling of
loneliness can arise if the number of relationships is smaller than expected or the quality of the
existing relationships is inferior to, what is desired (de Jong-Gierveld and van Tilburg ,1999). Victor
et al (2000) defined loneliness as incongruency between the desired interaction and the actual
interaction. Loneliness is often viewed as the subjective counterpart to social isolation and the
antithesis to social support (Victor, Scrambler, Bond and Bowling, 2000). The negative subjective
evaluation of social isolation leads to feelings of loneliness.

The nature of the familial unit is changing in India. There is a rapid transition from the joint family
system to a nuclear family system. Previously the needs of the elderly were being taken care of by
the family, but due to the changing family structure traditional modes of care are no longer feasible,
especially so with dual career families, where both husband and wife work. Traditionally in India
and many other countries, it was women who took care of the elderly, but now many of the women
work and they cannot look after the elderly. Due to the changing social fabric and an era where
twenty-four hours are not enough, no one has time for the elderly. Some risk factors that may lead
to social isolation and loneliness among elderly are gender, health, death of a spouse, disability, and
reduced social networks among others. Health seems to play a large role as a risk factor of isolation
and loneliness among the elderly, however there still is ambiguity regarding the direction of the
causal relationship; It's still disputed whether loneliness causes health problems, or health problems
lead to loneliness. Several researchers have noted an association between poor self-rated health and
increased loneliness (Mullins, Smith, Colquit and Mushel, 1996; Kivett, 1979; Hall and Havens,
1999; Mullins, Elston and Gutkowski, 1996; Tijhuis, deJong-Gierveld, Feskens and Kromhout.
1999). It has been reported that disabilities (or embarrassment because of physical limitations) and
poor health increase levels of loneliness and social isolation. Social isolation had similar predictors
such as poor perceived health (Hall and Havnes, 1999), a higher number of chronic illnesses (Hall
and Havens, 1999), compromised mental health (Victor, et al, 2000) and poor general health (Victor,
et al, 2000; van Baarsen, 2002; Havens and Hall, 1999). When analysing gender as a risk factor
Many studies point to women as being more at risk of loneliness and isolation than men (Kivett
1979). However, this may not be entirely accurate because of the interactions of loneliness with
other risk factors that disproportionately affect women. For example, the death of a spouse and
living alone are significant additive risk factors for loneliness and isolation (Hall and Havens,
1999). Both being widowed and living alone in later life are more common among women. Lose of
spouse also leads to isolation and loneliness. A vast body of literature points to the loss of a spouse
or intimate relationship as a strong determinant of both loneliness and social isolation (Havens and
Hall, 2003; Berg, Mellstrom, Persson and Svanborg 1981; Mcinnis, 2000; Chipperfield and Havens,
2001; Kivett, 1979; Tijhuis et al 1999; Koropeckyj-Cox, 1998; Davidson and Lopata as cited in Hall
and Havens, 2003). One study determined that the relationship between marital status and
loneliness was stronger than its relationship with social isolation. Events such as widowhood
emphasize that bereaved persons are especially vulnerable for emotional isolation (loneliness)
rather than social isolation (van Baarsen et al, 1999). Much of the literature also associated few or
reduced social contacts with family and friends with loneliness (Havens and Hall, 1999; Mullins,
Elston and Gutkowski, 1996; Berg et al, 1981; Victor et al, 2000). Many of the negative stereotypes
of the elderly are also responsible for their social isolation and feelings of loneliness. Stereotypes
lead to a reduction in both number and quality of interactions elderly have with people around them.

Social isolation and loneliness has many disadvantages. World Health Organisation (2003) reported
that social isolation and exclusion are associated with increased rates of premature death, lower
general well-being, more depression, and a higher level of disability from chronic diseases (p.16).
The elderly clearly value their social relationships as those age 65 years and over consistently
ranked relationships with family and friends second only to health as the most important area of
life (Victor et al, 2000 p. 409). s. Litwin (1997) found that old frail seniors with an attenuated
network have a very low rate of utilization of health services even though they may have the highest
need. Social isolation may also lead to a great deal of anxiety and stress due to insecurity arising
from social isolation.

In India about 2-3% of elderly men live alone while another 3% live with other relations and non-
relations. Among elderly women, 7-8% live alone and another 6-7% reported to live with other
relations and non-relations ( Central Statistics Office Ministry of Statistics & Programme
Implementation Government of India, 2011 p. 21) . This scenario has resulted mainly from the
change in the family structure. According to census 1981, In India the average number of people in
a family was 6. According to recent estimates it has reduced to 4. It was also found that Older
people from weaker sections and with a long term illness are almost three times more likely to feel
isolated as compared older people in general (31% compared to 10%) (HelpAge India, 2008).
Women specifically are a high risk group because of an increased liklihood of widowhood. It was
reported that less than 40% of women live with their spouses, compared to them more than 75% of
men lived with their spouses ( Central Statistics Office Ministry of Statistics & Programme
Implementation Government of India, 2011). Though 20% of aged men and about half of the aged
women live with their children it doesn't necessarily mean that they are satisfied with the quality of
social interaction they have. As already mentioned above, isolation and loneliness are two related
but different constructs, therefore it is possible for an elderly to not be objectively isolated but still
have feelings of loneliness. According to a survey by HelpAge India (2008) in Delhi and Mumbai,
21% of the elderly surveyed feel lonely and socialise with very few people, not even with their own
children. 12% (1 out of 8) older people said no one cares they exist and 13 % feel trapped within
their own homes. social isolation and loneliness are issues that need immediate attention if we are to
improve the quality of life of the elderly.

Health
The WHO constitution states "the enjoyment of the highest attainable standard of health is one of
the fundamental rights of every human being. It seems as people age they start losing this basic
human right, both because of biological factors and also through neglect. As people age the most
significant and explicitly observable change is the change in the health status of an individual.
Elderly become more succeptible to chronic as well as common health problems besides the
disabilities arising out of old age. Arthritis, rheumatism, heart problems and high blood pressure are
the most prevalent of chronic diseases affecting the elderly. Majority of the elderly in India were
found to be facing heart problems, number of elderly suffering from heart diseases is less in rural
areas compared to urban areas. This difference can be attributed to the different lifestyles of urban
and rural dwellers. Urinary problems are the second most prevalent chronic conditions among the
elderly in India. Followed by diabetes, hypertension and ulcer (Central Statistics Office Ministry of
Statistics & Programme Implementation Government of India, 2011). What is interesting here is
that all of these problems are lifestyle diseases. Although these problems are consequences of
physical deterioration from old age, but maladaptive lifestyle habits also are major causal factors of
these diseases. Many of these problems can be controlled (if not completely solved) by improving
the lifestyle habits of the elderly like daily exercise, improved eating habits, decreasing the use of
tobacco, alcohol or drugs among others. Disabilities also are a major physical problem of old age.
Disabilities arising from old age involve, loco-motor disabilities, hearing and vision impairments,
mental illness and mental retardation. The most common of disabilities among the elderly were
locomotor disabilities, followed by hearing disabilities (NSS, 2004).
Another factor taken into consideration when talking about health issues is; feeling healthy, that is,
the perception of an individual about his/her own health. According to a nss survey (2004) on the
perception of the elderly about their own health, it was reported that a high percentage of elderly
were satisfied with their health condition. In rural areas 55% of people with sickness and 77% of
people without sickness felt that they were in good or fair amount of health. In urban areas; 63% of
people with sickness and 78% of people without sickness reported feeling satisfied with their health
status. Though a large percentage of elderly seem to be satisfied with their health but that doesnt
necessarily mean that they are in good health. It should be noted that in the case of elderly most of
the physical ailments are not taken seriously and are usually dismissed as normal consequences of
aging. This tendency calls for an effort for increasing the understanding and the awareness among
the elderly abut normal aging. Efforts have to be made to encourage elderly to go for regular check-
ups and also in making health care facilities accessible and affordable.












































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