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Session 5: Combating Loneliness and Depression in Old Age

Debomita Sikdar, Lecturer, Department of Home Science, Calcutta University

Abstract In the present study an effort has been made to find out the different factors responsible for high level of loneliness and depression among the institutionalized aged. This is to find out strategies for combating loneliness and depression among elderly.

The sample consisted of 100 elderly persons between the age group of 60 to 90 years both from old age homes and the elderly living with family members in their own homes.

Results revealed that greater loneliness was associated with less friendship contacts, fewer close relationships, low marital status, lower life satisfaction, widowhood, poor income and poor physical health, retirement from work, death of a spouse or some sort of physical health. Retirement from work, death of a spouse or some sort of physical illness or defect may lead to depression in elderly.

Keywords Loneliness, Depression, Old Age, Institutionalized Aged, Non-Institutionalized Aged

Introduction

The development of modern science and technology has increased the lifespan of the individuals, on the one hand thus making ageing problems much more complicated. The joint family system, which avoided loneliness of the old persons and provided them ample security, is gradually breaking down. The emerging trends of nuclear families are keeping the elderly in a state of isolation. Thus, as society is advancing, old aged people are facing more medical, economic, social and psychological problems.

Today, the biggest problems of elderly include solitude, loneliness, isolation, depression, neglect and a sense of not being wanted. Rapid increase in the number of nuclear families, urbanization and the global nature of employment opportunities are facing a change in this implicit social contract. These changes are compelling the elderly to live alone or in old age homes.

Loneliness among the aged

Loneliness among the elderly has been associated with perceived social isolation, lack of integration into social network and role loss, it is also due to widowhood, retirement, loss of family members and friends, which involve the disruption of supportive relationships. Moreover, in advanced age physical and sensory functions decline which limit mobility and communication, which further add to loneliness. Loneliness in older people has been found to be associated with decreased income, having fewer friends, lower satisfaction with relationships etc. Elderly experience more loneliness due to the death of their spouse or their children might be in distant cities or on account of physical disabilities (Peplau et al, 1982). Weeks (1994) reviewed the concepts of loneliness with particular reference to old age and suggested that successful treatment of loneliness with particular reference to old age and suggested that successful treatment of loneliness in life reduces the risk of more serious complications, such as, feelings of worthlessness, decrease in social contacts, self-contacts and self-esteem and trust. Rokach (1996) proved that loneliness at any level can be reduced by acceptance and reflection, social interaction and increased activity.

Depression among the elderly

Depression is a common complaint of the aged and is caused by multiple factors, such as, biological, physical, psychological and social. Depression in old age often appears to be precipitated by the adverse changes in the life and circumstances of the elderly, such as, retirement from work, bereavement or the onset of some sort of serious physical illness or defect. Older people with simpler depressive reactions become slower in their thoughts, words and actions, unable to sleep, overly concerned about their physical condition and uncertain of themselves.

From the studies reviewed it is inferred that loneliness and depression is common among the elderly. Old age is characterized by insecurity, poor health, loneliness and depression, hopelessness along with failing physical and mental powers. Hence, this study has been attempted to find out the different factors responsible for high level of loneliness and depression among the institutionalized aged and to suggest ways for combating loneliness and depression among the elderly.

Objectives

The following objectives were:

To find out the different factors responsible for high level of loneliness among the institutionalized aged.

To find out the different factors responsible for high level of depression among the institutionalized aged.

To suggest ways of combating loneliness and depression among the elderly;

In the present study among all aspects of personality problem only loneliness and depression of elderly persons both living in “old age homes” and in “own homes” have been considered.

Methodology

Sample The investigation was carried out on a sample of 100 persons ageing 60 years and above. Out of 100 samples, a group of 50 elderly (25 males and 25 females) were selected from old age homes and the rest 50 elderly (25 males and 25 females) were selected from their own home living with family members in North Kolkata .

Tool used
The present study employed the following tools for data collection;

General Background Schedule, The Revised UCLA Loneliness Scale and The Beck’s Depression Inventory

General Background Schedule
A general background schedule for respondents have been used on certain demographic variables such as age, sex, educational background, marital status etc. This information schedule was designed by the investigator to gather demographic personal, economic and socio-cultural information from the subjects required for the study.

Revised University of California at Los Angeles (UCLA) Loneliness scale- Loneliness was measured by revised UCLA Loneliness scale. This is a 20-item self-report on which respondents have often expressed their feelings of isolation and dissatisfaction with social relationships and 10 statements dealing with satisfaction of one’s social relationships and 10 statements dealing with dissatisfaction of one’s social relationship. Participants indicated how frequently they experience each item on a scale from 1 to 4, corresponding to ‘never’, ‘rarely’, ‘sometimes’ and ‘often’ respectively. Split-half reliability in Indian context was 0.71 (Jha, 1988)

The Beck’s Depression Inventory (BDI)
The BDI is a self-report measure of depression. It contains 21 items, scored 0 to 3, of which 15 items deal with ‘psychological symptoms and only 6 items are concerned with somatic symptoms. It has high reliability and validity. The maximum score is 63.

Statistical Analysis
From the collected data loneliness and depression scores were found out. Mean depression and loneliness score of male and female respondents were calculated separately and percentages were found out.

Result and Discussion

Loneliness occurs whenever there is a discrepancy between one’s desired and one’s perceived or actual relationships (Peplau and Perlman, 1979). Therefore, loneliness results from deficiencies in the person’s social relations. Secondly, loneliness is a subjective phenomena (i.e. people can be alone without being lonely), and thirdly, loneliness is unpleasant and distressing.

Depression is a feeling of sadness, hopelessness, worthlessness and a feeling of self-reproach (Rosenfeld, 1985). Depression was found to be related to poorer financial status, less satisfying interpersonal relationships and poor physical health.

Depression and loneliness co-occur and the measures of the two states are substantially correlated. Bragg (1979) did a comparative study on loneliness and depression. Results indicated that loneliness and depression were significantly correlated (r = 0.49) but had different correlates.

Depression was associated with anger and dissatisfaction with the non-social aspects of life but loneliness was not. Loneliness was associated with low initiation of contact with friends, but depression was not.

Table No. 1

Mean scores for Institutionalized & non-institutionalized aged on loneliness and depression

Variables
Sex
Institutionalized
(Mean score)
Non-institutionalized
(Mean Score)
Loneliness
50 males
36.62
32.71
50 females
38.21
35.35
100 samples
37.41
34.03
 
Depression
50 males
15.85
12.44
50 females
14.42
14.84
100 samples
15.135
13.64

Table No. 1 shows that the mean loneliness score of the institutionalized aged is higher (X=34.03). This mean that institutionalized aged feel lonelier than the aged living with family.

The mean depression score of institutionalized aged (X= 15.14) and non- institutionalized aged (X=13.64) show that institutionalized aged feel more depressed than the non- institutionalized aged.

The high level of loneliness in the institutionalized aged could be due to the following reasons:

i. The institutionalized aged have been left in the institution by their families or relatives and they feel they have been abandoned and thus, are not needed or loved, which probably leads to greater feelings of loneliness and depression.

ii. The institutionalized aged have low or practically no income of their own, which probably makes them feel that because of the lack of income they are institutionalized and as a result they feel lonelier.

iii. Majority of women were either illiterate or had very few years of schooling, as a result they could not read newspapers, magazines or books and therefore felt more lonely.

iv. Loneliness might reflect the lack of a significant caregiver, i.e. a high level of loneliness may result in institutionalization for those who have no one in the home to provide care for.

v. Moreover, in advanced age physical and sensory functions decline which limit mobility (e.g. driving, walking) and communication (e.g. less ability to see or hear a voice on the telephone), which further adds to loneliness.

The high level of depression in the institutionalized aged could be due to the following reasons:

i) Lack of family and work roles among the institutionalized aged could be another cause of depression. The majority of the institutionalized aged in this study were either widows or widowers, thus they lacked a satisfying interpersonal relationship in a life partner.

Conclusion

The present study can be summarized with the inference that institutionalized aged have greater feelings of loneliness and depression. Greater loneliness was associated with less friendship contacts, fewer close friends, social anxiety, low marital satisfaction, low life satisfaction, widowhood, poor income and poor physical health. Retirement from work, death of a spouse or some sort of serious physical illness or defect may lead to depression in elderly. However, in spite of the fact that the elderly living in families are psychologically healthy than the elderly living in institutions, for the aged old age homes are slowly becoming a socially acceptable option with the joint family system breaking down and family members failing to provide the support.

Strategies to combat loneliness and depression

Keep Busy
If you are lonely, do with eagerness whatever is in front of you to do: write letters, visit people, take up a hobby, start collecting something of value. Keep busily involved in everything that gets your attention. Cure loneliness by keeping busy.

Involve yourself
If you are lonely, involve yourself in community affairs. Many times when people retire they find themselves in a burned –out condition. Involvement in work keeps one away from loneliness and depression.

Help others
If you are lonely, look for and strive to cure the loneliness of someone else-It will cure your own. There are thousands of people who need help, find them and help them by providing companionship.

Choose to be happy
If you are lonely, you are probably depressed and unhappy. Choose to be happy in difficult circumstances.

Avoid escapes
If you are lonely, avoid day dreaming, sleeping too much and watching TV as it is harmful. TV can be a life-saver on occasions, but constantly watching TV leads t depression and loneliness. Discuss with others about your problem, and try to find out solutions yourself.

Collect good thoughts
If you are lonely and depressed, collect inspirational thoughts, good religious books, literary works, read novels etc. Read lots of good books and magazines if you can; if you can’t, have someone read to you. Collect good thoughts to share with those people who come your way.

Join a social group
If you are lonely, join one of the many social groups in your community. Visit Senior Citizen Clubs and meet new people. Join religious groups and enjoy long hours with them.

Loneliness is often caused by wanting people to do something for us. When we do things for other people, we are never lonely. Think around towards all the exciting things of life and avoid thinking too much about yourself and your loneliness and depression will disappear.

Loneliness generally occurs at specific times of the day or during specific days. Planning for the holidays, birthdays and anniversaries in advance makes you involved, active and busy. This provides a very effective means of dealing with loneliness.

Retirement brings a sense of identity crisis, which adds up to depression. Therefore, it is very important to plan much earlier about the post-retirement life, regarding both financial and emotional aspects. Consult your financial planner to work out the financial issues of retirement. You need to consider the size of your pension schemes, make plans regarding insurance, which includes insuring your health, plans for saving and assets and investment plans as well.

The key to being happy post-retirement is an essential attitudinal change. It may be spending time with your pets, enjoying with grandchildren, gardening, volunteering in residence welfare associations, join NGOs, following past hobbies such as photography, educating children or writing. Or you may simply seek diversion in the daily pleasures, such as, walking, reading, listening to music, surfing the net, and so on. For women retirees, it is necessary that you go out at least once in a day, leaving the household and its chores from occupying centre-stage. Spouses can then join hands to simply enjoying leisure and even travel together, thereby ensuring a blissful marital life. It is also important to get regular health and medical check-ups. Retiring can be fun. It is not a halt to a journey but merely a shift in gears and speed. Even after retirement one may stay forever young and happy.

Bibliography

Birren, J.E.; (1996), Encyclopedia of Gerontology – Age, Aging & the Aged, Volume I & II, USA : Academic Press

Dhillon, P.K. Psychosocial Aspects of Aging in India. New Delhi : Concept Publishing Company. 214-240

Mallick, A. (2006) “Dealing with Loneliness in Elderly”. Help-Age India – Research & Development Journal. Vol.12 (3), Pg. 32-35

Prakash, I.J. (1999) Ageing in India. Geneva. WHO Report.

A study on different Government Benefits to Senior Citizens and their inadequacy

Sri Debdulal Chatterjee, Department of Commerce, Netaji Nagar Day College

Abstract There are so many works and researches having been done by different researchers on gerontological studies, but no one suggested and proposed regarding the different benefits to the senior citizens of our society on their mediclaim / medicare. In this paper the discussion is made on different benefits given to senior citizens regarding mediclaim and medicare and also:-

  • Summary of benefits given to senior citizen by different ministries and department.
  • National Policy for older person.
  • New Mediclaim policy for senior citizens launched by insurance companies.
  • Different Direct Tax Benefits.
  • Reverse Mortgage to be launched by National Housing Bank

IntroductionThe three main requirements of elderly people today are social, health and financial security. At present in our society the family means a nucleus form which is the effect of urbanization and socio-economic condition. As an effect of the above situation the elderly people are forced to leave alone which creates the loneliness and also economic problems. They are not at all conscious about the different policies taken by the Central and State Government in respect to senior citizens to provide basic benefits like health care, food, housing and insurance etc.

In India, traditionally, we had a strong and sound joint family set up. The elderly man in the family was considered a part of the family. Not only did he receive respect from other members, but also he exercised authority on the affairs of the entire family. Thus the family felt it was its responsibility and obligation to look after him. In the recent past, the joint family system got disintegrated and the elderly person was left to take care of himself on his own. Thus he had to face various hardships while spending the evenings of his life. Young people now see senior citizens as a burden. The respect they once enjoyed in the joint family is slowly disappearing. Many suffer mental and physical abuse. In Mumbai, a man and his wife locked their house before they left it turning the 68-year old mother out of the home with food and water for the day. She was let in only when they returned from work in the evening. This was allegedly in her “own interest” as stated by them. She was absent-minded and they feared she could even forget to switch off the gas. Ironically, the old lady was the owner of the property. Her neighbors complained to the police who intervened later.

Demographic ageing is a global phenomenon. India is still poised to become home to the second largest number of older persons in the world. Projection studies indicate that the number of 60+ in India will increase to 100 million in 2013 and to 198 million in 2030. The special features of the elderly population in India are:-

  • A majority (80%) of them are in the rural areas, thus making service delivery a challenge,
  • Feminization of the elderly population (51% of the elderly population would be women by the year 2016).
  • Increase in the number of the older-old (persons above 80 years) and
  • Large percentages (30%) of the elderly are below poverty line.

International comparison of average annual increase rates (%) of elderly populations

“We did not even have a policy for senior citizens till 1999. Since we have a tradition of joint families and caring at home for our senior citizens, this was not really a major concern till migration of adult children started from villages in the big cities and children started going abroad for studies and work…” Only government servants are entitled to pension. This means that literally 70 percent of the Indian population gets no pension – not even those who have worked in the corporate sector for 30 to 40 years. Most senior citizens are dependent on their savings or their provident fund and gratuity, whose value is shrinking by the day. The interest rates on bank deposits have shrunk from 12 percent to six percent. So the money available after retirement is further reduces because of the poor return from investments.

Medical care is a big problem. With increasing cost of living, they are uncertain about their future and that of their children. Though mediclaim facilities have been available for some years now, the premium for those over 55 is high. In fact, they expect for the Defence Forces, there is no health care support system for the aged.

A) Benefits given to senior citizens by different Ministries / Department

Sl. No. Name of the Ministry / Department Facilities / Benefits given to Senior Citizens
1. Ministry of Social Justice and Empowerment

Ministry of Social Justice and Empowerment is the nodal Ministry responsible for welfare of the Senior Citizens. It has announced the National Policy on older persons which seeks to assure older persons that their concerns are national concerns and they will not live unprotected, ignored and marginalized.

The National Policy on older persons confers the status of senior citizen to a person who has attained the age of 60 years. The Ministry has also written to all the Ministries / State Government concerned for adopting a uniform age of 60 years for conferring the status of senior citizen to a person and for extending facilities / concessions to them.

The Ministry is also implementing following schemes for the benefit of Senior Citizens:

a) The Scheme of assistance to Panchayati Raj institutions/ voluntary organisations / self-help groups for construction of old age homes/ multi-service centres for older persons.

b) An integrated program for older persons.

2. Ministry of Rural Development Under the National old age pension scheme, Central Assistance of Rs. 75/= p.m. is granted to destitute older persons above 65 years. This scheme has been transferred to the state plan w.e.f. 2002-03. Under the Annapurna Scheme, free food grains(wheat or rice) upto 10 kg. per month are provided to destituteolder persons 65 years or above who are otherwise wligible for old age pension but are not receiving it .
3. Ministry of Finance

Income Tax Act provide upto 1.85 lacs income tax free to senior citizens who have attained the age of 65 years at any time during the relevant previous year.

Senior citizens are excluded from "one by six" schemes for filing the Income Tax return under provision Section 139(1)

For senior citizen, the deduction in respect of medical insurance premium is up to Rs. 15,000/- under section 80D.

RBI has permitted higher rates of interest on saving schemes of senior citizens (persons having the age of 65 years and above). Accordingly banks permitted 0.5% higher rate of interest on fixed deposits.

Separate counters are marked for senior citizensat the time of the Income Tax returns. Senior citizens above 65 yearsas on 31 March of the assessment year must be a pensioner and should come personally, get priority while submitting their Income Tax returns. Besides, on the spot assessment facility is also provided.

4. Ministry of Health and Family Welfare The Ministry (on request from the Ministry of social Justice and Empowerment) has issued instructions to all State Government to provide for separate queuesfor older persons in hospitals for registration and clinical examination.
5. Ministry of Railways

Indian Railways provide 30% concession in all classes and trains including Rajdhani or Shatabdi trains for both males and females aged 60 years and above.

Indian Railways also have the facility of separate counters for senior citizens for purchase/ booking / cancellation of tickets.

6 Ministry of Civil Avaition Indian Airlines or Jet Airways are providing 50% discount on basic fare for all domestic flights in economy class to senior citixzens having attained the age of 65 years (men and women). Sahara India Airlines is providing 50% discount on basic fare for all domestic flights to senior citizens having attained the age of 62 years (men and women).
7. Ministry of Road Transport and Highways Reservation of two seats fore senior citizens in front row of the buses of the State road transport undertakings( ASTRU)
8 Miscellaneous Telephone connection is given on priority to senior citizens of age 65 years and above by the Ministry of Telecommunications. On the request of the Ministry of Social Justice and Empowerment, the Hon’ble Chief Justice of India has advised Chief Justices of all high courts in the country to accord priority to cases involving older persons and ensure their expeditious disposal

•  National Policy for Older Persons

The National Policy for Older Persons (NPOP) was announced in January, 1999, with the primary objective viz. to encourage individuals to make provision for their own as well as their spouse’s old age; to encourage families to take care of their older family members; to enable and support voluntary and non-governmental organizations to supplement the care provided by the family; to provide care and protection to the vulnerable elderly people, to provide health care facility to the elderly; to promote research and training facilities to train geriatric care givers and organizers of services for the elderly; and to create awareness regarding elderly persons to develop themselves into fully independent citizens.

Steps already taken for implementation of NPOP

National Council for Older Persons (NCOP) is the highest body to advice and coordinates with the Government in the formulation and implementation of policy and programs for the welfare of the aged. It has been re-constituted in 2005. The areas of concern have been emphasized include:

•  Uniform age of 60+ for extending facilities / benefits to senior citizens

•  Financial security to the elderly population by:

•  Proposing tax benefits and higher interest rates for senior citizens

•  Promotion of long term savings in both rural and urban areas

•  Increased coverage and revision of old age pension schemes for the destitute, elderly and

•  Prompt settlement of pension, provident fund, gratuity and other retirement benefits;

•  Health care and nutritional needs of the elderly population by:

•  Strengthening of primary health care system to enable it to meet the health care needs of older persons;

•  Training and orientation to medical and para-medical personnel in health care of the elderly

•  Promotion of the concept of the healthy ageing.

•  Assistance to societies for production and distribution of material on geriatric care,

•  Provision of separate queues and reservation of beds for elderly patients.

•  Food security and shelter by:

•  Coverage under the Antyodaya Scheme to be increased with emphasis on provisions for the benefit of older persons especially the destitute and marginalized sections,

•  Earmarking ten percent of houses/house sites for allotment to older persons

•  Barrier-free environment for the disabled and elderly persons etc.

•  Meeting the education, training and information needs of older persons.

•  Identification of the most vulnerable among the older persons and working for their welfare.

•  Realizing the crucial role by the media in highlighting the situation of older persons and emphasizing their continued role in Society

•  Protection of life and property of the elderly population

The Ministry has also set up Inter-Ministerial Committee (IMC) for ensuring speedy implementation of the decisions taken in the meeting of the National Council for Older Persons and also to review the progress. In many cases, the activities have to be initiated by the other Ministries / Department and, therefore, a combined effort by all the Ministries / Departments is required to implement the National Policy on Older Persons.

For the benefit of Senior Citizens following scheme has been implemented:

•  Integrated Program for Older Persons – This scheme has been formulated by revising the earlier scheme of “Assistance to Voluntary Organizations for Programs relating to the Welfare of the Aged”. Under this scheme, financial assistance up to 90% of the project cost is provided to NGOs for establishing and maintaining old age homes, day care centres and mobile medicare units and to provide non-institutional services to older persons. The budget allocation during 2005-2006 was Rs. 19.80 crores which was revised and the RE was Rs. 14 crores, against which the expenditure was Rs. 14 crores. The budget allocation for the year 2006-07 is kept at Rs. 28 crore.

•  Scheme of Assistance to Panchayati Raj Institutions / Voluntary Organizations / Self-Help Groups for construction of old age homes / multi service centres for older persons.

Under the scheme, one time construction grant for old age homes/multi-service centre is provided. The registered societies, public trust, Charitable Companies or registered Self-Help Groups of Older Persons in addition to Panchayati Raj Institutions are eligible to get the assistance under this scheme. Against the budget allocation during 2005-06 of Rs. 67 lakhs, the expenditure was Rs. 47 lakh.

VARISHTHA Mediclaim for Senior Citizens by National Insurance Company

Medical insurance (an improbability after 60years) and rising healthcare costs put seniors in a spot. Government has finally taken note and introduced a special health insurance scheme for senior citizens. For this purpose Varishtha Mediclaim has been launched by National Insurance Company earlier this year. Government has directed all other public-sector insurance companies, such as New India Assurance, Oriental Insurance Company and General Insurance Company, to come up with similar versions.

Major points for Varishtha Mediclaim Policy-

•  Under this scheme, fresh health insurance policies may be issued to people up to 80 years of age, the policy is renewable up to 90 years of age.

•  The policy has two sections, Section I covers Hospitalization & Domiciliary Hospitalization Expenses and Section II covers expenses for treatment of critical illnesses. Critical illness cover is optional.

•  Sum Insured (S.I.) is fixed under section I is Rs. 1, 00,000 and under section II is 2, 00,000.

•  Pre-existence diseases except malignant diseases will be covered – under section I after one claim free year.

•  Pre-existing Diabetes & Hypertension (excluding any ailment already manifested due to Diabetes & Hypertension) can be covered from the inception of the policy on payment of additional premium.

•  Cumulative Bonus @ 5% of S.I. for each claim free year up to a maximum of 50% of S.I. or 5% discount in renewal premium will be allowed in respect of each claim free year.

•  Under section I, Ambulance Charges up to a maximum of Rs.1000 in a policy year will be reimbursed.

•  Cost of Health check up @2% of average S.I. at the end of the block of 3 underwriting years.

•  Under Section I, Hospitalization expenses of person donating an organ during the course of organ transplantation will also be payable.

•  Cashless Access service available through TPA ( Third Party Administration )

Critical Illnesses are as under:

•  Coronary Artery Surgery

•  Cancer

•  Renal Failure i.e. Failure for both kidneys

•  Stroke

•  Multiple Sclerosis

•  Major Organ Transplants like kidney, Lung, Pancreas or Bone marrow

•  Paralysis and blindness at extra premium

Domiciliary Hospitalization benefit means medical treatment for a period exceeding three days for such illness/disease/ injury which in the normal course would require care and treatment at a Hospital / Nursing Home but actually taken whilst confined at home in India under any of the following circumstances, namely:

•  The condition of the patient is such that he /she cannot be removed to the Hospital / Nursing Home or

ii) The patient cannot be removed to Hospital / Nursing Home for lack of accommodation therein

Premium for different age group
Premium on VARISTHA Mediclaim for Senior Citizens
by National Insurance Company

Age Group
Premium on sum insured
Mediclaim (1,00,000)
Critical Illness (2,00,000)
Total
60-65 years
4180
2007
6187
66-70 years
5196
2130
7326
71-75 years
5568
2200
7768
76-80 years
6890
2288
9278

Pre-existing diseases of Hypertension and /or Diabetes from the inception of the policy he / she has to pay additional premium @ 10% for either hypertension or diabetes & 20% for hypertension & diabetes for first year of the policy.

Paralysis and Blindness may be covered under Critical illness by loading the Critical illness premium by 15% in each case or 25% in case of both covers together.

From the above discussion we see that the upper limit on amount insured is Rs.100,000 (Rs.200,000, if you opt for ‘critical illness’ option ), which seems quite inadequate considering today’s healthcare costs. The premium (inclusive of critical illness cover) ranges from Rs 6,187 per year for the age group 60-65 to Rs 9,178 for those in the age group of 76-80. Nearly 76%, Indians live without an insurance cover. (News published in 7 July 2007, The Statesman, Col – 1, Page 8). Nearly 30% of the elderly people are below poverty line. According to survey report conducted by teachers, non-teaching staff and students from Netaji Nagar Day College and Computer Centre under the leadership of Dr. Dilip Kumar Chakraborty in 2003-2004 in the urban areas in West Bengal 51% had yearly household income below 30,000. In such a situation large section of the senior citizens is deprives of getting such benefits. The government should consider the matter for increasing premium for upper age group so that at least the problem of non-availability of cover will be resolved at a reasonable cost.

•  Direct Tax Benefits for Senior Citizen

•  U/S 80 D Medical Insurance Premium paid by cheque is deductible Rs. 10000 to all individual and for senior citizens (65 Years) this deduction will be increased to Rs.15000.

•  U/S 80 DDE medical treatment in respect of diseases and ailment specified in Rule 1 ID will be allowed deduction Rs. 40000 and actual expenses whichever is less. In case of senior citizens this deduction will be increases to Rs.60000.

•  With effect from 1.4.2006 deduction from gross total income in respect of premium paid to LIC; deferred annuity contribution to provident fund; subscription to certain equity shares; debentures etc. will be allowed up to Rs. 1 lacs, to all individual including senior citizens.

Rate of Tax for different income slab

Income Slab
Rate of tax for male below 65 years
Rate of tax for women below 65 years
Rate of tax for senior citizen above 65 years
upto Rs. 1,00,000
Nil
Nil
Nil
Rs. 1,00,001 to Rs. 1,35,000
10%
Nil
Nil
Rs. 1,35,001 to Rs. 1,50,000
10%
10%
Nil
Rs. 1,50,001 to Rs. 1,85,000
20%
20%
Nil
Rs. 1,85,001 to Rs. 2,50,000
20%
20%
20%
> Rs. 2,50,000
30%
30%
30%

A surcharge @ 10% is to be applied where income exceeds 10 lacs in all the above cases. Education cess shall be levied at the rate of 2% in all cases.

Suppose for any individual business income Rs. 300000; income from hose property (gross) Rs. 120000 and interest from bank Rs. 10000.

His contribution to public provident fund 50000, ICICI tax saving bond purchased Rs.40000, repayment of house building loan Rs.15000, municipal tax 1200.

Computation of Gross Taxable Income for the assessment year 2006-2007

Income from house property
Gross annual value
1,20,000.00
Less-municipal tax
1,200.00
Net annual value
1,18,800.00
Less standard deduction @30% of net annual value
35,640.00
83,160.00
Income from business
3,00,000.00
Income from other sources
Interest from bank
10,000.00
Gross total income
3,93,160.00
Less-deduction u/s 80C
Contribution to public provident fund
50,000.00
ICICI tax saving bond
40,000.00
Repayment of house building loan (subject to max. 1 lac)
15,000.00
Total Income
2,93,160.00

Computation of tax payable

Income Slab
Rate of tax for male below 65 years
Rate of tax for women below 65 years
Rate of tax for senior citizen above 65 years
upto Rs. 1,00,000
Nil
Nil
Nil
Rs. 1,00,001 to Rs. 1,35,000
3,500.00
Nil
Nil
Rs. 1,35,001 to Rs. 1,50,000
1,500.00
1,500.00
Nil
Rs. 1,50,001 to Rs. 1,85,000
7,000.00
7,000.00
Nil
Rs. 1,85,001 to Rs. 2,50,000
13,000.00
13,000.00
13,000
> Rs. 2,50,000
12,948.00
12,948.00
12,948.00
 
Tax payable without cess
37,948.00
34,448.00
25,948.00

From the above table we see that for the same income and investment female below 65 getting tax benefits Rs. 3500.00 and senior citizen getting benefits 12000.00. But only around 5%-6% of the senior citizen pays taxes, so exemption on account of income tax would only benefit them. More indirect tax benefits specially tax relief on medicine which is generally used by senior citizen to be given to the senior citizen.

•  Reverse Mortgage Loans for Senior Citizens

With reference to paragraph no. 89 of the Union Budget Speech 2007-08, read out by the Hon’ble Finance Minister, it was indicated that “National Housing Bank will shortly introduce a novel financial product for senior citizens; a ‘reverse mortgage’ under which a senior citizen who is the owner of a house can avail of a monthly stream of income against the mortgage of his/her house, while remaining the owner and occupying the house throughout his / her lifetime, without repayment or servicing of the income and addressing their financial needs. Secular increase in residential house prices has created considerable “home equity” wealth. For most Senior Citizens, the house is the largest component of their wealth.

Conceptually, Reverse Mortgage seeks to monetize the house as an asset and specifically the owner’s equity in the house. He scheme involves the Senior Citizen borrower(s) mortgaging the house property to a lender, who then makes periodic payments to the borrower(s) during the latter’s lifetime. The Senior Citizen borrower is not required to service the loan during his lifetime and therefore does not make monthly repayments of principal and interest to the lender. On the borrower’s death or on the borrower leaving the house property permanently, the loan is repaid along with accumulated interest, through sale of the house property. The borrower(s) / heir(s) can also prepay the loan with accumulated interest and have the mortgage released without resorting to sale of the property. Reverse mortgages are one product within the “equity Release” category.

•  Reverse mortgaging Loans (RMLs) are to be extended by Primary Lending Institutions (PLIs) viz. Scheduled Banks and Housing Finance Companies (HFCs) registered with NHB.

•  Eligible Borrowers:

•  Should be senior citizen of India above 60 years of age.

•  Married Couples will be eligible as joint borrowers for financial assistance provided both are above age of 60.

•  Should be the owner of a residential property (house or flat) located in India , with clear title indicating the prospective borrower’s ownership of the property,

•  The residential property should be free from any encumbrances.

•  The prospective borrowers should use that residential property as permanent primary residence.

•  Determination of Eligible Amount of Loan:

•  The amount of loan will depend on market value of residential property, as assessed by the PLI, age of borrower(s), and prevalent interest rate. Quantum of loan maybe fixed as per the following table:

•  Nature of Payment:

Any or a combination of the following:

•  Periodic payments (monthly, quarterly, annual) to be decided mutually between the PLI and the borrower upfront.

•  Lump-sum payments in one or more tranches

•  Committed Line of Credit, with an availability period agreed upon mutually, to be drawn down by the borrower

It is important that nature be decided in advance as part of the RML covenants. PLI at their discretion may consider providing for options to the borrower to change.

•  Eligible End use of Funds

The loan amount can be used for the following purposes:

•  Up gradation, renovation and extension of residential property.

•  For uses associated with home improvement, maintenance / insurance of residential property

•  Medical, emergency expenditure for maintenance of family

•  For supplementing pension / other income

•  Repayment of an existing loan taken for the residential property to be mortgaged

•  Meeting any other genuine need

Used of RML for speculation, trading purposes shall not be permitted

Period of Loan: Maximum 15 years

Currently this scheme is only on recommendation stage. These have been formulated after taking to various representative organizations for senior citizens. This scheme will protect those senior citizens who feel neglected from their families. In this connection we must remember that this is a loan product and rate of interest at which this loan will be given to senior citizens will depend on the prevailing market rate of interest.

Conclusion

Most of the senior citizens are unemployed (73.65%) Notel . They are depending heavily on their family. Both State and Central Government should take more steps regarding their health and social security. In West Bengal large number of senior citizens in Urban area are not satisfied in present health system. They mostly visit private doctor’s chamber (78%) Notel as they are not getting proper medicare in Government Hospitals. To provide for compulsory maintenance, protection and welfare of senior citizens, “The Senior Citizens (Maintenance, Protection and Welfare) Bill, 2006, has already been placed in the Rajya Sabha on 3 rd March, 2006. On the 15 th June, 2007, “National Council on Older Persons” have been convened a meeting to discuss on this bill. This bill contains provisions on medical facilities for senior citizens, it is also important to ensure that their appropriate health insurance schemes are available to the senior citizens. Last year the National Insurance Company came up with Varishtha Mediclaim policy for the senior citizens but their premium is high. This Premium on Medical Insurance is to be reduced. More stress to be given to indirect tax benefits specially tax on medicine which is generally used by senior citizen. But still it is good to notice that majority of our senior citizens receive respect from their families (42.28% extremely and 35.86% moderately) Notel and reported their health care needs are met adequately (65.17) Notel . The number of older persons in the population is expected to increase by more than double from 71 million in 2001 to 173 million in 2026, an increase in their share to the total population from 6.9% to 12.4%. Availability of medical facilities, better quality of life and increased nutrition intake has contributed to this phenomenon on demographic aging. Presently ageing has become a major social challenge and there is a need to give more attention to the care and protection for the older person. All we hope government will take more initiative for the betterment of senior citizen.

Acknowledgement

I expressed gratitude to Dr. Dilip Chakraborty, Teacher-In-Charge, Netaji Nagar Day College for his help and guidance at every stage of this work.

References

•  Recent Trend in Geriatric and Gerontological Studies (2006); Published by NNDCC

•  http://sodaljustice.nic.m/social/sdcop/benefits.htm

•  http://socialjustice.nic.in/social/sdcop/opersons.htm

•  http:// www.nationalinsuranceindia.com

•  http://www.thehindu.com

•  http://www.nhborg.in

Note 1

•  Highlight of the survey report made by a group formed with representatives from teachers, non-teaching staff and students from Netaji Nagar Day College and Computer Centre under the leadership of Dilip Kumar Chakraborty in 2003-2004 through out West Bengal on different social, economic, health status. This group interviewed 3570 elderly persons residing in the urban areas in West Bengal .

•  27.5% of the senior citizen is above 75 years.

•  51% had yearly household income below 30,000

•  45.06% do not receive any cash benefits.

•  73.65% are either unemployed or retired.

•  29.82% reported that their health is poor and 41.36% reported their health as fair

•  The most common problems are hypertension with heart problems, walking and vision problem, blood sugar and diabetes, back pain etc. The top three health problems are hypertension with heart problem, vision and walking problem and blood sugar with diabetes.

•  52.49% are depressed,

•  78% visited the doctor’s chamber, 14.85% visited hospital and 3.6% visited other health care setting

•  66.28% prefer allopathic, 20.85% prefer homeopathy and 1.14% prefer Ayurvedic.

•  66.96% are concerned about their healthy diet.

•  28.17% reported that they are currently smoking and 11.6% reported they smoked in the past.

•  Only 2.2% drink alcohol on a regular basis.

•  13.29% took medication frequently, 46.82% took medication on a regular basis, 38.15% took medicine as advised by the doctor and 1.73% did not take medication,

•  Regarding overall satisfaction with health care in West Bengal 1.30% reported excellent, 23.52% reported very well, 34.31% reported fair and 40.84% reported badly.

•  Regarding life satisfaction 55.49% expressed that they are satisfied in the life they had spent,

•  Regarding respect received from family 42.28% reported they are treated extremely respectfully, 35.86% treated moderately, 2.86% treated slightly, 12.87% treated quite a bit and 7.14% felt that their family neglected them,

•  65.71% reported that their health care needs were met adequately.

Chairman
Sri.Sadhan Gupta, Ex. Advocate General, Govt. of West Bengal

Geriatric Dentistry
Dr. Biswajit Biswas, M.D.S. (Cal), Consultant oral and Maxillifacial Surgeon
310 Canal Street , Kolkata – 700048

With the advancement of medical sciences life expectancy has increased significantly. More than 15% population is above 65 years of age worldwide. So there is a need to think specially for this group of population. Nearly 65% of the aged (above 65 years of age) persons don’t receive any form of dental treatment worldwide and in Asian countries nearly 80% of the aged people don’t receive any form of oral care.

Dealing with the elderly requires an understanding of and sensitivity to the medical, psychological and financial states of these patients. Our education system will have to change to address these emerging issues. The traditional educational and practice structures currently in place are based on serving the needs of a healthy and affluent [population. An infrastructure that will allow these issues to be addressed will have to be created.

The provision and success of dental treatment for older patients are commonly complicated by an array of dental as well as non-dental factors, which may or may not be unique to older patients. Here various factors like oral and medical problems have to be considered during clinical management. The strategies to counter the full range of functional, occlusal, periodontal and restorative challenges likely to come across in the actual treatment course of such patients should also be discussed. Moreover, the treatment planning oral hygiene, mouth preparation and tissue management etc. should be given due importance during the rehabilitation of geriatric patients.

Human orofacial growth and development has been fairly well defined. Not so well understood is orofacial aging, which is obviously a component of general aging process. There are some factors which influence aging. Regarding this, two alternative views on the nature of aging are prevalent. First, it is the result of random damage and second it is the result of some program enhancement and controlled degeneration of the organism.

Evidence exists that the elderly are at a special risk for developing malnutrition and that vulnerability to nutrient deficiencies increases in the age. Factors contributing to nutritional problems in the elderly are –

• Oral

• Changes in ability to chew food

• Changes in taste and smell

• Drug induces xerostomia

• Physical

• Changes in ability to absorb and utilize nutrients

• Changes in ability to metabolize nutrients

• Changes in energy requirements and activity

• Effects of medication on appetite and nutrient absorption and utilization.

A dedicated team comprising of dental surgeons, specialist dental surgeons, Geriatric physician, nutrition specialist or dietician, nursing staff, dental hygienist and dental technicians are required to do the needful.