Women comprise by far the greater number and proportion of older population in almost all societies; this disparity is increasing with advancing age. In India, while the sex ratio favours men at all ages, the trend reverses in favour of females above the age of 70 years with the number of women exceeding the number of men in this age group. Sex ratio in elderly population, which was 928 in the year 1996, is projected to become 1031 by the year 2016. More often than not, women are over burdened with cumulative inequalities throughout the life cycle from womb to tomb as a result of socio-cultural and economic discriminatory practices leading to a secondary status. Thus, a longer life span is directly correlated to greater morbidity and higher incidence of health related problems among the older women.

The emotional turmoil which a woman goes through, the sense of anxiety, fear, anger and desperation that she faces in her early years, take its toll during the later years of life if she manages to survive the reproductive years. On reaching menopause, she looks forward to the years of freedom from the responsibility of bearing and rearing children and freedom of movement but often she finds herself with the responsibility of taking care of grand children, older husband or in semi urban and rural areas, she has to struggle for her daily livelihood. The relation between poverty and ill health has been universally established. Poverty affects the older women in rural areas the most.

Studies have revealed that the most common chronic problems of older women are fever, cold and cough, asthma, respiratory infections, dysentery, visual impairment, cataract, hearing impairment, swollen feet and diabetes whereas the major diseases and disorders of older women are rheumatoid arthritis, osteoarthritis, osteoporosis, backache and muscular problems, hypertension, cardiovascular and pulmonary disease, nervous disorders, demential Alzheimer’s disease and depression. Common reproductive health problem are pruritis vulvae, vaginal discharge, dispareumia, incontinence, uterus prolapse, cervical and breast cancer. Anaemia, ulcer in mouth and intestines, constipation, diarrhoea are the other manifestations of prolonged under-nutrition. In addition there may be diseases directly related to their occupations or habits like chewing tobacco (as a pain killer or hunger suppressant) “Gynecological problems of older women, who have passed the reproductive period, have yet to receive attention of researchers and programme planners. Problems related to menopause and those that occur in the post-menopausal period and later years have rarely received adequate attention in the Indian context. Research needs to be undertaken to study these problems and to identify those that need urgent attention. The magnitude of specific problems as well as the cost effectiveness and feasibility of organizing services need to be addressed. Some criteria should be developed to determine which service interventions should receive priority and how services can be incrementally expanded to address the particular priority problems.” Geriatrics is still relatively less known and geriatric wards exist merely in two hospitals in the whole of India. This shows the gross apathy towards this age group. In densely populated urban areas and poverty stricken rural areas where basic amenities are inadequate, health care of general population and specifically of the older population poses a great challenge. To meet the preventive, curative, restorative and rehabilitative needs of older population in general and older women in particular, in a country with a population of over one billion is a Herculean task

Across the globe, steps have been taken by various countries to provide social systems for the elderly and other disadvantaged groups. Such systems ensure that senior citizens are not deprived of their most basic needs when they lack the resources to fulfill them. A brief overview of the policies and programmes of the Indian government for the elderly is presented for a deeper understanding.

Government of India (GoI) announced the National Policy on Older Persons in 1999 to reaffirm its commitment to ensure the well-being of the older persons in a holistic manner. The NPOP while promising to safeguard their interest in terms of financial security, health, legal, social and psychological security, also envisages a productive partnership with them in the process of development by creating opportunities for their gainful engagement and employment. The Policy also appreciates special needs of older persons and therefore lays emphasis on empowerment of community as well as individuals to adequately meet the challenges of the process of ageing. To fulfill these objectives the NPOP broadly provides for the following:

Financial security through coverage under Old Age Pension Scheme for poor and destitute older persons, better returns on earnings/savings of Government/Quasi-Government employees’ savings in Provid

2. Health Security: The NPOP recognizes special health needs of the older persons to be met through strengthening and reorienting the public health services at Primary Health Care level, creation of health facilities and implementing health insurance.

3. Recognizing Shelter as a basic human need, the NPOP provides for earmarking 10% of the houses/housing sites in urban as well as rural areas for older persons belonging to the lower income groups.

4. Education/information needs of older persons the NPOP provides for proactive role in ensuring the same by disseminating knowledge about preparation of Old Age. It is also emphasizes the need for schools to have programme on inter-generational bonding.

5. Welfare and Institutional Care: Institutional Care has been provided for in the NPOP as the last resort. The State should also create infrastructure in partnership with voluntary organizations to provide for poor, destitute and neglected older persons whose care cannot be ensured within the family.

6. Protection of Life and Property of Older Persons: Maintenance of elderly within family, resorting to the provisions of law whenever needed is required to be ensured.

7. Training of Human Resource to care for Older Persons: The Policy lays emphasis on need for trained personnel/care givers.

This policy highlights the plight of older persons and offers an array of state interventions. However, let us examine some of its shortcomings to keep these in view as learnings for future efforts of this nature:

1. The pension rates paid to older persons afford hardly any additional income or livelihood security but is merely a token payment to ward off extreme destitution

2. The policy statement relied on the figure of 33% of general population for an estimate of the proportion below poverty line among those above 60 years as well – this may be an understatement

3. As there is no mention of the financial implications of carrying out the commitments questions of financial capacity, capability and viability arise

4. The provision for maintenance of parents by children is not to provide income or old age security but to prevent destitution and cannot substitute state action for providing risk cover to older persons. Further, there is reluctance on part of the parents to go to court against children

5. A 39 member National Council for Older Persons was created to advise, provide feedback, lobby and address complaints but ministries specifically dealing with important aspects of ageing have not been represented in it

The challenge of implementing such a multi level and multi dimensional promise is therefore, enormous and requires coordination, leadership, strategizing, networking, advocacy and above all effective monitoring, feedback and continuous system improvement.

The National Social Assistance Programme came into effect from 15th August, 1995 and is a social assistance programme for the poor households. The NSAP includes three benefits as its components: National Old Age Pension Scheme (NOAPS), National Family Benefit Scheme (NFBS) and National Maternity Benefit Scheme (NMBS) ent Fund, etc.

The Scheme covers older persons/destitutes having little or no regular means of subsistence from his/her own source of income or through financial support from family members or other sources. It covers older persons under Below Poverty Line and the government contributes Rs.200 (approximately $5) per month per beneficiary. In November 2007 it was rechristened Indira Gandhi National Policy on Older Persons (IGNPOP) and enlarged to include all persons above 65 years of age under BPL. The scheme currently covers 87 million old persons and the 2008-09 Union Budget has proposed an outlay of Rs.34 billion with the target of reaching 157 million beneficiaries.

Some of the public sector insurance companies provide life insurance coverage up to 75 years of age and many private insurance companies now have 55 years as the last entry age providing old age security to millions of elderly.

This ‘project’ put forth by the Ministry of Social Justice and Empowerment, GoI, has constituted an expert committee. The report of the committee recommends a pension system which can be used by individuals and enables them to attain old age security by making modest contribution during their working career.

This scheme by Self Employed Women’s Association, Ahmedabad caters to older women who work in the unorganised sector. The scheme allows payment of premium in lump sum after harvest time when they are in a position to make payments. Health insurance schemes such as this may be up scaled at the state and national level as well.

Annapurna Scheme covers all the other elderly below poverty line who are not covered under the NOAPS. Destitute senior citizens or 65 years of age or above who, though eligible for old age pension under the National Old Age Pension Scheme (NOAPS), are not getting the pension are covered under the Scheme. 10 kg of food grains per person per month is supplied free of cost under the scheme. In 2005-06 a total of 167,000 tonnes of grains were allocated under the scheme.

(An interesting observation here is that women beneficiaries of this scheme find it particularly useful as very often the ‘pecuniary dole’ to them is taken away by the male members of the family while this scheme ensures they are fed)

The government has launched a Reverse Mortgage System for senior citizens to extract value out of their property and lead a hassle free life by securing a regular income as loan against their existing property – the loan may be taken in installments or a lump sum.