Post Covid-19 pandemic vulnerabilities faced by the elderly: The case of India

Mary Princess Lavanya

St. Joseph’s University, Bangalore, India

CORRESPONDENCE:

Mary Princess Lavanya

e-mail: princesslavanya@sju.edu.in

Abstract

This paper focuses on the post Covid-19 pandemic vulnerabilities faced by the elderly, with specific reference to India. The impact of pandemic and post pandemic has left everyone of all age groups with no choice but to adapt to new ways in almost every area of life. This impact is more among the elderly who may also lack certain skills, capacity, or willingness to adapt to a new way of life and new forms of livelihoods; they need support to do so. The aftermath of pandemic is felt more acutely by elderly people. It is very common to find that elderly experience a standstill of their existence, which is expressed by their feeling lonely, ambiguous, insecure, uncertain, pain and by symptoms of mental illness, of lack of direction, unhappy and being lost. The author has adopted a qualitative approach with three case studies of elderly literally especially women facing vulnerabilities. There is an urgent need to address any such vulnerability faced by the elderly anywhere. Implication for social work practice in the geriatric care is the need of the hour.

Keywords

Vulnerability, elderly, Social Work, pandemic.

Introduction

According to World Population Prospects 2019, by 2050, 1 in 6 people in the world will be over the age of 65, up from 1 in 11 in 2019. All societies in the world are in the midst of this longevity revolution — some are at its early stages, and some are more advanced (https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulation Ageing 2019-Highlights.pdf). Population ageing has been recognized as one of the four global demographic «megatrends» — population growth, population ageing, international migration, and urbanization — with continued and lasting impacts on sustainable development.

Declining fertility and increasing longevity lead to rising numbers of older persons as well as a continuously growing share of older persons in the population. Preparing for the economic and social shifts associated with an ageing population is essential to ensure progress towards the achievement of the Sustainable Development Goals (SDGs) included in the 2030 Agenda for Sustainable Development. Elderly people can enrich our lives in every way possible, if only we care for them as they cared for us. Elderly are the assets of a Nation.

The elderly in the present world scenario seems to be facing health and psychosocial problems. However, if it could be ensured that more of the elderly received professional touch of a Social Worker (counselling & intervention) at the right time it would benefit them, the community in general and the world at large.

Status of Elderly in India

With the decadal growth rate of the elderly population of India currently estimated to be at 41%, and the percentage of elderly population in the country projected to double to over 20% of total population by 2050 (India’s 2023, India Ageing Report, The Hindu, 2023). There has been a steady rise in the population of senior citizens in India. The number of elderly persons has increased from 1.98 crore in 1951 to 7.6 crore in 2001, and 10.38 crore in 2011. The projections indicate that the number of 60+ in India will increase to 14.3 crore in 2021 and 17.3 crore in 2026 (http://socialjustice.nic.in/SchemeList/Send/43?mid=48565).

The traditional norms and values of the Indian society laid stress on showing respect and providing care for the aged. However, in recent times, society is witnessing a gradual but definite decline of the joint family system, as a result of which a large number of parents are being neglected by their families exposing them to lack of emotional, physical and financial support. These older persons are facing a lot of problems in the absence of adequate social security. This clearly reveals that ageing has become a major social challenge and there is a need to provide for the economic and health needs of the elderly and to create a social milieu, which is conducive and sensitive to the emotional needs of the elderly (Ministry of Social Justice and Empowerment, 2018).

Need for the study

The pandemic and post pandemic has left everyone both young and old with no choice but to adapt to new ways in almost every area of life. It’s even more for the elderly who may also lack certain skills, capacity, or willingness to adapt to a new way of life and new forms of livelihoods; they need support to do so. The impact of pandemic is felt more acutely by elderly people. It is very common to find that elderly experience a standstill of their existence, which is expressed by feelings of loneliness, ambiguity, insecurity, uncertainty, pain and by symptoms of mental illness, of lack of direction, unhappy and being lost. In fact, the elderly have the same rights as all others citizens, in reality, they face discrimination starting from their own families. They need special protection and attention during such pandemics, regain health, restored to normalcy or reintegration with the family.

Many practitioners and policy makers have scarcely shown any attention to the impact of pandemic and post pandemic on elderly battling it, who face physical, psychological, emotional, social, and financial challenges. This paper focuses on the experiences of the elderly battling psychological issues with regard to the post pandemic and the implication for social case work practice among them in an effort to increase understanding resulting in intervention.

Review of Literature

The causative agent of COVID-19, novel corona virus SARS-CoV-2 is definitely less fatal than its earlier congeners (Severe Acute Respiratory Syndrome or SARS and Middle East Respiratory Syndrome or MERS), but much more contagious with increased human to human transmission risk (Lai, 2020). Some studies suggest that the viability of the virus in aerosol and various surfaces is also one of the reasons for this (Van Doremalen, 2020).

A majority of infections are mild, but few have pneumonia and Acute Respiratory Distress Syndrome (ARDS), which can eventually lead to mortality. Also, the severity and fatality of the infection is higher in the elderly, immune suppressed and people with pre-existing respiratory illnesses, chronic medical problems as well as under-detection of symptoms (Zhonghua Liu Xing & Bing Xue Za Zhi, 2020) (https://www.natureasia.com/en/nindia/article/10.1038/nindia.2020.64).

The elderly are at a unique risk of all these vulnerabilities together. During the first wave of infection in China, 20 per cent of deaths were among people above the age of 60 (Wu & McGoogan, 2020). The Chinese Centre for Disease Control and Prevention has reported a fatality rate of 3.6 percent among 60-69-year-olds which can rise up to 20 percent in those above 80 years (Lai, 2020).

Stress impacts immunity and can increase proneness to infections. Autonomy and self-dignity may be hampered during a lockdown further impacting their mood, appetite, and sleep (Armitage & Nellums, 2020). Many elderly people live alone and are struggling with basic amenities like food, domestic utilities, and hygiene along with the lingering fear of the pandemic.

The WHO and CDC have updated data and precautions for the geriatric during Covid-19. The seniors might be vulnerable and frail due to age, but they are not weak. Their resilience can be amazing, if adequately cared for, and we can all borrow from their strengths. We need to hold our elderly together, integrating them into our struggle and recovery as we live through these troubled times. That will truly indicate the social evolution of our civilization (Camus, 2012).

Research Design

This paper focuses on qualitative approach, as the case work summaries are presented. Qualitative method is used to understand people’s beliefs, experiences, attitudes, behavior, and interactions, these case work summaries are the real-life context of people (https://researchguides.gonzaga.edu/qualitative). As these elderly were referred for professional help, the researcher chose to collect furthermore data from them; hence it is a convenient sampling technique. Case work summaries of three elderly are presented (i) a married elderly women with children, (ii) a widowed elderly woman with children and (iii) an elderly woman who remained a spinster. All the three of them are from Bangalore.

Case Work Summary 1

Retired elderly couple above 70 years well to do family with a son and a daughter married and settled abroad. They had a maid to help them in household chores, but now sent her on paid leave due to the pandemic. The provisions are there at home, but for vegetables and fruits that was part of their daily diet. As they were not prepared for the lockdown, the veggies and fruits were missed by them, especially the elderly man was very particular about it. After the lockdown was announced he realized that his tablets for diabetes were getting over in a day or two, so the next day he took the car and went out bought his tablets, despite his wife refusing to send him out. She complained about it to her children when they called and they were furious with their father.

The elderly woman literally burst into tears during one-to-one telephonic conversation with the case worker; about the anger he shows toward her after her children firing him and is pestering to let him go out as there are other people walking around outside. This has created a little restlessness and misunderstanding between them. He calls his friends talks to them, complains about her wife, but she said she couldn’t even share it with her children, because her husband might pick up another quarrel with her again. They had no rapport with their neighbors as they lived in a farmhouse, the only person the elderly woman would talk to was her maid. Since then, she’s disturbed and wanting to share with someone, who will understand her. She said that «she felt so greatly relieved on pouring out her heart to the counselor». She mentioned dates and days and quoted what she went through and post pandemic that little bitterness and friction continues now and then she said.

Case Work Summary 2

A widowed elderly woman in a middle-class family lives with her daughter’s family taking care of the grand children. She is financially supported by her son for her medical expenses, as she is diabetic. Due to this Covid-19, her son stopped his financial support as he was a pastor in a small church. Now that her medicines were getting over, she was afraid of troubling her daughter (a homemaker) and son-in-law (working in a small shop) managing the entire family of 5 paying the house rent and meeting other expenses. It is a budget family. The daughter somehow managed to get some help from her neighbors to buy the medicines for her mother costing Rs.1000/- per month.

The widowed elderly is depressed and feels that she is a burden to the daughter’s family; also she is terribly frightened that she will be infected with the new variants of corona, according to the vulnerability mentioned by the government. She is 60 years, is obese, diabetic, asthmatic, and has high blood pressure. She spoke of her fears to the counselor for nearly two hours and asked if she could call whenever she needs to talk, when the counselor said yes, she was so happy which reflected in her voice. The professional has also arranged for a sponsor to meet her medical expenses every month.

Case Work Summary 3

A 67-year-old elderly woman, who is a spinster, is rich, self-reliant person. She has everything stored at home enough. She didn’t worry about the lockdown initially, she’s used to being alone, it really didn’t matter she said. But once when the lockdown was extended, she had to order few provisions online, unfortunately she never had to buy a mask and so she didn’t have it on her, when the delivery boy arrived at her house, she managed to cover her nose and mouth with her saree. Since then, she began to wait for 14 days to see if something worse will happen!

After few weeks, she had no other option but to call up a regular shop to deliver two 25 liters drinking water can at her house. She was unable to carry it alone; hence the delivery boy came in to keep the can. She’s become paranoid once again and has cleaned the house several times despite of her joint pains. Her friends lived down the street, but she was not willing to entertain any one in her house for any reason during the pandemic. She became so anxious she told the counselor while sharing that she was slowly becoming OCD, as she was aware of these symptoms and disorders.

Now whenever she hears there’s spread of a new variant or other disease spreading, she’s terribly afraid and goes through panic attacks. She said she needs help but is afraid of going out on a regular basis for treatment of any sort.

Findings

These elderly were otherwise fine with no major issues. It is at a time as this they have money but can’t buy things, could buy things but feel unsafe, another person could not even afford to buy the medicines. Among all the three women, there is a kind of fear that is gripping their minds, that is because every TV channel invariably shows only regarding corona, providing statistics on the infected, affected, recovered, do’s and don’ts, awareness creation, but they said 24/7 hearing only this was overwhelming. In fact, all the three elderly women said that somehow they seemed to be the vulnerable ones that the TV channels were talking about. Every time the TV channels speak of a new variant, fear grips them even now.

Family support or social support is very much necessary for the elderly. Many volunteered to help people who had nothing, but these elderly have everything but not the human resource. All the three elderly women were feeling very low, anxious as to what next? When asked about the factors causing fear: two of them said, «fear of staying away from the family if infected, dying and being buried without anyone’s knowledge». Another person said, «why die of corona unnecessarily». Lack of human resource and even the practo, express and medi plus apps didn’t function during the initial days to deliver the medicines at home, now they stock up medicines always fearing the new variants.

Finally, all the three elderly women believed in God and that faith kept them away from fear taking over completely, yet they needed help to believe at times as it was difficult to. Post-pandemic has not changed many children with elderly parents, the elderly are still living a lonely life looking for someone to talk to, share their emotions, shower their love, and hold the hands of their loved ones.

Suggestions

Role of the Family

• Family, friends, relative and significant others, who would be able to support should reach out to the elderly. Especially build rapport with the neighbors, so that they are there any time to reach out if not all at least someone.
• Family members should explain patiently to the elderly who take time to understand the intensity of the problem.
• Families should focus on the physical, emotional, psychological, and financial aspects of the elderly than shunning away from it.

Role of the Government

• Elderly people, who go through psychological and health problems due to rejection by family and exclusion by society, and the ill-treatment from the Government servants when approached for pension or any other related welfare schemes, they are asked to bribe, these incidents really shock them and are helpless and feel hopeless, this has to be addressed seriously. Government should scrutinize and appoint sincere and honest personnel to reach out to these people and take severe action against those demanding bribe.
• Government should make health care services at the reach of the elderly with a 24/7 helpline to reach out to them.
• Government should appoint more Professional Social Workers to provide necessary care and psycho-social counselling for the elderly, as all that they require is a listening ear.
• Government should demand the TV channels to give correct information about the pandemic without exaggeration and focus more on promoting welfare programs, laughter therapy, meditation, positive psychology related ones, comedy shows, etc.

Role of the Social Worker

• Social workers should bridge the gap between the elderly and the government services that are available for them.
• Social workers should render their counseling services to everyone who is in need, especially to the elderly.
• Social workers should network so that we can reach out to any one in any nook and corner of the places that the elderly live.
• Professional social workers should train more people with counseling skills to reach out to as many as possible as the need is to address more of psychological challenges than the physical illness.
• Every sector staff should be given an orientation to be non-judgmental, respectful, and serve the elderly in a supportive manner. Professional Social Workers can play a very important role in this process particularly if they are part of every sector of the Government services.
• Social Workers can also raise funds to help the needy, to reduce the dependency worries.

Conclusion

Irrespective of class, colour, gender and religion, the pandemic affects anyone who is vulnerable physically and post-pandemic affects emotionally and psychologically. In the given case studies, it is clear that psycho-social challenges are the main concern for those not infected with. Social Workers who intend to work with the families should be trained in working with families where the members face a life-threatening illness and its psychological impact on them. They also should possess special skills in helping people to cope better where there are tensions, and communication difficulties in the family. They should be ideally suited to working with individuals, elderly couples and families dealing with the long-term impact of living with ailments and symptoms of disorders. If social workers can be active listeners not just to respond to them but to understand the clients, one can make a huge impact in their lives. As people have everything they need, at least essentials but not a listening ear; we are called to lend our ears in the genuine interest of serving others.

«LISTEN ─ Lovingly Support while Tenderly Empathize being Non-judgmental».

References

Article available online:

Armitage, R. & Nellums, L. B. (2020). COVID-19 and the consequences of isolating the elderly. Lancet Public Health. Available online DOI: 10.1016/S2468-2667(20)30061-X.

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Lai, C. C. (2020). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and corona virus disease-(COVID-19): The epidemic and the challenges. International Journal of Antimicrobial Agents. Available online DOI: 10.1016/j.ijantimicag.2020.105924.

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Report from website (consulted on January 2024):

India’s 2023, India Ageing Report, The Hindu (2023). https://www.thehindu.com/sci-tech/health/share-of-elderly-projected-to-double-to-20-by-2050-india-ageing-report/article67353547.ece.

Ministry of Social Justice and Empowerment (2018). http://socialjustice.nic.in/SchemeList/Send/43?mid=48565).

World Health Organization (2015). World report on ageing and health. http://www.who.int/ageing/events/world-report-2015-launch/en/

World Health Organization (2020). Coronavirus disease (COVID-19) Pandemic, https://www.natureasia.com/en/nindia/article/10.1038/nindia.2020.64

World Population Prospects (2019). Highlights (ST/ESA/SER.A/423). https://population.un.org/wpp/Publications/Files/WPP2019_Highlights.pdf.