International Journal of Advanced and Integrated Medical Sciences

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Status of living arrangements of elderly people in EasternUttar Pradesh
  IJAIMS
ORIGINAL ARTICLE
Status of living arrangements of elderly people in EasternUttar Pradesh
Anand Bihari1, Alok Kumar2
1Department of Community Medicine, Government Medical College, Azamgarh, Uttar Pradesh, India, 2Department of CommunityMedicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
Corresponding Author:
Anand Bihari,Department of CommunityMedicine, GovernmentMedical College, Azamgarh,Uttar Pradesh, India.
E-mail: anandbhu05@gmail.com
Received: 03-03-2018
Accepted: 17-03-2018
Published: 16-06-2018
 
ABSTRACT
Introduction: The increase in life expectancy over the years has resulted in anincrease in the population of the elderly. While the overall population of India willgrow by 40% between 2006 and 2050, the population of those aged 60 and above willincrease by 270%. This situation could be attributed to a combination of factors, suchas increase in age, longevity, and decreased death rates due to advancement in the fieldof medicine, improvement of life expectancy at birth, and enhancement in the averagespan of life. India ranks fourth in terms of the absolute size of elderly population.
Materials and methods: The data were collected using a specially designed interviewschedule technique through a house-to-house survey for those residing in the families.We find that the main factor that has contributed to the change in the living arrangementshas been the increase in migration.
Results and Discussion: Population aging is anunavoidable and irreversible change that comes through demographic transition in allsocieties. India is in the third stage of its demographic transition. The age structure ofthe country reveals that it has been aging rapidly.
KEY WORDS: Elderly, living arrangement, old-age support, social and economicstatus
How to cite this article: Bihari A, Kumar A. Status of livingarrangements of elderly people inEastern Uttar Pradesh. Int J AdvInteg Med Sci 2018;3(2):1-7.
Source of Support: Nil,
Conflicts of Interest: None declared.
 
 

INTRODUCTION

The United Nations defines a country as "Aging" where theproportion of people aged 60 years or overreaches 7% of thetotal population. By 2011, India exceeded that proportion (8.0%)and is expected to reach 12.6% in 2025. In India, as a result ofthe change in the age composition of the population over time,there has been a progressive increase in both the number andproportion of aged people. The Indian population increasedfrom 361 million in 1951 to 1.027 billion in 2001 and further to1.21 billion in 2011. Simultaneously, the number of older peoplehas increased from 19 million (i.e., 4% of the total population)to 77 million and further to roughly 93 million (i.e., 7.5% of thetotal) during the same time span.[1]

 
Living Arrangements in India

In India, elderly parents coresiding with their children can servea dual purpose: Children can take care of their parents' healthand daily needs, while parents can provide childcare for younggrandchildren. These are nonfinancial aspects of coresidencethat typify a joint living arrangement. Other benefits includethose to elder health, particularly in terms of the relationshipbetween coresidence and self-rated health and chronic andshort-term morbidity.[2] In a move to alleviate the financial costto coresidence, the Indian Government introduced the NationalPolicy on Older Persons in 1999. This policy has provisions fortax relief or children who coreside with their parents, allowingrebates for medical expenses and giving preference in theallotment of houses.[3] This policy, however, is yet to be adoptedand enforced by a majority of states, the locus of such policyexecution in India.

Living Arrangements among the Elderly

The overall reduction in general and infant mortality rates andthe steady increase in average age at death have resulted in thegrowth of the elderly population around the world. Accordingto the National Family Health Survey (NFHS)-2, 8% of thepopulation reported that they were in the age group of 60 orabove.[4] The conventional living patterns among the elderlyhave changed drastically following the reduction in fertilityand the increase in life expectancy at older ages. In India, thetraditional practice has been for people to live with children inold age; this is not necessarily with the intention of receivingsupport; and often the rest of the family also benefits fromthe arrangement. For example, when the younger women ofthe household go to work, the grandparents take care of theirchildren. On the International Day for the older persons (2003),the United Nations (2003) addressed healthy older people as aresource for their families, societies, and the economy of theirrespective countries.

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Bihari and Kumar Status of living arrangements of elderly people in Eastern Uttar Pradesh

The term "living arrangement" is used to refer to one's householdstructure.[5] Rajan et al.[6] explain living arrangements in termsof the type of family in which the elderly live the headship theyenjoy, the place they stay in and the people they stay with, thekind of relationship they maintain with their kith and kin, and theextent to which they adjust to the changing environment. Whiledealing with the welfare of any specific group, it is important tostudy their pattern of living arrangements. Here elderly, beingless independent, need the care and support of others in severalrespects. Taking care of the elderly refers mainly to emotionalsupport; on the contrary, support given to the elderly refersmainly to members or persons who are close to them, whereasthe latter is supposed to be a joint effort of the immediate familyand society.

 
There exist several living patterns for the elderly, such as livingwith the spouse, living with children, and living with others. Livingalone or with the spouse is the most stable living arrangement forpeople who are not too old yet. Living alone or with the child orgrandchild is the most stable arrangement.[7] Researchers haveput in a lot of effort to investigate the determinants leading to aspecific living arrangement. Living arrangements are influencedby a variety of factors, including the number and availability ofchildren and other relatives, kinship pattern of society, locationof household, marital status, financial status, availability ofservices, and physical and mental well-being of the elderly.[8]Attitude toward and perception about the living places are anotherimportant components that decide where they should live.[9]


Status of living arrangements of elderly people in Eastern Uttar Pradesh
SC: Scheduled caste; ST: Scheduled tribe; OBC: Other backward caste; UN: Unmarried; WM: Widower

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Bihari and Kumar Status of living arrangements of elderly people in Eastern Uttar Pradesh

Status of living arrangements of elderly people in Eastern Uttar Pradesh
SC: Scheduled caste; ST: Scheduled tribe; OBC: Other backward caste; BPL: Below poverty line; Other: Daughter-in-law, grandson, daughter; All: Husband,wife, child, and grandchild.


The effects of living arrangements on the physical andpsychological well-being of the elderly have also beenexamined by researchers. According to them, changes in livingarrangements, family structure, and mode of retirement affectthe old adversely.[10] Leaving the parental home for educationand employment results in elderly parents having to live aloneat home until the children come back.[11] The overall well-beingof the elderly consists of their physical, mental, and socialwell-being. It is widely known that the erosion of the traditionalnorm whereby the elderly generally live with children or relativesreduces the well-being of the older population.[5] However, it isnot necessarily so is shown by the experience of industrializednations where the government has fostered system to meet theeconomic and social needs of the elderly.

 

MATERIALS AND METHODS

Specific Objectives of the Study
  • To study about the demographic variables of elderly peoplein study area and
  • To study about the pattern of living arrangements of elderlyin Eastern Uttar Pradesh and the differences in livingarrangements according to important socioeconomic anddemographic characteristics.

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Bihari and Kumar Status of living arrangements of elderly people in Eastern Uttar Pradesh

Operational Definitions

The following terms were used in the study as per the definitionsare given:

Older person

One who has attained the age of 60 years or above at least6 months before the date of the study.

Living arrangements

Living arrangement is the type of household/family setting inwhich the elderly live, the headship they enjoy, the place theystay in and the people they stay with, the kind of relationshipthey maintain with their kith and kin, and, on the whole, theextent to which they adjust to the changing environment.
  • Coresidence with children: The household is comprised theelderly person or couple who are living along with son (s)or daughter (s) (married or unmarried) Living with spouseonly: The household is comprised
  • the elderly married couple. Living alone: The household iscomprised the
  • elderly person who is staying alone.
  • Living with relatives: The household is comprised theelderly person living along with siblings/grandchild (ren) orother relatives of the family (paternal/maternal).

 
Sampling Procedure and Sample Size Formula

A multistage sampling method was used to select the sample forthe study. A caveat needs to be mentioned here. Although carewas taken to avoid investigator bias in selecting the sample forthe study using a random sample, 60 years and above 60 years,each respondent on selected villages was approached during datacollection. In this manner, a list with a total of 410 elderly wasenumerated from all the four districts in Eastern Uttar Pradesh.


Status of living arrangements of elderly people in Eastern Uttar Pradesh
SC: Scheduled caste; ST: Scheduled tribe; OBC: Other backward caste; BPL: Below poverty line

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Status of living arrangements of elderly people in Eastern Uttar Pradesh
Graph 1: Distribution of the elderly based on living arrangement after 60 years

Status of living arrangements of elderly people in Eastern Uttar Pradesh
Graph 2: Distribution of the elderly based on major change in life

Status of living arrangements of elderly people in Eastern Uttar Pradesh
Graph 3: Distribution of the elderly based on main reasons forchange in living arrangement

The required number of sample households would be
nh = m × n = m × ❴p (1 - p) (z2/e2) × f❵

Where n is the required sample size for elderly having solitaryliving; m is the required number of households to get at leastone such elderly; p is the proportion of elderly living alone; z is1.96 (z value at 5% level of significance); e is 0.05 (amount ofadmissible error); f is 1.5 (assumed design effect).

Thus, as an approximation, suppose that about 6% of the elderlylive alone in rural areas (Central Region, NFHS-3), then
n = p (1 - p) (z2/e2) × f = 86.68 × 1.5 = 130 (approx.)

 
To ensure separate estimates based on location (districts withlow, medium, and high composite index), at least three estimateswill be needed.

Thus, the required minimum sample size will be 130 × 3 = 390.

The sample has to increase by 5% to account for contingencies,such as nonresponse or recording error.

n + 5% = 390 × 1.05 = 409.5 ~ 410

As per government reports (census, NFHS), from threehouseholds in a village of Eastern Uttar Pradesh, one can get atleast one elderly person.

Thus,

nh = 410 × 3 = 1230 households

Therefore, 1230 households will be chosen from the rural areasto get the required number of elderly in the sample.

Data Collection

Data collection took approximately 4 months, i.e., from May 15,2014, to September 20, 2014. On average, it took 1 h to 1½ h toadminister the interview schedule (median: 1 h).

Ethical Considerations

The researcher carried a formal letter signed by the researchguide and the head, Department of Community Medicine,stating that the researcher is pursuing the PhD degree at theFaculty of Medicine and that the findings of the study wouldbe used for educational purposes only. The letter assured fullconfidentiality and that the researcher would make one visit tospend an hour for the interview. The respondents were informedthat participation in the study was voluntary and that they couldask the researcher to stop the interview at any point in time andexpress their unwillingness to continue the interview withoutgiving any explanation. This ensured that the elderly wereinformed of the purpose of the visit and their verbal consent wastaken before proceeding to administer the interview schedule.

DATA PROCESSING AND STATISTICAL
ANALYSIS



For the purpose of quantitative data analysis, first, a suitabledata entry module in the coded form was created for its rapidcomputerization. An electronic structured datasheet in Cs-Pro-10version considering suitable width for each field was made. Thevalidity of the whole data was checked by running the validationprogram prepared by the investigator himself for this datasetas well as manual cross-checking as needed. The Cs-Pro-10version datasheet was then exported to Statistical Package forthe Social Sciences trial version 16.0, and the grouping of valueswas made into meaningful, dichotomous, nominal, or ordinalcategories following the scientific logic and accordingly thesewere numerically coded.

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Bihari and Kumar Status of living arrangements of elderly people in Eastern Uttar Pradesh

RESULTS AND DISCUSSION

It is assumed that deviation in the living arrangement of the elderlymay vary with different characteristics. In the following analysis,gender, age, marital status, social status, economics status, typesof family, and education are considered as effecting variables ofliving arrangement. Table 1 presents the distribution of variableand deviation in living arrangement conditions among the elderlyin Eastern Uttar Pradesh. Coming to space they slept in duringthe night [Table 1], more than half of the elderly reported noseparate room for sleeping. Here, difference between male andfemale, age group-wise, married, widow, widower, caste-based,nuclear and joint family, illiterate and literate, social status based,and economic status based could be seen.

Less than half of the elderly reported that they have separaterooms for sleeping; more than half of the elderly reported thatsleeping place is comfortable. Table 1 shows 29.23% of femalescompared with 24.29% males reported their living arrangementas uncomfortable. Age factor and marital status do not affectthe living arrangement condition. The table indicates that socialand economic status and educational status of elderly affectedthe living arrangement condition. The Chi-square test statisticsalso satisfied the association of variables (gender, social andeconomic status, education, and caste) with living arrangementconditions.

The traditional coresidential family living arrangement is the mostcommon practice across the survey. Table 2 shows the distributionof different variables with an opinion about living arrangement ofelderly. Opinion about living arrangement of elderly people wasaffected by the different variables (gender, marital status, types offamily, education, and landholding). The Chi-square test statisticsalso satisfy significant association with the different variables andopinions about living arrangement of elderly.

As shown in Table 2, the predominantly preferred livingarrangement across all the elderly is living with sons, higherpercentage of elderly men (49.30%) compared with women(33.08%) living with others comes next across all respondents. Thepreference of living with spouse is in the third position [Table 2].Predominantly preferred living arrangement across all the elderlyis living with son, higher percent were married (54.20%) comparedwith widow 23.53% and widower 41.43%, respectively. Maximumwidows preferred to living with others than son and spouse. Thepreference of living is not affected by caste. All categories of casteshow a similar pattern of living arrangement.

When the present living arrangement is compared with thepreferred living arrangements, it can be seen that overall mostelderly are already in their preferred living arrangement.

The majority of the elderly are coresiding, but a fifth of allelderly are living alone. A higher proportion of elderly women(5.36) than elderly men (4.62) live alone. The elderly whocoreside with their child were asked whether they always staywith the child they were living with at the time of interview.

 
When living arrangements of the elderly are furtherdisaggregated by their background characteristics [Table 3],the dominant type of living arrangement across all categoriesremains living with one's spouse, children, and grandchildren.It is seen that elderly widows who have no education and havenever worked live mostly with all the members (son, daughterin-law, and grandson) presumably due to helplessness andless of a choice of a living arrangement that is associated withincreased vulnerability of such elderly. Elderly living alone[Table 3] shows that fewer oldest old (aged 80 and above) livealone. Consistent with the above finding, 3.84% of widowedelderly live alone while 9.90 in scheduled caste/scheduled tribecategory, 13.49 in other backward caste category, and 6.01% inother categories also live alone.

About 5.36% elderly with no education live alone comparedwith 4.84% of educated elderly (literate). A similar gradientexists with the agriculture field; more landless percent of elderlylive alone; 6.82% elderly with below poverty line card holderslive alone compared with 4.66% elderly with other card holders.

Graph 1 shows that of the entire elderly sample, 57.32% reportedchanging their living arrangements after the age of 60 years.The preponderance of rural, poor widowed elderly women onceagain highlights the vulnerability of women as reflected in livingarrangements. The biggest reason for change among both menand women was that about half of the total population started tolive with their children (45%).

Graph 2 shows that the biggest reason for change was that theystarted to live with their children (45.11%), 17.45% reportedthat their children migrated to other cities, and 17.02% reportedthat they started living alone and only 1.28% elderly were livingwith other relatives. Notably, about 20% elderly in rural areasrepresented that they did not know what changed their life, butthey only told that there was a change in the living arrangement.Graph 3 shows that the main reason for change in the livingarrangements is death of spouse/children, migration of son/daughter, marriage of children, economic dependency, familyconflict, and health-related issues. The graph shows that 23% ofelderly reported that the change in the living arrangement wasdue to death of spouse/children, 23% migration of son/daughter,26% marriage of children, and remaining 27% reported that manyreasons change the living arrangement (economic dependency,family conflict, health-related, and others).

SUMMARY

Living arrangement of the elderly is an important part of qualityliving. The traditional coresidential family living arrangement isthe most common practice across all research areas. The majorityof elderly in the selected area have no separate room availablefor sleeping. The availability of separate rooms underliesdifferent factors such as gender, age, marital status, socialstatus, economic status, caste, education, and type of family.Living arrangements of the elderly are further disaggregatedby their background characteristics; the dominant type of livingarrangement across all categories remains living with spouse,children, and grandchildren. Fewer oldest old (aged 80 andabove) live alone. About 12.50% illiterate elderly live alone,compared with 5.38% literate elderly. Maximum 19.18% elderlywith no land live alone compared with 16.15% of the elderlyhaving agriculture land. About 57.32% elderly reported changein the living arrangement after old age (60 years and more).Major reasons for change in living arrangement of elderly weredeath of spouse/child, migration of son, etc.

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